Occupational Safety and Health For Development PDF

OSH for Development
OSH for Development

This book is written for professionals in developing countries, for occupational
safety and health specialists, production engineers, managers and trade union
representatives. The book links occupational safety and health with production
and productivity, showing the positive relationship between good and safe
working conditions and sustainable high productivity. The book makes use
of research results, and is intended to be used in connection with training
activities, but does not concentrate on research or training. The focus is action
for change to eliminate or reduce risks at workplaces.
Edited by
Kaj Elgstrand
Nils F Petersson
978-91-633-4798-6
Royal Institute of Technology
219401 omslag The Bookvit.indd 1 09-05-28 11.03.55

OSH for Development
Occupational Safety and Health for Development
Editors
Kaj Elgstrand & Nils F Petersson

Editors Kaj Elgstrand and Nils F Petersson
kajelg@kth.se ocka@kth.se
Publisher Royal Institute of Technology

Industrial Ecology
SE – 100 44 Stockholm
Sweden
English language editors Adrienne Taylor and Roger Tanner
Graphic design Amer Assad, Eva Lidén and Eva Söder
Financial support Swedish National Institute for Working Life

Swedish International Development Cooperation Agency
Printed by Elanders Sverige AB, www.elanders.com

June 2009
ISBN 978–91–633–4798–6
10.1
List of contents
1. INTRODUCTION; Kaj Elgstrand & Nils F Petersson

Aims and contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Basic concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
2. HISTORY AND FUTURE
2.1 HISTORICAL DEVELOPMENT OF THE RISK CONCEPT; Gideon Gerhardsson

From hazards to risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Risk concepts are childs of political systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Risk perception and risk measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Driving forces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Case Sweden . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Evolving options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Suggestions for further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
2.2 A NEW OSH PARADIGM IS NEEDED; Tom Dwyer & Kaj Elgstrand
The birth of the industrial safety and health paradigm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Paradigm formation and components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
The undermining of the paradigm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Considerations relating to the development of a social OSH paradigm . . . . . . . . . . . . . . . . 52
A social paradigm – macro level considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Suggestions for further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

3. MANUAL WORK
3.1 BASIC WORK PHYSIOLOGY; Ewa Wigaeus Tornqvist

Heavy work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Physical work performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Energy supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Factors affecting physical work performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Physical training…. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Effects of heavy work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Measures to prevent heavy work…………… . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Suggestions for further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
3.2 FOOD, NUTRITION AND WORK; Leif Hambraeus

Nutrition in transition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Nutrients in food . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Energy turnover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Assessing energy and nutrient balance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Physical performance and nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
3.3 MUSCULOSKELETAL DISORDERS; Eva Vingård

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Manual handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Symptoms and disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Reducing exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
The future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Appendix: Models for assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
3.4 WORKPLACE DESIGN AND EVALUATION; Roland Kadefors

Workplace design definitions and limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Creating new workplaces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
The workplace design process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
Workplace evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157

4. PREVENTION OF PHYSICAL RISKS
4.1 RISK AND RISK CONTROL; Lars Harms-Ringdahl

Concepts of risk and safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Causes of accidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Risk control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Risk analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
Perspective on insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
4.2 ACCIDENTS; Carin Sundström-Frisk

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Safety management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190
Plans for remedial actions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Haddon´s principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
Major accidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
4.3 HEAT AND COLD STRESS; Ingvar Holmér

Exposure to heat and cold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Adjustments to thermal extremes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Individual factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
Hot environments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Cold environments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
4.4 NOISE; Ulrik Sundbäck

Effects of noise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Nature of noise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Programmes to eliminate or reduce noise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Practical noise abatement measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
4.5 VIBRATIONS; Rauno Pääkkönen

Basic concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Sources of exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260

4.6 RADIATION; Kjell Hansson Mild & Ulf Bäverstam
Non-ionising radiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Ionising radiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
4.7 ELECTRICAL SAFETY; João José Barrico de Souza

Electrical shock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Electrical arc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Secondary or indirect injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
Electrical risks to property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
Preventive actions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
Planning and procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290
Safety inspections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Personal protective equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294
Work tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296
First aid and training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
4.8 FIRE SAFETY; Håkan Frantzich

Causes and consequences of fires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Prevention of the outbreak of fires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300
Limitation of the consequences of fire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
Training for rescue operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
5. PREVENTION OF CHEMICAL RISKS

INTRODUCTION; Gun Nise & Catharina Wesseling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
5.1 RISK ASSESSMENT AND CONTROL; Gun Nise & Linnéa Lillienberg
Chemical exposure and uptake routes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
Risk management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320
Control of hazardous substances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321

5.2 PESTICIDES; Catharina Wesseling
What are pesticides? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Workers exposed to pesticides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Pesticide related tasks in agriculture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
Routes of exposures and uptake . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
Health risk profiles of pesticides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
Chemical classes of pesticides and health effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330
Knowledge, attitudes and practices in developing countries . . . . . . . . . . . . . . . . . . . . . . . . . 337
Research on exposure and health effects from pesticides use in developing countries . . . . . 337
Risk reduction strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
Recommended strategies for pesticide illness prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . 342
5.3 SOLVENTS AND GASES; Gun Nise

Organic solvents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345
Uptake, biotransformation and elimination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 346
Health effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
Risk assessment and risk management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
Irritating and asphyxious gases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355
Isocyanates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360
5.4 DUSTS AND METALS; Linnéa Lillienberg & Bengt Sjögren

Inorganic dusts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
Metals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366
Organic dusts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
Urban air pollutants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372
5.5 SKIN DISORDERS; Carola Lidén & Anders Boman

Skin diseases caused by chemical exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
Contact allergens and dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376
Irritants and dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377
Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377
Hazardous substances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
Rubber and plastics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381
Preservatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382
Dyes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
Fragrances and colophony . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384
Pesticides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385
Organic solvents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385
Corrosives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 386
Skin irritants and wet-work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 386
Natural products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387

5.6 EPIDEMIOLOGY; Gun Nise & Bengt Sjögren
Basic concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 389
Time perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391
Study design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391
Potential errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391
SUGGESTIONS FOR FURTHER READING, SECTION 5 . . . . . . . . . . . . . . . . . . . . . 394
6. PREVENTION OF BIOLOGICAL RISKS; Mohamed Jeebhay & Eliana Alvarez

The HBA panorama . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401
High risk occupational settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403
Health effects of biological agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403
Risk assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 404
Managing risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405
Industrial hygiene and medical surveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423
Education and training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424
7. PREVENTION OF PSYCHOSOCIAL RISKS
7.1 PSYCHOSOCIAL RISKS AND WORK; Staffan Marklund

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429
Stress and psychosocial risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431
An influential experiment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 432
The demand and control model of psychosocial conditions . . . . . . . . . . . . . . . . . . . . . . . . . 434
Measurements of psychosocial working conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435
7.2 IMPROVEMENT OF PSYCHOSOCIAL CONDITIONS; Annika Härenstam

Changes in psychosocial risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439
A comparative study on the relationship between work organization
and psychosocial conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 443
Remedial strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 447
Differentiating and polarization of psychosocial risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 450
Targets for prevention of psychosocial risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 452

8. DEVELOPMENT OF WORK AND ENTERPRISE SURVIVAL
INTRODUCTION; Marianne Döös & Gunnar Broms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 459
8.1 ENTERPRISE SURVIVAL – CHALLENGES AND OPTIONS

Gunnar Broms & Marianne Döös
Scope available . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461
Globalisation and competition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462
Development of work as a way to compete and survive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464
8.2 NEW PRINCIPLES OF WORK ORGANISATION; Tommy Nilsson

Taylor´s scientific management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465
Some alternatives to scientific management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 466
New market conditions and the rationalization of capital . . . . . . . . . . . . . . . . . . . . . . . . . . . 466
Integrated production systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 468
Wage models for work development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 471
Concluding remarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 472
8.3 LEARNING AT WORK; Marianne Döös

We are all learners all the time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 475
The quality and usefulness of what is learnt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 476
Some basic learning principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477
Collective and organizational learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 481
Concluding remarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 485
8.4 MANAGING UNDERSTANDING – A NEW LEADERSHIP CHALLENGE

Jörgen Sandberg & Axel Targama
Participative development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
Understanding: the basis for action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 488
The case of competence in engine optimizing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 489
Managing understanding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 490
8.5 ORGANISATIONAL DEVELOPMENT AND GENDER INTEGRATION

Martha Blomqvist
Integration of women and men at the workplace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493
Resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 494
Ways of acting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 495
Why bother? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 496

8.6 STRATEGIES FOR CHANGE AND TEAM WORK; Gunnar Broms
Participatory strategies of change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 497
How to go about implementing change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 498
Team work – organizing for efficient production and learning . . . . . . . . . . . . . . . . . . . . . . . 500
The formation of teams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501
Creating a supportive environment for teamwork . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 504
The process of change, organizational development and OSH . . . . . . . . . . . . . . . . . . . . . . . 505
8.7 A REWARDING CHANGE – AN EXAMPLE FROM INDIA; Vimal Mahendru

Organisation of work prior to the change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 507
Abandoning the functional layout – introducing team work . . . . . . . . . . . . . . . . . . . . . . . . . 508
Significant gains – tangible and intangible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 508
Entering the future with competence for change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 511
9. AGE, GENDER AND MIGRATION
9.1 CHILD LABOUR; Bahira Lotfy

What is child labour? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 517
Where do children work?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 518
Main characteristics of child labour… . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 520
Why do children work?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 521
Why are children especially susceptible to environmental hazards… . . . . . . . . . . . . . . . . . . 524
Legal framework… . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 526
International convention on child labour… . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 526
Recent developments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 526
Action to be taken to eliminate child labour. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 528
Suggestions for further reading……… . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 532
9.2 GENDER AND WORK; Hanna Westberg

Gender issues in a global perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 533
Occupational safety and health of men and women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 539
How to improve women´s working conditions? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 545
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9.3 MIGRANT WORKERS; Bo Johansson
Migration and migrants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 551
General trends in contemporary migration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 557
Migration´s impact on development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 560
Labour migration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 566
International regulations on migrant workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 572
Migrants´ safety and health at work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574
What should be done? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 580
10. OSH AT THE ENTERPRISE
10.1 INFORMAL SECTOR AND SMALL ENTERPRISES; Peter Hasle & Ann-Beth Antonsson
Basic concepts and problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 587
Constraints and possibilities for preventive strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 593
The approach to occupational safety and health in small enterprises . . . . . . . . . . . . . . . . . . 594
Tools tailored to small enterprises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 599
Institutionalisation and intermediaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 600
Programmes for small enterprises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 602
10.2 MANAGEMENT AND PARTICIPATION; Nils F Petersson

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 605
Occupational safety and health management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 605
Participation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 612
Case studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 616
10.3 OCCUPATIONAL HEALTH SERVICES; Kaj Elgstrand

The origin of occupational health services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 623
Organisation of occupational health services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 625
Prevention versus health care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 627
To what extent do occupational health services exist? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 627
Basic Occupational Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 629
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11. NATIONAL PLANNING OF OSH
11.1 ROLE OF SOCIAL PARTNERS; Petra Herzfeld Olsson & Kerstin Ahlberg
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 635
The right to organize – a human right . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 636
Standards in occupational safety and health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 639
The OECD guidelines for multinational enterprises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 642
Case study, Latvia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 643
Case study, Tanzania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 645
11.2 EDUCATION AND TRAINING; Kaj Elgstrand

Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 649
Basic need for OSH training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 650
The schooling system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 651
Training of OSH specialists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 653
Training of managers and workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 656
Training within international development cooperation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 657
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 659
Distance education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 666
Attractive teaching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 668
Evaluation of training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 668
11.3 SUPERVISION AND CONTROL; Bernt Nilsson

The history of labour inspection systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 673
The principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 673
The role and scope of labour inspection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 675
Policies and methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 676
Trends in labour inspection systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 678
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12. A GLOBAL PERSPECTIVE ON OSH
INTRODUCTION; Christer Hogstedt & Tord Kjellström . . . . . . . . . . . . . . . . . . . . . . . . . . . . 682
12.1 GLOBALISATION AND WORKING LIFE; Christer Hogstedt & Tord Kjellström
The concept of globalisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 683
Economic forces behind globalisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 687
Trade, WTO and OSH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 691
Social and health development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 693
Global workforce and work organisation trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 696
Export processing zones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 700
Traditional subsistence work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 703
Informal and illegal work arrangements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 704
Migrant workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 707
War, terrorism and violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 707
12.2 GLOBAL SITUATION CONCERNING WORK RELATED INJURIES AND

DISEASES; Tord Kjellström & Christer Hogstedt
The official picture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 713
Hazards of importance in new workplaces of developing countries . . . . . . . . . . . . . . . . . . . 720
Unemployment as a health hazard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 729
The occupational burden of disease and injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 731
Improving the quality of data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 735
Surveys of working life and health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 737
Putting together the full picture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 739
12.3 INTERNATIONAL GOVERNANCE AND PARTNERSHIPS

Christer Hogstedt & Tord Kjellström
Global governance organisations with OSH responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . 741
Trade and economic development organisations influencing OSH . . . . . . . . . . . . . . . . . . . . 745
International trade union organisations and NGOs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 746
The impact of major global conferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 749
A global strategy on “Occupational health for all” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 750
Global research needs for OSH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 756
Financial resources for OSH development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 757
An integrated approach for success . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 758
SUGGESTIONS FOR FURTHER READING, SECTION 12 . . . . . . . . . . . . . . . . . . . . 760
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13. ACTIONS FOR CHANGE
13.1 STRATEGY FOR CHANGE; Lennart Svensson

Individual versus organisational change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 765
Strategies for change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 767
Case studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 770
The role of education, research and change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 772
13.2 PROJECT GUIDELINES; Nils F Petersson & Kaj Elgstrand

Why conduct projects? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 775
Characteristics of a project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 775
Project management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 776
Project pitfalls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 781
NOTES ON AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 783
ENGLISH LANGUAGE EDITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 798
14
1
Introduction
1
Introduction
Kaj Elgstrand & Nils F Petersson
aims and contents
Aims
This book is written for professionals in de- The contents of the book are focused on the
veloping countries, for occupational safety and prevention of occupational safety and health
health specialists, production engineers, manag- risks. Actions and developmental processes at
ers and trade union representatives working to enterprises and workplaces have the highest
improve working conditions and eliminate risks priority. Activities at national and international
for occupational accidents and diseases. levels are also included in relation to their im-
The origin of the book lies in the internation- portance for action at enterprise level.
al training programmes in Occuaptional Safety Efforts to foster development of occupational
and Health & Development, sponsored by the safety and health (OSH) traditionally deal with
Swedish International Development Coopera- the study of risks through scientific or other in-
tion Agency (Sida), initially managed by the vestigations. The results are then documented in
Swedish National Institute for Working Life, reports or articles. When knowledge exists about
and later by the Royal Institute of Technology safety and health risks, information is dissemi-
in Stockholm. The majority of the authors have nated in the form of written or oral information,
been engaged in several of these eleven training and/or through training activities. This book
programmes. These programmes were largely makes use of research results, and is intended
based on action oriented development projects to be used in connection with training activi-
carried out by the participants. The theoretical ties and programmes but does not concentrate
content given by the lecturers aimed to prepare on research or training. The focus is action for
and assist participants to manage their action change to eliminate or reduce risks for occupa-
oriented projects. During these training pro- tional accidents and diseases.
grammes we lacked a basic text outlining the Besides dealing with OSH issues, the book
principles of occupational safety and health and also links OSH with production and productiv-
ways to take action to improve occupational ity, showing the positive relationship between
safety and health in developing countries. This good OSH and the creation and maintenance of
book has the ambition to fill this gap. sustainable high productivity.
17
Chapter 1
The authors use examples of ways that basic Development of work and enterprise survival
knowledge can be used for practical action and is discussed in Section 8. Work organisation,
evaluation. The reader is not expected to read learning at work, managing understanding, gen-
this book from start to finish but to consult parts der integration, and strategies for change and
of it when confronted with practical problems team work are highlighted.
in working life. We hope that the book will help In Section 9 the overall practical issues related
readers to find their own solutions to practi- to child labour, gender and work, and migrant
cal problems, solutions that relate to individual workers are discussed.
workers limitations and possibilities. Organisation of OSH at enterprise level is
discussed in Section 10, dealing with informal
Structure and contents sector and small enterprises, management and
The book is structured into 13 sections, most of participation, and occupational health services.
them containing several chapters. In total there National planning issues are highlighted in
are 47 chapters. Section 11, related to the role of social partners,
The following part of this introductory sec- education and training, and supervision and
tion deals with a number of basic concepts. control.
What is occupational safety and health (OSH)? Section 12 gives a global perspective on OSH
What is meant by development, and how is it including globalisation and working life, the
related to OSH? What is meant by hazards and global situation concerning work related injuries
risks, and why is prevention such a key concept and diseases, and international governance and
within OSH? partnerships.
Section 2 outlines the historical development The final section is a summary and reitera-
of the risk concept. The current OSH paradigm tion of the book’s orientation towards practical
is described, and the need for a new OSH para- actions for the prevention of risks and the de-
digm is discussed. velopment of work, working environment and
Sections 3 to 7 deal with workplace hazards productivity.
and how to eliminate or reduce them. Section
3 focuses on manual work including basic work Overlapping
physiology, food and nutrition, musculoskeletal There are overlaps in the content of various
disorders and workplace design and evaluation. chapters and sections. We consider this to be
The prevention of physical risks is covered in an advantage. It enables independent study of
Section 4 including accidents, heat and cold different chapters and furthermore, where there
stress, noise, vibrations, radiation, electrical and are different statements on the same issues in
fire risks and an introductory chapter on risk various parts of the book, they serve as a re-
and risk control. Section 5 covers the prevention minder that different views exist.
of chemical risks including pesticides, solvents,
gases, dusts, metals and skin disorders. There are
special chapters on risk assessment and control,
and epidemiology. Sections 6 and 7 deal with the
prevention of biological and psychosocial risks,
respectively.
18
Introducation
basic concepts “occupational safety and health” as they are

trained to address illnesses or health problems
Occupational safety and health
rather than safety problems. They consider
Problems of occupational safety and health “health” to be the overall concept that also
(OSH) have been present since the emergence of includes safety. The other meaning of the abbre-
human work. The recognition that work is risky viation OHS is “occupational health services”.
to life, safety and health was heightened in the This book uses OSH for “occupational safety
eighteenth and nineteenth centuries as the In- and health” and OHS is generally used for “oc-
dustrial Revolution occurred in Europe. Public cupational health services”.
concern about these problems led to legislation
and special agencies set up to protect workers Development
safety and health. The concept of development is used in different
The scope of occupational safety and health disciplines from biology, technology and other
has gradually broadened from the diseases or in- natural sciences, to philosophy and social sci-
juries attributable to work to the nature of work ences. This book addresses some of the issues
itself, the wider work environment, and work- concerning human development in relation to
ers´ wellbeing. OSH is divided into a number living standards and quality of life, with special
of specialities related to particular problems emphasis on working conditions and working
and applications within physiology, psychology, life. The concept of development is often used
sociology, ergonomics, medicine, hygiene, work to convey a particular meaning, i.e. a general
safety, toxicology, epidemiology amongst others. move in a positive direction, synonymous with
Occupational health is sometimes represented improvement. On the other hand the concept
as a superior concept to occupational safety, of change is often portrayed as being devoid of
however, we prefer to use the term occupational value judgments. Development is often charac-
safety and health as this better reflects safety terized as “man made” while evolution is more
and health as factors of equal importance. Oc- dependent on uncontrolled forces working on a
cupational safety and health is defined in ILO longer term basis.
convention no. 155 (1981) that provides scope Development theories have been commonly
and definitions, principles of national policy, and associated with the concept of underdeveloped
suggestions for action that should be undertaken or developing countries. Development was
at national and workplace level. earlier considered to be a process following cer-
The widely used abbreviation OSH for “oc- tain natural and thereby predictable principles
cupational safety and health” is used in the title but over time more attention was given to the
and throughout this book. The assumption is problems that complicated the process, which in
“safety first”, meaning the priority should be the turn stimulated interventions by governments.
prevention of accidents to avoid fatalities and The effects of colonial heritage were empha-
injuries, followed by health issues. It is common sised so the rich industrialised countries were
for engineers to think this way about OSH. considered to have a special responsibility. Dur-
The abbreviation OHS is also used some- ing the 1980´s the main tendency was to play
times. The abbreviation has two distinct mean- down the effects of a colonial background as an
ings. One is “occupational health and safety”, explanation for the poverty of ”the third world”
sometimes preferred by physicians instead of instead blaming the corruption, autocratic ways
19
Chapter 1
and erroneous economic policies of third world this has mostly taken the form of pouring public
regimes. The North-South dialogue changed money into banks and selected industries nota-
character. Instead of giving development aid to bly the auto industry.
compensate for a historical exploitation, which While it is accepted that global economic
had deprived the former colonies of resources growth will be needed during the 21st century,
and distorted their economic structures, the more attention must be paid to the structure and
industrialised countries started to give economic quality of that growth to ensure that it is direct-
assistance that imposed conditions for a process ed to supporting human development, reducing
of adjustment to the rules of a deregulated world poverty, protecting the environment and ensur-
market. “Structural adjustment” aimed to im- ing sustainability.
pose liberalisation and macro-economic balance.
A new tendency in the activities of interna- Occupational safety and health for
tional funding agencies, i.e. the World Bank, development
International Monetary Fund and regional de- During the last decades, the positive relation-
velopment banks, has recently emerged as these ship between OSH and productivity has been
agencies have started to look beyond economics, highlighted in many countries and international
currency markets and capital flows. Considera- organisations. This has partly come about be-
tion of social issues and strengthening of public cause of increasing difficulties to convince the
institutions are now seen as important measures employers with the traditional arguments of de-
for promoting development. At the Okinawa cency, like “production should finance the costs
Summit in July 2000, the leaders of eight major for OSH activities”, “health for all”, “workers
industrialised democracies (G8) and the Europe- should not only be provided with work but also
an Commission President underlined that health with safe and healthy work”, etc.
is the key to prosperity. The final communiqué The difficulties to convince employers in
of the summit states that good health contrib- developing countries to improve OSH may be
utes directly to economic growth whilst poor connected with the structural adjustment pro-
health drives poverty – health is wealth. grammes initiated by the international funding
A new era of globalisation has reshaped mar- agencies. These programmes increased the pres-
kets over the last fifteen years. Deregulated flows sures on enterprises to become more competi-
of capital, and increased exchange of knowledge tive on the global market and so money spent on
and work forces between countries have oc- OSH is seen as a cost without obvious benefits.
curred rapidly, posing both serious problems and Increasing unemployment in industrial countries
new possibilities for societies. Since late 2008, results in the same difficulties.
the character of the current era of globalisation These difficulties may also occur because
seems to be changing. The global integration of OSH demands appear to be endless, complex
the world economy is in retreat. The movement and disturbing production. Workers never seem
of goods, capital and jobs is going into reverse. to be safe and healthy even though changed
Industrial production is falling, factories are technology is making a lot of work lighter
closing and trade is slowing down. Unemploy- and easier to perform. There are a lot of rules
ment worldwide is on the rise. Popular opinion about how to deal with OSH risks that appear
backs more state regulation. So far (May 2009), to be more effective in preventing production
20
Introducation
Figure 1.1. Fatal occupational accidents and competitiveness index for 31 industrialised and developing
countries. Source: World Economic Forum; ILO/Safework, 2002.
improvements rather than OSH risks. A focus Now there is a move to integrate occupa-
on repeated measuring and monitoring is not tional safety, health and production in order
enough to solve OSH problems. to improve the safety and health of workers
Until relatively recently many OSH special- and to increase productivity at the same time.
ists viewed “production”, “productivity” and Productivity, effectiveness and OSH can be of
“effectiveness” as dirty words of no concern to common interest for workers, employers, own-
them, because engineers dealt with these issues. ers of industry and wider society. This positive
OSH experts, many of them physicians, were relationship between productivity and safety is
the “good guys” who cared only for the safety, illustrated in Figure 1.1. Countries with high
health and well-being of workers while produc- competitiveness index tend to have low number
tion engineers, managers were the “bad guys”, of fatal occupational accidents.
squeezing profit out of the workers without
consideration.
The positive relationship between OSH and development is emphasized in a statement by the
former UN Secretary-General, Kofi A. Annan (1997):
“The world of work will continue to undergo dramatic changes. Already, we see growing
demands for flexibility mobility and productivity. As we look to the future, we must always
remember that human being are not servants of economies. Rather, economic development
and production must serve men and women. Occupational safety and health is a crucial
means towards that end. As an essential component of the United Nations Charter’s vision
of ‘social progress and better standards of living in larger freedom’, it is and must remain a
high priority on the international agenda.”
21
Chapter 1
Categorising countries Hazards can also be of biological or psychosocial

As this book is oriented towards occupational nature.
safety and health specialists in developing coun- The term risk expresses the likelihood of an
tries, the terms “developing countries” and event to occur and its severity. The term hazard
“industrial countries” are often used, however, expresses a quality, while risk expresses a quan-
this does not mean that the two terms are well tity. The concepts of hazard and risk are often
defined or that other terms cannot not be used. used without distinction, sometimes causing
There are many alternatives: developed and confusion.
underdeveloped countries; North and South The ultimate aim of occupational safety and
countries; countries belonging to the First, Sec- health work is to eliminate hazards and risks and
ond and Third World; poor and rich countries; if this is not possible, to reduce them.
high, middle and low income countries are just Figure 1.2. shows a number of concepts used
some of the most common categorisations of to define and manage the risks of occupational
countries. While some terms are better defined accidents and diseases.
than “developing” and “industrial” countries The first step in a risk assessment is the rec-
most of them are not. ognition and definition of a hazard, i.e. hazard
For the purpose of this book we believe that identification. The second step is to estimate
the simple categorisation in developing and the magnitude of the risk (risk rating) so priori-
industrialised countries, favoured by the UN ties for action can be set. A number of different
organizations, is practical. methods exist for hazard identification and risk
We are also well aware that the existing 200 rating, some of which are discussed in this book.
countries in the world represent a continuum Risk evaluation includes not only hazard iden-
in relation to all the important parameters like tification and assessment of the magnitude of
health, economy, industrial development, popu- the risk, but a judgment as to whether the risk is
lation and country size. How can a country of 1 tolerable or not.
billion inhabitants be placed in the same cate- The term risk analysis is sometimes used syn-
gory as a country of 10 000 inhabitants? How to onymously with risk assessment but risk analysis
categorise a country of 200 million inhabitants is a broader term as it may include an analysis of
that includes both highly industrialised activi- the consequences of the risks.
ties alongside a large sector of non-mechanised Risk communication is the exchange of infor-
agriculture? mation about the detection of hazards and risks
and how they can be dealt with. Risk commu-
Hazards and risks nication may also consider public perception of
A hazard may be defined as a substance, agent or risk and the assessment of a risk by individuals
physical situation with a potential to cause an ef- (risk perception).
fect in terms of ill health, injury or damage to a
human being, animal, property or environment. Prevention of risks
The presence of a harmful chemical (even if it Risk prevention has long been a well known
is not used), or an uncovered hole in a floor are concept within occupational safety and health.
examples of a chemical and a physical hazard. It is often emphasized that actions to improve
22
Introducation
Risk management
Risk assessment Selecting and Risk

implementing communication
Hazard
activities to
identification
eliminate,
reduce or
control the
risks
Risk Surveillance
rating
Figure 1.2. Basic concepts related to risk management.
working conditions and work environment must spections, registration and analysis of accidents,
firstly focus on prevention of accidents and dis- and/or health examination, have to be taken. If
eases. However, “prevention” is attributed with a control measures are not fully successful, work-
number of different meanings, depending on the ers have to be protected through the use of
context. collective protection such as general ventilation
In medicine prevention is generally used in or protective barriers, or of personal protec-
three different contexts. Primary prevention seeks tive equipment (PPE) such as ear plugs or dust
to prevent diseases and injuries from occurring masks. The use of PPEs should not be seen as a
e.g. through immunization, adequate nutrition, readily acceptable and first stage solution, but as
or elimination of toxic substances from produc- a measure to be applied only when prevention
tion. Secondary prevention aims to detect and and control of risks have failed. PPEs should
treat any disease at the earliest possible time in only be used as a temporary intervention, not as
order to reduce the more serious consequences a permanent method of dealing with hazards and
of disease e.g. screening for occupational risks.
asthma. Tertiary prevention attempts to reduce Preventive actions can be taken at a number
the progress or complications of an established of levels in society, from the national to the local
disease through therapy and rehabilitation e.g. level. Action at national level is important, e.g.
x-ray investigations to control silicosis. introduction of new legislation supported by
This book focuses on the prevention of oc- information and training activities. Although
cupational accidents and diseases through the such actions are discussed throughout the book,
elimination or reduction of risks. If this is not the main focus is on direct actions at workplaces
fully successful, control measures, such as in- and within enterprises.
23
Chapter 1
The most efficient and least expensive ways rule violation. A statistician may see an accident
to prevent risks are achieved through the ap- as a random occurrence while someone else may
propriate design of production and organisa- see it as bad luck. Such single-minded approach-
tion of work. Risks can also be most effectively es are not conducive to understanding accident
prevented when machines, tools, furniture and causation and prevention.
chemical substances are selected and purchased. Basic human errors are not made by the
These preventive actions apparently lie within worker (the “end-user”) but by those who have
the responsibilities of purchasers, production en- designed the layout of workplace locations, work
gineers and managers. The knowledge of OSH processes and workplaces, as well as by those
specialists should be integrated with the work of who select and buy furniture, machines, chemi-
those responsible for the design of production cal substances and tools. Those responsible for
systems, work and workplaces, and those who the organisation of work, and for the mainte-
purchase machines, tools etc. nance of machines and tools also play a role in
prevention. To start by blaming a worker for an
Who is the culprit? accident does not allow a real understanding of
It is common to hear that occupational accidents what has happened and why, and is not helpful
or diseases are caused by someone making an er- for the prevention of future accidents.
ror, i.e. by a “human factor”. Such an expression Designing the work environment and produc-
is mere nonsense as work is created by humans, tion technology so that safety and health risks
performed by humans and controlled by hu- are eliminated or reduced to a minimum, places
mans. Evidently 100% of occupational accidents the main responsibility for a safe workplace on
and diseases are caused by human factors. the employer. A manager or an occupational
Depending on professional background, we health physician may regard the provision of
may fall into the trap of using a single cause to personal protective equipment (PPE) such as
explain an occupational accident or disease. A breathing masks, gloves, and helmets as pre-
worker may say that an accident was caused by vention. If a worker doesn’t use the protective
stressful working conditions, while a manager equipment, he can be blamed for the accident
may see it as caused by a careless worker. An regardless of existing possibilities to prevent the
engineer may understand the same accident to risks. This view of prevention totally blocks any
be caused by a technical failure while a labour real prevention by elimination or minimisation
inspector may consider it as a consequence of of the risks.
24
2
History and future
2.1 Historical development of the risk concept 27

2.2 A new OSH paradigm is needed 45
2.1
Historical development of the risk concept

Gideon Gerhardsson
from hazard to risks that we reflect it to our people in decisions

that we make and actions that we take.”
The terms hazard and risk, are often inter-
changed, however, there is a difference. The This chapter follows the long road from phi-
term hazard includes all kinds of unwanted losophies of risk to concepts of well-being as
events, both natural and manmade while the these visions have appeared in the curative and
concept of risk also embraces efforts to reduce preventive strategies of their time.
the number and severity of unwanted events
in other words risk implies some ambition to Fatalism was the core
master uncertainty. For example, the most spec- The history of humankind dates back more than
tacular project to master uncertainity the Apollo four million years. The quest for survival and
moon landing in 1969. In a speech on July 29, subsistence was evolved through labour to gain
1969, the day of the first man landed on the control of the natural environment. More hos-
moon, Jerome Lederer, Director of the Manned tile natural environments concealed numerous
Space Flight and Safety for NASA, declared: hazards, most of most of which were considered
to be inevitable hazards, i.e. fatalism was the
“ This nation was built on risk. Personal risk core belief. Magic, mysticism, trial and error,
in tackling the wilderness, financial risk in were the first tools employed to manage the
business, risks in exploring the scientific un-
known, enormous engineering risks, manage- risks from hazards. The hardest types of work
ment risks. We shall continue to take risks of were based on slavery, which was prevalent
greater magnitude than in the past. But the in many parts of the world, including China,
consequences of failure are becoming less per-
missible. The political, social, as well as eco- Egypt, Greek, and India. Slaves represented a
nomic and personal risks that now accompany cheap and inexhaustible supply of labour and
our ventures can have enormous repercus- workers’ health was not an issue. New technolo-
sions when failure occurs. Growing risk fac- gies were developed in the Asia-Pacific Region,
tors require a more comprehensive approach
to hazard management than our wealth and particularly in China and India, before they were
isolation have permitted in the past .…. In or- developed in Europe, but the concept of manag-
der to accomplish our goal, we must develop ing risks connected to working conditions came
a sensitivity to the severity of risk-taking, so
first from Europe.
27
Chapter 2.1
Population density as a risk factor both epidemics were widely attributed to super-
As societies became more settled there was natural influences.
growing concern about human health, par- Early textbooks dealing with health, accidents,
ticularly on the conditions of those dwellers in and diseases recommended that practices, rules
congested areas, but not particularly focused and regulations remain the same rather than
on labourers. The learned Greek, Hippocrates, taking a creative approach. There was a marked
460-370 B.C., the father of medicine was con- resistance to change.
cerned as was the Roman scholar Pliny the elder,
23-70 A.D., the author of the classical “Historia The expansion of man-made hazards
Naturalis”. Pliny the elder is also credited as the The Renaissance, rooted in Italy in the 1300s,
first person to speak of a protective mask against opened the doors to exploration, experimenta-
dust. There were earlier pronouncements about tion and new visions. Manufacturing of various
“prevention being better then cure”, and the goods escalated but new technologies initially
idea was even put into practice. The Yellow caused great fear of unemployment. For exam-
Emperor of China, Huang Di, from the Shang ple, in 1397, the use of a devise that automati-
Dynasty, 1500-1040 B.C., stated: cally pressed pinheads was banned in Cologne.
During the Luddite riots of 1811-12 in Eng-
“Hence the sages did not treat those who land some 1 000 stocking frames and 80 lace
were already ill; they instructed those who
were not yet ill. To administer medicines to machines were destroyed by workers. Those
diseases which have already developed and to accidents and diseases that were reported were
suppress revolts which have already developed generally accepted as “fate”.
is comparable to the behaviour of those who Georgius Agricola, 1494-1555, was a Ger-
begin to dig a well after they have become
thirsty, and of those who begin to cast weap- man mineralogist, scholar and physician who
ons after they have already engaged in battle”. is considered to be the father of geology. In his
book “De Re Metallica”, published in 1556, he
Galen, 129-200 A.D., a Greek born physician
described accidents and diseases among miners
and medical writer living in Rome, observed the
and also recommended a number of preven-
great danger faced by miners but did not include
tive measures. He also believed that there were
occupational accidents and diseases. The influ-
harmful devils and dwarfs living in the mines.
ential Arabian physician Avicenna, 980-1037
Another mixed product of the Renaissance
A.D., wrote five volumes about the theoretical
was the Swiss medical thinker Aureolus Philip-
and practical medicine of his time. While he
pus Theophrastus Bombastus von Hohrenheim,
wrote with great clarity and detail he had little
more known as Paracelsus, 1493-1541. His
to say about work-related hazards. Such hazards
interest in astrology and the occult did not pre-
were minor compared to others in society such
clude his famous chemical experiments. He saw
as the increasing appearance of epidemic diseas-
the human body as a chemical laboratory and
es which presented much greater threats. There
attributed lung diseases to toxic air in mines and
were two major epidemics during the Middle
metal melting plants. His textbooks on health
Ages. The Black Death raged in Europe from
were regarded as the established knowledge on
the 1340s, killing one quarter of the world’s
the subject for two centuries.
population. The Great Plague of 1665 wiped
out twenty percent of the population of London;
28
The London surgeon, Percivall Pott, 1714- “Encyclopédie”, announced as the key to human
1788, gave the first description of an occupa- progress under the banner of “Rationality” but
tional cancer, scrotal cancer, called the “chimney even here labourers’ health was a minor issue.
sweeps cancer”. This was the first occupational
link to cancer but it was many years before pre- Growing awareness
ventive measures were taken to protect chimney The first industrial revolution, 1700-1850,
sweeps. The British chemist Sir Humphry Davy, developed from a combination of technology,
1778-1829, was more influential. He investi- improved power sources (steam from the 1780s
gated mine explosions and developed the min- and electricity from the 1800s), new materials,
ers’ safety lamp that saved many lives. Accidents and improved long distance transportation. The
impacted more than diseases. number of wage earners expanded to form a
The Italian physician Bernardino Ramazzini, class of its own, the “working class”.
1633-1714, is called the father of Occupational In 1841 Great Britain had a total population
Health. His classical De Morbis Artificum Dia- of 18 350 000. Three million were engaged in
triba was published in 1700. Ramazzini examined trade and manufacturing. 1.5 million were em-
the conditions of work and hazards of the most ployed in agriculture and in mining, see Figure
important occupations of his time. He also pro- 2.1.1, and 750 000 in quarrying and transport.
posed preventive measures and asked physicians There was a total of 5 250 000 employers and
to routinely include the question about what employees at a time when London had less than
trade patients worked in when making a diagno- 2 million citizens.
sis. His book was compulsory reading at numer- The economic theory of Capitalism, based on
ous medical universities around the world over private ownership and free enterprise, was gain-
for 200 years but was poorly applied in practical, ing momentum. In the middle of the 1800s the
hands on medicine. rest of the world looked at England as the major
The British physician Charles Thackrah, centre of capitalism and the place that the risks
1795-1833, devoted his life to the study and pre- to workers were observed and defined over time.
vention of the occupational hazards of industri- The greatest sociological study in the 19th-
alism. His systematic observations of 128 trades century of working and living conditions in
in Leeds, England, played an important part in London was undertaken by Henry Mayhew,
the formulation of later factory and health legis- Figure 2.1.2, and published as London Labour and
lation. the London poor (2 076 pages in four volumes) in
Despite the increasing knowledge of occupa- 1861-62. His aim was “to publish the history of
tional hazards that was gained in the first half people, from the lips of the people themselves-
of the 18th century, little was done to safeguard giving a literal description on their labour, their
workers. earnings, their trials and their sufferings, in their
The Age of Enlightment was a philosophi- own unvarnished language”.
cal movement that developed in France, Britain Mayhew invented oral history a century be-
and Germany during the second part of the 18th fore the term was coined. He walked hundred
century. Rationalism and Science were leading of miles through London streets in the 1840s
ideas. The French philosopher and essayist Den- and 1850s and gathered thousands of pages of
nis Diderot, 1713-1784, signed the monumental testimony. His findings first appeared as a series
29
Chapter 2.1
Figure 2.1.1. A female coalminer in 1840. “I have a belt round my waist, and a chain passing between my
legs, and I can go on my hands and feet”.
Figure 2.1.2. Henry Mayhew, London, 1861.

30
of articles in the Morning Chronicle in 1849-50. Who are real workers?

The English writer W.M. Thackeray 1811-1863 Mayhew used broad definitions. He applied the
wrote: “Mayhew provides us with a picture of title “worker” to all those who did anything to
life so wonderful, so awful, so piteous and pa- earn their living, who performed any act consid-
thetic, so exiting and terrible, that readers of ered worthy of being paid for by others, without
romances own they never read anything like to regard to the question of whether such labour-
it”. ers tended to increase or decrease the aggregate
The hazards inherent in the society, “the wealth of the community. All persons doing
total social fabric”, Mayhew pleaded, could be or giving something in return for any kind of
identified, measured, and evaluated in series of comforts were defined as “self-supporting indi-
comparisons. As a first approach he arranged the viduals”. An informative comparison was made
population into four different groups: a) those between living and working conditions of three
that will work, b) those that cannot work, c) groups of non-workers: a) incapacitated or those
those that will not work, d) those that need not not allowed to work, b) those who were indis-
work. He stated that under one or other sec- posed or choosing not to work, and c) independ-
tion of this four part division, every member of ent and privileged non-workers. These non-
not only the English community, but of other workers included people diametrically opposed
civilised states, could be accounted for – those to each other from the very rich to the very
who were rich, poor, industrious, idle, honest, poor, from the honest to the dishonest.
dishonest, virtuous, vicious. Mayhew noted that the circumstances gov-
However, there were so many branches of erning the classification of commercial trades
industry with the division of labour so minute were totally different from those regulating the
and various, that it seemed impossible to reduce division of other types of work. However, dis-
them into any workable system. Mayhew was tinct sets of workers were required, according to
assisted by various statistics that increasingly the specific demands of trades. From his main
were being collected. In 1827, M. Payon had groupings Mayhew pictured society as a living
tested a classification of labourers into five major organism moving from the whole to the parts.
divisions, arranging the crafts according to their He made a systematic outline of the health and
origin: chemical, mechanical, physical, eco- safety conditions of all his groups and subgroups
nomical, and miscellaneous. In 1834, M. Dupin of workers and non-workers.
proposed a classification that was found to work
better than earlier classifications. He viewed hu- Charity agencies
mans as: a locomotive animal, a clothed animal, According to Mayhew, the support or aid offered
a domiciled animal etc. By tracing individuals by charity is a main social resource in a capital-
through their various daily needs and activities, istic society so he also mapped out charitable
Dupin arrived at a classification in which all activities. In the 1850s, some 530 charitable
crafts were placed under nine headings, accord- societies in London spent 2 million pounds an-
ing to their contributions to society. nually. Mayhew grouped them as: a) curative,
b) preventive, c) repressive and punitive, and d)
reformative. The curative agencies were mainly
based on societies promoting Christian knowl-
31
Chapter 2.1
edge and city missions. Preventive agencies “The poor will never cease from the land.
worked with issues such as home hygiene, the There always will be exceptional excesses and
out-breaks of distress that no plan can have
provision of free drinking water, and public im- provided against, and there always will be
provements of conditions of the working classes, those who stand with open palm to receive, in
including the employment of women. Among the face of heaven, our tribute of gratitude for
the repressive and punitive agencies, suppression our own happier lot. Yet there is a duty of the
head as well of the heart, and we are bound as
of vice dominated the agenda, but prevention of much to use our reason as to minister of our
cruelty to animals was also observed. abundance.”
Mayhew comments upon many favourable
and unfavourable factors in society. “The path of Registers and statistics enter the scene
man, even of a man on the highway to heaven, is
Mayhew considered earlier events that fore-
never one of perfect safety”. As to those people
shadowed or confirmed his own observations.
far away from the highway to heaven, Mayhew
As early as 1506 Torella proposed the periodic
devotes many pages to beggars whom he illu-
examination of prostitutes as a measure for the
minates as a catalogue of victims caused by the
control of venereal diseases. At the beginning
process of industrialisation, including children,
of the 18th century, Howard set forth a plan for
women, and injured men. A striking example
reform of prisons and hospitals. In England in
were the beggars who appeared on the streets
particular, registers of births and deaths, and of
after a disaster including shipwrecked sailors,
statistical methods, were launched in the 17th
injured miners, burnt or maimed tradesmen.
century. In Germany Johann Peter Frank pro-
“A man who has lost both arms, or even one, is
duced his Magnum Opus in social medicine: The
scarcely in a position to earn his living by labour,
System of Comprehensive Medical Policy in 6 vol-
and is therefore a fit object for charity”.
umes, with 3 supplements, from 1784.
Charity, however, can be misused. After a seri-
In 1887, Conrad published his work Contribu-
ous coal mine accident, injured miners swarmed
tion to the Study of the Effect of Social Conditions
into London in such numbers “that one might
and Occupations on Mortality based on data of the
suppose the whole of the coal-hands of the
town of Halle for 1855-1874. His work preceded
north had been blown south by one explosion”.
epidemiology. He divided recorded deaths into
Numerous others pretending to be beggars join
two age groups, one with deaths of those up to
the victims. The real miners, Mayhew notes, are
5 years of age and one over 5 years of age. He
very charitable and don’t think it shameful to
found that in both groups almost 90% of the
seek aid from their betters when they really need
cases were related to poverty.
it.
Several mortality and morbidity studies
Burnt and maimed tradesmen were another
published later confirmed that social position
group of beggars often showing bloody cover-
affected mortality. A Danish demographer,
ings over leg and arm sores. While such sores
Westergaard, analysed the life expectancy for
can be faked, ill health and accidents in work-
the nobility and for the rest of the population in
places often ended in street begging. Henry
England during 1800-1855. He found that the
Mayhew maintained his fighting spirit and
Aristocrats could expect a longer life expectancy
claimed that the wealth produced in a society
than the rest of the population.
must be properly shared. He concluded:
32
Risks and human nature Watson’s message was challenging because

Second to the belief that all events were deter- behaviourism meant that people could be pro-
mined by fate and were therefore inevitable, gramed or reprogramed to understand the
comes the concept of inherent “human nature”. principles of their own behaviour. His idea that
Humans are naturally accident prone or gam- it was possible to condition consumers to buy
bling risk takers so to master hazards was to anything, was successfully exploited commer-
master human nature. Numerous early studies cially, particularly in the US, but was not used as
included the “accident-prone personality”. a tool to change the behaviour of people at risk.
Holism and evolution was a striking book writ- However, Watson and an American Professor of
ten by J.C. Smuts, 1870-1950, published in Experimental Psychology, B. F. Skinner, 1904-
1926. The author was an English born South- 1990, are revisited in what is currently called
African statesman who tried to bridge the gaps “program learning”. Watson was given remark-
between matter, life and mind. He indicated the able publicity in both west and east but he did
need to reform all three concepts. However, one not trigger substantial new activities on hazard
condition prevailed, and he stated that the parts abatement.
should be interpreted from the whole, not the
other way round. The mind should not be stud- risks concepts are childs of
ied as a distinct phenomenon but as a universal political systems
process, i.e. a holistic approach must be taken. The British industrialist Robert Owens, 1771-
His ideas were not taken seriously for many 1858, was a front runner of modern socialism
years. in Great Britain suggesting a number of social
The founder of behaviour psychology, the reforms in the 1820s. Two German socialists,
American scientist, J. B. Watson, 1878-1958, Karl Marx, 1818-1888, and Friedrich Engels,
made his main contributions during 1910-1920. 1820-1895 highlighted the basic incongruity of
His thesis was that environmental factors ruled capitalism: the contradiction between the social
behaviour. He studied the behaviour of animals nature of the process of production and the pri-
and people in the “real world”, in their own sur- vate capitalist method of appropriation. Accord-
roundings. According to the British philosopher ing to Engels and Marx, socialism offered politi-
Bertrand Russell, 1872-1970, Watson’s achieve- cal conditions for human development through
ments equated to Aristotle. Prediction and con- the abolition of private ownership and exploita-
trol of behaviour were his two prevailing issues. tion and by giving all citizens equal political
Behaviourism used external signs to keep track and legal rights and duties. Appropriate science
of the individuality. Watson studied how subjects could be transformed into a directly productive
responded to different stimuli. He transformed force so production would gradually become the
his findings into “learning curves”. He charac- technological embodiment of science. Everyone
terised basic behaviours that normally last over a had a duty to serve in a socialist society – “he
life-time as “the habit equipment” that included who does not work shall neither eat”.
disturbances and maladjustments of behaviour Academics in the Union of the Soviet Socialist
that could be corrected. Individual expectations Republics, recognized three stages in the evolu-
could be manipulated. tion of the interrelationships between science
and production. During the first stage dated
33
Chapter 2.1
from the emergence of scientific knowledge to The Club of Rome

the industrial revolution of the late 18th century, The Club of Rome was initiated in 1968 by the
science mainly developed in accordance with its Italian industrialist Aurelio Peceri, 1908-1984.
internal laws. There was no direct connection The Club of Rome was a private group of 100
with either production or technology except independent specialists from more than fifty
some through some haphazard influence. countries. They looked at the contemporary
The second stage spanned almost two cen- predicament of mankind and focused on the
turies, separating the first and second industrial consequences of population growth, standards
revolution. Large-scale mechanised industry of living, and geographical boundaries. Using
transformed production by replacing obsolete computers they tried to structure a world model
methods through the conscious application of based on system dynamics. In 1972 they plotted
science and scientific data. a first course from exponential growth into
The third stage in the historical evolution of global equilibrium, coordinating a number of
science and work began when scientists, indus- subsystems: social, technical, economic and
trial workers and engineers cooperated directly. political. In an evaluation in 1992 they noted
Science has become a cornerstone of modern that implementation of their most urgent global
technology and production processes. Common recommendations had not even started.
risk factors can be eliminated or substantially re- The statements of the Club of Rome were the
duced. According to official Soviet statistics, the subject of much attention in the capitalist world.
rate of industrial injuries and accidents fell by By applying what they called “System Dynam-
more than 75% between 1928-1975. However, ics” the world of growth with increasing risks
detailed data were not presented. could gradually be transformed to a world of
It became imperative to find what conditions equilibrium with low risks.
could achieve a reasonable balance whereby na-
ture could be developed in accordance with the No state of equilibrium
needs of human culture. Humans rule nature. Soviet scientists, however, were arguing against
“Labour is, in the first place”, wrote Marx, “a the Club of Rome calling the recommenda-
process in which both Man and Nature partici- tions in World Dynamics and The Limits to Growth
pate, and in which man of his own accord starts, (1972) “unrealistic”. This publication stated
regulates, and controls the material reactions that the only way to safeguard humankind from
between Himself and Nature”. a future catastrophe and to establish a “state of
Waste and pollution could be brought under world equilibrium” was to limit the open-ended
control by closed-cycled technologies, however, growth of all parameters: population, produc-
a switch to closed-cycle technology would in- tion, consumption, and pollution.
volve much greater consumption of energy. The An unrestricted capitalistic system, directed
Soviets felt that the energy problem could be by the market, is mainly based on the princi-
solved by using controlled thermonuclear proc- ple of one-time use of natural resources. This
esses. type of production uses only part of extracted
primary materials and the rest is converted into
waste. Capitalists said that the demand for a zero
growth rate was also unrealistic theoretically as
34
it is impossible to halt economic development risk perception and risk

but the socialists claimed that economic devel- measurement
opment was stimulated by a centrally planned Up to the middle of the 19th century in all in-
economy. Soviet researchers made a distinction dustrialized or industrializing countries, action
between growth and development of an eco- programs and legislative measures were largely
nomic system. Growth describes the increase based on classical risk concepts. Although the
in the system’s productive potential. Develop- basic conditions of work were had been outlined
ment, on the other hand, reflects the ability of a long time before, e.g. by Mayhew, among oth-
an economy to accomplish specific programs in ers, human health and productivity were dealt
a flexible way. with separately. Multidimensional risk concepts
including damage, injury, and material losses
Metapotential
only appeared in the later part of the 1900s.
In socialist terms, one of the most important Risk aversion was defined as the actions taken
factors in the development of an appropriate to control holistic risk patterns, including risk
economic system was preparatory technological estimation and risk evaluation.
measures. The extent to which the production As a rule risk prevention does not eliminate
systems already in use produced discharges, or the risks but reduces them to a defined “accept-
produced zero discharge, served as an index for able” level. There were no arguments about
this. As such an index the metapotential (MP), whether workers should be protected but the
describes the ability of an economic system to costs of protection were a decisive issue. Two
realise long-term development programs. De- types of studies were referred to for guidance on
termination of preferred growth rates expressed this issue, cost-effective and cost-benefit calcula-
in MP terms presumes measuring of the MP tions. However, no data for damages or benefits
elements in value terms. Four aspects had to be were credible enough to determine political
considered: decisions.
1) Economic potential reflects the total produc- While cost-effectiveness studies can indicate
tion of a nation the cheapest way to achieve an agreed level of
2) Scientific and technological potential includes protection, such studies are complicated. Most
education, science, and management cost-benefit equations take time to prepare but
3) Human potential embraces the size of the political decisions must be made quickly and
population, its physical and mental health,and decision makers must combine hard data with
creative activity subjective value judgements. This includes rank-
4) Ecological potential reflects the boundaries of ing results in a priority order and making ration-
possible expansion of production. al decisions (but often based on intuition). There
is uncertainty not only about facts but also what
Changes in any of the four elements should be people think about those facts and uncertainties
appropriately balanced in the three others. Polit- about future consequences. New risk patterns
ically, the scientists’ models were used as impres- may require detailed multidisciplinary studies
sive arguments against Western concepts but in e.g. involving biochemistry, physiology, genetics,
practice there was little implementation.
35
Chapter 2.1
behavioural science, or epidemiology. The time ponent, sub-system or system failure at all stages
available is a critical factor. of a system’s life cycle enables management to
All industrialised countries have gradually make decisions that could correct control prob-
established statistical systems for rating both lems a system becomes operational. Product
serious and less serious accidents, e.g. the fre- safety engineering will be more commonly ap-
quency and the incidence rates (injuries divided plied in future.
by worked man-hours) of injuries that cause
disability. These statistics are excellent indicators Retrospective and prospective epidemiology
within a country, but cannot be used directly for Epidemiology is an important tool for the study
wider comparisons as recording and reporting of risks. Epidemiology is a non-experimental sci-
systems and practices differ greatly from one ence that studies disease through observations of
country to another. disease phenomena in population groups. Thus,
At the factory level, quantitative informa- in case-control studies a group of individuals af-
tion is usually collected through recording the flicted with a particular disorder is selected along
number of accidents, near misses, rates of absen- with a control group free from the disorder. Dif-
teeism, and occupational hygiene measurements. ferences between the two groups are then com-
In larger companies or health centres, statistical pared on issues such as in lifestyle, diet, working
reports also include workers’ medical records. conditions, and environmental factors. This type
of study is sometimes referred to as a “retrospec-
Predictive technology tive” study because the presence or absence of
The Apollo Mission to land a man on the in a predisposing risk factor is determined from
1969, involved some 20 000 national and interna- some time in the past.
tional companies employing more than 350 000 Cohort studies are more reliable and costly.
people in the construction and assembly of They involve subjects in a large population who
15 000 000 component parts. While there were are questioned in detail about their habits and
great possibilities for accidents or failures due to environment. The entire study population is
human error a flight system was produced that followed for years or decades to see who get sick
proved to be more 99.9% reliable. It is possible and who doesn’t, to identify what diseases they
that one of the greatest benefits achieved by the suffer from and what factors may be different
space programs was the safety related measures between the study groups. This type of study is
that were utilized to ensure the success of these referred to as a “prospective” study because it
great ventures. At all stages of conception, de- looks forward from exposure to the possible de-
sign, manufacture and operation, the man-ma- velopment of disease. Since the 1950s epidemi-
chine-environment-equipment subsystems were ologists have succeeded in identifying a number
considered to be interrelated and interdependent of long term diseases such as cancer caused by
components of the overall system. smoking and asbestos.
The enormous potential for catastrophic loss
led to the development of a new safety discipline driving forces
that came to be known as “Systems Safety En- During the first half of the 20th century, there
gineering”. The application of new predictive were some important supporters for society´s
techniques to determine the probability of com- responsibilities for Occupational Safety and
36
Health (OSH). The international Permanent many industrialised countries for the working
Commission on Occupational Health (now the environment. The Commission of the Euro-
ICOH), was founded in Milan in1906 driven by pean Community (CEC) published in 1985 five
the fact that 10 000 workers were killed in the comprehensive volumes on the law and practice
construction of the St Gotthard and Simplon of occupational health in the Member States.
tunnels in Switzerland. To prevent a repetition, The scope and content of occupational health
international cooperation was required at all legislation and non-statutory measures has been
levels. The International Labour Organization examined in detail and extensive annexes cite the
(ILO) was created in 1919, and the International full text of numerous documents, from statutory
Social and Security Association (ISSA) in 1927. requirements down to guidance notes. Compari-
The World Health Organization (WHO) was sons between countries were a major feature.
founded in 1948. These bodies all co-operated “Quality based benchmarking” (comparison
to collect, elaborate and distribute research with the best available practice) has been treated
findings, field experiences, and rules and recom- warily in OSH although quality based produc-
mendations. The British Health of Munitions tion has gradually replaced mass production.
Workers´ Committee (1915-18) established the The birth and growth of various quality based
first fatigue research board in the world. Scien- methods that have developed over the years has
tists were invited to study work-related fatigue, been put into perspective by John Butman in
particularly in women´s work, in controlled 1997. He emphasises the important differences
experiments on the shop floor. In 1950 the between static and dynamic strategies. Advanced
ILO/WHO introduced a new health concept, quality production cannot succeed in companies
widening the old ´health as the absence of ill- with pronounced internal tensions. Numerous
ness´, to a more positive one: ´the promotion other volumes address the question of quality
and maintenance of the highest degree of physi- production. A highly influential management
cal, mental, and social well-being of workers in guru is Peter F. Drucker. Two of his books
all occupations´. The behavioural sciences were published in 1987 and 1992 have a particular
acknowledged. However, all the conventions, bearing on OSH management. Other pioneer-
recommendations and standards issued by these ing writers on new management strategies are
global organizations are still not universally ap- Michael Hammer and James Champy who sug-
plied, (nor are later EU directives). gest that continuous quality improvement is not
“Think globally and act locally”´ was a slogan always enough; in some instances a radical rede-
introduced in 1992 with the UN Agenda 21 on sign of a whole corporation is needed.
Environment and Development. Agenda 21 mir- Support for OSH is always lagging behind the
rored current demands and future goals. Level 4 many changes in priorities and perspectives that
of Agenda 21 means that physical, psychological, occupy governments, employers and trade un-
ethical and existential needs should be integrated ions. Classical tripartite relations are weakening
at local community level. This is, of course, in some countries and new arrangements are un-
easier said than done. clear in the current age of irreversible globaliza-
Preliminary work outlined different scenarios. tion. It is not easy to update OSH measures in a
Good progress had already been made in terms globalised world lacking traditional ´responsible
of legislation. The 1970s were golden years in employers´ and ćollective workers´ of the past.
37
Chapter 2.1
company based occupational health such as the placement of workers through job
services selection and job analysis, pre-employment and
Historically it is possible to discern the broad periodic medical examinations, medical and bio-
evolution of medical practice, commencing with logical screening and monitoring, caring for the
witch-craft and folk medicine, through to sani- health of both workers and executives, prepara-
tary improvements and public and occupational tion for retirement and occupational hygiene
health. This development has been marked by measures including the definition of maximum
an advance from an empirical to a scientific ap- allowable exposures to chemicals, dust, fumes
proach. and gases, and workload.
At the beginning of the 20th century, Germany
Increasing complexity
was the pioneer of national health services that
stimulated similar developments in the other Expanding and changing industrial technol-
countries of Western Europe. A national health ogy has resulted in environmental changes of
service was introduced in Great Britain in 1912. increasing complexity, Figure 2.1.3. Sanitary
The United States later became leaders in the problems such as bacterially contaminated air,
expansion of company based health and safety water, and food have now been largely replaced
programs. by chemical pollution and other hazards.
Company occupational health services led
to the development of techniques and practices
Figure 2.1.3. Levels of technology and production. Every level is related to its special set of hazards and
risks. Based on data from Galli E. & Wennersten R.: Understanding Safety (Swedish National Institute
for Working Life, 2003).
38
The idea that humans are part of the overall The changes of Swedish working life illustrate
ecosystem is an important fundamental concept the impact of new technologies and the strong
for current preventive work. Potential sources forces behind current trends including the in-
of disruption to an ecosystem must be given due herent resistance of people to changes. In 1880
consideration. Decisions on the localisation and Sweden was a poor farming country that had
operation of industrial plants, production plan- become an advanced industrialized society by
ning, transportation and the end use of prod- 1950. In1980 Sweden was considered to be an
ucts are all potential threats to the ecosystem. established industrialized country in contrast to
The prevention and technical aspects of hazard the newly industrialized countries such as Korea
elimination requires the monitoring of work and China.
processes, the working environment and the Historically, Sweden is unique because early
surrounding outdoor environment. Integrated on the Swedish EmployersĆonfederation (SAF)
strategies covering these three issues have only and the Swedish Trade Union Confederation
been seriously considered since the 1990s. (LO) formulated operational rules governing
The growth of OSH during the first part of cooperation in each sector of the economy. The
the 1900s differed between countries accord- two organizations created joint tools of coopera-
ing to needs. In Italy, occupational medicine tion and employed their own specialists to im-
grew out of clinical medicine; in France, out of plement their shared objectives. Initially, serious
legal medicine; in the United Kingdom out of instability in the labour market, immediately
protective legislation; in the United States, out after the turn of the century, was instrumental in
of industrial hygiene; in the socialist countries, forcing this decision on the parties. A series of
as a part of public health; and in Sweden, out disputes, strikes, and violent conflicts of inter-
of a tripartite cooperation. The development of est characterized the labour market in Sweden
occupational health from medical diagnosis and throughout the 1920s and 1930s. Proposals for
cure to comprehensive prevention has followed coercive legislation to stabilize conditions were
a long and crooked path. An important step was put forward in several government study papers
the introduction in 1950 of a broader scope for and parliamentary bills introduced by the politi-
occupational health by the ILO and WHO that cal parties. In this situation, SAF and LO elected
included the concept of human “well-being”, to ward off government interference by secur-
distinct from human disease. In most European ing industrial peace through the negotiation of
countries, the general principles of health and voluntary agreements in the private sector.
safety at work in the 1980s were maintained The most important document was the 1938-
through legislation. agreement to maintain industrial peace, the
Saltsjöbaden Agreement (named after the place
case sweden where it was signed), with the prime purpose of
Sweden is a large country with a small popula- safeguarding production and employment. Wage
tion of 9 million. Four million people are in agreements negotiated by both sides at the
employment. The industrial history of Sweden central level were to be binding at the local level
is relatively short but Sweden has made some throughout the period of validity of the agree-
remarkable contributions to the development ment. In a series of corollary agreements, the
of occupational safety and health in Europe. negotiating parties formulated their community
39
Chapter 2.1
of interest in three fields: industrial health and meaningful job content. As in other quality pro-
safety, occupational training, and arbitration. grams, the active participation of all employees
Following a series of council and committee was needed. Work and the work environment
meetings and later agreements, the two sides did should be structured to reflect the statutory and
not merely secure opportunities for promoting negotiated requirements for a good working
constructive and mutual cooperation, but also environment. The organization of work and the
secured funds to engage the services of qualified tasks allotted to an individual employee should
external experts. This move in turn necessitated be designed to ensure that the work was as inter-
the employment of in-house experts. The SAF esting and stimulating as possible. An employer
engaged its first medical adviser in 1939 and the was required to account for factors motivating
LO in 1964. the introduction of new technology and to list
The relationship of working environment the technical and financial consequences includ-
factors to health was subdivided into five main ing the impact on employment and the environ-
categories: level of activity (physical and mental); ment. In many cases, this process required the
physical impact (noise, vibrations, radiation, participation of skilled experts.
electromagnetic fields, climate); chemical impact The Equal Opportunity Agreement set out
(fumes, gases); biological impact (micro-organ- the objectives and guidelines for the promotion
isms); social impacts. of equal employment opportunities. The agree-
ment stated that the promotion of equal oppor-
Agreements tunities for men and women were an important
The voluntary guidelines from the labour mar- objective for both salaried staff and wage earn-
ket parties in the private sector for risk preven- ers.
tion and occupational training were efficient The Work Environment Agreement con-
tools for application on the shop-floor. tained the rules governing activities related to
The following three agreements help to illus- the work environment, guidelines for company
trate the transition from risk to well-being: health programs and an agreement on occu-
pational training. The agreement stated that a
• The Development Agreement (1982)
corporate health program should consist of a
• The Equal Opportunity Agreement (1982)
technical and medical section, both giving spe-
• The Work Environment Agreement (1983)
cial emphasis to psychosocial questions. Staff
employed in company health programs should
The Development Agreement identified that the
take a scientific approach and utilise proven
development and promotion of efficiency and
experience of the workplace under the supervi-
security of employment in private companies
sion of a joint industrial safety committee or
as issues of common interest to companies and
company health program committee. Emphasis
employees alike. The parties to this agreement
was placed on preventive action. Rigorous pre-
expressed their desire to promote the efficiency,
cautions must be taken to assure the impartiality
profitability, and competitive ability of private
of company health programs. Issues related to
companies. They also agreed to create condi-
interpretation of the terms “scientific approach”
tions favourable to the maintenance of employ-
and “proven experience” was referred to a na-
ment levels, job security and satisfying and
tional level scientific committee for resolution.
40
In addition to the establishment of clearly de- Eventually, increased efforts by the labour mar-
fined objectives for their joint sphere of opera- ket parties to enrol small companies in OSH
tions, the negotiating parties at the central level proved successful. In 1988, 80% of the Swedish
of the labour market allocated material resources working population of four million employees
and staff to realise these objectives. The parties had access to organised occupational health
also pursued their own separate activities within services. Some 10 000 people, including safety
the frameworks laid down by the negotiated engineers, occupational hygienists, physicians,
agreements and guidelines. nurses, physiotherapists, behavioural scientists
The tripartite philosophy that dominated in and others, were employed in occupational
Sweden up to the 1970’s, meant that new legisla- health services.
tion should be based on tested, practical experi-
ence. Directives from authorities were expected evolving options
to confirm proven experiences from the shop There is a close connection between technology
floor. In the 1970s, direct legislation, not based and social progress. Historically, humans were
upon tripartite agreements, appeared as a pre- hunters and gatherers for 50 000 generations.
sumed speedier tool. They then became hunters and farmers for 500
generations and then farmers and artisans for
Revised law slightly more than 200 generations. Industrial
A major revision of the law went into force in workers started to receive earnings 10 genera-
1974. Safety delegates were given the authority tions ago.
to temporarily stop jobs that were judged to be The industrialisation era with urbanisation,
acutely dangerous. Factories with less than 50 mass production and cheap, long-distance trans-
workers could now, when needed, be ordered to port radically changed human life. In the early
organize a joint safety advisory committee with stages of industrialisation, attempts were made
members representing employers and workers to maintain old tools and strategies from the
(prior to that time a company had to have a min- self-sufficient society. It took time to realise that
imum of 50 workers). In 1978 further amend- the new sources of power, and new machines
ments tightened up existing regulations and set and materials created new skills, techniques and
more ambitious targets. The authorities policed organisation. Currently, massive efforts are be-
more thoroughly and executed harder sanctions. ing made to project outdated strategies from the
Inspectors had to enforce written directives and old industrial society into the future. However,
were not permitted to give advice in matters such attempts are a repetition of the mistakes of
where written directives were lacking. Lawyers the past.
joined the staff of all districts of the inspectorate. Since the 1960s, humankind has passed
The 1974 Act signalled the route to the 1976 through a paradigm shift into the knowledge-
law on codetermination, which marked the of- based society. Knowledge (rather than minerals
ficial end of the Saltsjöbaden Agreement. While or wood) is now the main capital of a developed
confrontation became stronger, the labour mar- economy, and knowledge creates new tools
ket parties maintained their cooperative spirit in and strategies that were not available in the old
important health matters. industrial society. Our generation is the first to
experience a knowledge based society, that is
41
Chapter 2.1
continuously changing. Individual and collective The challenge for management is to organise
learning is the most urgent issue in the short enterprises that function on both global and
term. local markets. Multinational trading requires
Many individuals and organisations study the complex systems for global production, product
changing aspects of the world situation. The development, supply technology, finance, and
earth is limited in size and there are many prob- distribution.
lems associated with many subsystems: demo- Modern information technology advances
graphic, industrial, agricultural, etc. Models of through the increasing use of artificial intel-
ecology are now being used in order to explain ligence, intelligence amplification and virtual
the interactions between various systems and to thinking. Knowledge systems using such re-
find preventive measures. Industrial activities sources now solve production and productivity
impact on both the natural and the social envi- problems and are helpful for research and edu-
ronment and workers´ health cannot be sepa- cation. The knowledge base of an expert system
rated from community health. is readable and easy to modify and are highly
The first industrial revolution created a quan- interactive. For example, if a number of health
titative increase in mass-produced products, new and safety standards are changed in a plant with
markets on distant continents and increases in 30 000 production standards, an expert system
output that were quantified in terms of volume. will quickly identify the need for appropriate
Society gradually started to consume on a large changes of all affected operative standards in the
scale (for good or evil...). The current techno- plant.
logical revolution is quite different in character In theory, new technology gives us more
because it is principally concerned with quality alternatives than earlier technologies permitted
and progress is measured by quality. so it should be possible to make both large and
In the knowledge-based society, multinational small organizations more agreeable for humans.
production is essential for economic success.
42
suggestions for further reading

Brune D., Gerhardsson G., Crockford G.W. and Frick K., Jensen P.L., Quinlan M. and Will-
DÁuria D. (eds). Fundamentals of health, safety hagen T. (eds). Systematic Occupational Health
and welfare. The Workplace Volume 1. Theo- and Safety Management: Perspectives on an
retical Aspects. Scandinavian Science Publisher. International Development. Oxford: Pergamon/
1997. Elsevier Science. 2000.
Brune D., Gerhardsson G., Crockford G.W. and Grieco A., Iavicoli S. and Berlinguer G. (eds).
Norbäck D. (eds). Major Industries and Occupa- Contributions to the History of Occupational
tions. The Workplace Volume 2. Scandinavian and Environmental Prevention. Elsevier. Am-
Science Publisher. Oslo 1997. sterdam. 1999.
Davidow W. H. and Malone M. S. The Virtual Grieco A., Fano D., Carter T. and Iavicoli S.
Corporation. Structuring and Revitalizing the (eds). Origins of Occupational Health Associa-
Corporation for the 21st Century. Edward Bur- tions in the World. Elsevier. Amsterdam. 2003.
lingame Books/Harper Business. New York.
Salvendy G. (ed). Handbook of Human Factors.
1992.
John Wiley. New York. 1987.
Drucker P. F. Managing for the Future. Butter-
worth/Heineman. Oxford. 1992.
43
2.2
A new OSH paradigm is needed

Tom Dwyer & Kaj Elgstrand
The ‘Great Western Paradigm,’ founded by visible as human hands created destructive pow-
Descartes, would come to be associated with far ers and an ecological imbalance hitherto unim-
more than just science; it would become as- agined in the history of the world. From the late
sociated with ‘modernity’ and would carry the 1960s there was increasing questioning in the
spirit of reason into all the nooks and crannies West about the role of science and about type
of Western life. The new paradigm met with of society it had played such an important role
extraordinary success as its rationalising power in producing. Such questioning was symbolised
helped build the wealthiest nations ever seen. by the ‘doomsday clock’ which graphically por-
Through science and education, came the high- trayed the likelihood of nuclear war and inspired
est average levels education and knowledge dis- the anti-nuclear bomb movements. Rachel
tribution known in human history. This system, Carson’s book Silent Spring published in 1962
allied with an economic system, became the and the Club of Rome’s 1972 report The Limits
largest producer of wealth in the history of the to Growth fed a growing ecological conscious-
world, achieved through a general process that ness. The ‘small is beautiful’ concept emerged in
sought to crush traditions and all other imagined opposition to mass production and large mo-
obstacles to the spread of reason. The idea of nopolies. Diverse forms of modern domination:
reason was exported, by imposition or by imita- colonial, cultural, monopoly capitalist, and male
tion, as though it were universally applicable. were increasingly denounced. The very idea that
One reason for the spread of the paradigm universal principles of reason were being applied
was the increasing capacity of scientific activ- in all forms of social and economic life in the
ity to explain and to be applied thereby trans- West was contested. Various counter culture and
forming the world. As science grew, its diverse liberation movements, ranging from feminist to
languages became increasingly esoteric and the ecological movements, profoundly affected
distant from citizens. Science contributed to the many parts of the World, particularly in the
concentration of power into the hands of people industrialised countries.
who had no role in producing it, especially the
leaders of large corporations and nation states. A
darker side of the modernisation process became
45
Chapter 2.2
the birth of the industrial ment and private sector institutions developed
occupational safety and health in the form of specialised professional groups,
paradigm and enforcement agencies whether public (e.g.
Information relating to diseases of miners and factory inspectorates) or private (e.g. insurance
to workers in dangerous trades can be found company inspectors and rules). In addition a
already in the sixteenth century. In the middle series of scientific, technical and administrative
of the century, Agricola and Paracelsus wrote milieus grew, as their members built scientific
on the subject of miners´ diseases and accidents. and professional societies (nationally and inter-
In 1700 came the classical work of Bernardino nationally), specialist journals, training, confer-
Ramazzini, the Father of Occupational Medi- ences and formed pressure groups. In some
cine, De morbis artificum diatribe (Diseases of cases an international agenda guides the imple-
Workers). He made a striking addition to the mentation of OSH measures most particularly
Hippocratic art: “When a doctor visits a work- by multinational corporations and large firms
ing class home he should be content to sit on a adopting international ‘best practices’, or when
three-legged stool, if there isn’t a gilded chair, governments implement international standards.
and he should take time for his examination; and These are the means by which the paradigm has
to the questions recommended by Hippocrates, come to be a part of the reality of life for work-
he should add one more – What is your occupa- ers, professionals, civil servants, trade unionists
tion?” In summary, Ramazzini’s pioneering work and employers in many corners of the globe.
saw a worker’s profession as a key factor in ill
paradigm formation and
health.
components
With the rise of industrial society the causes
of misfortune came to be blamed on human It took over a century for the current industrial
agents and, in the case of work accidents in OSH paradigm to acquire its form. This time
mines and large industrial plants, specifically on lag is particularly visible in the case of industrial
owners. The notions of responsibility, cause and accidents. Sir Humphrey Davy invented the
prevention that emerged were closely linked to first modern work safety equipment in 1815, i.e.
the development of science, technology and a the mine safety lamp that still bears his name.
legal system that sought to respond to the prob- In 1931 when Heinrich’s book Industrial Ac-
lems of an industrial age. Such measures com- cident Prevention was published, it was consid-
bined to form the dominant paradigm of safety ered by many to be the ‘safety man’s bible’, and
and health at work that is closely linked to the its publication marks the consolidation of the
Great Western Paradigm. The world was sepa- safety component of the paradigm. The book’s
rated into the world of things (objects) and the important contribution was to systematise an
world of thinkers (subjects), concepts that were engineering-based theory of prevention inspired
eventually translated into ‘unsafe conditions’ and by a rationalising perspective similar to that
‘unsafe acts’ in the field of industrial safety. developed for industry by F. W. Taylor. The
In order to prevent disease and injury it was book also helped to transform safety engineering
seen to be necessary to intervene and apply into a distinct sub-discipline. Institutions were
preventive measures. As a consequence govern- built up in areas such as industrial medicine,
industrial hygiene and human factors engineer-
46
ing. Heinrich’s theory defended the idea that resulting social unrest were broadly criticised. It
85% of accidents are caused by unsafe acts and was in such a context that legislation designed
15% by unsafe conditions. The idea of ‘unsafe to produce healthy and safe working conditions
acts’ opened up a space for the application of gradually won out in the British Parliament,
psychological knowledge, and for the notion and the laissez faire approach lost out to the
that accidents were due to the failings of sub- industrial approach. Gradually the government
jects. Many attempts to determine the cause of set up inspectorates to guarantee that legislation
accidents and illness sought to relieve employers was obeyed. This change from a laissez faire to
of legal responsibility for what was happening to an industrial model received employer support
their workers. However, the foundation mem- from the mid 1800s. For example, in 1864, Mr.
bers of what later became the British ‘Society of E. Potter, Britain’s and the world’s largest calico
Occupational Medicine’ in 1935, “were anxious printer, told the Social Science Association that
to distinguish their approach from that of prac- “the Factory Acts were opposed by many of us
titioners involved in assisting employers with as economically unsound and as an unjust in-
compensation claims. From the start they were terference with the rights of labour and capital.
keen to transform their interests into improve- They have been soundly beneficial.” The Brit-
ment and extensions of industrial health practice ish model, which concentrated principally on
for the benefit of the employees, the enterprise mining, manufacturing and later construction,
and themselves.” In other words they had a vi- gradually spread to many countries. At the very
sion of prevention that they saw as technical and end of the 19th Century, workers, particularly
neutral. those in Western European coal mines, mobi-
The industrial OSH paradigm emerged from lised and achieved political influence, contest-
a long process. The earlier laissez faire approach ing the degree to which managers implemented
to accident prevention and health protection healthy and safe work practices and demanding
was seen to produce death and injury among participation in the process. As a result a lim-
workers, (children, adults, women and men), and ited degree of worker participation in safety
this perception was particularly acute in Great and health came into law firstly in Belgium and
Britain, the country considered to be the cradle subsequently in other countries.
of industrial society, especially in the coal mines By the end of the 19th century the payment of
and manufacturing. However, some employers, adequate compensation to the victims of injury
who can be characterized as traditional capital and illness gradually started to become an ac-
ists, defended a laissez-faire approach to all work cepted principle of the system. Notable progress
place and economic issues and were opposed on this issue was made by Chancellor Bismarck
to government intervention. Other employers, in Germany, and his initiatives were widely
defined as industrial capitalists, had a quite dif- copied. In many cases limited legal responsibil-
ferent approach, believing that investment in ity for compensation of illness and accidents was
the improvement of working conditions could transferred to employers, who in return were
yield higher levels of productivity. The worst generally freed from criminal responsibility.
excesses of rampant laissez-faire capitalism, such Many countries also sought to guarantee quick
as child and women’s labour, were widely seen to and efficient medical attention to victims, there-
be degrading and unhealthy, accidents and the by guaranteeing rehabilitation and a reduction
47
Chapter 2.2
in the potential damage resulting from illness health in general. Communicable diseases (such
and injury. In other words, the social problems as malaria, tuberculosis and HIV/AIDS), under
of unregulated capitalism were transformed into nutrition or over nutrition are major health con-
administrative problems, to be dealt with by cerns in most countries of the world. However,
specialist State or private bureaucracies. the main concern of this chapter is occupational
By the early 20th century the key elements of safety and health for the working populations. It
the industrial OSH paradigm were coming into is estimated by ILO and WHO that 250 million
place in the most advanced democratic and in- occupational accidents, resulting in more than
dustrial countries, concepts and institutions that 300 000 fatalities, and 160 million new cases of
would later spread to many points of the globe. work-related diseases, occur every year. Besides
The disciplines of industrial medicine and the loss and suffering for individuals and en-
engineering were applied through armies of terprises, these injuries and diseases constitute
specialist professional practitioners who dealt serious impediments to industrial and economic
with working conditions. Also a particular focus development. An unhealthy workforce is not a
developed on men engaged in physical activi- productive one and as we have already seen this
ties associated with industrial work. Industrial was a historical motivation for the development
psychology was employed to combat illness and of industrial health services in most of the indus-
accidents seen to be caused by malingering and trialised countries. Over time industrial health
unsafe acts. Training, regulations, incentives services came to be organised along general
and penalties were developed to channel behav- lines compatible with specialist industrial safety
iour in desired directions. Specialised education services, i.e. in line with the industrial OSH
emerged in universities, and on a mass basis paradigm.
through technical courses. This “industrial OSH paradigm” can be sum-
In general, the technical and economic de- marised as follows:
velopment of a country determines the overall
• Accidents and diseases due to work can and
health status of its population and promotes
should be avoided. The health of workers
safety and health. The average health status of
should be promoted.
the world population has improved considerably
• Prevention is the preferred action.
during the last 50 years. WHO has estimated
• The employer has the main legal responsibil-
that life expectancy at birth in the world popu-
ity.
lation has increased from less than 50 to more
• Workers and government should cooperate
than 65 years, since 1950. So, the question be-
with the employer to achieve OSH.
comes why bother with occupational safety and
• Injured and diseased workers must be rehabil-
health? Surely if technical and economic devel-
itated and compensated. In cases of fatalities
opment continues, the safety and health of the
the family should get economic support.
population will improve? Well, firstly there are
great health variations both between and within The implementation of these five components
nations, variations that, as argued by Lindstrand requires the application of science and practical
et al in Global Health (2006), “remain very unfair experience, resource allocation, organisational
by any standards of morals and justice”. Sec- infrastructure, competence and training, legal
ondly, the inequality referred to applies to public and regulatory systems, control and supervision.
48
Figure 2.2.1. Overview of occupational safety and health activities at national and international levels.
A general description of how the industrial OSH and the latter because legal responsibilities are
paradigm operates in both industrialised and limited in exchange for adhesion. We have also
developing countries is given in Figure 2.2.1. seen that there has been strong professional
The industrial OSH paradigm spread because activity developed in the area, it legitimates itself
of its association with the idea of modernity and when its technical skills are seen to be applied
progress. It is accepted as being legitimate be- in a neutral manner. The languages of preven-
cause it can be seen to have successfully reduced tion, rehabilitation and eventually of rights to
accidents and illness. Legislators have trans- compensation have come to be accepted in most
formed its key ideas into laws, and these have countries.
been enforced in a manner seen to be equal for
all employers. Both trade unions and employers’ the undermining of the paradigm
representatives have adhered to the paradigm, Currently the industrial OHS paradigm is in-
the former because it guarantees rights for creasingly contested. We have identified four
injured and ill workers and their dependents, specific reasons for this state of affairs.
49
Chapter 2.2
Failures and constraints Many writers endorsed the hypothesis that a

A growing series of research results questioned new basis for a productive society was being
the all-encompassing nature of the dominant built. To differentiate this new society from the
paradigm, particularly in relation to prevention. industrial society that had gone before, it was
This questioning reflected rising accident rates referred to by some as a ‘post-industrial society’.
and concerns about ill health in a number of The OSH paradigm assumed that product and
countries in the 1970s, particularly in the United labour markets were relatively stable, that people
Kingdom and the United States. In the U.K. a held their jobs for lengthy periods, that produc-
major review of the international research litera- tive activities would be increasingly concentrated
ture by Hale and Hale concluded in 1972 that in large enterprises and that controls would be
gross deficiencies surrounded existing notions of increasingly vertical. The combined forces of
accident prevention and causation. They claimed globalisation, the rise of information or post-
that a great deal more research was required industrial society and the reorganisation of work
into the effectiveness of prevention techniques, to generate greater efficiency, challenged the va-
and “radically new theories are needed”. Ma- lidity of the industrial OSH paradigm’s underly-
jor industrial disasters in Seveso, Bhopal and ing assumptions. Thus the forces that had result-
Chernobyl pointed out that the paradigm was ed in management hierarchies and centralisation
inadequate to prevent major accidents in certain of enterprises gave way to enterprises that in-
highly complex industries. creasingly subcontracted out non-core activities,
Workplace health issues also brought up new flattened hierarchies, made production activities
agendas and challenges. In some cases, health leaner, and where the physical content of much
problems already known about by researchers work in industrialised countries was reduced as
became broader public issues as work changed. core activities became increasingly intellectual in
Repetitive strain injury (RSI) mushroomed as nature. In many cases the division of labour lost
the service sector computerised , to become its regional and national dimensions to become
an epidemic and major drain on compensation more global, particularly in the case of manufac-
funds in many countries. New illnesses, espe- turing and certain types of service jobs.
cially AIDS, made the rigid separation between Beyond the workplace new sources of power
work and non-work related health seem danger- and new cultural patterns emerged, representa-
ously artificial. Growing workforce mobility also tions of productive activity changed, certain
made it much harder to establish causal relation- social conflicts consequently lost their force or
ships between the exercise of a particular profes- became increasingly institutionalised (e.g. be-
sion in a particular workplace and ill health. tween capital and labour in the industrialised
countries) and social conflicts emerged around
Development of production and work new themes (e.g. ecology, women’s movement,
organisation rights of cultural minorities). One significant
Investment in knowledge, knowledge produc- new site of conflict emerged and is expressed in
tion, storage and transmission, gradually re- that fact that considerations relating to ‘risk’,
placed investment in the division of labour and and its avoidance, had become central concerns
in machinery as the central process for generat- in the running of modern complex societies.
ing economic growth in the wealthy nations.
50
Restricted application of the OSH paradigm and professional skills available are unable to
It was gradually understood that the applica- guarantee standards for the increasing numbers
tion of the OHS paradigm had been highly of workers employed in the manufacturing and
restricted. It treated only a small number of all construction sectors. In many cases adult and
the workplaces in the world and the model was child labourers being subjected to extremely
particular rather than universal, there was enor- unhealthy and/or degrading working conditions
mous inequity surrounding its operation. and, in extreme cases, to slavery (one only needs
In a recent review of the challenges posed to to read Charles Dickens or Karl Marx to dis-
OSH by globalisation, Jorma Rantanen says: “At cover parallels with industrialising 19th century
present, only a minor percentage, according to Great Britain). In addition, many work proc-
an optimistic estimate, about 10-15% of workers esses that hark back to pre-industrial times still
in the world are covered by adequate occupa- survive in developing countries little touched by
tional health and safety services, labour inspec- the OSH paradigm. With increasing frequency
tion, and social security systems.” The figure is such processes are integrated into the supply
definitely optimistic when it comes to occupa- chains of modern industries. For example, this
tional health services. If these services are to be is the case for impoverished rural workers who
preventive, which is a major requirement ac- make the charcoal used to produce the pig iron
cording to the ILO´s convention on occupational that supplies Brazil’s modern steel mills, and for
health services, it may be questionable to say many sugar cane cutters who are essential to the
that even 5% of the workers in the world have country’s bio-fuel programme. OSH is unregu-
access to such services. Some important industr- lated in both subsistence work and in work that
ialised countries still have significant contingents is a part of many local or international supply
of workers who are not covered. This particular- chains – for many workers, the paradigm simply
ly comes about where economic decentralisation does not apply.
occurs, the informal economy expands and legal
regulation of work consequently weakens. Political developments
Labour inspection is mainly organised for the The social partners build the current OSH para-
formal sector, which means that the majority of digm upon cooperation and contributions from
the world’s working population has no contact at workers, employers and government. During
all with such inspectorates. the last 30-40 years, a series of political devel-
At the same time economic globalisation opments have greatly influenced the balance of
has made it increasingly difficult to maintain power between these partners in many countries.
full time, properly contracted employment and Employers´ influence has been strengthened at
previous levels of hourly wages, particularly in the expense of weakening influence of work-
the unskilled manufacturing sector of the indus- ers and governments. These developments are
trialised economies. As a result men and women described and discussed in Naomi Klein´s The
in these countries work longer and longer hours, Shock Doctrine. Klein argues that events includ-
sometimes in a variety of part time jobs. ing Pinochet’s 1973 coup in Chile, Thatcher´s
However, the increasingly global nature of wars in the Falkland (Malvinas) Islands and
manufacturing can lead to new OSH problems against the Coal Miners Union in 1982 and
in developing countries, as regulatory structures 1984-85 respectively, the massacre at Tianan-
51
Chapter 2.2
men Square in Beijing in 1989, the economic considerations relating to the

shock therapy applied in Russia in 1991-94, the development of a social osh
1997-98 financial crisis in Asia, the 1999 NATO paradigm
attacks on Belgrade, the attacks of September 11 In Thomas Kuhn’s seminal book The Structure of
2001 in New York, the invasion of Iraq in 2003, Scientific Revolutions, he states that the anomalies
and the aftermath to the Hurricane Katrina in produced by research undertaken within a given
New Orleans in 2005, were either intended to paradigm accumulate. This opens up the way for
or used as pretexts for extensive privatisation a scientific revolution whereby a new paradigm
and government deregulation, followed by deep is founded, one that permits the knowledge
cuts in social spending. The British geogra- accumulated under the old paradigm, especially
pher David Harvey systematically links many including the anomalies discovered, to be inte-
of the changes identified by Klein to a process grated into a new body of theory. Of the four
of neo-liberal managed ‘creative destruction’ of features associated with the undermining of the
the existing regulatory features of the capital- industrial OSH paradigm only the first (Con-
ist economic system. In essence, policies were straints and failures) and the third (Restricted
promoted with the aim of separating economics application of the OSH paradigm) correspond
from politics, political and regulatory control, to Kuhn’s anomalies. In contrast to the world of
i.e. various controls over economic activity were the natural sciences upon which Kuhn built up
reduced or abolished in the name of prosperity his model, the world where OSH knowledge is
and economic growth. The overall result, Har- applied is both produced and changed by social
vey argues, has been increasing inequality and action. This is the reason why the paradigm
“deregulation that allowed the financial system itself is also undermined by the social action of
to become one of… fraud and thievery. Stock human subjects and not simply the social action
promotions and Ponzi schemes… the promotion of scientists as seen in processes of investigation
of debt incumbency that reduced whole popula- and the construction of scientific consensus (as
tions, even in the advanced capitalist countries, in Kuhn’s case). The social world is different to
to debt peonage – to say nothing of corporate the world investigated by natural sciences since
fraud, the dispossession of assets such as the natural objects of investigation do not them-
raiding of pension funds and their decimation.” selves have a capacity to modify their own nature
While defending neo-liberal policies govern- and their relations with other objects through
ments decreased their involvement in certain actions based on reflexive and rational thought
areas of social policy by simultaneously reducing about the consequences of one course of action
taxes and delegating public tasks and services to instead of another. What we human beings see
the private sector. This has led to the constric- as relevant in determining our own actions may
tion of coverage of services in the areas and change from one moment to another, from one
sectors in which the market was alleged to be situation to another, from one historical period
unable to provide sufficient incentive to deliver to another. For this reason theories of social
services. While occupational safety and health action must have a capacity to deal with context,
was not a direct focus during these events it was and with human reflexivity.
one of the many social casualties.
52
It is impossible to think about a renewal of policy), is one where the market is seen as the
thought and action around OSH in an isolated supreme form of rationality where life is evalu-
manner, it must be placed within a wider vision ated in monetary values; more valuable lives are
of historical change, one that integrates con- calculated to be worthy of more investment than
siderations of economic, political and cultural less valuable ones.
factors, as well as new intellectual horizons. At the other end of the scale is a systemic
However, human beings always adapt ele- approach to safety and health that is, as we saw
ments of the present as they seek to orient their earlier, a product of the rise of a knowledge
actions towards the future. Individuals may do economy or a post-industrial society. This ap-
this during face-to-face interaction, or gov- proach uses systems theory as a basis for the
ernments may seek to channel human action identification and analysis of hazards in order
through administrative regulations, taxes or to design a system that eliminates the possibil-
incentives that highlight desirable or undesirable ity of accidents or ill health occurring. It seems
activities. The history of OSH as depicted ear- to have been very successful when products and
lier was the history of governments moving from machinery have specific safety and health con-
treating accidents and illness at work as a private siderations ‘designed into them’. The key idea is
matter, to making them a public responsibility that scientific and technical knowledge should be
through regulations and compensation insurance applied so as to eliminate all potential physical
and by building institutions to reorient activities. dangers and hazards. With respect to safety it is
Now climate change has become a major issue, frequently developed on an ad hoc basis, project
there is much debate around how to reorient by project, and such cases can become extremely
action, which centres on regulation on the one expensive. However, in some specific types of
hand and the development of a system of carbon activities including space travel, nuclear power
credits on the other. generation, and genetic engineering, safety
The laissez faire approach mentioned earlier becomes a supreme value. Serious accidents such
is a precursor for what is now called the consen- as those at Three Mile Island and the Chal-
sus based assessment approach, a methodology lenger crash associate negative effects and the
that permits employers to calculate the benefits development and application of systems safety.
of the risk of infrequent accidents and illnesses Hyper complex organisations have blind spots
against the costs that might arise should these built into their operation because the theories
occur; investment decisions are based on es- used to think about them are incomplete, ironi-
timates of potential savings. The ideology of cally such organisations come to be ‘designed’
deregulation which has dominated the most in such a way that the negative consequences of
recent period has played an important politi- their regular operation become ‘normal’ (to use
cal role since it was defended by those who saw Charles Perrow’s idea of ‘normal accidents’).
it as more rational and economically effective It is in such limited cases that the social ele-
than the industrial OSH approach constructed ment, traditionally excluded from design solu-
around the need for regulation. The eventual tions, has come to be seen as fundamental incor-
adoption of neo-liberal economics as a guide to porating the idea that it is essential to consider
policy development, (Klein’s description of the ‘human factors’ in both the design and opera-
‘shock doctrine’ reinforces such a view of social tion. Theoretical advances are currently occur-
53
Chapter 2.2
ring at a micro level in the workplace, the level OSH paradigm, creating unjust and unequal life
at which we believe a new paradigm is being chances for different groups of people. In order
developed. to produce a conceptual response to the injus-
We have earlier outlined a number of reasons tices of modern life, where never before in the
why the industrial OSH paradigm has been par- history of humanity has such opulence existed
tially discredited. Furthermore, from September alongside such massive poverty and degradation,
2008 onwards, the lack of proper regulations has one to the 20th century’s most important political
been seen to lie at the very heart of the econom- philosophers, John Rawls, elaborated a theory of
ic collapse that started in the USA and is now af- distributive justice. His theoretical framework
fecting countries all over the world (May 2009). can help us think about the underlying wisdom
One result of this collapse is that currently for arriving at new institutional arrangements
dominant models of social and economic policy capable of reducing such injustices. In The
will increasingly be contested. Such questioning Theory of Justice Rawls seeks to establish the
liberates us from the past and demands that we basis of a just social contract. He begins by
think creatively to find new ways forward; in our constructing a fictional state, an original posi-
view this means to discover a social paradigm. tion, where individuals are free and alone, and
need to define the rules of a future society. Their
a social paradigm – macro level job is to define these rules without any advance
considerations knowledge of the place that each will occupy
We now move to examine a proposal for the so no individual can choose the rules as a func-
development of a social paradigm within which tion of their personal interests because these are
policy development can be framed at both a unknown. In such a hypothetical situation each
macro level and at a micro level in the work- individual could imagine him/herself ending up
place. In so doing, we briefly enter into the in the worst condition possible when eventually
realm of philosophy and economics, seeking to allocated his/her position in the social hierarchy.
go beyond the Great Western Paradigm. We Thus, knowing the risk of ending up at the bot-
don’t expect that there will be wide agreement tom of society, there is a tendency for people to
on what is written here but the times require imagine rules that would make such a position
creativity and reflection. However, before enter- less intolerable. From here onwards it is pos-
ing into an examination of a social paradigm it sible to imagine that individuals, placed in such
may be useful to recall Adam Smith’s statement, a fictional situation, would seek the most just
made 250 years ago, about the powerful role of and equitable system possible. Rawls’ imaginary
non-profit values. While stating that “prudence” system is constructed in terms of two principles,
was “of all virtues that which is most helpful to equal liberty and difference. The principle of
the individual”, Smith went on to argue, “hu- equal liberty defends the right of access to a
manity, justice, generosity, and public spirit, are range of fundamental freedoms. The principle
the qualities most useful to others”. of difference determines that inequalities are
permitted to exist under certain circumstances:
Rethinking justice first, that people have equal chances of moving
It is clear that large parts of the world’s working into coveted positions in the society; second, the
populations are not covered by the industrial society must help its least favoured members to
54
reach the best possible situation, i.e. to be able The writings of these two authors don’t specifi-
to improve their position within society. Rawls’ cally examine OSH but they encourage us to
formulation permits inequalities to be seen as think afresh about such issues and their relation-
a part of society, on the condition that the less ship to justice, freedom and development. Sen
favoured have a perspective of social mobility writes “Individual freedom is a quintessentially
and are included in the social system through social product, and there is a two way relation
redistribution policies. In this way Rawls’ politi- between (1) social arrangements to expand in-
cal philosophy breaks the traditional tie made dividual freedoms and (2) the use of individual
between freedom and inequality; freedom and freedoms not only to improve the respective
equality can go hand in hand because there is a lives but also to make the social arrangements
system of distributive justice. We believe that it more appropriate and effective.” It can be visu-
is possible to adapt this reasoning so that un- alised that if OSH institutions were to refocus so
equal exposure to risks (a fundamental inequal- as to place work within a development perspec-
ity) could be rectified through appropriate social tive that could be seen as an expansion of free-
arrangements, enabling new thinking about dom. A perspective designed to promote social
prevention, rehabilitation and compensation. justice (in a sense theorised by Rawls) would
Nobel prize winning economist, Amartyra necessitate three types of change: institutional,
Sen, has engaged in a fertile dialogue with John workplace change (i.e. to improve the lives of
Rawls and an important part of his thinking workers) and changes in the way that experienc-
centres on the question of development. He es and reflections from the workplace contribute
conceives that it is best to see the prime goal of to the modification of institutions.
development not in terms of expanded material
wealth but, rather, in terms of expanding degrees Developments at the workplace
of freedom, and diminishing types of ‘unfree- The Achilles’ heel of systemic safety is that high-
dom’. ‘Unfreedom’ reduces peoples’ capacity ly complex systems designed and operated to the
to act autonomously on the basis of their own highest standards can fail (e.g. the Three Mile
values and reasoning. Sen’s book Development Island incident, the Challenger crash and Bho-
as Freedom sets out this approach. He focuses pal). In each of these cases information could
especially on the roles and interrelationships not be processed accurately or in sufficient time
between a range of instrumental freedoms (e.g. to prevent the disastrous event. Such rare events
economic opportunities, political freedoms, per- cast a shadow over the viability of any project
sonal security, social facilities, guarantees about that seeks to plan and eliminate risks to health
knowledge and transparency) and institutional and safety from the design of a complex system.
arrangements (e.g. public discussions, state, The shadow cast by these events has led to the
political parties, markets, legal systems) that can birth of a new social paradigm that embraces
serve to guarantee freedom. In Sen’s words “a participation and management. This new para-
very elemental freedom: the ability to survive digm allocates a space for workers to have access
rather than to succumb to premature mortality” to information, and to discuss and act in relative
can be seen as an important dimension of devel- freedom, in other words, to act as subjects.
opment. A number of North American researchers
in organisational psychology and management
55
Chapter 2.2
have asked a very important question about how expertise, as exhibited by encouragement of a
work can be safely executed in complex systems. fluid decision-making system.”
Weick and Sutcliffe’s book Managing the Unex- The social system and the people that make
pected builds upon earlier research that examines up an enterprise are seen as a solution rather
the notion of ‘safety culture’ to explain the para- than a problem. Even though complex organisa-
dox already observed, that planning for safety tions have hierarchies and people are placed in
can also create conditions for disasters. They unequal positions, this must not become a bar-
develop the idea that certain types of organisa- rier to performance. The social system needs to
tions, specifically those that deal with extremely be organised in order to channel activities to-
complex and potentially dangerous materials and wards safe operation, and this occurs only under
situations, have fewer accidents than expected. specific circumstances. This conception of what
This is because they create a state of “mindful- is necessary for safety (but not health) is very dif-
ness” among managers and workers that trans- ferent from most of the approaches formulated
forms their organisations into high reliability since the industrial revolution.
organisations such as air traffic control, hospital However, these authors assume that work-
emergency departments, hostage negotiating ers and managers are committed and submitted
teams and nuclear powered aircraft carriers. to the goals of their organisation and society.
All staff, including both workers and manag- In other words they are not free in the sense
ers, must be capable of dealing with the unex- given by a more abstract definition of freedom
pected in order to guarantee performance. How- as elaborated by Sen or in terms of a more theo-
ever, the ‘unexpected’ is by definition unplanned, retical and sociological definition provided by
it upsets routines, threatens and potentially Alain Touraine in his book A new paradigm for
destroys organisations. Organisational cultures understanding today’s world. For Touraine the
typically impose powerful blinkers that impede subject is formed in the will to free oneself from
vision beyond certain horizons therefore, when the forces, rules, and powers that stop us from
something unexpected occurs, human beings being ourselves, forces which try to reduce us to
lack the capability to deal with it. The authors being an element in their system and that seek to
propose that it is necessary to develop the hu- take over our activity, and everyone’s intentions
man side of any enterprise, particularly to create and interactions.
a ‘mindful infrastructure’ among workers and
managers so that they can safely manage poten- Traditional participative approaches to
tially destructive surprises and guarantee safe workplace management
operation. It is important to note that their view We saw earlier that the industrial OSH para-
has been carefully built up on the basis of case digm introduced limited official recognition of
studies and inductive theorising. The authors participation as a result of struggles by workers
isolate five processes that contribute to a state of for autonomy from the imposition of excessive
‘mindfulness’: “(1) preoccupation with failures dangers and insufficient management adherence
rather than successes, (2) reluctance to simplify to rules and regulations beginning in Belgian
interpretations, (3) sensitivity to operations, (4) mines in 1897. The participation of workers was
commitment to resilience, and (5) deference to officially recognised as relevant to improving
safety and health in the workplace. This ap-
56
proach expanded its influence, particularly in the ing considerations as to the roles of knowledge
mining sector in Western Europe, and was later and power in decision-making processes.
taken up by accident insurance companies in the In France an approach called ‘activity ergo-
USA. Later, participation came to be seen, par- nomics’, pioneered by Faverge and developed by
ticularly due to influential research conducted by Alain Wisner, sought to systematically capture
the socio-technical school of the Tavistock Insti- worker knowledge and orientations when de-
tute, as a pre-condition for higher levels of pro- signing interventions to improve productivity
ductivity in situations of workplace change. In and the quality of working life. Much later Wis-
the post World War II climate a small number ner developed a more complex notion which he
of Western European industrial enterprises em- called ‘anthropotechnology’. Wisner was aware
barked on participative strategies seeing them as that technology transfers were associated with
the key to safer, more efficient and trouble free many difficulties, and that traditional ergonom-
production. ics (a part of the industrial OSH paradigm) was
Lessons drawn from the Tavistock research unable to deal with these. He had observed that
were taken to Norway and implemented in in- when technology and operating principles estab-
dustries, later they were applied in some Swed- lished in one national setting were introduced
ish industries. Although Swedish ergonomists into a new setting (typically into a developing
had tried to persuade enterprises to employ par- country) marked by working populations with
ticipative approaches, it was not until production different anthropometric measurements, culture,
engineers used the methods themselves that they or economic, climatic and political systems, they
could see their benefits e.g. in Volvo Kalmar did not perform as well as expected. Wisner
and Uddevalla. In the 1970s, changed legislation was one of the earliest researchers to see that
and policies, supported by training, empowered the industrial OSH paradigm had limited ef-
workers´ representatives in Sweden to take an fectiveness in non-Western societies, that there
active part in the planning and supervision of was not ‘one best way’. Basing his analyses on
production and safety and health at work. case study research he illustrated how ergonom-
By the 1980s such approaches had spread ics could achieve a more complete view of the
into various sectors and were being studied complex questions involved if it incorporates
by a range of academic disciplines in both the history, geography, anthropology, sociology and
technological and social sciences. An increas- some currents of the cognitive sciences into its
ing number of forms of workplace participa- reflections. While his traditional methodological
tion were observed and came to be defended as proposal remained, he took the view that it was
part and parcel of successful safety and health essential for ergonomics to renew itself and to
programmes. By the 1990s John Wilson, a lead- refer to the cited disciplines in so doing. There-
ing British ergonomist, postulated that access fore the barriers between research and interven-
to workers’ views, as expressed in participative tion would have to be broken down in order to
strategies, could be seen as a “framework and a produce an understanding of the complexities of
foundation for ergonomics.” He built up his case technology transfer, to increase productivity and
through reference to a series of classical themes to minimise undesired effects.
found in the literature on participation, includ- Participative strategies seem to require a
subtle balance from those who manage and
57
Chapter 2.2
coordinate them. There must be a balance be- for paradigm development in this area. From a
tween being focused but open to change, being social science perspective the subjectivity of ac-
both flexible but disciplined, and being able to tors who have a certain freedom to opine and to
combine technical expertise with a readiness to act (in democracies), in spite of the inequalities
listen to workers and seeking to understand their of the power structures in which they are im-
visions of solutions. In other words those who mersed, appears likely to constitute a key refer-
choose participative strategies must be capable ence point in theory construction. In keeping
of playing a complex role that includes facili- with our times theory will be built up inductive-
tating, consulting, educating and supporting. ly, with strong reference to the complexities of
Such requirements are a long way from those working life. However, we must refer to an ad-
traditionally demanded of prevention person- ditional element that is virtually ignored in the
nel. Successful participative strategies imply that high reliability organisation literature but that is
superiors must listen to, give freedom to and included in the socio-technical school literature,
respect subordinates, such strategies dissolve the i.e. the dynamics of power relations within or-
rigid separation between subject and object at ganisations. Some of the literature points to the
the heart of the Great Western Paradigm. importance of autonomy in permitting workers
Paradigm development implies social theory to refuse known risks. Other research highlights
development. Paradigms are necessary because that money or rewards should not be used to en-
they provide useful and coherent ways to think tice people into working in situations that they
in a systematic manner about how various types know are risky. There is also a substantial body
of actors could act in a array of situations. We of literature that discusses the necessity to have
have gone from the industrial OSH paradigm knowledge about tasks that potentially threaten
(a product of the Great Western Paradigm) that health and safety. As such these factors appear as
helped organise thinking all around the world vital for the exercise of freedom and in the for-
to a new situation where such thinking is seen mation of conscious and autonomous subjects,
as inadequate. It is necessary to develop a new in this way they are compatible with the views of
paradigm that provides a clear view to actors at Sen and Touraine.
all levels in society about how to confront the The question is how is such knowledge, once
challenges that lie ahead. It is our bet that it will consolidated, capable of influencing the estab-
be a paradigm that incorporates a capacity to lishment of new institutions that will be able to
deal with a complex view of the world incorpo- overcome the problems observed with the de-
rated with reflection about strategies designed to regulated laissez faire or consensus-based assess-
combat injustice/inequity in the face of differen- ment approaches and the industrial OSH para-
tial probabilities of death, injury and ill health. digm? For example, how can it be guaranteed
At this point in time we believe that the high that the focus of institutions move to where
reliability organisations and socio-technical there is most need, to the majority of the world’s
approaches described above, along with other working population that appears to have been
new knowledge and thinking, can contribute untouched by the industrial OSH paradigm?
to the development of a theory of prevention. Firstly, a series of policy related questions for
Our focus on prevention in this chapter comes OSH related institutions would emerge. For
from the belief that this is a logical starting point example, what policies would permit those who
58
currently work in the unhealthiest jobs to have centre of politics, (seen as both a means and an
less unhealthy jobs in the future? What policy end), to promote good living instead of well be-
measures can be developed to make up for a life ing. Similarly the work of Henri Bartoli seeks to
of suffering faced by those who have reduced life place humans at the centre of economics (rather
chances? What are the roles of modern informa- than vice versa), constituting a necessary step
tion technologies to make people more aware of to overcome two ills of contemporary living:
the risks they face? What can be done to reduce individualism and solitude. Only then will it be
these risks? Under what conditions of knowl- possible to regenerate education, renew work, to
edge and life can risk-taking be compatible with turn solidarity into a living reality and to seek to
freedom? What mechanisms can guarantee the live based on principles of good living.
minimum of ‘unfreedoms’ for victims and their One factor that was observed to undermine
dependents? the industrial OSH paradigm was that industrial
Secondly, investigation would need to focus development was concerned principally with
on the workplace. People need to have suffi- material well-being that led to large parts of
cient liberty and guaranteed access to relevant working populations suffering the constraints
knowledge as well as institutional support that and ‘unfreedoms’ of threats to their lives and
permits them to consciously, and as freely as health. This is inequitable and deserves consid-
possible, make decisions relating to the dangers eration in any new approach. However, as we
around them. In such a way development, when saw, the anomalies identified within the indus-
it is seen in terms of providing greater freedom, trial OSH paradigm and in the systemic safety
permits people to make crucial decisions neces- approach have resulted in a variety of distinct
sary to live long and healthy lives, particularly perspectives that emphasise how the interaction
working lives. We have seen that in diverse types of human and technical systems varies from one
of workplace an approach to safety is being built situation to another. It is essential to free up
that unites freedom, knowledge, and transpar- human capacity building in order to avoid costly
ency. We believe that some core issues of an and damaging results.
OSH paradigm are being worked out in such an Currently we don’t have the knowledge and
approach. clarity of vision that would permit us to talk of a
new social paradigm. Rather, the final section of
Cultural change and a social paradigm the chapter should be seen as bringing together
Edgar Morin’s critique of industrial civilisation a set of theoretical reflections, capable of being
has had a strong influence on the macro-level applied to examine many different questions and
dimensions of this text and some of his most contexts, ones associated with the building of
recent writing seeks to put humans back into the new practices.
59
Chapter 2.2

Dwyer, T. 1991. Life and Death at Work. New ments, dictators and international monetary
York, Plenum. agencies like the World Bank and IMF. Gov-
Advances the theory that workplace acci- ernment deregulations have been linked to
dents as being produced by systems of social the privatizations, and in many cases been
relations. It examines both the history of followed by deep cuts to social spending. A
contemporary OSH institutions, and reports similar message is given in a shorter and more
on workplaces studies to defend this notion, academic article by David Harvey: Neoliber-
which with dominant theoretical approaches alism as Creative Destruction; The Annals of
about workplace accidents. the American Academy, AAPSS, 610, March
2007.
Elgstrand, K (ed). 2006. Anthology on Industrial
Development. OSH & Development No. 7. Ac- Lindstrand et al. 2006. Global health – An intro-
cessible at www.ufa.se ductory textbook. Studentlitteratur.
13 articles on industrial development and how The book provides an overview of the global
it relates to components like transport, tel- health situation related to the concept of hu-
ecommunication, the concept of time, envi- man development and the factors that deter-
ronment, income distribution, culture, human mine the public health of the populations in
rights, nutrition, health, accidents, democracy different countries.
and globalisation.
Perrow, C. 1984. Normal Accidents. New York,
Heinrich, H. W. 1959. Industrial Accident Pre- Basic Books.
vention. New York, McGraw Hill. (4th edition) This book produces a typology of accidents
This pioneering books applies Taylorist en- and demonstrates how complex systems come
gineering oriented management theory to to be designed so that accidents are a ‘normal’
industrial health and safety issues, particularly (even if undesired) consequence of their op-
those associated with safety. Considered for eration.
many decades in the anglo-saxon world as
Rantanen, J. 2008. Challenges Posed by Glo-
‘the safety man’s bible’ it is of great historical
balization to Ethics in Occupational Health.
interest.
Newsletter of the International Commission of
Klein N 2007. The Shock Therapy. Penguin, Occupational Health, Vol. 5, No. 3, December
2007. 2007.
In this extensive book, Klein is analysing the An overall analysis of the role of occupational
economic and political developments in the health and safety in a globalising work life.
world during the last 40 years. She focuses on
Rawls, J. 1971. A Theory of Justice. Cambridge,
dramatic and violent events that have been
Harvard University Press.
utilised for great economic transformations.
One of the major works of political philoso-
These events and the shock they have caused
phy of the 20th Century, this books lays out a
to societies and nations, have been exploited
highly original theory of redistributive justice.
for privatization of enterprises by govern-
60
Sen, A. 1999. Development as Freedom. Oxford, Weick, K. E. and Sutcliffe, K. M. 2001. Manag-
Oxford University Press. ing the Unexpected. Jossey-Bass.
The 1998 Nobel Prize in Economic Sciences This book sets out to answer the question as
defends a redefinition of development in to how an organization should prepare for
terms of its capacity to produce human free- and manage itself so as to guarantee high per-
dom and to reduce lack of freedom. formance, especially when unexpected forces
push towards failure.
Touraine, A. 2007. A New Paradigm for Un-
derstanding today’s World. Cambridge, Polity Wisner, A. 1985. Quand voyagent les usines.
Press. Paris, Syros.
A simply written book by one of the world’s The foundations of an ‘anthropotechnological
most influential sociologists, which sets out approach’ to ergonomics designed to reduce
the basis for a new paradigm, one built to help human suffering and productivity loss associ-
understand today’s world and centred around ated with technology transfer to developing
the idea of the subject. countries.
61
3
Manual Work
3.1 Basic work physiology 65

3.2 Food, nutrition and work 89
3.3 Musculoskeletal disorders 131
3.4 Workplace design and evaluation 151
3.1
Basic work physiology

Ewa Wigaeus Tornqvist
Demands for energy vary largely between differ-

ent occupations. The energy consumed during
light sedentary office work may be 50 % more
than the energy used while resting, Figure 3.1.1.
Physically demanding jobs such as those in for-
estry or construction work, may increase energy
consumption by 500 %. Humans are designed
for mobility and physical activity and physical
activity requires energy. Skeletal muscles are
unique when compared with all other tissues
because their metabolic rate can vary more than
Figure 3.1.1. Energy expenditure at rest and dur-
any others meaning that human energy require-
ing different work tasks expressed as multiples
ments mainly depend on the level of muscular of the resting metabolic rate, METs. One MET
work. The energy expenditure required for is equivalent to the metabolic energy expendi-
extremely heavy short term physical activities ture of sitting quietly which for an average adult
may increase by 10-20 times and in some top is approximately 3,5 ml of oxygen * kg body
athletes, up to 30 times. weight-1 * minute-1 or 4,2 kJ (1 kcal) * kg body
Various physical work tasks place different de- weight-1 * hour-1. From Ainsworth, B et al, 1993.
mands on specific capabilities. For some tasks the
energy yielding processes (aerobic and anaero-
bic) are of primary importance, while other tasks heavy work
put high demands on the neuromuscular func- In this chapter the term heavy work refers to
tion (strength and technique). For some tasks any activity that calls for great physical exertion
psychological factors (attitudes and motivation) characterised by high-energy consumption and
are of major importance. There can be many high strain on respiratory and cardiovascular
reasons why a job or work task may be stressful functions. As soon as physical work is performed
and tiring but no work can be performed without the body makes adjustments and adaptations that
energy production, neuromuscular function and affect almost all organs, tissues and fluids. The
a willingness to perform the work. most important adjustments are:
65
Chapter 3.1
1. Deeper and more rapid breathing. ficiency for heavy work tasks while ergonomists
in many industrial countries are seeking ways to
2. Increased heart rate, accompanied with an ini-
increase physical activity and variation in seden-
tial rise in heart stroke volume (up to approxi-
tary occupations. In the industrial world con-
mately 40% of the maximal aerobic capacity).
tinuous sedentary work, often combined with
3. Dilatation of the blood vessels in the organs monotonous and static work postures, increased
involved (muscles and heart), but constriction stress, and lack of physical activity, has increased
in other blood vessels that diverts blood sup- static loads (especially on the neck and shoul-
ply to those organs and tissues that need more ders) leaving many organs in the body “under
oxygen and nutrients i.e. mainly the working used”. Sedentary life styles have increased the
muscles. risk of negative health outcomes, such as neck
4. Rise in blood pressure by increasing the pres- and shoulder disorders, obesity, cardiovascular
sure from the main arteries into the dilated diseases, diabetes and osteoporosis. However,
vessels of the working organs and tissues in jobs that can be categorised as physically heavy,
order to speed up the blood flow. and that lead to overload, still exist in industrial-
ised countries e.g. in the construction industry,
5. Increased supply of carbohydrate (glucose and small scale farming and home care.
glycogen) into the blood from the liver.
6. Rise in body temperature and increased me- physical work performance
tabolism. The increased temperature speeds The ability to perform physical work depends
up the chemical reactions of metabolism on the ability of a muscle cell to transform the
which increases the conversion of chemical chemical energy in fuel into mechanical energy
energy into mechanical energy. that can be used for muscular work. Fuel uptake
depends on the amount, nature and quality of
Energy consumption and cardiac capacity limit the food ingested and on the frequency of meals.
the performance of heavy work and these two The ability to transform fuel into useful energy
functions are often used to assess the severity of depends on the capacity of the service functions
a physical task. that deliver fuel and oxygen to the working mus-
Mechanisation has reduced occupational cles, Figure 3.1.2.
physical activity; heavy work is becoming rarer If nutrition is adequate, the capacity for oxy-
in industrial countries but is still widespread gen uptake is of primary importance to liberate
in developing countries. Occupations that are sufficient energy during prolonged heavy dy-
generally regarded to involve heavy work in- namic work that engages large muscle groups.
clude construction, agriculture, iron and steel Such work implies a high load on respiratory
industries, the armed services, fishing, forestry, and cardiovascular functions and the individual
mining and wharf labour. Some occupations strain depends on the proportion of an indi-
with predominantly female workers, including vidual’s maximal aerobic capacity that is utilized.
cleaning, nursing, elderly and home care, also The maximal aerobic capacity is defined as the
frequently involve heavy work. highest oxygen uptake that can be measured in
A major target for ergonomists in developing an individual, and can only be obtained during
countries is the achievement of high levels of ef- dynamic work with large muscle groups (e.g.
66
Figure 3.1.2. Factors affecting physical work performance; modified from Åstrand, P-O et al, 2003.
running or bicycling). This capacity varies large- Oxygen uptake increases in a linear fashion with
ly between individuals. If sufficient nutritional increasing energy demands, Figure 3.1.3.
supply is provided, genetic factors play a major The amount of energy liberated when 1 litre
role for the inter-individual variability - up to of oxygen is consumed is approximately 20 kJ
70 % may be explained by genetic factors. In- (20.2 kJ at rest and 20.6 kJ at work). The amount
dividual factors, e.g. gender, age, and health, as of oxygen consumed, i.e. oxygen uptake (V̇O2),
well as life-style factors, e.g. physical training, is determined by the cardiac output [heart rate
are also of importance, see Figure 3.1.2. In addi- (HR)* stroke volume (SV)] and the extraction
tion, the type of work to be performed (dynamic of oxygen from the arterial blood, i.e. the dif-
or static work), the environmental conditions ference in oxygen content between arterial and
(temperature and humidity), and psychological venous blood.
factors (attitude and motivation) also interact in
a complex way to affect work performance.
67
Chapter 3.1
Figure 3.1.3. Cycle ergometer work and corresponding oxygen uptake (l/min) and energy expenditure
(kJ/min) at different work loads (Watts); modified from Åstrand, P-O et al, 2003.
Among healthy individuals, only cardiovascular choice of fuel for the exercising muscle is mainly
functions, (not respiratory functions), are deci- limited to carbohydrate and fat, whereas protein
sive for V̇O2max and the stroke volume is nor- is mainly used for building new cells and replac-
mally of primary importance. ing parts of old cells as long as the energy supply
is adequate. The relative proportion of energy
energy supply yield from carbohydrate and fat, respectively,
Physical work requires energy. For an average depends mainly on the following factors:
adult the energy requirement during rest is ap- 1. Type of work: duration and intensity
proximately 4.2 kJ per kg body weight and hour.
During light sedentary office work the daily 2. State of physical training: trained or untrained
energy requirements is approximately 11-12 MJ subjects
for a 75 kg man and 8-9 MJ for a 55 kg woman. 3. Diet: high or low carbohydrate diet
During extremely heavy manual work such as
forestry or mining work, the daily energy de- Type of work
mand may increase to 20 MJ. Provided an individual has a normal mixed diet,
We eat a variety of nutrients in food but only carbohydrate (glucose and glycogen) and fat
the carbohydrate, fat and protein content can contribute equally to their energy supply during
yield energy for muscular work. However, the rest and short-term light to moderate physical
68
Figure 3.1.4. The percentage contribution to the energy yield of fat and carbohydrate related to the oxygen
uptake in percentage of the subject’s maximal oxygen uptake. Prolonged exercise, endurance training and
diet can markedly modify the relative contribution; modified from Åstrand, P-O et al, 2003.
work/exercise, Figure 3.1.4. As the work con- exercise. During such heavy work the oxygen
tinues the relative contribution of fat gradually supply is inadequate and energy is liberated by
increases. 60-70% of energy can be derived anaerobic oxidation that can only proceed as far
from fat during moderately heavy work/exercise as the production of lactic acid allows.
that can be endured for 4-6 hours (including rest
pauses); compared with 50% during short-term State of physical training
work. The ability to use fat as a fuel depends on the
With increasing work/exercise intensity body’s capacity to transport oxygen and there-
there is a gradual change toward a greater pro- fore the proportion of energy yielded from fat
portion of energy yielded from carbohydrate, at a given workload depends on the workload
Figure 3.1.4. The energy efficiency is about intensity in relation to the individual’s V̇O2max.
10% higher for carbohydrate compared with fat Because physical training increases V̇O2max, it
consumption, so the energy production per unit also increases the ability to utilize fat as a source
of oxygen consumed is higher when carbohy- of muscular energy. During prolonged exercise
drate rather than fat is consumed. Carbohydrate at a given workload it is a distinct advantage to
contributes to nearly 100% of the energy supply be able to use more fat, because fat stores are
used during very heavy or near maximum work/ definitely larger than carbohydrate stores. In
69
Chapter 3.1
addition, a physically trained individual utilizes produced at corresponding V̇O2 during work
a lower proportion of their maximal oxygen that includes static postures (compare blood lac-
uptake when work is performed at a given sub- tate concentration during skating and bicycling
maximal workload and less lactic acid is formed. in Figure 3.1.6).
Diet
Adaptation to a high fat and low carbohydrate
diet results in lower muscle glycogen content
and a higher rate of fat oxidation during exer-
cise. Such adaptation can spare muscle glycogen
and, since muscle glycogen storage is essential
for endurance performance, it is possible that
adaptation to a high fat diet potentially could
enhance endurance performance. However,
Figure 3.1.5. A simplified formula of what happens
since the consumption of a low carbohydrate
when carbohydrate is oxidised during dynamic
diet decreases the glycogen storage in both
muscular work when oxygen supply is adequate
muscles and liver, the training intensity may be (a). The carbohydrate (stored in the muscles and
compromised in those adapted to a high fat diet. the liver) are oxidised with the help of oxygen
which enters the body via the inhaled air and
Aerobic and anaerobic metabolism is then transported by the blood to the muscles
When oxygen supply is adequate, energy is re- (and other organs). The end products are water
leased by aerobic oxidation of (mainly) carbohy- and carbon dioxide, and free energy for mus-
drate and fat with the end products being water cular work. The same end products are formed
when fat (and protein) is oxidised. This process
and carbon dioxide, see Figure 3.1.5a.
is called aerobic, as it occurs in the presence
When oxygen supply is inadequate, energy is of oxygen. During very heavy work or during
released by anaerobic oxidation where carbohy- static work that impairs the blood flow, and thus
drate is oxidized in the absence of oxygen and decrease oxygen transport, the oxygen supply
lactic acid is formed as the end produce, Figure may be inadequate. In such situations the energy
3.1.5b. The concentration of lactic acid in the needed for muscular work is supplemented by
body is closely correlated with muscle fatigue. a process where carbohydrate (not fat) is split
The concentration of lactic acid in blood in- without the presence of oxygen (b). Lactic acid
is created as the end product. When too much
creases exponentially with increasing workload,
lactic acid is accumulated in the muscles fatigue
Figure 3.1.6. During dynamic work with large and pain will make it impossible to continue the
muscle groups, e.g. running and bicycling, the work allowing oxygen to break down the lactic
formation of lactic acid starts to increase mark- acid accumulated.
edly when the workload corresponds to approxi-
mately 50 % of an individual’s maximal aerobic
capacity. If work continues at this intensity, lactic
acid will accumulate in the muscles and blood
with increasing muscle fatigue and pain arising
because of the reduced pH. More lactic acid is
70
wasted on “unproductive” static or dynamic load

such as work in awkward postures and/or efforts
to hold and support things.
Activity Efficiency, %
Shovelling in stooped posture 3

Shovelling in normal posture 6
Using a heavy hammer 15
Going up and down stairs without load 23
Cycling 25
Walking on the level without load 27
Walking uphill on a 5º slope without load 30
Examples of factors that influence work effi-

Figure 3.1.6. Blood lactate concentration and cor-
ciency are working methods, design and mainte-
responding work load expressed as percentage of
the individual’s maximal oxygen uptake during nance of tools and other equipment. To optimise
bicycling and speed skating. At corresponding efficiency it is important that work equipment
oxygen uptake, more lactic acid is produced is properly maintained (e.g. keeping cutting
during speed skating than during bicycling. This tools sharp) and fits individuals of varying sizes.
is due to the more purely dynamic work during Examples of individual factors that influence ef-
cycling compared with speed skating where the ficiency are body dimensions, e.g. length of lever
static load on mainly the thighs is quite evident arms, and working techniques such as speed of
(knees constantly bent deeply). During bicycling
movements, postures and neuro-muscular coor-
the blood lactate concentration starts to increase
markedly at approximately 50 % of maximal dination.
oxygen uptake; from Åstrand, P-O et al, 2003.
factors affecting physical work
Work efficiency performance
Only part of the chemical energy in food is Nutrition

transformed into mechanical energy for mus- In many developing counties nutritional and
cular work; the rest is liberated as heat. This health status are important limitations for
heat production makes it possible to keep a worker performance. Under-nourishment and
relatively constant body temperature around malnutrition reduce worker performance es-
37oC although environmental temperatures are pecially in manual or semi mechanised work
often lower. Under the most favourable condi- demanding high energy, e.g. in the construction
tions during dynamic muscular work with large industry, agriculture, iron and steel industries,
muscle groups, 30 % of energy expenditure is the armed services, fishing, forestry, mining and
transformed into “productive” mechanical work wharf labour. In addition to individual suffer-
and the remaining 70 % is transformed into ing, it is very expensive for an industry to have
heat. However, work efficiency during most under-nourished workers. It has been suggested
work tasks is lower than 30 % because energy is that under-nourishment is as important as heat
71
Chapter 3.1
stress for explanations of low productivity in arm muscles. There are inter-individual differ-
tropical countries. The rapid population increase ences in the proportion of slow and fast twich
in many developing countries in combination muscle fibres in specific muscles, partly due to
with the negative effects of under nourishment both genetic factors and how the muscles are
on productivity makes it very difficult for some used.
countries to come out of the problematic situa- Blood circulation is often impaired during
tion. The energy reserves necessary for produc- static contractions causing inadequate oxygen
tion gets smaller and smaller relatively seen at supply that increases the anaerobic metabolic
the same time as an increasing production is a process and the formation of lactic acid. In ad-
remedy for this problematic situation. A rational dition, reduced blood flow impairs the transpor-
arrangement to supply meals to workers engaged tation of metabolites from the muscle resulting
in heavy manual tasks might be a decisive fac- in considerable increase in the concentration of
tor to increase production in some developing lactic acid and muscle fatigue.
countries. Long periods of static work increase the risk
of muscular pain and disorders. Static muscular
Dynamic or static work load is an important problem in working life as
Contractions that cause changes in muscle work-related static postures often involve mus-
length are called dynamic contractions and cles that are not primarily postural muscles.
include situations where the muscle tension Purely dynamic work is unusual in work-
is developed during shortening (concentric ing life as work tasks generally consist of both
contraction) as well as during lengthening (ec- dynamic and static muscle contractions. For
centric contraction) of the muscle. Both types example, work with elevated arms or sideway
of dynamic contraction occur regularly in daily movements, e.g. carpentry work, painting, clean-
life, e.g. when lifting a cup of tea the biceps ing and repair work, entails static load mainly
works concentrically and when replacing the cup on the shoulder muscles. Work efficiency and
the biceps works eccentrically to slow down the V̇O2max is markedly reduced during such work
movement and prevent breaking the cup. tasks. When nailing at different heights, V̇O2 is
When the muscle doesn’t vary in length, relatively constant whether the arms are elevated
and no movement takes place, the contraction or not but productivity (nails/min) and work ef-
is static (or isometric). Static contractions play ficiency is lower when nailing in a ceiling com-
an important role in stabilising and maintain- pared with work at bench height, Figure 3.1.7.
ing joint positions such as staying upright when The heart rate, blood pressure and the concen-
standing. The primary function of antigravity tration of lactic acid in blood is also higher.
or postural muscles is to adjust to gravity and
maintain postures, e.g. the trunk muscles. These Large or small muscle groups
muscles have a high percentage of muscle fibres V̇O2max cannot be obtained when only small
with primarily aerobic metabolism, (often called muscle groups are used e.g. only approximately
slow twitch fibres), so they have better endur- 70 % of V̇O2max is reached during maximal ef-
ance compared with muscles that have a higher fort using only the arms. At a given sub-maximal
percentage of fibres with primarily anaerobic workload, V̇O2 and cardiac output are about the
metabolism, (often called fast twitch fibres), e.g. same whether small or large muscle groups are
72
Figure 3.1.7. Productivity, heart

rate, blood pressure and venous
blood lactate concentration
during nailing with different
arm postures, during bicy-
cling and during standing with
the arms hanging down and
Nailing Biking Standing arms above the head, respectively.
Horisontal Vertical Ceiling 50 75 Max up down
Although, the oxygen uptake
was approximately 1 l/min dur-
ing nailing at all three postures
VO2
Nails/min the productivity was markedly
reduced (5 compared with 15
nails/min) when nailing in the
ceiling compared with at bench
height. Work efficiency was
thus decreased. During bicy-
cling at 50 Watts and during
nailing in the ceiling the heart
Heart frequence
rate was approximately 100 and
130 beats/min, respectively,
although the oxygen uptake
was the same. Both the systolic
(S) and the diastolic (D) blood
pressure was also markedly
higher during nailing in the
ceiling compared with bicy-
cling at corresponding oxygen
uptake. The blood lactate
Blood pressure mm Hg concentration was higher the
higher the arm posture. Note
S
the increase in heart rate and
blood pressure just by lifting
the arms above the head; modi-
fied from Åstrand, I, 1990.
D
Venous blood lactate concentration mmol/l
73
Chapter 3.1
used, however, heart rate and blood pressure are

significantly higher. The lower work efficiency
during work with small muscle groups is further
reduced when the work is combined with static
postures, see Figure 3.1.7.
Continuous or intermittent work

When it is possible to influence work pace,
frequent pauses can allow the performance of
extremely heavy work with less physical strain
without reducing productivity. Figure 3.1.8
shows the heart rate of a worker who is mov-
ing 30 kg iron pigs from a machine to a loading
platform.
The heart rate is approximately 150 beats/min
at the end of a work cycle when 14 iron pigs are
carried continuously before pausing. The pauses Figure 3.1.8. The heart rate of a worker who is
moving 56 heavy iron pigs from a machine to a
were 1.5 times longer than the working period.
loading platform. When he carried 14 iron pigs
When the worker reduced the number of iron continuously and then took a pause, continued
pigs carried before pausing, but still kept the to carry 14 iron pigs and then paused again etc,
pause duration 1.5 times longer than the work- his heart rate was approximately 150 beats/min
ing period, the heart rate was reduced. When at the end of the work cycle (dotted line). The
carrying 4 iron pigs before pausing, i.e. taking pause duration was 1.5 times the working pe-
14 short pauses, the heart rate decreased to 110 riod. When he reduced the number of iron
beats/min. Thus, the shorter the work period pigs before pausing, keeping the pause duration
1.5 times the working period, his heart rate
the lower the heart rate although productivity
was reduced. When he took 4 iron pigs before
remained constant. After 13 minutes 56 iron pausing, thus he took 14 short pauses, his heart
pigs had been carried in all cases. When the rate decreased to 110 beats/min (thin solid line).
number of iron pigs carried before pausing was Thus, the shorter work period the lower the
further reduced the heart rate decreased further heart rate although the productivity remained
but the work process felt jerky and irregular. constant; from Åstrand, I, 1990.
Similar results have also been shown in the duration is less critical because during short pe-
laboratory during bicycling and running. Both riods of heavy work, the oxygen demand is prob-
heart rate and the concentration of lactic acid in ably covered by oxygen bound to myoglobin in
blood were lower over a shorter work period. In- the muscle cells. During the pause the myoglob-
terestingly, provided the work period was short, in is quickly loaded with new oxygen so work
the pause duration did not influence the reduc- can continue with aerobic energy supply as long
tion in heart rate or blood lactate concentration as the work periods are not too long. If the work
if the pause duration was above a certain mini- periods are extended, anaerobic energy supply
mum. The conclusion is that the work period will take over and lactic acid will accumulate.
should be as short as possible while the pause
74
Frequent micro pauses are recommended when and dynamic efforts, and engage large muscle
it is possible to influence the pace of heavy work. groups for heavy manual work tasks. It is im-
Work pace that is set by machines means that portant that work equipment fits individuals of
it is not always possible to influence the work- differing sizes and is maintained properly, e.g.
pause pattern but these principles should guide keeping cutting tools sharp. It is frequently pos-
work organisation to reduce physical strain. sible to decrease physical load by easy measures.
However, apart from these short pauses, it is
important to have longer rest pauses and breaks
needed for physical and mental recuperation,
water and food intake and social relations.
Working methods and equipment

Working methods and the design and mainte-
nance of work equipment influence the levels of
physical strain and productivity, Figure 3.1.9 and
3.1.10 a and b. For optimal efficiency working
methods should minimize “unproductive” static
Figure 3.1.9. Energy consumption and productiv-

ity during work with five different types of saws. Figure 3.1.10. With a constant load and transport speed
The shaded columns represent the average ener- the oxygen uptake is lower when the wheel-barrow has
gy consumption per square meter of cut surface larger compared with smaller wheels (a) and when the
and the white columns show the average time tyre pressure is higher (b). The oxygen uptake during the
needed to saw one square meter. The vertical most unfavourable conditions is set to 100 and the more
marker (P<0.01) indicates a difference in energy favourable conditions are expressed as percentage of the
consumption that is statistically significant; from most unfavourable conditions; modified from Hansson,
Kroemer, K H E and Grandjean, E, 1997. J-E, 1970.
75
Chapter 3.1
physical training if not all, days of the week. For most people,
Physical training may be defined as any repeated the more vigorous and prolonged the activity
physical activity that improves or maintains is, the greater the training effects and health
endurance, strength, mobility and coordination. benefits, provided that the increments in activ-
One important goal of physical training is the ity level are not too abrupt. The improvement
achievement of physical condition and a level of of aerobic capacity is greater in cases where the
fitness that surpasses that required for everyday level of physical fitness is lower before training.
work. Physical training activities must be of suf- Maximal training effect is generally achieved
ficient intensity, frequency and duration while after approximately 6-8 weeks, Figure 3.1.11.
allowing enough time for recovery and adapta- During periods of inactivity, e.g. due to illness or
tion between training sessions. The effects of bed rest, aerobic capacity declines quite rapidly.
physical training are very specific with regard to It is important not to increase training intensity
the particular functions that are being trained. too quickly to avoid overloading tendons and
For example, workers required to do heavy ligaments. Although maximal training effects
manual work will benefit from training that regarding aerobic capacity are normally reached
increases their oxygen-transporting functions within 8 weeks, it takes several months before
to enhance maximal aerobic power and endur- ligaments and tendons strengthen markedly.
ance thus reducing relative load and fatigue. To
date there is no scientific evidence showing that
heavy manual occupational work has any positive
effects on work performance. On the contrary,
some studies suggest that heavy occupational
work may accelerate the age related impairment
of physical capacity probably because the load
in occupational work is not optimal regarding
intensity, frequency and duration. Most impor-
tantly, there is not optimal time for recuperation
to allow for central and peripheral adaptation
that results in a training effect.
A general rule for training to increase aerobic
capacity requires the engagement of large mus-
cle groups, i.e. walking/jogging, bicycling and
swimming. For an average sedentary person to
improve their aerobic capacity, a training inten-
sity corresponding to 50-60 % of the individuals
Figure 3.1.11. Changes in maximal oxygen uptake
maximal aerobic power, (a moderate degree of before and after bed rest in five individuals at
breathlessness), for a minimum of 30 minutes various intervals during training. Vertical bars
(not necessarily continuous although the periods mark the time during the training period when
should not be shorter than approximately 10 the maximal oxygen uptake had returned to the
minutes) is sufficient for a training effect. The control value before bed rest; from Åstrand,
activity should be performed regularly on most, P-O et al, 2003.
76
Central circulation generally limits the maximal aerobic uptake increases, the maximal workload
oxygen uptake during work that engages large that could be performed also increases. In addi-
muscle groups. Training of aerobic capacity tion there is improvement of peripheral circula-
improves central circulation by increased stroke tion in the muscles engaged in training. This
volume. The heart rate, and physical strain, improvement increases the oxidative capacity in
decreases at a given sub-maximal workload, the working muscles allowing the oxygen to be
Figure 3.1.12. As maximal cardiac output (due to more effectively utilized, i.e. the arterio-venous
increased maximal stroke volume), and maximal difference increases.
Figure 3.1.12. Individual work-load - heart rate relationship for a subject before and after aerobic capac-
ity training. Heart rate was measured at three sub-maximal intensities and the line extended to maximal
heart rate. After training his maximal oxygen uptake had increased from approximately 2.4 to 3.0 l/min*.
The heart rate on a given sub-maximal load, expressed in Watts or oxygen uptake (VO2), is lower after
training, thus the strain during work is reduced. The reduced strain may also be demonstrated by ex-
pressing a certain load in percentage of the individual’s maximal aerobic uptake. A work task requiring
an oxygen uptake of 1 l/min represents 42 % of the subject’s maximal oxygen uptake before training and
33 % after training.
* Note, that the values are based on a linear relationship between oxygen uptake and heart rate up to
maximal heart rate, although the heart rate increase with increasing oxygen uptake generally levels off
somewhat close to maximum. Therefore the estimated maximal oxygen uptake is probably slightly un-
derestimated.
77
Chapter 3.1
As heavy manual work generally includes lifting, Tobacco use

carrying and pushing/pulling objects, muscle Smoking and other forms of tobacco use can
strength training and training in lifting tech- cause acute effects on the cardiovascular system.
niques is also important to reduce fatigue and Nicotine decreases peripheral blood circula-
the risk of accidents from overload and over ex- tion, increases heart rate and blood pressure and
ertion. Muscular strength may increase markedly influences hormone excretion. Tobacco smoke
through strength training. Muscle strength may contains up to 4 % carbon monoxide that has
increase by 20-40% during the first 6-8 weeks of an affinity to haemoglobin that is approximately
strength training with heavy loads. This “ini- 225 times the affinity of oxygen to haemo-
tial” training effect is due to a nervous adapta- globin. The presence of even small amounts
tion resulting in more effective recruitment of of carbon monoxide can markedly reduce the
muscle units. If training continues for more than oxygen transporting capacity of blood and
2-3 months, further adaptation takes place by work capacity. At a given sub-maximal V̇O2, the
increases in the muscle fibre area. Muscle fibres heart rate may be 10-20 beats/min higher after
may increase their size by 100% or more after smoking 1-2 cigarettes; the heavier the work,
several years of training so when neural and the greater the difference between smokers and
muscular adaptation are taken together, muscle non-smokers.
strength may increase 150-200%.
Figure 3.1.13. The decline in maximal heart rate with age, and heart rate during a sub-maximal work
load. Mean values from 350 subjects. The standard deviation is approximately + 10 beats/min in all age
groups; from Åstrand, P-O et al, 2003.
78
Gender and age V̇O2max increases during childhood and adoles-

The maximal heart rate is on average the same cence and generally reaches its maximal value
for men and women, but varies considerably at 18-20 years of age, followed by a gradual
between individuals. The maximal heart rate decline, Figure 3.1.14. At the age of 65 the
decreases with increasing age, Figure 3.1.13. V̇O2max is about 70% of the value for an average
The relative load and physical exertion on the 25 year old; the average V̇O2max for a typical 65
body that is working with a given heart rate, year old man is the same as that of a typical 25
is therefore generally higher in older subjects year old woman.
(when compared with younger subjects). Women’s maximal muscle strength is lower
The V̇O2max for an adolescent female is on than men’s, Figure 3.1.15. This difference be-
average 65-75% of that of a male, see Figure tween men and women varies according to the
3.1.14. This is partly due to differences in size. muscles involved. For example, the maximal
When weight is taken into account women reach strength of a female’s leg muscles is, on aver-
on average 75-85% of the male’s V̇O2max, which age, 65-75% of that of a man. The same figures
is mainly explained by the woman’s greater for trunk and upper arm muscles are 60-70 and
proportion of fatty tissue having lower energy 50%, respectively.
consumption.
Figure 3.1.14. Mean values for maximal oxygen uptake in 350 female and male subjects 4 to 65 years of age.
Included are values from a group of 86 students trained in physical education and data from a follow-up
study of 35 female and 31 male students from the same group; from Åstrand, P-O et al, 2003.
79
Chapter 3.1
to 1% of the body weight, there is already a

measurable decrease in performance. Heart rate
increases with approximately 10 beats per % of
hypohydration and body temperature increases
approximately 0.2° C per % of hypohydration
making it very important to replace water loss.
Water should be drunk frequently, in greater
quantities and much more often than indicated
by feelings of thirst. 5-8 litres needs to be re-
placed during a normal shift of moderate or
heavy work.
Various physiological changes, (i.e. acclima-
tisation), takes place during prolonged expo-
sure to heat, especially during the first week of
Figure 3.1.15. Changes in maximal isometric
exposure, that help individuals adapt to better
strength with age in women and men; from
Åstrand, P-O et al, 2003. endure heat stress. The heart rate and body
temperature at a given sub-maximal load will
decrease while sweat production increases. The
Maximal muscle strength in men is usually salt content in sweat also tends to decrease.
reached around the age of 20, (a few years earlier Heat stress not only impairs the capacity for
for women), followed by a gradual decline. The the performance of heavy work but also impairs
strength of an average 65 year old is 75-80% of capacity for precision work, intellectual tasks
an average 20-30 year old. The rate of decline and decision making, potentially leading to risk
with age is somewhat greater for the leg and taking and accidents. Therefore it is of consider-
trunk muscles compared with the arm muscles. able practical importance to minimise heat stress
by organisational, technical and behavioural
Temperature and humidity preventive measures.
Heat stress increases cardiovascular load and In a cold climate heavy manual work is most
decreases work performance and productivity. problematic before the muscles have been
The heart rate accelerates due to increased skin warmed up as blood circulation and nerve con-
perfusion to enhance the transportation of heat ductivity is reduced in cold tissues resulting
from the working muscle to the skin that then in reduced musculoskeletal function and work
boosts evaporation of sweat taking heat from the performance. There is also an added risk of inju-
body. When high temperature is combined with ries in cold tissues. Reduced nerve conductivity
high humidity, work performance and produc- means that fast and precise work is difficult to
tivity are reduced even more since evaporation perform if the hands and fingers are cold. Cold
is hampered. Prolonged heat stress leads to loss hands also increase the risk of accidents dur-
of body fluid (hypohydration) through increased ing manual handling since muscle strength and
sweating that in itself further increases the heart coordination is reduced. Appropriate clothes are
rate and reduces work performance, especially important to keep individuals warm in a cold
endurance. At a hypohydration corresponding climate, however, warm and heavy clothes may
80
have a negative impact on work performance as pulmonary ventilation and heart rate at sub-
they may reduce mobility and increase energy maximal workloads increases compared with that
demands because of additional weight. at sea level, to compensate for the low oxygen
pressure in arterial blood. Work at a given work-
Altitude load at high altitude requires more effort and
Physical work performance is reduced at high endurance is reduced.
altitudes. The oxygen pressure of inhaled air Beside maximal cardiac output, V̇O2max
decreases with increasing altitude, from ap- depends on the maximal oxygen extraction from
proximately 100 kPa (760 mm Hg) at sea level the blood. During maximal work at sea level
to approximately 70 kPa (525 mm Hg) at 3 000 almost all oxygen is extracted from the blood
metres altitude, Figure 3.1.16. During acute ex- passing the active muscles so the lower oxygen
posure, i.e. without adaptation to high altitude, content in arterial blood at high altitude cannot
Figure 3.1.16. Reduction in maximal oxygen uptake in relation to barometric pressure. o = data from
acute exposure, • = data after various periods of acclimatization. In principle, the maximal oxygen
uptake during acute exposure to reduced oxygen pressure decreases at the lower part, within the
dotted lines; during acclimatization, it is shifted toward the upper part of the field; from Åstrand,
P-O et al, 2003.
81
Chapter 3.1
be compensated for by more effective extraction. about these changes. Fatigue has been defined
The maximal cardiac output remains the same as a state of disturbed homeostasis, attributable
at high altitude as at sea level but the maximal to both work and the work environment, which
aerobic capacity decreases in proportion to the may imply both subjective and objective symp-
decreased arterial oxygen content, e.g. at an alti- toms and reduce work performance. Sometimes
tude of 4 000 metres, the reduction in maximal fatigue occurs together with pain in various parts
aerobic capacity is approximately 30% in non- of the body so fatigue and pain should be re-
acclimatised subjects, see Figure 3.1.16). garded as warning mechanisms for overexertion.
During prolonged exposure to high altitude, Fatigue may be physical or psychological
various physiological changes, (i.e. acclimati- (mental). Both forms of fatigue can be caused
sation), occur to compensate for the reduced by heavy physical work and normally occur with
oxygen pressure in the inhaled air. A further reduced work performance. If fatigue is to be
increase in pulmonary ventilation takes place reduced and work capacity restored, work must
during the first days of exposure and the heart be discontinued or the workload lightened to
rate at sub-maximal levels gradually decreases at allow recovery.
a given oxygen uptake. At a later stage of ac- Physical fatigue can be local or general. Local
climatisation, the same or even lower heart rate or muscular fatigue may occur during and after
levels as at sea level are attained. The maximal intensive use of a specific body region, e.g. the
cardiac output decline gradually at high altitudes shoulder when working with lifted arms. The
but the haemoglobin concentration increases so physiological factors responsible for fatigue may
that the content per litre of arterial blood can be be of mechanical, metabolic (e.g. depletion of
the same in an acclimatised person at 4 500 me- energy and accumulation of lactic acid) or elec-
tres as at sea level. There are also gradual mor- trophysiological origin. General fatigue may oc-
phological changes in the tissues, e.g. increased cur after long duration of heavy work with large
capillary density, increased myoglobin content muscle groups, e.g. manual forestry and agri-
and modified enzyme activity. The initial reduc- culture work or aerobic capacity training when
tion in maximal aerobic capacity will gradually there is increased blood lactate concentration
decrease and at an altitude of e.g. 4 000 metres, and accelerated heart rate. General fatigue can
the reduction in aerobic capacity is approximate- also be associated with hypoglycaemia (reduced
ly 15% in an acclimatised person compared with blood sugar concentration) after prolonged
30% in non-acclimatised subjects, Figure 3.1.16. sub-maximal work or hypo hydration in heat-
exposed workers who do not consume enough
Fatigue water during their working shift. General fatigue
Fatigue is a multifactorial condition that is a may also be a symptom of disease.
common and important constraint in work. Sub- Psychological fatigue may be caused by a
jective symptoms of fatigue range from slight disturbed central nervous control. Typical symp-
feelings of tiredness to complete exhaustion. toms are impaired sensory and motor func-
Although there are objective symptoms indicat- tion, impaired intellectual and decision making
ing disturbances in the balance and feed-back capacity and slower information transmission.
systems to keep equilibrium of body substances Situations that may cause psychological fatigue
and processes (homeostasis), very little is known are prolonged work requiring high mental con-
82
centration and attention, heavy physical work, tion for women and elderly persons than men
monotonous work and environmental factors and younger individuals, although there are
such as noise, improper lightening and uncom- large variations within gender and age groups.
fortable climate. E.g. two workers who carry a heavy load uphill,
The prevention of fatigue requires to be require an energy expenditure corresponding
organised in such a way that there are varia- to an oxygen uptake of 2 l/min. One worker has
tions in workload, workers have the possibility a V̇O2max of 6 l/min and the other’s is 2 l/min.
to influence their workload and work pace, and The first worker uses 33 % of his V̇O2max
that enough time is allowed for rest breaks for whereas the second worker is using 100 % of his
recuperation. V̇O2max. The lactic acid concentration during
dynamic work, e.g. bicycling, increases mark-
Workload in relation to work performance edly at 40-50% of maximal aerobic capacity (the
capacity lower value for untrained subjects), see Figure
Prolonged work can be classified according to 3.1.6.
severity of workload and cardiovascular response However, occupational heavy work generally
for a group within a certain age range. includes manual handling operations with static
work and work with small muscle groups, (as in
Workload V̇O2 , l/min HR, beats/min the above example of the two workers carrying
Light work up to 0.5 up to 90 a heavy load uphill) that reduce work efficiency.
During mixed physical work, including manual
Moderate work 0.5-1.0 90-110
handling operations, the upper limit for the
Heavy work 1.0-1.5 110-130 maintenance of homeostasis and prevention of
Very heavy work 1.5-2.0 130-150 the accumulation of lactic acid and fatigue over
Extremely heavy work over 2.0 150-170 an 8-hour workday is approximately 30-35% of
V̇O2max, the lower value for untrained subjects.
The figures refer to average 20-30 year olds and are
Consequently, the first worker in the example
only general classifications because of the large indi-
vidual variation in ability to perform physical work. given above can work all day without marked
fatigue whereas the second worker becomes
exhausted after only a few minutes. It is mean-
The strain on an individual is, however, highly ingless to express individual workload in abso-
dependent on the individual’s V̇O2max. In gener- lute values, i.e. as V̇O2 in l/min (or comparable
al, an individual’s experience of a specific work- measures) so workload should be expressed as
load and their perception of exertion is more a percentage of an individual’s V̇O2max i.e. the
closely related to heart rate than to V̇O2 during ratio between the load and capacity.
work because heart rate not only reflects the
actual workload but other factors that influence
work performance. International Labour Organisation (ILO) has sug-
gested 33 % of V̇O2max as the highest acceptable
Because maximal aerobic capacity varies average load during an 8-hour work shift. If this can-
greatly between individuals, a workload that is not be achieved by organisational and/or technical
easy for one worker can be quite exhausting for preventive measures ILO recommends decreased
another. Generally, work requires more exer- working hours.
83
Chapter 3.1
creasing workload; the higher the ambient tem-

perature and humidity, the greater proportion
of static to dynamic effort and the smaller/fewer
muscles involved, Figure 3.1.18. Emotional fac-
tors such as nervousness and apprehension also
increase heart rate at rest and during work at
light to moderate workloads.
Although the workload/heart rate relationship
can be established for a specific individual (indi-
vidual calibration), heart rate can only be used
to estimate workload under certain conditions.
These conditions require that roughly the same
large muscle groups are engaged in the calibra-
tion assessments as in the measured work task,
and the proportion of static to dynamic work,
ambient temperature, emotional stress and other
Figure 3.1.17. The individual relationship between factors that affect work performance must be the
the heart rate at different sub-maximal work-
same. Heart rate can easily be monitored con-
loads and the predicted corresponding oxygen
uptake. The measured maximal oxygen uptake
tinuously during a whole workday with small,
(V̇O2max) is used to construct another paral- comfortable ambulatory heart rate monitors.
lel scale, which shows the load expressed as Maximal heart rate declines with age. A heart
percentage of the individuals maximal oxygen rate of 130 beats/min for an average 25 year old
uptake (aerobic power). The weighted mean of man roughly corresponds to 50% of his maximal
the continuous recording of the heart rate, e.g. aerobic capacity, however, the same cardiovascu-
during 2 different work days, is then used to
approximate average oxygen uptake during work
as well as the load expressed as percentage of the
maximal aerobic power; from Åstrand, P-O et
al, 2003.
A worker’s V̇O2max can be determined by direct

measurements of oxygen uptake at maximal
work or can be estimated on the basis of heart
rate measurements from sub-maximal tests.
Workload can be assessed either by measure-
ment of V̇O2 during the actual work or by indi-
rect estimation of V̇O2 by heart rate measure-
ments. There is normally (within certain limits),
a linear relationship between V̇O2 and heart rate Figure 3.1.18. Increase in heart rate during differ-
in a given individual, see Figure 3.1.17. Howev- ent working conditions; from Kroemer, K H E
er, there is a steeper rise in heart rate with in- and Grandjean, E, 1997.
84
lar strain and feeling of exertion is experienced

by an average 65 year old man at a heart rate
of 110, Figure 3.1.13. Maximal heart rate also
varies considerably between individuals within
the same age group. Therefore, the cardiovascu-
lar strain and degree of physical exertion is best
expressed as an increase in heart rate from rest-
ing level as a percentage of the heart rate reserve
(HRR); the heart rate reserve is the difference
between maximal and resting heart rate of a sub-
ject. A heart rate of 130 beats/min corresponds
to 50% of the HRR for a person with a maximal
heart rate of 200 and a resting heart rate of 60
beats/min:
(130-60)/ (200-60) *100 = 50%
whereas the same heart rate corresponds to Figure 3.1.19. Average body temperature (meas-
about 70% of the HRR for a person with a ured in rectum) in relation to oxygen uptake in
maximal heart rate of 160 beats/min: percentage of the individual’s maximal oxygen
uptake. Seven subjects were exercising for 60
minutes on a bicycle ergometer. To the left are
(130-60)/(160-60) *100 = 70%.
data obtained at rest. SD=standard deviation;
modified from Åstrand, P-O et al, 2003.
During prolonged heavy work the body tem-
perature can be used as a measure of relative
workload. Body temperature increases in a linear If workload is not too high, the oxygen uptake
way with increasing workload, at least up to an during an actual work situation can also be esti-
energy demand of about 75% of an individual’s mated from measurements of pulmonary venti-
maximal aerobic capacity. However, it takes lation as there is a linear increase in pulmonary
approximately 40-50 min before the increase in ventilation with increasing oxygen uptake up to
body temperature levels off to a steady value. At an oxygen uptake of about 1.5-2 l/min, Figure
50% of an individual’s maximal aerobic capac- 3.1.20.
ity, body temperature will reach approximately
38oC, see Figure 3.1.19.
85
Chapter 3.1
muscles can be assessed by electromyography

(EMG). The same principle of relating load
to individual capacity also applies for localised
muscular loads because only a certain percent-
age of the maximal strength can be taxed before
local fatigue develops.
effects of heavy work

Heavy work may lead to undesirable acute
and/or long-term effects. Acute effects such as
overstrain and fatigue impair sensory and mo-
tor control as well as perceptive and cognitive
functions. In turn, these effects can lead to poor
co-ordination, and awkward working move-
ments and postures in handling operations that
may increase the risks such as over-exertion
injuries and musculoskeletal disorders. Addi-
tionally, workers who have developed fatigue at
work may have difficulties managing their non-
occupational duties leading to social problems.
Heavy work has been associated with negative
Figure 3.1.20. Pulmonary ventilation at rest and long-term health effects such as increased risk of
during 2-6 min of exercise (running or cycling). coronary heart disease, back, neck and shoulder
Four individual curves are presented. Several pain and osteoarthritis. Studies also suggest that
rates of exercise gave the same maximal oxygen
heavy occupational demands may accelerate the
uptake. Individuals with maximal aerobic up-
age-related deterioration of physical capacity,
take of 3 l/min or higher usually fall within the
shadowed area. Note the wide scattering at high contrary to the positive effects of physical train-
oxygen uptakes. *=individual values from top ing on physical capacity. The main reason for
athletes measured when maximal oxygen uptake the difference in effects between high physical
was attained. At oxygen uptake values up to activity during leisure time (e.g. aerobic train-
1.5-2.0 l/min the relationship is linear and thus, ing) and occupational activities is probably that
oxygen uptake may be estimated from values of the load in occupational work is not optimal in
pulmonary ventilation; from Åstrand, P-O et al,
intensity, frequency and duration. Most impor-
2003.
tantly, there may not be sufficient time for recu-
Oxygen uptake, heart rate and in some cases peration to allow central and peripheral adapta-
body temperature and pulmonary ventilation, tion that results in a training effect.
are suitable and valid measures for assessing the
general magnitude of physical load and strain, measures to prevent heavy work
(i.e. energetic and cardiovascular load), but these It is very important that workers are allowed to
measures are not suitable for measuring localised influence the pace of work and the frequency of
muscular strain. The load exerted on specific pauses particularly if elderly workers are to be
86
able to work until normal retirement age. How- suggestions for further reading
ever, high physical demands are unpredictable
and difficult to avoid in some occupations, e.g. Ainsworth B.E., Haskell W.L. et al. Compen
in fire and rescue services so it is important that dium of physical activities: Classification of
such workers maintain a high physical capac- energy costs of human activities. Med. Sci.
ity by regular physical training. Consideration Sports Exerc. 1993; 25(1): 71 – 80.
should also be given to possibilities to enlarge Åstrand P-O., Rodahl K., Dahl H.A. &
the range of work tasks to also include less Stromme S.B. Textbook of Work Physiology.
physically demanding tasks that allow physical Physiology Bases of Exercise: Human Kinetics;
recuperation. During very heavy work tasks mi- 2003.
cro pauses can also markedly reduce work strain
without reducing productivity. Physical load may Kroemer K.H.E. & Grandjean E. Fitting the
also be markedly reduced by increasing work task to the human. A textbook of occupational
efficiency. The use of technical aids, improved ergonomics. 5th ed. London: Taylor & Francis;
working methods, better design and mainte- 1997.
nance of work equipment and tools can greatly
reduce physical load and increase productivity.
The extent of physical strain should be ap-
propriately investigated before new work meth-
ods, equipment and tools for manual work are
introduced. These measurements should include
both assessments of energy and cardiovascular
demands (e.g. oxygen consumption, pulmonary
ventilation, heart rate) and neuromuscular de-
mands (e.g. muscular load, awkward postures,
repetitive movements and local pressure) as well
as psychological factors (e.g. motivation and
satisfaction).
87
3.2
Food, nutrition and work

Leif Hambræus
What is nutrition?
The process whereby living organisms utilise food for maintenance of life, growth, the normal function-
ing of organs and tissues, and the production of energy.
The science and study of the reaction of the body to intake of food, the variation in the diet, and to
other factors of pathological or systematic significance.
(Definition according to WHO/FAO/IUNS 1974)
nutrition in transition the nutritional situation as a result of changes in

In most countries there is an ongoing change in diet composition and physical activity character-
dietary habits and food availability. In the af- ised as nutrition transition in development. Obes-
fluent societies the transition from hunting and ity and cardiovascular diseases are now rapidly
gathering to agriculture took thousands of years, increasing in LIC, “the nutrition transition”,
and industrialisation about two centuries. This and the diet-health situation more and more
transition now occurs in the low-income coun- polarised in all countries. Thus the diet-health
tries (LIC) over a few decades. The concept of relation is valid for all types of societies and both
malnutrition which means “wrong nutrition” has malnutrition plus (pattern 4 and 5 below) and
a wider meaning today. The role of malnutrition malnutrition minus (pattern 1 and 2 below) oc-
in public health perspectives is no longer only a cur in all societies, i.e. in LIC as well as in afflu-
question of “undernutrition” i.e. lack of energy ent societies, and represent a great public health
and/or nutrients, often referred to as “malnu- concern. Nutrition transition in development
trition minus”. It also refers to effect of over- could be described as “a question of over-eating
consumption of energy and certain nutrients, and/or under-exercising”.
overnutrition or “malnutrition plus” leading to The following five broad patterns have been
obesity and cardiovascular disease. described in nutrition transition (Popkin):
Severe protein-energy malnutrition, e.g. 1. Collecting food (hunting and gathering).
kwashiorkor and marasmus, has decreased during The diet in pattern 1 is characterised by a varied diet
the last two to three decades as well as most vi- comprising plants and low-fat wild animals and the
tamin deficiencies under “normal” conditions in nutritional status characterised as robust with low body
fat percentage but fewer nutritional deficiencies. This is
LIC. However, on the same time some vitamin typical of the rural low-density population with low life
deficiencies now reappear as a result of environ- expectancy with high mortality essentially as result of
mental stress situations in refugee populations. infectious disease but few epidemics.
Although undernutrition, i.e. lack of energy
2. Famine (from acute to chronic lack of food)
and nutrients, still is a dominant nutritional
The diet in pattern 2 is characterised by a monotonous
problem in LIC, changes in urbanisation and so- cereal-based diet and the nutritional status is deteriorat-
cio-economic development also lead to shifts in ed especially within the vulnerable groups, i.e. children
89
Chapter 3.2
and women, with low fat intake, occurrence of nutrition- nomic development can be found in the World
al deficiencies and wasting and stunting. High infant and Health Chart on internet (http://www.whc.ki.se)
maternal mortality, low life expectancy and epidemics
and endemic diseases follow famines.
As most of the effects on health panorama are
related to the nutritional status of the individual,
3. Receding famine this also indirectly illustrates the public health
The diet in pattern 3 is still less varied although more
perspectives on the linkage between socio-econ-
fruits, vegetables and animal products occur, and a few
starchy items form the staple food. The nutritional status omy and nutrition.
is still dominated by mother and child health problems,
especially during weaning. However, there is a slow nutrients in food
mortality decline and population growth although infec-
All food contains a mixture of nutrients. The nu-
tion and parasitic infestations are common.
trients can be grouped into energy-yielding and
4. Degenerative disease typical of urban popula- essential nutrients and comprise macronutrients
tion and micronutrients.
The pattern 4 is typical of affluent societies with in-
creased urbanisation with a diet rich in empty calories Priority of nutritional needs
from high fat intake, especially animal fat, sugar and
processed foods with less fibre. This leads to increased Under normal conditions the body gives priority
prevalence of obesity and osteoporosis. Fewer jobs with to cover its energy needs, which can be covered
heavy physical activity together with increased mecha- from any of the energy-yielding macronutrients
nisation in jobs as well as households increase the risk
(carbohydrate, fat, protein and alcohol). Thus
of obesity. Life expectancy is high but chronic diseases,
e.g. cardiovascular disorders (CVD) and cancer, increase the energy need is essentially a matter of the
while infectious diseases decline. amount of food needed, i.e. a quantitative aspect
on the dietary intake.
5. Behavioural changes
The pattern 5 comprises behavioural changes as result of When the energy intake via the diet, i.e.
increased health promotion and lead to a diet with less in- exogenous energy, does not meet the energy need,
takes of fat and processed foods, and increased consump- energy is released from mobilisation of energy-
tion of fruits and vegetables. This in combination with an yielding substances stored in the body (glycogen
increased leisure exercise to combat physical inactivity in
job and household reduces the body fat content, as well as
in liver and muscle; fat from subcutaneous and
risk of developing obesity and osteoporosis. This results adipose tissue) but also from breakdown of tis-
in high life expectancy and reduced CVD. sues, essentially skeletal muscle, where muscle
protein is used as energy source through gluco-
An illustrative presentation of the changes in the neogenesis. Thus energy deficit results in muscle
health panorama and its relation to socio-eco- catabolism.
Energy yielding nutrients Essential nutrients

Macronutrients Macronutrients Micronutrients
Carbohydrate Water Trace elements

Fat Essential fatty acids Vitamins
Protein Essential amino acids
Alcohol Minerals i.e. calcium
Figure 3.2.1. Grouping of nutrients.
90
The nutrient needs refer to the specific need of Nutrient density

certain nutrients, i.e. protein, trace elements and Nutrient density refers to the amount of essential
vitamins but also water, leading to qualitative nutrients, i.e. protein, vitamins, minerals, per en-
aspects on the dietary intake. The requirement ergy unit (joule or kcal). Food items with a high-
of essential nutrients, i.e. protein, minerals, vi- energy content usually have a low nutrient den-
tamins, is essentially related to fat-free mass and sity. Thus high-fat, high-sugar containing food
to little extent to the extent of physical exercise. items result in a low nutrient density of the diet.
Thus nutrient requirement is related to age, sex
and body size and refers to a specific need of
certain nutrients. The concept of empty calories
Protein plays a two-fold role. There is (i) Components which are rich in fat and refined
a specific nutritional role as source of essential sugar have a high energy density while they on
amino acids for protein synthesis i.e. building the same time have a low content of essential
up, repairing and maintaining tissues; as well as nutrients, i.e. protein, trace elements, vitamins.
(ii) a non-specific role as an energy-yielding nutri- They contain what is sometimes called ”empty
ent. If energy needs are not met, protein will be calories”. A high consumption of such products
used as energy source, no matter if protein needs may be an easy and sometimes cheap way to
are increased and not met. If more protein is cover the energy needs. However due to their
consumed than specifically needed for protein low nutrient density there is a great risk to over-
turnover, which is the case in most affluent soci- consumption of energy leading to obesity before
eties, the surplus is used as energy source since the needs of the essential nutrients are met. The
protein can not be stored in the body. It is con- problem of a high intake of empty calories is
sequently not possible to discuss energy and pro- typical of the fat and sugar rich diet in affluent
tein requirements separately. This is of special societies.
relevance when discussing nutritional problems
in relation to physical performance. Consumption of energy-yielding
macronutrients
Energy density
With the aid of national food balance sheet data
The energy density of the food refers to the
on 85 countries Perissé and collaborators already
amount of energy per weight or volume. The
in 1969 made an attempt to identify the general
energy density of fat-rich items is higher not
trends of consumption patterns as a function of
only as fat has a higher energy value than carbo-
income. They could show that although the pro-
hydrate and protein (38 kJ vs. 17 kJ per g), but
tein energy percent (E%) was almost the same
also because fat-rich food items have lower water
in low-income countries and affluent societies,
content. Most concentrated energy sources in the
the amount of fat and refined sugar constituted
diet are oils which contain 100% fat, while butter,
much higher E% in the diet of affluent societies
margarine and lard contain about 80% fat, some
leading to increased energy density and reduced
low-fat spread as low as 40% or even 25%. Water
nutrient density. Although more than 30 years
constitutes the remaining percentage.
has passed since then, the same tendency in
energy percentage distribution between ma-
91
Chapter 3.2
Figure 3.2.2. Schematic presentation of nutritional role of essential and energy-yielding nutrients. Bold
lines refer to the major roles of protein, fat and carbohydrate. Dotted line indicates that there are only a
few essential fatty acids.
cronutrients occurs in rich and poor in affluent Figure 3.3.3 illustrates the interesting fact,
societies as well as in low income-countries. which is often not fully realised, that the energy
Complex carbohydrate sources (cereals, tu- in the diet derived from protein in the poor in
bers) represent the major energy source (about LIC represents 10-15 E% and is similar to that
70%) amongst the poor, especially in LIC, while in high-income groups. This leads to the follow-
the fat consumption is low (less than 10%). In ing two very essential conclusions:
the affluent societies fat constitutes 35-40% of 1) The higher protein intake in high-income
the energy intake, while the intake of complex groups is not due to a higher protein concentra-
carbohydrate only represents about 30-40%. tion in the food per se but to the fact that the
Refined sugar may constitute up to 17%. total energy consumption is much higher.
Units of energy
The old unit used in energy studies was the calorie, which referred to the energy needed to raise the
temperature 1 degree Celsius (from 14.5 to 15.5) in 1 g of water. This unit is still used in nutritional
science, especially kcal (=1,000 calories) in biological systems, sometimes referred to as Calorie (with
capital C).
Today Joule is used in most scientific papers dealing with energy as it is an SI unit.
To convert between calories and joule:
1 kcal = 4.186 kJ
1 kJ = 0.239 kcal
92
2) The high prevalence of protein deficiency are used: fruits and vegetables, meat, fish and
in low-income countries is essentially due to a milk; cereals; sugar and fat. Other systems use
too low total intake of food (i.e. energy), and 3 groups: body building foods, energy-yielding
not primarily due to a low protein content in foods and protective foods.
the food per se. The latter misconception has for The food square system was introduced as a
a long time lead to action programs for protein way to group food items from a combination of
and amino acid enrichment of food. nutritional and practical perspectives. It com-
prises four sectors:
The grouping of food items 1 staple food items
Many systems have been used throughout the 2 protein supplements
years to group various foods in relation to nu- 3 vitamin and mineral supplements
tritional perspectives. Sometimes five groups 4 energy supplements
Example
The energy density of vegetable oil is high, e.g. soy oil which contains 3.8 MJ (900 kcal) per100 g. The
energy density of potato is much lower, being 315 kJ (75 kcal) per100 g. This is due to the fact that
soy oil is almost pure fat, whilst potato, which is one of the highest energy-yielding crops per acre, con-
tains almost 80% water. On the same time the nutrient density of vegetable oil is very low, with excep-
tion for its content of fat soluble vitamins, but high for potato, which contains both protein, vitamins
and minerals in balance with the energy content.
Figure 3.3.3. Structure of the diet and income (country-level sources of energy, 1962).
93
Chapter 3.2
Case study: Food and nutrient intake in male adolescent Kenyan runners
A 2-week nutritional survey on 12 representative athletes, adolescent male Kenyan runners, showed
a diet very high in carbohydrate (71 energy%) and low in fat (15 energy%) while the total protein
intake (12 energy%) was still above the recommended daily intake according to FAO/WHO/
UNU. The energy intake was mainly derived from vegetable sources (90%) with maize and kidney
beans as staple foods constituting 81%. The diet met recommendations for endurance athletes for
total protein and most essential amino acids as well as carbohydrate intake even though based on a
small range of food items.
(Ref Christensen et al, Brit J Nutr 2002; 88; 714-717)
CONCLUSIONS
The balance between energy-yielding food items is a central problem in low-income countries as
well as in the affluent societies. The following conclusions can be drawn:
1. A diet which is adequate to cover energy needs of an individual will also meet the needs of most
essential nutrients if the content of empty calories is low.
2. It is not the quality of food per se that leads to malnutrition in low-income countries, but the fact
that the amount of food is too small. The solution of the malnutrition problem is consequently not
primarily to change the dietary habits but to increase the availability of food.
3. The high intake of fat and refined sugar in the diet of affluent societies, e.g. “empty calories”,
where they constitute more than 50% of the energy intake means that the intake of essential nutri-
ents is almost the same as in low-income countries despite the fact that they have almost double the
energy intake. If the diet in low-income countries had the same relative amount of empty calories,
their nutrition situation would have been much worse.
4. The food consumption pattern of high income groups in combinations with a too low energy
intake is deleterious to their health and thus affluent societies as well as low income countries the
dietary habits play an essential role for public health.
5. For people with low access to food or low energy needs there is a risk that the diet might not
provide enough essential nutrients, e.g. iron, unless
A. The consumption of food items with high nutrient density is increased
B. Food items are fortified;
C. Food supplements are used
D. Physical activity is increased as this leads indirectly to increased food intake to meet the extra
energy needs. The same diet may then cover the nutrient needs despite a low nutrient density as
the need of essential nutrients only to a very little extent is increased at higher energy turnover.
94
The reason for the introduction of this system Cereals are the essential source of most B-vita-
was that too little importance had been given mins, especially in whole meal and also contain
to the staple food as source of both energy and minerals and trace elements but these can be lost
essential nutrients and too much emphasis to during milling to flour. Wholemeal also contains
animal products as sources of protein. The antinutrients, phytin and tannins, which reduce
basis in this grouping is the staple food, which the bioavailability of minerals and trace ele-
contains the major and cheap part of the diet in ments.
most cultures and which also constitutes the ma- Roots and tubers (cassava, potato, and yams)
jor source of both energy and essential nutrients. have a higher water content than cereals which
Depending of which type of staple food that is leads to low energy density, but the energy yield
available there is a need to supplement with food per acre in agricultural production is high. The
items from the other groups in order to increase protein content may be low, only 2 weight%, but
the intake of protein, energy and minerals and energy wise it represents around 10 energy%.
vitamins. Potato has a relatively well balanced protein
constituting about 11 energy %, while cassava
Example is extremely low in protein which constitutes
How to use the food square system to plan a diet only 2 energy %. Some roots and tubers are rich
to supply the total nutrient needs of a 9-months- in vitamin C and those with an orange colour
old child contain carotenes, a pro vitamin A. The mineral
content is about the same as in cereals but they
Group 1 Group 2
contain fewer antinutrients.
– Staple food – Protein supplement
Cereal: 40 g wheat 15 g chick peas Legumes (cowpea, common beans, ground-
flour nut, and soy bean) are rich in protein which
Group 3 Group 4
constitutes about 20% both in relation to weight
– Vitamin-mine- – Energy supplement and energy content; some of them are also rich
ral supplement in fat (groundnut, soy bean). Legumes contain a
25 g dark green 10 g vegetable oil number of antinutrients (e.g. antitrypsin activity
leaves
in soy bean and lectins in brown beans) which
necessitates cooking for long time in order to
Nutritional characteristics of various food inactivate them. The legumes are good sources
groups of B vitamins.
Nuts and oil seeds (peanut, rapeseed, and
Cereals (wheat, rice, maize, corn, rye, and oats)
sesame, sunflower) are especially energy rich
constitute the major energy source in most diets
and have a low carbohydrate and water content
in affluent societies as well as low income coun-
giving them a high energy density. They are
tries. The water content is usually low, but the
usually good sources of B-vitamins but are low
dietary fibre content high, which leads to low
in vitamin A and C. The mineral content can be
energy density. Carbohydrate, essentially starch,
high especially iron and calcium. Nuts are essen-
constitutes about 80 % of the energy and pro-
tial sources of calcium for those who do not have
tein 10-15 %. The protein quality is not optimal
access to dairy foods.
due to low lysine content.
95
% of rec nutrient density % of rec nutrient densiity % of rec nutrient density
96
100
150
200
250
350
0
50
300
0
50
100
150
200
250
300
350
400
450
500
Pr Pr
ot ot
1000
2000
3000
4000
5000
6000
7000
8000
9000
0
10000
Pr ei
ot ei
n n
ei
n
Chapter 3.2
Fa Fa
Fa Ca t Ca t
Ca t lci lci
lci um um
um
I ro Iro
I ro Re n Re n
Re n tin tin
tin ol ol
ol eq eq
eq Th v v
Th v ia Th
ia m ia
m in m
in e in
Ri e Ri
bo Ri e
bo fla b of
fla vin la
Ni vin Ni vin
ac ac Ni
Potato 1250 g = 1000 kcal

in ac
Milk 1670 ml = 1000 kcal
in
Spinach 6250 g = 1000 kcal

eq eq in
v Fo v eq
Fo
lic Fo v
A s lic a As ac li c
co cd co d As ac
rb
ic
rb
ic
co d
rb
ac
id
ac
id ic
ac
id
% of rec of rec nutrient

% nutrient densitydensity %%
of of
recrec
nutrient densiity
nutrientdensity % of rec nutrient density % of rec n
P
0
50
100
150
200
250
300
350
400
450
500
0
50
100
150
200
250
300
100
150
0
50
1500
2000
2500
3000
3500
4000
4500
0
500
1400
1600
1800
2000
10000
200
400
600
800
1000
1200
0
200
400
600
800
1000
1200
1400
1600
1800
2000
Pr Pr P r rot Pr Pr
ot ot ot ot
e in ei
ot e i
ei n ei
n
ei
n
n n
Fa Fa Fa Fa Fa
t Fa t
The values refer to per cent of recommended nutrients per 1000 kcal.
Ca C t Ca Ca t Ca t Ca t
l ciu a lc
m i um
lci lciu
um m
lci
um
lci
um
I ro
I ro I I ro
Figure 3.2.4. Nutrient profiles of various food items based on nutrient density.
Rn Iro
Re Iro
tin et n Re Re ron n Re n Re n
ol
e
in tin tino t tin
in
ol o l le
T h qv eq e q ol ol
ia T v eq
v
eq
m h ia
T h T h qv v
ia ia m Th Th v
in m in ia ia
Ri e m in
e
i m m
bo R in in
e e
Ri Ri b ne e
fla ib bo o Ri Ri
vi ofla fla fla bo b
Ni
a c Nn vin v fla of
la
Ni Nia vin in
Papaya 2080 g = 1000 kcal
i n ia
Potato 1250 g = 1000 kcal
ac c vin vin
Chickpea 267 g = 1000 kcal
e ci Ni Ni
in in
Chickpea 267 g = 1000 kcal
F o qv n e e q e ac
in
ac
in
Rice 278 g = 1000 kcal
lic F qv
As a o
F o F o qv v eq eq
c o A c d lic l li
A s A s ic a c a Fo v Fo v
rb sc ac l ic li c
ic o d co co cd cd As ac As
a c rb rb r b ac
id ic ic ic co d co d
ac a c ac rb rb
id id id ic ic
ac ac
id id
Vegetables and fruits (amaranths, tomato, However the nutrient profile should be evalu-
onion, banana, citrus, papaya, mango, and guava) ated in relation to the amount to be consumed
have high water content and low fat content and when covering the energy needs. Please observe
consequently a low energy density. The protein that due to differences in energy density the
energy percent may be about 5 % .They are amount that contains 1000 kcal varies consider-
good sources of vitamins and provitamins and ably between the food items. In this example
dark leaves also of folate and iron. 1000 kcal is found in 1.7 kg of milk; 0.3 kg of
Animal products (milk, meat, fish, and egg) rice; 1.3 kg of potato; 2.4 kg of carrot; 0.3 kg of
are usually expensive products in most LIC. chickpea; 6.3 kg of spinach and 2 kg of papaya.
Animal products contain almost no carbohydrate The energy and nutrient content per weight
and the energy density varies with its fat con- or volume is given in food tables. Most food
tent. The protein content is usually high and the tables have to be somewhat region specific be-
protein quality high. They are also good sources cause environmental factors interfere with the
of most vitamins and minerals and trace ele- quality of the product. Furthermore one has to
ments with a high bioavailability. Dairy products know whether the values refer to crude products
are extremely good calcium sources. or the edible part of the product and if they are
Fats and sugars (coconut, oil palm, rape raw or prepared.
seed, sesame, beet sugar, and cane sugar) have
a high energy density but low nutrient density. Two alternatives of meal composition
They contain no protein and play a little role as The two alternatives in Figure 3.2.6 and 3.2.7
source of vitamins with two exceptions: the high may to some extent illustrate the differences in
content of beta-carotene in red palm oil, and a meal in an affluent society versus that in low
vitamin E in vegetable oils. income countries. It shows that it is no problem
to cover the same energy intake in a vegetarian
Nutrient profile meal as in a mixed meal based on vegetable and
The nutritional density for various food items animal products. However, the protein amount
can be illustrated by the nutrient profile. This is only 2/3 and the calcium content only half
refers to the nutrient content of various foods in the vegetarian diet meal. The role of sesame
per energy unit, expressed as per cent of the milk as calcium source as alternative to dairy
recommended intake of that specific nutrient per products in the mixed diet is also illustrated.
energy unit for the consumer. Thus the nutri- Figure 3.2.8 illustrates the amounts of nu-
ent profile differs for a food item in relation to trients when 100 kcal is consumed of various
the intention of its use. The nutrient profile of potato products. Thus 100 g of boiled peeled
cereals when used for a 1-3-year-old child differs potato contains the same energy as 18 g potato
from that when used of an adult male. However, chips but has a negligible amount of fat, while
in this way it is easy to illustrate the nutritional more than 50% of the energy is derived from fat
characteristics of the various types of foods. The in potato chips.
following figure illustrates the nutrient profile
of some food items (cow’s milk as well as food
items of vegetable origin (rice, potato, chickpea,
spinach and papaya) used in the diet of adults.
97
Chapter 3.2
Protein Fat Calcium Iron Retinoleqv Thiamine Riboflavin Niacin Folic Ascorbic
eqv acid acid
Milk 178 186 295 12 84 112 333 191 52 0
Rice 62 20 15 36 0 222 16 250 28 0
Potato 67 5 8 74 0 125 56 340 102 430
Carrot 76 9 130 59 8000 203 136 383 213 456
Chickpea 1710 47 668 1840 27 133 44 183 300 0
Spinach 372 116 969 1250 7750 105 2090 1250 7580 8900
Papaya 39 8 83 210 833 103 69 119 0 4034
Figure 3.2.5. Nutrient content in per cent of recommended amount per 1000 kcal in various food items.
Source Total Energy Protein Fat Carbohydrate Iron Calcium Vit C

gram kJ gram (E%) gram (E%) gram (E%) mg mg mg
Milk 3% 200 494 7 (24) 6 (45) 9 (31) 0.2 226 1.2
Bread 35 409 2 (9) 1 (10) 19 (81) 1.8 9 -
(wheat/rye)
Margarine 20 624 - 16 (100) 0 - - -
Cheese 20 272 7 (44) 4 (54) 0.3 (2) 0.1 187 -
Apple 100 272 0.2 (1) 0.6 (8) 15 (91) 0.3 7 10
Total 2071 16 (14) 28 (50) 43 (36) 2.4 429 11.20
Figure 3.2.6. A mixed meal, in an affluent society, comprised of one glass of milk (200 ml), one slice of
wholemeal bread (35 g) with margarine (20 g) a slice of cheese (20 g) and an apple (105 g) has a total
energy content of 2071 kJ.
Source Total Energy kJ Protein Fat Carboh Iron mg Calcium mg Vit C mg

gram gram (E%) gram (E%) gram (E%)
Rice 40 600 3 (8) 0.2 (1) 32 (91) 0.3 10 -
Chickpea 22 340 5 (23) 1 (10) 13 (67) 1.5 33 -
Spinach 19 20 0.2 (15) 0 1 (85) 0.1 5 4
Sesammilk 100 300 2 (11) 6.4 (78) 2 (11) 1.6 111 -
Oil 15 564 - 15 (100) -
Clementine 150 225 0.8 (7) 0.2 (3) 12 (90) 0.4 40 50
Total 2049 11 (9) 22.8 (41) 60 (50) 3.9 199 54
Figure 3.2.7. A vegetarian meal, in low income countries, composed of 40 g rice, 22 g chickpea, 19 g spin-
ach, 100 g sesame milk, one clementine (150g) and 15 g vegetable oil has a total energy content of 2049
kJ.
98
Raw potato Boiled potato Pommes frites Potato chips

Amount (g) 124 104 30 18
Protein 2.2 1.7 1.3 1.0
Fat 0.6 0.6 5 6
Carbohydrate 21 22 12 11
Energy %
Protein 9 7 5 4
Fat 5 5 45 54
Carbohydrate 86 84 48 44
Iron 1.4 0.7 0.4 0.3
Vit C 13 7 - -
Thiamine 0.05 - - -
Niacin Eqv 1.8 1.3 - -
Figure 3.2.8. Nutrient content per 100 kcal in various potato products. The figure illustrates that product
development in affluent societies does not always lead to better products from the nutritional point of
view. This also explains why dietary changes in affluent societies such as when boiled potato is substituted
by potato chips lead to increased energy and decreased nutrient density in the diet.
Change in dietary habits in Sweden “Diet and Exercise” to formulate recommenda-

Blix classical studies of the dietary habits in tions. The “Diet and Exercise” campaign which
Sweden showed that the nutrient density was was started in 1971 and the uniqueness of this
the same in high-energy consumers, e.g. lumber campaign was that dietary habits were discussed
jacks, and low-energy consumers, e.g. female together with exercise habits from a public
office clerks. This indicated a potential risk of health point of view. The campaign also in-
deficient intake of essential nutrients in low-en- cluded a close collaboration between the health
ergy consumers. sector, athletic organisations, food producers
On the same time analysis of the change in and food industry in the campaigns as well as the
life style and dietary habits during the 20th cen- use of health promotion in marketing food.
tury showed a decrease in total energy turnover Despite all these efforts, nutritional perspec-
of about 30% in the Swedish population during tives on food production and agricultural policy
the last 40 years and a simultaneous increase in in Sweden are meagre. The interest from the
energy density in the diet as a result of intake National Board of Health and Welfare for nu-
of empty calories, i.e. fat and refined sugar. As tritional problems have deteriorated and the
shown in Figure 3.2.9 the peak in fat intake oc- responsibility for nutrition and food policy has
curred during the 1950’s. been taken over by the Food Administration and
The result from studies on dietary habits the Public Health Board, but with less resources
motivated a campaign for better eating habits, and collaboration with athletic organisations and
and the Swedish National Board of Health and the food industry. Interestingly when the Diet
Welfare established an Expert Committee on and exercise campaign, which was unique inter-
99
Chapter 3.2
CONCLUSIONS
There are many ways to cover the nutrient and energy requirements by a combination of various
food items. The essential point is to keep a certain nutrient density in the diet by combination of
foods which makes it possible to cover the nutrient needs without leading to any malnutrition prob-
lems due to too low or too high intake of energy or certain nutrients. This calls for a certain basic
knowledge of the nutritional value and characteristics of various food items. The more monotonous
diet and lower physical activity as in a sedentary life, the greater is the risk to develop malnutrition
problems. A mixed diet in combination with less sedentary life minimizes the risk to develop nutri-
tion deficiencies and deleterious effects on health.
nationally ended, the United States started its ommended that all countries, affluent as well as
program “Dietary guidelines for the Americans low-income countries, need to establish a food
2000” by stressing the ABC:s : Aim for fitness, and nutrition policy. This was further stressed in
Build a healthy base and Choose sensibly. the 1992 conference which also called for a plan
Also in an international perspective the im- of action for food and nutrition policy. Interest-
pact of nutrition perspectives on food and agri- ingly in 1996 conference it was stressed that the
culture policy is still very limited. UN-confer- food availability for the individual is not only a
ences in Rome 1974 (World Food Conference), question of nutritional requirements but also a
1992 (International Conference on Nutrition) political question of human rights.
and 1996 (World Food Summit), all have ended One of the reasons for the problems to get an
in recommendation to all countries to establish a impact of nutritional perspectives on food policy
national food policy. The 1974 conference rec- is that it interferes with agriculture and indus-
1886-95 1896-1905 1906-15 1920-29 1930-39 1950-59 1989 1997
ENERGY 2331 2708 2954 3036 3114 2825 2057 2116

kcal
PROTEIN 63 74 81 82 87 73 75 82
g
FAT 49 66 78 94 111 120 84 82
g
PROTEIN 11 11 11 11 12 11 15 16
E%
FAT 20 23 25 29 33 39 36 34
E%
CARBOHYDR 69 66 64 60 55 50 47 47
E%
Figure 3.2.9. Nutrient and energy intake in Swedish population during 100 years.
100
Figure 3.2.10. Relation between energy intake and some nutrients in Swedish population.
101
Chapter 3.2
trial interests. Agriculture production and food balance. Changes in body composition are con-
industry are considered as positive factors and sequently of great interest from the nutritional
the consumer needs unfortunately as negative point of view. The body fat content is the major
factors from national economy point of view. We indicator of the nutritional status of the indi-
are in the public health sector still fighting to get vidual and consequently most methods to study
politicians and the market to recognize a healthy body composition comprise methods to evaluate
population as a human capital of at least the same body fat.
economic value as industrial production. Without From the nutrition point of view the problem
a good health there are no workers in the factories of energy is essentially related to the balance
and the production per capita limited. Optimal between energy intake via the diet and energy
nutrition is the key for productivity and socio- expenditure, which comprises energy costs of
economic development in all societies. body maintenance and function as well as physi-
cal work. As the body gives priority to cover
energy turnover its energy need and this can be covered from
Energy balance and body composition carbohydrate and fat as well as from protein, the
closely related energy turnover cannot be discussed separately
The priority of dietary intake is to guarantee a from protein turnover.
normal body composition and body function. It This means that energy deficit leads not only
is estimated that cell mass constitutes about 55% to a mobilisation of energy stores but indirectly
of the body weight and the extracellular tissue also has an impact on protein turnover and
30% and fat 15%, respectively, under normal body function. Consequently methods to ana-
conditions in a healthy adult man. Water is an lyse energy balance are essential to evaluate the
essential component constituting about 73% metabolic and physiological complications in all
of the fat free mass. Body fat is related to age situations.
and sex, which must be taken into consideration
Energy store in the body
when the data are analysed. The fat content is
also of importance for the endocrine (hormo- The immediately available energy source in the
nal) function, especially in females. A body fat body is in the form of ATP and creatine phos-
content less than 17% is assumed to be affiliated phate. However as indicated in the table, from a
with disturbed menstruation. quantitative point of view, they only constitute
Changes in body fat not only reflect energy a negligible amount and at energy deficit the
balance, but also indirectly protein balance, energy substrates stored in the body have to be
which is influenced by the energy balance, and mobilised almost immediately. Based on calcula-
thereby secondarily also water and electrolyte tions of the available energy stored in the body,
CONCLUSIONS
There is still an urgent need to get a better response from the politicians to recognize the impact of
malnutrition, both over- and undernutrition, on public health and productivity in the population in
both affluent societies and low income countries.
102
Figure 3.2.11. Various levels in compartmentalisation of the body composition.
see Figure 3.2.12, a normal person may survive

6-8 weeks without food. Energy source Amount Energy covers energy need
Content during basal
Please observe that although the adipose metabolism
tissue represents the biggest energy store, body (hrs)
protein constitutes a substantial fraction of the (kg) (MJ)
total energy store in the body.

The body gives priority to use carbohydrate ATP 0.0005 0.002
Creatine 0.015 0.006
as energy source. However, blood glucose only phosphate
represents a minor role and while liver glycogen Carbohydrate 0,6 8.5 6-12 hrs (Liver
glycogen)
is available for total energy turnover in the body, Protein 14 32 10-12 days
muscle glycogen is only used as energy source in (only 50% can be
the same muscle and not for energy use in other used)
Fat 10,5 390 20-25 days
muscle groups.
Body fat constitutes the dominant energy (The values refer to a male body weight 70 kg, body fat 15%,
and 200 g protein/kg)
source in the body. However, the amount of fat
in the cell membrane, often referred to as essen-
tial fat, is not mobilised during fasting state. Figure 3.2.12. Energy store in the body.
103
Chapter 3.2
Although the total protein content in the body tone bodies at energy deficit. This is one of the
might correspond to 20% of the weight only reasons why a negative energy balance already
about 50% of the body protein, essentially skel- at an early stage leads to disturbances in protein
etal muscle protein, can be mobilised as energy turnover and muscle catabolism. Protein catabo-
source. lism then secondarily results in disturbances in
During energy deficit leading to a negative the electrolyte and endocrine balance, as they
energy balance the following stages can be ob- are regulated by hormones, which are proteins.
served in the change in mobilisation of endog-
enous energy: The concept of BMI (Body Mass Index)
Under normal conditions the best indicator of
Phase Dominant energy balance is a constant body weight. Daily
energy source Time span variations in body weight are essentially influ-
1 Nutrient absorption in enced by changes in body water content, which
gastrointestinal tract 1–6 hours is explained by the fact that water constitutes
2 Glycogenolysis Day 1–3
about 60-65% of body weight or about 73% of
3 Gluconeogenesis Day 1–7
4 Ketosis (lipolysis) After 3–4 days the fat free mass. However, in a longer perspec-
5 Reduced gluconeogenesis tive, the body weight indicates changes in fat
Increased utilisation of ketone bodies stores in the adipose tissue and to a less extent
in the central nervous system After > 2 weeks
by changes in muscle mass.
Based on this the concept of BMI as indicator
Figure 3.2.13. Mobilisation of energy in the body. of obesity was introduced. This is also known as
Quetelet´s index and calculated as follows:
During the first hours after eating, the energy Body weight in kg / (height in meter)2.
from food intake dominates as energy source.
After this the first immediate available energy BMI is used as indicator of total body fat, which
is derived from the carbohydrate sources, blood is related to the risk of disease and sudden death.
glucose, liver glycogen and muscle glycogen. The score is valid for both men and women but
Almost simultaneously the body starts to mobi- it does have some limits. As increased muscle
lize energy from protein breakdown resulting mass may also give rise to overweight and high
in gluconeogenesis. It is first at a later stage that BMI-values, it means that there is a risk to over-
the large energy store in the body, fat in the estimate body fat in athletes and people with
adipose tissue, is mobilised, ketosis and lipolysis. increased muscle mass. On the other hand BMI
Please remember that the central nervous system values may underestimate body fat in older per-
uses carbohydrate as energy source and that it sons with a lower muscle mass than the reference
takes some time until it has converted to use ke- person.
104
Classification of obesity by BMI Country Men Women Year

The BMI is often used in medical examinations
England 15 17 1995
as a health indicator and for risk evaluation of Czech Republic 16 20 1988
individuals in preventive health care. The fol- Finland 14 11 1991/3
lowing ranges are given using BMI score as indi- Netherlands 8 8 1995
cator of the nutritional status of an individual. Sweden 5 9
1988/89
Age (years) Desirable BMI range Iran 3 8

19-24 19-24 1993/94
Kuwait 32 44 1994
25-34 20-25
Cyprus 19 24
35-44 21-26 1989/90
45-54 22-27
Mali 1 1 1991
55-64 23-28 Mauritius 5 15 1992
> 65 24-29 Tanzania 1 4
1986/89
Figure 3.2.14. Desirable ranges of BMI with age. South Africa black 8 44 1990
USA 20 25 1991
BMI Brazil 6 13 1989
Underweight < 18.5
Normal 18.5-24.5 Australia 12 13 1989
China 0 1 1991
Overweight 25.0-29.9
Japan 2 3 1993
Obesity > 30 Samoa (urban) 58 77 1991
(rural) 42 59 1991
Figure 3.2.15. BMI scoring.
Figure 3.2.16. Prevalence of obesity (BMI > 30) in

The differential diagnosis between obesity and
the last decades.
increased muscle mass as cause of high BMI
values calls for analysis of total body fat using Figure 3.2.17 shows the trends in prevalence
more specific methods. This is of certain interest (%) of underweight and obesity in female adults
for risk evaluation in individuals with high BMI in a middle-income country such as Brazil. It
values. illustrates the effect of nutrition transition dur-
ing 1975 to 1997 and the occurrence of regional
Occurrence of obesity
differences.
As indicated in Figure 3.2.16 obesity represents The figure illustrates that there is a trend to
a problem in affluent societies as well as low-in- reduced underweight and increased obesity in
come countries during the last decade both the poorest and the richest. The southeast
It is obvious that problems of obesity and region is however of special interest as not only
dietary excess represent an increasing challenge obesity is more prevalent in the poorest than the
for most societies where urbanisation increases. richest in 1997, there is also an increase in un-
This could be described as a result of over-eating derweight in the poorest from 1989 to 1997, and
or under-exercising per se or in combination. a decrease in overweight in the richest. These
105
Chapter 3.2
CONCLUSIONS
The best indicator of energy balance is a constant body weight.
Calculation of BMI is of great help as indicator of body fat for risk evaluation of obesity but has its
limitations.
In short term perspectives changes in body weight are not reliable indicators of energy stores. Since
fasting leads to mobilization of glycogen, which contains 2.7 g water per g glycogen, only 30% of
weight changes of the immediate weight loss indicate changes in energy stores.
In long time perspective weight changes are better indicators of energy stores, as there is no water
stored with fat in adipose tissue almost all weight changes are due to mobilisation of fat from the adi-
pose tissue during nitrogen balance.
During energy deficit there is always an increased protein catabolism essentially from muscle catabo-
lism initially.
changes might be due to rural-urban migration which may include a conversion between various
and changes in the socio-economic conditions. forms of chemically bound energy (see below). An
energy imbalance may also result in changes in
The energy equation body temperature.
According to the first law of thermodynamics
energy in must balance energy out, which leads Conversion of energy intake via the diet to
to the following equation: metabolisable energy
Ediet + Estore#1 = Eurine + Efaeces + Emiscellaneous + Ework The energy content of foods is released during
+ Eheat + Estore#2 + Ebody temperature change oxidation of the organic compounds protein, fat,
carbohydrate and alcohol. Of practical impor-
The energy intake side of the equation comprises tance is however to differ between the chemi-
the chemical energy bound in the food consumed cally bound energy which is released as a result of
(dietary intake) (Ediet) and available in body stores complete oxidation, and the metabolically avail-
(Estore#1) able energy which takes into account the energy
The energy “losses” comprises not only real losses during synthesis and catabolism i.e. due to
losses from the body by excretion of components absorption ratio, costs for transport and storage,
in urine and faeces but also components that and excretion of waste products.
represent the costs of metabolic turnover and the Thus the energy value of food items in abso-
conversion of chemically bound energy from one lute terms is not directly the same as the meta-
energy source to another as well as to mechanical bolically available energy. In order to estimate
(Ework ) and thermal energy (Eheat). the metabolically available energy the energy
The equation also comprises the changes in content of food (Ediet ) should be reduced by the
body energy stores (i.e. glycogen in muscle and energy losses in urine and faeces: Eurine + Efaeces .
liver, fat in adipose tissue, protein in the muscles Thus, although the physical energy value of pro-
(Estore#2 - Estore#1 ) as well as in body temperature tein is 23.6 kJ per g the metabolically available
(Ebody temperature change) energy is only 17 kJ, since the metabolic cost of
When the energy intake is higher than energy using protein as energy source is substantial, due
losses, the surplus is stored as energy reserve, to the costs of gluconeogenesis as well deamina-
106
Region and income group Underweight Obese

BMI < 18.5 BMI > 30
1975 1989 1997 1975 1989 1997
Brazil 13 8 7 6 11 12
Northeast region 16 10 8 4 8 13
25% poorest 18 11 10 3 5 8
25% richest 12 6 6 7 10 15
Southeast region 11 5 5 8 14 12
25% poorest 14 6 9 6 11 14
25% richest 7 4 3 8 14 9
Figure 3.2.17. Underweight and obesity prevalence in adult females in Brazil and its regions.
tion and urea excretion secondary to protein tion (homeostasis) and result in various efficiency
oxidation. This is a further reason for the waste in energy utilisation as indicated in the example
of resources to use dietary protein as energy below:
source in the diet. Figure 3.2.20 shows that starting from the
The Atwater factors refer to the metabolisable same energy substrates, based on glucose and
energy (carbohydrate and protein 17kJ, fat 38 kJ) a fatty acid (palmitic acid), the metabolism can
and were introduced in order to help to estimate be performed in two different ways, via direct
energy intake from data obtained at chemical oxidation (alternative 1) or in two steps (alter-
analysis of food constituents. native 2) where part of the glucose is first con-
verted to fat through lipogenesis and oxidised at
kJ/g kcal/g a later stage. Interestingly the final production
Protein 17 4 of energy differs depending on which meta-
Fat 38 9 bolic way that is chosen. It is still not known to
Carbohydrate 17 4 which extent and why the body can select the
Alcohol 29 7
metabolic pathway, but this might have an im-
Figure 3.2.18. Metabolisable energy. pact of different tendency between individuals
to become obese. Thus “inefficient” metabolic
Are all calories “equal”? interconversion leaves 6% less energy available
Energy balance comprises the conversion of to perform other metabolic or physical work or
energy in various forms with different efficiency. to be stored in the adipose tissue! Consequently
“Man is built for carbohydrate oxidation”. Con- not only the type of energy substrate but also the
verting energy from protein means a substantial choice of metabolic pathway, is as essential as the
loss of chemically bound energy. Changes in total energy intake for optimal energy balance,
the use of various substrates for energy store or i.e. less risk to develop obesity.
utilisation may have an impact on energy regula-
107
Chapter 3.2
Alternative 1 Alternative 2
Oxidation in 1 step Oxidation in 2 steps

18 C6H12O6 + 2 C16H32O2 + 154 O2 9 C6H12O6 + 8 O2
1)
→ 140 CO2 + 140 H2O → 2 C6H12O6 + 22 CO2

RQ = 0.91* RQ = 2.75*
906 moles ATP generated 12 moles ATP generated
2) 9 C6H12O6 + 4 C16H32O2 + 146 O2
→ 118 CO2 + 118 H2O
RQ = 2.75*
* calculated respiratory quotient (CO2 / O2 ) 840 moles ATP generated
Conclusion: Difference in generation of ATP 906 vs. 852.
Figure 3.2.20. Efficiency in energy conversion differs depending on metabolic pathway used
Example: Oxidation of glucose and palmitate (9:1) (cited from Simonson & DeFronzo, 1990).
Energy turnover in the body is based on tion will consequently have an effect on energy
oxidation needs. Changes in body temperature increases
The release of energy in the body comprises an BMR with 10% per centigrade.
oxidation of the chemical components which 2. Thermogenesis due to physical work
leads to heat production, thermogenesis. The Any form of physical activity and muscular work,
following forms of thermogenesis occur during i.e. the conversion of chemically bound energy to
the energy turnover in the body: mechanical energy, leads to heat production. The
1. Basal thermogenesis Basal Metabolic efficiency of the energy conversion to mechanical
Rate (BMR) refers to the energy needed for the work in the muscles is calculated to be about 25%,
basic function of the body, i.e. keeping body i.e. equivalent to what is reported for a two-stroke
temperature, heart and lung function as well as engine. It seems to be the same for all, no matter
the chemical processes in various metabolically if they are well trained or not. Better technique
organs that keep us alive, i.e. liver and kidney. may however call for less muscle work in some
BMR is measured under standardised condi- individuals to perform physical work.
tions of thermal neutrality (around 25ºC) when 3. Dietary induced Thermogenesis (DIT)
the body is at complete rest and not moving but DIT (earlier called specific dynamic action, SDA)
awake. It is usually measured in the morning just refers to heat production due to the oxidation of
after the individual has been awake. The lowest various chemical compounds in the liver as well
metabolic rate is usually recorded during sleep as increased circulation of blood in the digestive
in the early morning (between 3.00 and 5.00 tract. Maximal effect of DIT is observed about 6
AM) and called sleeping metabolic rate (SMR). hours postprandial. DIT usually represents 5-15%
The amount of energy needed for maintaining of the energy content of the substance, depending
the basal metabolic rate (BMR) in order to keep on the relative amounts of energy-yielding sub-
an individual healthy varies with the person’s strates.
age, weight, and sex as it is related to the amount 4. Environmentally induced Thermogenesis
of active cell mass. Differences in body composi- Environmentally is essentially related to ther-
108
Energy turnover Protein turnover
Physical
activity
(PAL) Variable
Anabolism
Growth
pregnancy,lactation
Basal
metabolic Obligatory
Stationary
rate nitrogen loss
(BMR))
Figure 3.2.21. Stationary and variable parts of energy and protein turnover.
moregulation of the body. Optimal clothing can protein synthesis, and energy stores, e.g. fat and
reduce the effect of the environment. However glycogen, should be added. The basal meta-
it is not only a problem of energy losses in a cold bolic rate represents a stationary phase, which
climate but also the cost of cooling at high tem- does not vary from day to day. The addition for
perature during sweat production. physical activity may vary considerably from
0.25 to 20 times BMR (when lying continuously
Energy and nutrient turnover for survival or during short time heavy physical
The energy turnover is based on essentially activity, respectively).
two compartments: the need to keep the basal The turnover of essential nutrients, i.e. pro-
metabolism and the energy needed for physical tein, minerals and vitamins, also comprises two
activity. During phases of growth and anabolism compartments, one stationary phase which is
the energy costs of synthesizing tissues, e.g. related to the maintenance of various tissues,
Age Men Women

MJ/24hrs Kcal/24hrs MJ/24hrs Kcal/24hrs
0-3 0.255W - 0.226 60.9W+54 0.255W - 0.214 61.0W - 51

3-10 0.0949W+2.07 22.7W+495 0.0941W+2.09 22.5W+499
10-18 0.0732W+2.72 17.5W+651
19-30 0.0640W+2.84 15.3W+679 0.0615W+2.08 14.7W+496
31-60 0.0485W+3.67 11.6W+879 0.0364W+3.47 8.7W+829
>60 0.0565W+2.04 13.5W+487 0.0439W+2.49 10.5W+596
Figure 3.2.22. Calculation of BMR based on age, sex and body weight (W). Source: FAO/WHO/UNU
1985.
109
Chapter 3.2
and a variable phase which is related to periods Exercise

of anabolism, i.e. during growth, convalescence,
pregnancy and lactation when new cells are Calculate your own BMR by filling in your
formed. The stationary phase is by far the domi- data below and use the accurate equation
nant part.
BMR, which is related to fat free mass (FFM), Sex Male/Female
will be rather stable from day to day and can be
Age ……. Years
calculated by means of equations based on em-
pirical data. Weight ……. Kg Equation used:
The 2005 report from FAO/WHO/UNU
developed new equations for predicting energy Result MJ/Kcal
expenditure in infants and boys and girls and
reported 18-20 per cent lower energy require-
ments for boys and girls under the age of 7 sex, height and weight) for calculation of BMR.
years, 12 and 5 per cent lower values for boys In the 1985 version of the international en-
and girls, respectively, between 7 and 10 years of ergy and protein requirements (WHO/FAO/
age, and 12 per cent higher for adolescent boys UNU 1985) the daily energy requirement of
and girls when compared to the values given in man expressed as multiples of BMR (BMR fac-
the 1985 report. No changes were suggested for tors) was first introduced.
the equations given for adults. Various activities in daily life as well as dur-
During some periods in life energy is needed ing various forms of physical activities should be
for building new tissues, i.e. growth. This com- expressed as multiples of BMR, often character-
prises not only the energy stored in the tissues ised as BMR-factors (FAO/WHO/UNU, 1985;
but also the energy costs for synthesis and build- James & Schofield, 1990), PAR (physical activity
ing up new tissue. This is especially commented ratio) or MET-values (MET = metabolic energy
in the 2005 version of the energy requirements. turnover) (Ainsworth et al, 2000). In this case
the BMR or MET-factor multiplied by the min-
The concepts of BMR factors and PAL levels utes of physical exercise times BMR (expressed
The total energy turnover comprises basal meta- per minute) gives the total energy turnover for
bolic rate (BMR) as well as the energy needed that specific activity (FAO/WHO/UNU, 1986).
for daily life. Based on large population stud- The total energy turnover (ET) per 24h can
ies, equations have been established in order to then be calculated based on BMR with the ad-
calculate BMR with reasonable accuracy based dition of energy for various physical activities
on anthropometrical data (weight, length, age based on intensity and duration throughout the
and sex) (FAO/WHO/UNU, 1985). In order to day. The total energy turnover (ET) in relation
calculate the total daily energy needs, informa- to BMR per 24 hour is an indicator of the Physi-
tion of life style of the individual must then be cal Activity Level (PAL) of the individual, thus
known, i.e. time spent on various forms of activi- expressing the life style. This concept of lifestyle
ties (sleeping, sitting, walking, household work) includes physical activity during work as well as
in addition to basic anthropometric data (age, during leisure time.
110
Category PAL value lifestyles refer to those who are regularly engaged
in strenuous work or strenuous leisure activities
Sedentary or light activity 1.40 – 1.69 for several hours a day.
lifestyle
The 2005 report also stresses that extremely
Active or moderately 1.70 – 1.99 low energy expenditure ( i.e. PAL=1.27 in the
active lifestyle
1985 report) allow for survival but are not com-
Vigorous or vigorously 2.00 – 2.40* patible with long term health and that food sup-
active lifestyle ply should satisfy a PAL of 1.40, i.e. the lower
* PAL values > 2.40 are difficult to maintain over a limit of sedentary lifestyle, also in short-term
long period of time relief interventions.
To calculate a person’s daily energy need, his
Figure 3.2.23. Classification of lifestyles in rela- or her BMR value should be multiplied with the
tion to the intensity of habitual physical activity
relevant PAL value.
or PAL (FAO/WHO/UNU 2005).
Figure 3.2.24 shows the changes in energy
Sedentary light activity lifestyles occur in those turnover in a male subject with age during his
who are only occasionally engaged in physically active working period. The y axis refers to MJ
demanding activities during or outside working per 24 hours and the columns illustrate total en-
hours (PAL around 1.55). Active or moderately ergy turnover with age as a result of differences
active lifestyles refer to individuals with seden- in body size and body composition and how this
tary occupations who spend a certain amount of has an impact on total energy turnover related
time in moderate to vigorous physical activities to various physical activity levels with age, using
(PAL around 1.75). Vigorously or vigorously active the WHO equation. The values refer to a nor-
Examples of daily energy needs (24 hrs) = BMR x PAL
Example I:
A 33-year-old woman weighs 55 kg. She does housework and cultivates her fields. She has a heavy physi-
cal activity level so her PAL is 1.82. Her BMR is calculated to be 1308 kcal/day (5.47 MJ) and her daily
energy needs are:
5.47 x 1.82 = 9.96 MJ (2380 kcal)
Please note that according to statistics she does not “work” although she has a high PAL
Example II:
A 25-year-old man, weighing 60 kg who usually has a moderate PAL level (1.78) is biking 2 hours at a
speed of 15 km per hour (MET=4.0). This leads to a total energy turnover of 4 times BMR during these
two hours and will increase his PAL level from 1.78 to 1.97
[(22 hrs x 1.78 + 2 hrs x 4)/24 =1.97]
111
Chapter 3.2
mal healthy male with office work but keeping weight change is essentially due to increased
his fitness by regular training during life making body fat while the muscle mass may even have
it possible for him to participate in strenuous decreased at least during the last decade. Thus
endurance activities (300 km bicycle races) up to the fat free mass, which is metabolically active,
the age of 60. From his body size data his BMI has probably decreased both in relative and
can be calculated and shows an increase from absolute amounts. However, this is taken into
18.9 at the age of 15 to 24.2 at the age of 60. consideration when BMR is calculated as the
The increase is partly due to increase in weight equation based on total body weight is different
but also to a slight reduced height with age. The for various ages.
18
16
14
12
10
8 BMR
6 PAL 1,27
4
PAL1.55
2
0 PAL 1,85
PAL 2,0
g)
g)
5k
g)
3k
g)
6k
;6
g)
0k
;7
g)
m
0k
;7
m
;8
4k
5c
;8
8c
;8
8c
18
m
8c
18
m
7c
18
s(
18
6c
s(
yr
18
s(
yr
s(
18
15
yr
s(
25
yr
s(
35
yr
45
yr
55
65
Figure 3.2.24. The effect of weight and physical activity with age in a male subject on total energy
turnover.
112
Males Females
Activity BMR-factor Activity BMR-factor
Sleeping 1.0 Sleeping 1.0

Lying and sitting quietly 1.2 Lying and sitting quietly 1.2
Standing 1.4 Standing 1.5
Walking slowly 2.8 Walking slowly 3.0
-“- uphill 4.7 -“- uphill 4.6
Office work 1.3 Cooking 1.8
Sitting weaving 2.1 sweeping house 3.0
Sharpening axe 1.7 Washing dishes 1.7
Tailoring 2.5 Washing clothes 3.0
Carpentry 3.5 Fetching water from well 4.1
Driving lorry 1.4 Grinding grain 3.8
Bricklaying 3.3 Bakery 2.5
Feeding animals 3.6 Laundry work 3.4
Milking cows by hand 2.9 Weeding 2.9
Loading manure 6.4 Harvesting root crops 3.1
Cutting sugarcane 6.5 Picking coffee 1.5
Cutting trees 4.8 Cutting fruit from trees 3.4
Fishing by spear 3.3
Sawing by hand 7.5
Pedalling rickshaw 7.2-8.5
Mining, shovelling 5.7
Jungle march 5.7
Figure 3.2.25. Gross energy expenditure in specified activities (from WHOFAO/UNU 1985).
In Figure 3.2.25 a number of BMR-factors some changes in the approach throughout the
are listed to exemplify the increase of energy years. In 1949 it was stated that if a person was
turnover in relation to BMR for various activi- in good health and energy balance, i.e. neither
ties. The reader can find a more complete list over nor underweight, then he/she is consuming
in the WHO/FAO/UNU publication of 1985. food according to his/her energy requirement.
The corresponding BMR-factors during various In the 1950-57 edition the energy requirements
sport activities (in this case called MET-factors) were based on estimates of energy expenditure
have been have published by Ainsworth and col- and the energy needs of a group is represented
laborators, the latest version in 2000. by the average of the individuals in that group.
For more detailed information of BMR-fac- The energy requirement of a reference man or
tors for various activities the reader is referred to woman constituted a baseline for the assess-
publications by FAO/WHO/UNU 1985, 2005 ment of energy needs of a population in general.
and Schofield et al 1990. The 1973 edition of the report stressed that the
estimates should be based on individuals rather
International reports on energy requirement than groups and the concept of reference man or
Energy and protein requirements have been woman was rejected. The 1985 edition of FAO/
analysed throughout the years and several inter- WHO/UNU report on energy requirement
national reports from FAO and WHO have been stated that the actual energy intake in popula-
published, the latest in 2005. There have been tions in developing as well in developed coun-
113
Chapter 3.2
tries might not necessarily be optimal. BMR was assessing energy and nutrient
introduced as a conceptional framework and the balance
concept of BMR-factor of PAR (physical activity
Are requirement and recommended daily allow-
ratio) was introduced. The 2005 edition further
ances equivalent to optimal nutrition? For each
stressed the different requirements for popula-
nutrient there is a range of intakes from mini-
tions with various lifestyles and levels of habitual
mal requirement to prevent nutrient deficiency
physical activity already from the age of 6. New
diseases to toxic levels. Somewhere in-between
values for infants, children, adolescents, and for
is what is defined as optimal intake. According
additional energy during pregnancy and lacta-
to the original definition, requirement refers to
tion were introduced. Interestingly the 2005
the minimal nutrient intake needed in order to
report on energy requirement also included
prevent nutritional deficiency diseases. As this
recommendations for levels of physical activity
may differ between individuals according to a
required to maintain fitness and health.
statistical normal distribution the mean value
The 2005 report also stresses that the term
of minimal requirement is used and called Esti-
“lifestyle” is preferred to “occupational work”
mated Average Requirement (EAR). The recom-
and the 24hr PAL should not be based on physi-
mended dietary allowance (RDA) is defined as
cal effort demanded by occupational work but
the mean of requirement for a special population
on the total life style including activities in spare
group (EAR) + 2 standard deviations, thereby
time, i.e. discretionary physical activities. Earlier
covering 97.5% of the need of a normal popula-
differences in PAL and PAR values for men and
tion. The Upper Limit (UL) refers to the level
women in the 1985 edition of the recommenda-
above which toxic effects may occur. For most
tions were rejected as BMR values are already
nutrients there is an upper limit although the
gender specific, which consequently indirectly
safety margin may be very great. Figure 6 also
are corrected for when PAR-values are convert-
indicates where an adequate intake (AI) is. With
ed into energy units by multiplying with BMR.
CONCLUSIONS
The concept of BMR-factors makes it easier to calculate the energy turnover in various individuals as it
takes in consideration the cost of energy in relation not only to the activity per se but also in relation to
the body size and composition.
It is essential to recognize that the concept of lifestyle does not only include special physical activities
due to more or less athletic performances but a continuous analysis of the daily activities throughout
24 hrs, i.e. number of hours sleeping, sitting, walking doing household activities in addition to energy
costs during working hours and specific physical activities during leisure time.
Please note that at sedentary life with office work and much sitting, still the PAL-value is around 1.5. As
BMR can be calculated from an individual’s age and sex it is thus easy to make an estimate of the daily
energy needs at sedentary life by using multiplying the BMR value with 1.5. Any intake below that value
will lead to energy deficit, indicated by weight loss.
A dietary energy intake below 1.5 times BMR in an individual who has a constant body weight thus
indicates that there are methodological problems in the dietary assessment.
114
Where is OPTIMAL INTAKE?
Figure 3.2.26. Schematic illustration of the relation between requirements optimal intake. Dietary Refer-
ence intake (DRI); Recommended Dietary Allowances (RDA); Estimated Average Requirement (EAR);
adequate intake (AI) and tolerable upper limit (UL).
respect to energy intake there is little margin for and its relation to physical activities and work
effects of too low or too high intakes. Energy performance.
deficit leads to metabolic disturbances while Based on the concept of BMR and PAR it is
overconsumption of energy leads to obesity and obvious that there is a direct relation between
its clinical consequences. For most other nutri- the energy intake and energy balance on the
ent however there is a safety margin as changes one hand and that energy restriction will have a
can be balanced by increasing or reducing body direct impact on physical performance and work
stores which have no effects on the metabolism capacity. It is only when the basic metabolic
under normal conditions. energy needs are covered that energy will be
However, a better distinction between the available for physical work. The most effective
concepts “requirement” and “optimal intake” way of increasing work capacity of the labours is
of nutrients is urgently needed. The mere fact consequently to guarantee optimal energy intake
that a more optimal restitution post-exercise is in relation to work performance.
reached at a higher nutrient intake does not nec- The cost of increasing work capacity in an
essarily mean that there is an increased require- individual leading to an increase of the PAL
ment as such in order to counteract any poten- value from 1.70 to 2.00 in a 60 kg 25 year old
tial nutrient deficiency. This further accentuates man means an additional need of about 500 kcal
the need to differentiate between various activity (2.1 MJ). This investment of extra 18% of his
periods, whenever discussing the concept of daily energy turnover (corresponds to 4 glasses
nutritional perspectives on nutrient turnover of milk, 100g potato chips or 80 g chocolate
115
Chapter 3.2
CONCLUSIONS
The impact of over- and under nutrition differs between energy-yielding nutrients and essential nutri-
ents. It is still somewhat difficult to give the exact values for requirements for various nutrients as there
is a biological variation between individuals. Consequently all requirement data are based on a statistical
analysis of a normal distribution in individuals.
To obtain energy balance is of special concern since over- and underintake immediately leads to meta-
bolic disturbances. For most other essential nutrients a slight positive balance can always be compen-
sated for by increasing the stores without any metabolic disturbance.
bars) converts him into a vigorously active and Assessing energy balance
probably also more healthy young man. The Energy occurs in the biological system in the
cost-benefit for the employer of food subsidies following forms:
in preventive health care systems for the workers 1. chemical energy
is thus obvious. 2. mechanical energy
3. physical energy
4. electrical energy
5. radiation energy
Figure 3.2.27. How to study the energy balance equation; schematic illustration of various compartments
in analysis of energy balance in man.
116
Before analysing the methodology regarding en- 3) Conduction, (heat losses through skin)
ergy balance studies it is essential to remember 4) Convection, (radiation from body surface).
that energy turnover is following the first law
of thermodynamics, i.e. energy cannot be lost, Indirect calorimetry
neither produced. The whole problem of energy Indirect calorimetry is based on measurement of
balance is a question of conversion between oxygen consumption and carbon monoxide pro-
various forms of energy. This also means that all duction as indirect indicators of the oxidation.
studies on energy balance must include methods, Using double-labelled water technique changes
which can analyse various forms of energy. in water production as indicator of oxidation is
Methods for energy turnover studies are usu- also used for measurement of energy turnover.
ally referred to under the term calorimetry. This Measurement of heart beat frequency and physi-
is in many ways an inaccurate terminology as ca- cal activity by means of ergometer equipment
lorimetry refers to measurement of heat (calor= and activity diary are other examples of indirect
heat, metry=measure). However, most methods calorimetric methods.
of today do not measure heat production as Indirect calorimetry is usually easier to per-
such, but indirect results of energy turnover, form under field conditions but has its limita-
often called indirect calorimetry, which of course tions as well. First it only gives information
is also inaccurate, as it is still not a measure of about total energy turnover, but in combination
heat production. with direct calorimetry there is a possibility also
to study more in detail changes in substrate oxi-
Direct calorimetry dation in the regulation of energy turnover.
Direct calorimetry refers to the assessment of
heat production as a result of oxidation of sub- Assessing dietary intake
strates during energy turnover. In food and ex- There are several forms of methods used for
cretes this can be made using bomb calorimetry, studies on dietary intake, both retrospective and
and in man and animal by means of calorimeter prospective, based on anything from personal
rooms or calorimeter suits. interviews, records, and use of food frequency
questionnaire to double portion technique. Each
The heat production is the summary of the fol- of them has its pros and cons. There is no single
lowing parameters: golden method for estimation of the dietary in-
1) Changes in body temperature; take without error, and the goal of the study is of
2) Losses through expiration of water through utmost importance when selecting the optimal
skin and respiratory system method for dietary assessment. Furthermore,
Energy intake Energy turnover in man Nutritional Status
Assessment of dietary intake using Calculation of BMR based on anthropo- Anthropometrical data
recall and record methods metrical data (weight, height, skinfold)
Heart frequency recording
Activity recording (diary)
Mobile respiratory calorimetry
Doubly labelled water
Figure 3.2.28. Indirect calorimetric methods for assessment of energy turnover adapted for field studies.
117
Chapter 3.2
different types of errors have different effects in first law of thermodynamics, e.g. energy can-
analysis and interpretation. Consequently, data not be created nor destroyed, and it can only be
collected by means of one dietary assessment transferred from one form to the other. Avail-
aimed to study the intake of one nutrient may able energy from energy intake must balance
not necessarily be as valid to evaluate the intake energy turnover if bodyweight is stable and body
of another nutrient. composition unchanged during a certain length
of time. Thus an objective and reliable reference
Validation of dietary assessments to validate obtained data on dietary intake can be
Dietary assessments will almost without excep- based on a comparison between the observed or
tion result in an underestimation of energy registered energy intake (EI) and the theoretical
intake. Energy turnover should consequently be calculations of energy turnover based on calcu-
based on studies of energy expenditure based on lated BMR with the addition of a relevant PAL
calculated BMR with the addition for the cost of factor.
physical activity. The energy equation fulfils the
Method Coverage Advantage Disadvantage

Dietary history All food items or selected Long-term perspectives of Time consuming
items dietary habits Skilled interviewer needed
Individual data Memory demanding
Quantitative data difficult
to obtain
Variations in dietary habits
lost
24h recall All foods Relatively rapid and simple Selection of interview day
Can be repeated critical
Individual data Quantitative data difficult
to obtain
Skilled interviewer needed
Food frequency Only listed food items Rapid and simple Restricted number of food
Questionnaire (FFQ) Easy to computerize items
Large groups covered by Memory depending
mail No direct contact with
interviewer
Food records All foods Individual data Selection of day critical
Intake during various days Dietary intake may be
Quantitative data affected
Needs resources
Time consuming
Collaboration necessary
Double portions All foods Exact data on nutrient Dietary intake may be
content possible (not affected
depending of accuracy of Resource demanding
food tables) Collaboration necessary
Figure 3.2.29. Summary of various methods for dietary assessments.
118
Step Procedure Example

1 Collect antropometric data Female, 21 years,
(Age and sex, body weight, height) weight 57 kg; height 171 cm
2. Verify that bodyweight has not changed Stable body weight

= energy balance
3. Calculate energy intake (EI) 8936 kJ

From dietary assessment
4. Calculate BMR according to

FAO/WHO/UNU 1985 equation 5585 kJ/24hr or 233 kJ/h
5. Analyse physical activity from

training report and life style
(hours of sleep, sitting, walking etc) occupation hrs BMRfactor Energy (kJ)
Sleep 10 1 2330
Work 8 hrs
(laundry work) 7 3.4 5545
Training
(biking 30 km/h) 1 12 2796
Sitting,
Reading, TV 1 1.3 303
Walking 1 2,5 583
Household 2 2.5 1165
Misc. 2 2.5 1165
6. Calculate total energy turnover (ET)

using BMR-factors (see step 5) ET = 13887 kJ
7. Calculate PAL factor
based on ET (step 6)/BMR(step 4) ET/BMR = 2.4
8. Compare estimated EI from dietary
assessment (8936 kJ) with
a. estimated BMR (5585 kJ) EI/BMR = 1.6
b. estimated ET from theoretical
calculations of BMR and PAL EI/ (BMRxPAL): 0.64
Figure 3.2.30. How to validate dietary assessment by comparing energy intake (EI) and energy turnover
(ET) based on BMR and PAL including one practical example.
Comments: The EI/BMR-ratio is 1.6, e.g. only covers the normal energy turnover in an individual with a sedentary life
style. This is quite different from her PAL according to life style and training record (2.4). If the dietary assessment is
right there is consequently no room for physical training and her activity record is wrong. If on the other hand her phy-
sical activity record is right, the recorded energy intake represents only 64% of calculated ET (8936kJ vs. 13887kJ).
This means a serious negative energy balance, which will affect body weight and body composition. If bodyweight
is stable a more probable explanation is an under-evaluation of dietary intake. Please note that 1 h intensive training
represents about 50% of the energy turnover at her work. If this training was exempted her PAL would be reduced to
about 2.1.
The most probable explanation is that the registered dietary intake has been too low or that the registration was not
performed under the same conditions as the physical activity registration if the body weight is kept constant. In this
case only limited conclusions regarding the dietary intake can be drawn.
119
Chapter 3.2
physical performance and nutrition should be covered and fluid losses compensated,
The relation between dietary intake and physical as well as that all essential nutrients, i.e. vita-
performance can be divided into four different mins, minerals, fatty acids, are consumed in ad-
aspects: equate and balanced amounts. The meal pattern
– Dietary habits in order to keep optimal nutri- should also be adjusted to the daily schedule.
tion (energy vs. nutrient balance) Substrate utilisation during muscle work
– Dietary intake before a physical performance
The effect of physical exercise is not only related
(loading phase)
to energy turnover as such. Physical exercise also
– Dietary intake during performance (compen-
has an impact on substrate utilisation and may
satory phase)
help the individual to balance his/her body com-
– Dietary intake immediately after a perform-
position, metabolic regulation and homeostasis.
ance (recovery phase).
Muscle activity leads to increased energy turn-
Increased physical activity is essentially a ques- over and substrate oxidation in the muscle tissue.
tion of increased energy turnover, while the Figure 3.2.31 illustrates the oxidation of
turnover of essential nutrients is usually not carbohydrate, fat and protein during 24 hours
related to energy turnover to such an extent that and the effect of physical exercise (indicated by
there is a need for increased intakes. To what whole line) at fast and feeding (indicated by the
extent the intake of essential nutrients is a valid striped line). The two figures show the substrate
problem is mainly due to two other factors: (i) is utilisation at normal protein intake,e.g. 1 g per
there energy balance? and (ii) is the diet nutri- kg body weight and at a high protein intake, e.g.
tionally balanced? 2.5 g protein per kg body weight. The relation
The principle behind any dietary advice in between the non-protein energy sources, carbo-
relation to work performance is that energy need hydrate and fat, being the same in both cases.
Real time (clock hours) Real time (clock hours)
a. 1g protein per kg bw per day b. 2.5g protein per kg bw per day

Figure 3.2.31. Effect of physical work on substrate utilisation at normal and high protein intake at energy
balance (Forslund et al, 1999). The line indicates physical activity (biking 100W during 180 minutes).
The striped line indicates food intake similar portions every hour during 9 hours).
120
During physical activity (indicated by whole dation is high while during feeding most energy
lines), which was performed on a bicycle ergom- is covered from carbohydrate.
eter, in a fasting state and during eating (contin- By comparing the figures one can also see that
uous meal intake indicated by striped line), the a higher protein intake leads to increased pro-
carbohydrate oxidation increased on both diets, tein oxidation, which is due to the fact that pro-
while the protein oxidation decreased. Thus tein can not be stored to any extent in the body
although protein oxidation is increased during and the overconsumtion must be balanced by
muscle activity the relative proportion of protein increased oxidation. Thus there is no advantage
as energy source is decreased. This illustrates the with a high protein intake for the protein bal-
wellknown fact that carbohydrate is the substrate ance. Please note that at high protein intake the
of choice during physical exercise, and that mus- relative contribution of carbohydrate is reduced
cular work does not lead to a relative increase and from fat increased. Thus it seems as a high
in protein oxidation. Although exercise leads to protein intake leads to increased fat oxidation
increased oxidation of all energy substrates, the and reduced carbohydrate oxidation. This might
relation between carbohydrate, fat and protein partly explain why high protein intakes in some
oxidation is different when fasting and feeding. dietary prescriptions for reducing body weight
The diagrams illustrate that during fast, fat oxi- may have an impact on body fat.
CONCLUSIONS
Before drawing any conclusions between recorded dietary intake and potential health risks both in
retrospective and prospective aspects, the data obtained from dietary assessments must be validated. The
easiest way to do this is to analyse the life style of the individual in order to estimate the relevant PAL-
level and to calculate the BMR of the same individual. In case the individual has a constant body weight,
she or he can be assumed to be in energy balance and if the total energy turnover per 24 hr indicates a
PAL-value lower than 1.6 in a sedentary individual there has most probably been an underestimation
of the dietary intake. Please note that most methods for dietary assessment show an underestimation of
about 25-30% for various reasons as commented above.
Metabolic stress secondary to physical work leads to malnutrition, and the development of a
Physical stress will have an impact on metabolic metabolic syndrome and obesity. There are also
turnover both on a short-term as well as on a indications that too high intake of certain nutri-
long-term perspective. In both cases increased ents will stress the metabolic turnover and lead
energy turnover, which is not balanced with an to an impaired immune defence.
increased energy intake, leads to energy defi- It is not only a physical but also a psychologi-
ciency and secondarily a metabolic stress. This cal stress that may lead to metabolic disturbanc-
should be compared to our knowledge that es. Thus a psychological stress has been related
malnutrition also leads to a metabolic stress to disturbed magnesium and zinc turnover and
syndrome as a result of catabolism and tissue deficiencies of magnesium and zinc related to
damages. Similarly, a too high-energy intake also irritability, aggressiveness and lack of concentra-
121
Chapter 3.2
tion. The mental stress has been suggested to be which leads to problems such as anything from
involved via the sympathetic nervous system in loss of appetite to diarrhoea and obstipation.
the pathophysiology of the characteristic insulin As a result they are at high risk for developing
resistance or metabolic cardiovascular syndrome gastrointestinal problems, e.g. ulcer, as well as
in young men. obesity and heart disease. It is typical that shift
Chronic stress, whether psychological and/or workers especially during night work consume
physical, exerts an intense effect upon body more snacks and eat more fast food and sweets,
composition, which in turn, significantly affects drinking coffee and exercise less.
longevity and survival of the organism. Most data indicate that altered dietary habits
Stress is followed by specific endocrine ab- should be encouraged in shift workers. In most
normalities followed by accumulation of intra- cases however it is recommended to schedule
abdominal, visceral fat masses and insulin resist- regular meals, to cut back on highly seasoned
ance, which may end in the development of a foods and fried foods and fast food high in fat.
metabolic syndrome. Several healthy small meals/snacks throughout
the shift instead of larger meals have been rec-
Effect of shift work on energy and nutrient ommended and the increased use of light meals
requirement including fruits and vegetables, low fat dairy
A specific metabolic stress from the nutritional products.
point of view occurs in shift workers. An in-
creasing number of individuals have irregular Impact of energy and nutrient intake on
working hours. This affects their meal pattern. physical performance
The human body has an endogenous circadian Subnormal levels of one or more nutrients in
rhythm for body temperature and endocrine body fluids can not be taken as an indicator that
regulation. There is however still only limited there is a nutrient deficiency which calls for
knowledge on how the body reacts metabolically food supplements, unless the energy needs are
to changes in the meal pattern and food intake covered. Several studies indicate that subnormal
especially during night shifts. levels of nutrients can be restored by means
Several studies have shown that shift workers of a well-balanced diet consumed in adequate
have problems to keep a normal eating schedule amounts to cover energy requirement.
CONCLUSIONS
Analysis of substrate utilisation indicate that there is no need whatsoever of an increased protein intake
during hard physical activity or high work load as in heavy industry. The essential factor is that the di-
etary intake covers the energy need at an increased work load in order to counteract a catabolism in the
body. A normal diet comprising 12-15 energy per cent protein is sufficient to cover the protein needs.
During hard physical work load leading to a high energy turnover, an increased dietary intake of energy
is essential. As long as this is covered by conventional diet, the nutrient density is of minor importance.
However at less energy turnover e.g. at office work and a sedentary life, there is a need to have a higher
nutrient density.
122
Food supplements may be motivated in order to formance, especially in those who are at risk to
increase body stores and thereby physical capac- develop iron deficiency anaemia. However, the
ity, e.g. carbohydrate loading, or to compensate effect of iron nutrition on physical performance
subnormal plasma levels of certain essential is exclusively related to the haemoglobin value,
nutrients, e.g. vitamin and mineral supplements. which is responsible for the oxygen transport,
The use of supplements to increase psycho- and not related to the iron store in the body, il-
logical capacity, e.g. B-vitamins against anxiety, lustrated by serum ferritin. Except for iron there
branched-chain amino acids against central are no indications that mineral supplementation
tiredness, has also been reported but is contro- may enhance physical performance.
versial. Excessive dietary intake of certain minerals
Several nutrients have been described to be as- and trace elements may impair the balance of
sociated with physical working capacity and avail- other minerals due to interaction in the intesti-
able data indicate that physical fitness and work- nal absorption, e.g. zinc intake above 50 mg per
ing capacity may be affected by subclinical forms day impairs copper and iron metabolism, and
of vitamin and iron deficiency. high iron supplementation impairs the uptake of
Iron nutrition is a classical example of the other minerals, e.g. zinc. A high protein intake
importance of nutritional status on oxygen has also been reported to be deleterious for the
uptake and physical work performance. Viteri calcium, phosphor, zinc and copper require-
and Torun in their classical paper in 1974 could ments.
show not only that iron deficiency anaemia Vitamin supplementation may restore per-
significantly reduced physical work capacity but formance capacity in subclinical and clinical
also that haemoglobin values above normal bor- vitamin deficiencies but supplementation with
derline values increased physical capacity. The quantities above recommended doses has not
increased oxygen transport capacity of increased been shown to improve physical performance.
haemoglobin had a direct impact on physical Under normal conditions a mixed diet will cover
capacity, a factor that has been used in doping all needs for mineral and vitamins when energy
among athletes, i.e. the use of erythropoietin. As needs are met.
the uptake of inorganic iron in the diet is in- In general, the effects of the diet supplements
creased by ascorbic acid, intake of both iron and mentioned have not been well-examined neither
vitamin C may stimulate haemoglobin synthesis for possible positive qualities nor for toxicity,
and thus have a positive impact on work per- side effects and long-term effects.
CONCLUSIONS
The metabolic stress during intensive physical activity or high work loads are essentially due to the
fact that the increased energy needs are not covered in the diet. This leads to increased catabolism
and secondarily to changes in the endocrine response and water and electrolyte balance.
123
Chapter 3.2
Optimal fluid intake cardiovascular regulation. It is therefore very

During physical activity fluid is lost depending important to drink at least as much fluid as lost.
on the degree of work intensity, temperature and
primary and secondary
humidity of the surroundings. A general guide is
malnutrition
to consume 1000 ml per 1000 calories expended.
Studies have shown a tendency to drink too Disturbances in the nutritional status lead to ill
little (involuntary dehydration) since increased health and complications as well as increased
thirst during physical activity does not appear susceptibility to various diseases. This is partly
until too late. Even a dehydration of 1-2% of due to the fact that deficiencies of many specific
body weight reduces performance because of nutrients may impair the immune response. This
compromised temperature and adjustment of does not only lead to increased susceptibility for
Figure 3.2.32. Sequence of events during the development of nutrition deficiency.

The lines indicate at which stages the various diagnostic methods can be used.
124
infections but also to less than expected response Macronutrient and micronutrient
to immunisation and antibiotic treatment. De- malnutrition
terioration of the nutritional status in a subject The word malnutrition is also used for both
may be the result of two different forms of macronutrient deficiencies and micronutrient
malnutrition: primary malnutrition and secondary deficiencies. A woman with anaemia due to iron
malnutrition. Primary malnutrition refers to the deficiency may be said to be malnourished. But
situation where the nutrient requirements are most commonly the word malnutrition will
not met by the diet. This is consequently mostly be used for a macronutrient deficiency, which
seen in subjects who have to rely upon the envi- means that a person is consuming too little
ronment or other persons, i.e. the young child energy for her needs and will therefore loose
and the elderly, but also individuals depending the body stores of energy (=loose weight). Lack
on catering systems, i.e. prisoners, hospital pa- of dietary energy may also lead to micronutri-
tients, or as a result of famine. Secondary malnu- ent deficiencies and in children it may impair
trition refers to the situation where any disease growth. Disease susceptibility will also increase.
or pathological conditions disturb the intake and
metabolism of the nutrients, i.e. gastrointestinal
diseases, or due to increased losses, i.e. surgical
wounds, burned patients, vomit and diarrhoea,
or needs, i.e. infections with high fever, or blood
losses, i.e. malaria or hook worms. Although
primary and secondary malnutrition differs with
respect to their aetiology, the sequence of events
is the same as illustrated in the figure below.
This figure also illustrates at what stages in the
sequence of events that the various diagnostic
tools may be helpful.
Adults with Children with Adults with Children with

macronutrient macronutrient micronutrient micronutrient
deficiency deficiency deficiency deficiency
Wasting (thin) Yes Yes No No
Susceptible to disease Yes Yes Yes Yes
Impaired growth No Yes No Yes
Specific vitamin or mine- Usually Usually Yes Yes

ral deficiency
Figure 3.2.33. The effects of macro- and micronutrient deficiencies in adults and children.
125
Chapter 3.2
Type I and Type II nutrients in a non-specific catabolism of the tissues lead-

Golden in 1996 suggested grouping of nutrients ing to growth failure in the growing individual.
with respect to their effect on the nutritional sta- In adults there will be no characteristic changes
tus and the sequence of events during deficiency. in tissue concentrations as the catabolism of tis-
sue will result in the fact that other nutrients will
Type I Type II be released, metabolised and excreted as well,
Vitamins Essential aminoacids secondary to the catabolic state. This has lead
Thiamine, riboflavin Nitrogen to a number of misinterpretations. The lack of
Cobalamin, folic acid Sulphur confirmatory tests of an inadequate intake of the
Pyridoxine Water
Ascorbic acid Sodium, potassium
Type II nutrients has probably lead to an under-
Retinol, tocopherol Magnesium estimation of their nutritional importance.
Minerals Zinc
Iron, copper Phosphorus The malnutrition-infection complex
Calcium
Manganese, selenium
As both ‘inadequate dietary intake’ primary mal-
Iodine nutrition and ‘diseases’ (secondary malnutrition)
contribute to undernutrition, the phrase ‘mal-
Figure 3.2.34. Examples of Type I and Type II
nutrients. nutrition-infection complex’ has been proposed
to avoid to accuse only one of the causes of the
Type I nutritional deficiencies lead to the classical condition. Another way to express the relation-
concept of events where the deficient intake is ship is the use of the concept ‘undernutrition-
compensated for by mobilizing the potential re- overdiseasing’.
sources in tissue stores. This leads to a successive The most important mechanisms for the
reduction in tissue concentrations until a criti- impact of infectious diseases on the nutritional
cal level is reached and metabolic disturbances situation are:
occur which result in more or less characteristic • Disturbed appetite leading to anorexia
symptoms and signs. • Decreased intestinal function, producing mal-
Type II nutritional deficiencies are less easy to absorption
• Fever, which increases the energy need, e.g.
diagnose. As they all represent essential nutri-
10% increase of energy turnover per centi-
ents they are needed for a normal growth and
grade.
development. However, a deficiency will result
Characteristics Type I Type II
Tissue level variable, of diagnostic use tissue level fixed
Use in specific pathways ubiquitously used
Physical signs characteristic non-characteristic
Growth response late or never immediate
Body stores depleted no bodystores
Response to diet buffered direct
Excretion little control homeostatic control
Relation to other nutrients not interdependent affects each others balance
Figure 3.2.35. Characteristics of the Type I and Type II nutritional deficiencies.
126
• Catabolic effects of microbes leading to tissue Other 12% Neonatal

degradation
32%
• Production of immunological proteins, which Measles
increases the nutritional needs 6%
• Decreased circulating concentrations of mi- Malaria
cronutrients. 7% Malnutrition
49%
The most important mechanism for impact of
undernutrition on the infectious susceptibility is
due to the fact that it leads to disturbed protein
turnover including reduced synthesis of immune Diarrhoea
19% ARI 24%
globulins and reduced immune response to mi-
crobes and parasitic infestations.
When looking at vital statistics, for instance Figure 3.2.36. Of the 10.4 million deaths among
children under 5 years of age in 1995, it is es-
child mortality, there is the same problem of
timated that 5.1 million (49%) of these were
separating a ‘food cause’ from a ‘disease cause’ precipitated by undernutrition (WHO 1999).
because often both a disease and a primary un- ARI = acute respiratory infection.
dernutrition have contributed the death of a
child. Often the child had an infection, for in-
stance diarrhoea, and at the same time he or she
became undernourished. So when the child dies,
is it due to the diarrhoea or due to the under-
nutrition? Because health staff often collects
the data for vital statistics they will often tend
to report the medical problem, in this case the
diarrhoea. In a recent work it was estimated that
in 49% of the deaths malnutrition was a major
contributing factor leading to the death of the
child.
127
Chapter 3.2

Ainsworth, BE, Haskell WI, Whitt, MC, Irwin,
ML, Schwartz, AM, Strath, SJ, O’Brien, WL,
Bassett DR Jr, Schmitz, KH, Emplainscourt PO,
Jacons, DR Jr, Leo AS. Compendium of physical
activities: an update of activity codes and MET
intensities. Med Sci Sports Exerc 2000; 32; 498-
504.
Antonsson-Ogle, B, Gustafsson, O, Hambraeus,
L, Holmgren G & Tylleskär, T. Nutrition, agri-
culture and health when resources are scarce. 2nd
rev edit. Uppsala 2000.
Bender, DA. Introduction to Nutrition and
Metabolism. 3rd edit Taylor & Francis, London
2002.
Caballero, B & B M Popkin (eds). The Nutri-
tion Transition: Diet and disease in the develop-
ing world. Academic press New York 2002.
Energy and protein requirements. Report of a
Joint FAO/WHO/UNU Expert Consultation
WHO Technical Report Series 724, Geneva
1985.
Human energy requirements. Report of a joint
FAO/WHO/UNU Expert Consultation, Rome
17-24 October 2001. Food and Nutrition Tech-
nical Report Series.
Gibson, R S. Principals of nutritional assess-
ment. 2nd edit Oxford University Press, Oxford
2005.
Gibney. M J. Margetts, BM, Kearney, J M &
Arab, L (eds). Public Health Nutrition. Nutri-
tion Society. Blackwell Publ. Oxford 2004.
128
Glossary
Abbreviations and Definitions
BMI Body mass index, used as indicator of overweight and calculated as follows: Body weight in kg / (height
in meter)2. Also known as Quatelet’s index
BMR Energy turnover when the individual is in supine position under standard conditions of rest, fasting,
immobility, thermoneutrality and mental
CVD Cardio-vascular disease
DIT Dietary induced thermogenesis
DRI Dietary reference intake
EE Energy expenditure
ET Energy turnover
FAO Food and Agricultural Organisation of the United Nations System
LIC Low income countries
PAL Total energy expenditure (TEE) for 24 hours as a multiple of BMR. In adult man and non-pregnant,
non-lactating woman, BMR times PAL is equal to TEE or daily energy requirement
PAR The energy cost of an activity per unit of time (usually a minute or an hour) expressed as a multiple
of BMR. Also called BMR-factor or MET-value.
RDA Recommended dietary allowances
TEE Total energy expenditure. i.e. energy spent on average in a 24hr period by an individual or group
of individuals
UNU United Nations University
WHO World Health Organisation of the United Nations System
Direct calorimetry Methods to estimate heat production by m easuring temperature changes using sealed
and insulated chambers or equipments, i.e. calorimeter rooms, calorimeter suits, bomb
calorimeters
Indirect calorimetry Methods to measure energy turnover by indirect methods. i.e. chemical analysis of food
and using conversion facors; registration of oxygen consumption and carbon dioxide
production as result of oxidation which gives energy; registration of heart frequency
which is related to energy turnover
Energy density amount of energy per weight or volume
Gluconeogenesis synthesis of glucose from non-carbohydrate precursors, i.e. amino acids from protein
breakdown and glycerol from triacylglycerols
Nutrient density amount of essential nutrients, i.e. protein, vitamins, minerals, per energy unit (joule or
kcal).
Malnutrition minus undernutrition, i.e. too low intake of energy and/or nutrients leading to nutrition and
energi deficiency states
Malnutrition plus overnutrition, i.e. too high intake essentially of energy, leading to overweight and
obesity and its coimplications (e.g. cvd, diabetes)
Quetelet´s index see BMI
129
3.3
Musculoskeletal disorders
Eva Vingård
introduction long periods. In extreme positions, e.g. bending,

This chapter briefly describes the musculoskel- the joints are more likely to be injured and mus-
etal system and a number of disorders that can cles are less able to work in a coordinated way.
affect it. There are a number of work-related Awkward positions may give considerable load
factors of physical and psychosocial origin, to certain parts of the body, Figure 3.3.1.
including repetitive, forceful and heavy work,
static or awkward postures, mechanical stress
and vibration, that result in adverse outcomes
for the musculoskeletal system. The chapter
concludes with an appendix that describes mod-
els for the assessment of work postures, manual
handling and physically monotonous, repetitive
work.
background
The human body is designed for motion and an
appropriate mixture of movements, loads and re- Figure 3.3.1. The weight of parts of the body (e.g.
covery is needed to sustain bodily functions. The the arms), can be a heavy load.
skeleton, muscles, tendons and ligaments form
the musculoskeletal system and these structures Musculoskeletal pain, dysfunction and disorders
must be flexible, stable, strong and supple in are very common in all countries, regardless of
order to function satisfactorily. The capacity of their level of development. In parts of the devel-
this system varies widely between individuals, oping world where nutrition is poor, diseases that
and is influenced by age, sex, nutritional status, affect musculoskeletal structures are common
fitness level, existing disorders and experiences in both childhood and adult life, and people are
such as injuries. Particular care must be taken exposed to heavy loads in both their occupational
if the musculoskeletal system is frequently sub- and domestic life. However, such problems are
jected to excessive loads or subjected to loads for overshadowed by other risk factors which have
131
Chapter 3.3
a more acute effect on health and life. A muscu- To lift 15 kg is very easy for a strong young man
loskeletal disorder can cause lifelong pain and but more streneous for an older women.
considerable loss of function and quality of life. In many developing countries lifting and
In industrial countries, musculoskeletal disorders handling heavy loads are still the main prob-
are the most common cause of long periods of lem. In more industrialised countries, lifting
sickness absence and early retirement. and handling methods have been improved and
The predominant symptom associated with loads have become lighter, but repetitive and
musculoskeletal problems is pain. Pain is defined static loading is still problematic. Even if manual
by the International Association for the Study lifting and handling is made easier, very little is
of Pain, (IASP), as “an unpleasant sensory and gained in the prevention of musculoskeletal pain
emotional experience associated with actual or and disorders if the pace of work is increased
potential tissue damage, or described in terms of and made more repetitive.
such damage”. The definition says that the pain
is experienced and as such, is subjective and im- prevention
possible to measure and question in an objective Primary preventive measures, i.e. measures to
way. Underlying the basic concept of mechani- eliminate potential risk factors, are vitally im-
cal, neurogenic or pain of unknown origin, there portant for both individuals and society. Preven-
is an individual quality which gives psychological tion of musculosketal disorders is of interest to a
and emotional colour to the experience of pain number of international organisations including
and the way it is endured. The interpretation the ILO (International Labour Organization),
of pain differs between individuals and cultures. which recognises musculoskeletal disorders as a
In Sweden, pain is the most common reason for work-related condition. International meetings
individuals to seek medical treatment. However, on the prevention of musculoskeletal diseases
the health care system often has very little to have been arranged by the ICOH (International
offer to cure pain, a situation that frustrates both Commission on Occupational Health) and the
the patient and the caregiver. In some societies, IEA (International Ergonomics Association).
pain is an everyday phenomena that is given The ISO (International Standardization Organi-
little attention in the health care system. zation) has produced guidelines, recommenda-
The causes of musculoskeletal pain and dis- tions and limits for different types of exposure,
eases are many and varied. Physical and psy- e.g. hand and arm vibration. The EU has also
chosocial loads at work play important roles in published information on prevention.
the development of pain, disease and disability. The avoidance of musculoskeletal disorders
The assessment and classification of exposures partly depends on the knowledge of employees
are important when investigating and judging about the correct way to perform a task. Train-
potentially harmful factors. A harmful external ing in work techniques is important when new
exposure (e.g. exposure to a toxic chemical), can employees are hired or when changes are made
usually be measured, but exposures that af- to work processes. Sufficient time should be
fect parts of the musculoskeletal structure, e.g. reserved for an employee to practise appropri-
tendons, muscles or joints, are more difficult to ate, safe working postures and movements, to
identify and vary from individual to individual. learn to handle equipment and working aids,
and to learn how to collaborate on tasks which
132
are difficult to perform single-handed. Instruc- for back problems which develop into general
tion may sometimes also be needed on the use pain syndromes. Furthermore, the causes of pain
of controls and technical aids. A simple checklist and disease in the low back and neck are com-
can be a useful means of ensuring that nothing is plex and multi-factorial, potentially caused by
overlooked. a multitude of risk factors from heavy physical
Employers need to check that routines for in- loads to unsatisfactory psychosocial conditions at
structions, information, etc. are relevant, ade- the workplace. Most studies which have investi-
quate, and regularly updated. It is also necessary gated the connection between workplace factors
to check that instructions are complied with. and low back or neck disorders are cross-sec-
To ensure satisfactory preventive work, the in- tional studies. This means that the exposure and
teraction between different factors within a work pain/disorder is measured at the same time. The
system should be considered. For example, the causual chain is thereby hard to evaluate. This
introduction of work techniques which reduce makes it difficult to draw any reliable conclu-
unsuitable movements, positions and physical sions and connections, but it would seem to be a
factors such as vibration, can also reduce mental reasonable assumption as many studies indicate
stress and create variety and stimulation. the same trend.
The vast majority of studies are unable to
Pain and disorders of the low back and neck accurately show the level of exposure and the
Patients complaining of low back and neck pain time required for pain or ill health to emerge.
very often have no identifiable pathological or This means that arbitrary judgements are made
anatomical disease. Pain and/or poor muscle about what is considered to be harmful and what
function do not show up in blood tests, on x-ray is harmless, and non-linear relationships become
or through other examinations. While some rare uncertain and difficult to define precisely.
disorders such as spinal infections, spinal malig- There are very few intervention studies. The
nancy, compression fractures and sciatica can be authors of a systematic survey of studies carried
diagnosed, many other back problems cannot out before 1994, detected a trend that showed an
be diagnosed. However, patients suffering pain improvement in the biomechanical conditions at
should not be neglected. The progression from the workplace also improved health with regard
pain to ill-health and incapacity is also likely to to musculoskeletal disorders. Changes in pro-
depend on cultural and economic factors. Most duction systems may also have a positive effect,
scientific studies indicate that self-reported pain although health variables are seldom fully inves-
over different periods, (i.e. currently, during the tigated and followed up in studies.
recent past or over a life time), is the outcome Physical factors associated with low back pain
variable against which different exposures are include different types of vibration that affect
measured. A clinical examination can sometimes, the whole body, frequent bending and twisting,
but not always, provide further information. manual handling such as lifting and carrying,
The chosen outcome for a study obviously re- and pushing and pulling. Those at greatest risk
flects the identified risk factors, e.g. the outcome appear to be workers in extreme work environ-
for a clinically verifiable condition such as a rup- ments, e.g. nurses, construction workers, and
tured disc. The outcome for a diagnosed condi- farmworkers. In Sweden for example, blue-collar
tion is likely to be completely different from that
133
Chapter 3.3
workers of both sexes have more problems than manual handling

white-collar workers. Manual handling mainly refers to the transfer of
loads, with one or more employees exerting mus-
Awkward working postures
cular force to lift, deposit, push, pull, roll, carry,
Working in a heavily bent, twisted or extended hold or support an object or person. The tradi-
position can require the body to handle unsuit- tional concept of manual labour involved a great
able loads, which stress the joints and force them deal of lifting, carrying, pulling, dragging, etc.
to work close to their outer limits, see Figure Manual handling is still required for such tasks
3.3.2. Poor working conditions require workers as stocking shelves, handling and sorting bundles
to adopt poor working postures, e.g. work above of paper, loading machines or mixers with raw
shoulder height requires extreme wrist flexion. If materials, helping and moving hospital patients,
awkward movements such as bending or stretch- pushing and pulling trolleys, serving food and
ing are prolonged or recurrent, the risk of injury drink and moving heavy outdoor play equipment.
increases. Other tasks may involve the use of considerable
There is considerable risk of injury if the physical force to use an object rather than to
work posture demands bending, twisting and/ move it. Examples include the use of hand-held
or extension at the same time, particularly for machinery or tools such as chain saws; the opera-
manual handling operations. The body is also put tion of controls with heavy resistance; bricklaying
under great strain if work is performed in the or spray painting; steering a vehicle; the control
same position for a long time because of static of work processes with buttons, levers and ped-
loading of muscles, even if the work position is als; opening swing doors by kicking or nudging.
not extreme. These stresses are further aggra- In some situations, the most hazardous factor is
vated if the task also involves material handling. the degree of precision required for the handling
Musculoskeletal disorders can easily occur if the rather than the actual force needed. Figure 3.3.3
body has to bend or twist suddenly and without shows examples of manual handling or the exer-
control, (e.g. to regain balance). tion of physical force.
Figure 3.3.2. Work postures involving bending,

twisting and extending always entail risk.
Figure 3.3.3. Various forms of manual handling and
exertions of physical force which can be harmful.
134
Heavy manual handling primarily involves a risk there is sufficient scientific evidence and experi-
of overloading the lumbar region of the spine ence to support practical recommendations on
but there is also a risk to the arms and shoulders, how this kind of work can be assessed. The Ap-
particularly when bad work postures are adopt- pendix to this chapter contains a model for the
ed. There is a risk of knee injuries when lifting assessment of lifting operations, focused on two
with the knees heavily flexed or when carrying main factors, the weight of the load and the dis-
heavy loads on stairs or on uneven, unsteady or tance between the body and the centre of gravity
hard surfaces. In addition, the heart, circula- of the load when the lift is performed.
tion and lungs are put under strain during heavy For many years there have been efforts to re-
lifting and carrying. Work of this kind requires duce the risks of back problems caused by lifting
both strength and fitness, but can still be hazard- through instruction in correct lifting techniques,
ous even for strong and fit workers. i.e. lifting with the back straight and the knees
Acute overloading of joints, muscles and ten- bent, however, ensuring that this instruction is
dons very often occurs when manual handling put into practice has been problematic. Current
deviates from normal procedures. Accidents of knowledge and experience emphasises the fol-
this kind can occur, for example, when health- lowing instructions as most important measures
workers move a patient who doesn’t move as ex- to prevent back injuries:
pected; when handling a container whose centre
• avoid heavy lifting if possible, and use techni-
of gravity has changed because the contents have
cal aids whenever possible
shifted; when making a sudden movement to
• make sure that the load is held close to the
recover balance after a slip or trip. In such situa-
body
tions, the impact of the load can greatly increase
• avoid lifting and twisting simultaneously.
compared with normal conditions. Advance
planning for the best way to perform a lifting or
moving operation is very important. Lifting people safely
Manual lifting of people can be largely avoided
Lifting and carrying if the workplace premises are spacious, well
Most operations to transport people, materi- planned and equipped with sufficient, appropri-
als, equipment or goods can be performed on ate and readily available equipment.
wheels, at moderate expense. This is particularly When trying to solve a lifting problem
important for transport over long distances. through the use of technical aids, it is important
Stairs are normally unsuitable for use as regular that there are clear instructions and that staff
transport routes as carrying of heavy or awkward are trained in the use of the aids in the specific
loads on stairs entails a severe risk of acute mus- situation they are used in. Training is especially
culoskeletal disorders and other accidents. important for techniques used to transfer people
The risks from lifting and carrying depend who need assistance in a variety of situations.
on a number of factors including: what is lifted, Staff assisting people need to know how to cope
how and where the lifting is done, who is lift- with unforeseen events such as patient falls. Lack
ing or carrying. It is very difficult to define an of space or shortage of time can force a staff
absolute limit value for any single factor, e.g. the member into a difficult handling operation and
maximum permissible weight of a load, however, awkward work posture. It is important that there
135
Chapter 3.3
is adequate and properly planned space and ap- leave their workstations, even for short periods,
propriate time allocated for tasks such as moving without service or output being disrupted.
patients to and from the toilet, between a wheel-
chair and bed, and helping patients to change
position in bed.
Pushing and pulling

Pushing and pulling means moving an object,
with all or part of its weight resting on an under-
lying surface such as a floor, or with the object
suspended, e.g. from a telpher. The force needed
to move and keep an object in motion depends
on the weight of the object and the amount of
friction and the gradient between the object
and the underlying surface. It is necessary for
a worker to get a foot-hold, i.e. to have good
friction between his/her shoes and the walking
surface, in order to exert strong force on the Figure 3.3.4. A physically monotonous, repetitive
object. In other words, it is desirable to have low job.
friction between the object and the underlying
surface but high friction between an individual Typical situations of the types of work listed
and the walking surface. above are assembly lines, checkouts, data entry,
some types of laboratory work, mass catering,
Repetitive work loading and unloading in semiautomatic systems,
Monotonous, repetitive physical work characteristi- (Figure 3.3.4) and punch press work. Drivers
cally involves the performance of a single or may also experience monotonous work if they
small number of tasks that require the opera- drive the same routes all the time. Some forestry
tor to repeatedly use the same movements for a work involves the use of machinery which is
considerable part of the working day. The work particularly physically monotonous and repeti-
cycle time is often very short and the task is a tive, but which also requires a high standard of
small part of a rapid, flow line sequence. While precision.
this kind of repetitive work is often considered Repeated performance of the same move-
to be “light” work, it can cause considerable pain ments gives rise to a constant, uniform load. The
and tension in the neck. object that is being handled may weigh very lit-
Closely controlled work means that the employ- tle but the weight of the arms themselves is suf-
ee has little or no chance of influencing factors ficient to impose an unsuitable load on muscles
like the pace of work, the sequence of tasks, the and joints. This can lead to the gradual appear-
setting of deadlines for completion of work, ance of serious injuries that are slow to heal.
methods for performing work or the timing The appendix contains a model which can be
of breaks and recovery periods. Restricted work consulted for the identification and assessment
means that it is difficult for the employee to of physically monotonous, repetitive work.
136
Manual work and the process of industrialisation

The long-term, overall influence of the process of industrialisation on health and safety of the
human population is positive. Increased industrialisation creates economic wealth that amongst
other things improves working conditions and the safety and health of the working population.
One such development is that heavy manual work has diminished when production is mecha-
nised and computerised. On the other hand, the process of mechanisation and other forms of
technical rationalisation of work do not always result in light physical work and comfortable
working environments. The process can for instance give an extreme load on small muscle
groups when repetitive and static loads are introduced instead of heavy dynamic loads engaging
the entire body. There is still need for concern about the musculoskeletal safety and health of
man and women at work.
The mechanisation, automation and computerisation may lead to many unfavourable work ar-
rangements. What is ideal for machines, is not always ideal for the workers who operate them or
whose work is paced by the machines. But man can sustain inadequate arrangements of climate
and ventilation, illumination noise, et cetera, and by applying uncomfortable body positions man
can even handle badly designed machines and working equipment. He can also perform mo-
notonous or extremely heavy tasks. This type of ”adaptation” of man to work may be anatomi-
cally, physiologically and psychologically necessary in the work situation, but when frequently
repeated, it brings adverse effects to the efficiency of work as well as to the safety, health and
well-being of man.
Swedish work physiologists and ergonomists have been researching forestry labour for about
60 years, and have been able to show the development of this labour. These studies show that:
• mechanisation and productivity has increased
• whole-body work load has decreased
• the ”ergonomic quality” of machines and tools has improved.
But in spite of the above:

• occurrence of low back pain has been constant
• shoulder-neck disorders have increased.
Some of the reasons for this health development may be found in that:
• productive work time duration has increased
• work load variation has decreased.
As industrialisation, computerisation and globalisation of markets are developing,

working life all over the world is changing. The traditional ergonomic problems
related to heavy manual work, musculoskeletal disorders, design of tools and
machines et cetera today exist simultaneously with problems related to the human-
computer interface (call-centres, control rooms et cetera), reliability, road safety and
other issues where cognitive and organisational aspects of work is dominating.
137
Chapter 3.3
symptoms and disorders work is the only risk factor, the connection is
The shoulder region less clear and needs further investigation.
The structures round the shoulder and shoulder
Carpal tunnel syndrome
joint can be affected by inflammatory conditions
and the incarceration of tendons under the bone. Carpal tunnel syndrome is an incarceration of
The muscles of the rotator cuff, (supraspinatus, the median nerve in the carpal tunnel at the wrist.
infraspinatus, teres minor and subscapularis), Symptoms of carpal tunnel syndrome are tingling
are the most commonly affected. These muscles and numbness in the hand, (especially at night),
are used for lifting and rotating the shoulder as well as pain and weakness in the hand, ac-
and arm. Trapped tendons of the supraspinatus centuated by movement. The nerve conduction
muscle under the bursa may cause a painful con- velocity is reduced in the median nerve measured
dition, (an “impingement”), and the long tendon over the carpal tunnel. Carpal tunnel syndrome
of the biceps muscle attached at the shoulder commonly occurs in connection with diabetes,
may also become inflamed. Other inflammations hypothyreosis (changed function of the thyroid
of the bursa, are also common. The symptoms gland, resulting in low or no production of thy-
of these disorders are pain and restricted move- roid hormones), diseases of the connective tissue,
ment in the shoulder joint. and pregnancy. A number of workplace exposures
A number of factors are often linked to the are connected with the development of carpal
development of symptoms and disorders in the tunnel syndrome but the connection between
shoulder region. The first factor is work pos- exposure to vibration is the best researched and
ture where the arms and hands are raised above documented. Highly repetitive work using the
60 degrees. These disorders are exacerbated if arms and hands for a long period can also result
a worker uses a tool such as a welding unit or in clinical carpal tunnel syndrome. There is no
drill. Many studies have also shown a connection definite evidence to confirm that exposure to
between highly repetitive work and disorders of high levels of bending and stretching in the wrist,
the arms, neck and shoulders. However, awk- or to loads with a forceful grip, can alone result in
ward working postures often occur in conjunc- a carpal tunnel syndrome.
tion with work with raised arms so the effect of Most of the risk exposures do not occur sin-
repetitive work is not as easy to assess separately. gly, and combinations of exposures are more
harmful than a single exposure. Combined expo-
Epicondylitis (tennis elbow) sures to work which is repetitive, requires non-
neutral positions of the wrist, and all exposures
Epicondylitis is an inflammation in the tendons
to vibration present a high probability of causing
of the lower arm muscles attached to the epi-
carpal tunnel syndrome.
condyle bones of the elbow, often referred to as
“tennis elbow”. The connection between physi- Osteoarthritis
cal loads at work and epicondylitis is difficult
Osteoarthritis is a partially degenerative joint
to ascertain because of insufficient knowledge,
disease and is the most common condition af-
however, work situations where both repetitive
fecting the joints. Age is the strongest risk factor,
work and heavy tasks occur at the same time,
although it is unclear whether the age-related
seem to be most risky. Where repetitive or heavy
changes are primarily biochemical or mechani-
138
cal. Osteoarthritis can be divided into a primary reducing exposure

form with no known predisposing factors, and If the risks of injuries from harmful physical
a secondary form where the osteoarthritis arises loads are to be reduced, a full assessment of
as a result of an anatomical defect, injury, devel- the work situation must be undertaken. Physi-
opmental disorder, infection or physical load. cal and/or technical measures taken alone are
The disease primarily affects the cartilage in the seldom sufficient unless the work is completely
joint, but the underlying bone surfaces can also mechanized. The main concern should be re-
be affected resulting in a stiff and painful joint. duction of repetitive tasks and limits on the
The main joints affected are the large ones such length of time individual employees spend on
as the knee and hip, and the joints of the fingers this type of work, measures which are likely to
and hand. necessitate some form of organizational change.
The knee joint consists of two joints, the If the organisation of work is altered through
tibiofemoral joint between the femur (the thigh job rotation, job diversification and job enhance-
bone), and the tibia (the shin bone), and the ment, employees have more scope to influence
patellofemoral joint between the patella and the their own work arrangements and timing of
femur (the thigh bone), and the tibia (the shin breaks, increasing the opportunities for varia-
bone). Great force is exerted on the knee joint tion, participation and personal development.
during movement and weight bearing.
Many studies have established a clear connec- • Job rotation generally means that employees
tion between osteoarthritis and work requiring alternate between different tasks of a similar
crouching, kneeling or bending. Heavy work is nature. If job rotation is introduced, it is im-
also strongly suspected to be a risk factor for the portant that it leads to a meaningful variation
development and early emergence of osteoartritis. in workload. Job rotation often has only a lim-
The hip joint is one of the largest in the body. ited effect on reducing harmful physical loads.
It has a weight-bearing function and must be • Job diversification/enlargement means a number
flexible and able to bend, stretch and rotate. of tasks as combined, e.g. supplementary
Osteoarthritis is unusual in young people but duties, such as maintenance and cleaning,
those with a congenital hip disorder or who have are added to an existing job or employees are
suffered an infection in the joint, e.g. tubercu- allotted a bigger share of the flow line se-
losis, can develop osteoarthritis, particularly if quence. Job diversification typically lengthens
they are also exposed to heavy loading during the work cycle.
their working life. • Job enhancement/enrichment gives employees
A number of studies from different countries, a wider range of duties requiring a variety of
using a variety of methodologies, show a con- skills and qualifications, e.g. through the addi-
nection between early development of osteoar- tion of a number of tasks including work plan-
thritis of the hip and farming work, although the ning, inspection of work output or customer
exact nature of the exposure is unclear. Some contacts.
studies have shown that generally heavy work
(mainly heavy lifting, jumping or movement As regards limits on the amount of time an em-
between different levels), can cause osteoarthritis ployee spends on physically monotonous, repeti-
of the hip. tive work, the distribution of working sessions
139
Chapter 3.3
throughout the day has an important bearing on jective experience of disorders. Good job control
the risk of musculoskeletal disorders. This type means, (amongst other things), the ability:
of work should be performed in short spells,
• to alternate between different tasks,
spread out over an entire shift and continuously
• to alternate between sedentary and standing
interspersed with other work, breaks and rest
work,
intervals.
• to take short breaks for recovery when
If physically monotonous, repetitive work is
needed,
automated or changed, care must be taken to
• to choose or adapt the pace of work,
ensure that no “residual tasks”, (e.g. filling or
• to get help from others when necessary,
extraction of production material), are created at
• to be involved, (on the strength of one’s
either the beginning or the end of fully or semi-
own experience), in the procurement of new
automated systems.
equipment and the introduction of new work-
In some occupations, (e.g. orchestral musi-
ing methods.
cians, data-entry operators), static loading of the
neck region can cause acute and/or chronic pain.
Some types of pay systems, such as piecework or
There is also evidence of a connection between
incentive pay systems, can lead employees to use
forceful, dynamic work tasks such as the use of
very poor and unsafe work techniques because
handheld tools, affecting the neck and arms.
they feel under pressure to exceed their physical
There is also a connection between low back
and mental limits in order to earn more money.
and neck problems and psychosocial factors such
It is essential that pay systems put a premium on
as high demands, combined with factors such as
quality and general competence rather than on
low control, job strain, lack of job satisfaction,
product quantity and specialization.
stress, bad relationships with co-workers and su-
periors, monotony and dull work content. Most Work using hand-held machines, hand tools
of these psychosocial exposures occur together and controls
with harmful physical loads. It is difficult to
Hand-held machines and tools commonly
distinguish the degree of harmfulness from any
contribute to musculoskeletal disorders of the
individual other risk factor but a combination of
hands, wrists, arms and shoulders. Vibration is
exposures often leads to the highest risks of ill
a major risk factor, e.g. from the use of chain
health, as is the case for both low back and neck
saws, grinders, hammers and drills. Other risks
disorders.
depend on the design and use of machinery and
The ability to influence the arrangement
tools which are not always adapted to suit peo-
and conduct of one’s own work is an essential
ple with small hands and limited muscle power,
prerequisite for individual wellbeing and de-
particularly women.
velopment potential. Influence over planning,
The use of hand-held machines or tools often
working arrangements and methods, the timing
demands both strength and precision. Where
of work and breaks, the pace of work and the
high standards of precision are required, as for
procurement and use of working aids, helps to
example in the case of a dentist or watchmaker,
prevent musculoskeletal disorders.
static workloads can be hard to avoid. In such
Social interaction with management and fel-
cases, it is important to have functional tool
low employees at the workplace has proved to
design and frequent opportunities to rest.
play an important part in the occurrence and sub-
140
To minimize the risk of musculoskeletal disor- bated even after the veritable explosion of stud-
ders, employers should provide their employees ies published in the 1980´s and 1990´s. There
with hand-held machines and hand tools that: is a lack of high quality scientific research on
the situation in low income countries where the
• permit appropriate grips, are adapted to the
problems are likely to be greatest. The 1983 edi-
requirements for force and precision
tion of the ILO Encyclopaedia of Occupational
with good friction and with the gripping force
Safety and Health had no references to muscu-
properly distributed over the hand, so as to
loskeletal disorders but the 1998 edition includes
avoid unsuitable concentrated pressure, e.g.
about 400 references on the topic. This example
with no sharp edges,
illustrates the changing approach to muscu-
• will fit different sized hands,
loskeletal problems when the pain, discomfort
• can be used with either hand,
and disability are considered to result from poor
• permit a neutral positioning of the wrist and
working conditions. It is possible to prevent
arm (the position of the hand when relaxed
injuries and is a legitimate concern for workers
and resting on a table) whenever possible,
safety and health.
• afford good vision and easy access to the item
Heavy workloads are now less common in
being worked on,
high income countries but still exist in some
• are equipped with a trigger with a reasonable
sectors such as the construction industry, small
control resistance for force,
scale farming and home care. Sectors including
• vibrate as little as possible,
mining, transport work, and forestry have been
• are as light as function permits,
mechanised, however, other problems arise as
• are well balanced.
work is increasingly mechanised and compu-
terised. Higher technical skills are needed and
The use of controls (such as foot pedals), mainly
there is an increase in monotonous, static work
occurs in work situations involving mobile
postures and stress, all factors that can cause
machinery or vehicles but may also be used at
musculoskeletal disorders. As production and
stationary workstations. It is important that con-
work are transfered to poorer countries with
trols are designed and positioned to suit employ-
lower wages and less developed safety regula-
ees’ physical characteristics such as body size and
tions, more work-related musculoskeletal disor-
strength. This applies to both manually operated
ders will appear in the poorer countries.
controls and to pedals and other controls oper-
Occupational health and safety managers in
ated by the feet or legs.
developing countries need to be aware of this
the future problem because it is likely that musculoskeletal
pain and disorders are substantial burdens to
It has been known for centuries that hard labour
the workforce. Improvements to ergonomic and
causes pain and discomfort, however, the con-
psychosocial conditions at the workplace are
cept of work-related musculoskeletal disorders
important ways to improve the health status and
was not recognised as an important occupational
the well-being of all workers in all societies.
health problem in the industrialized world until
The Appendix on the following pages is origi-
the 1970’s. The causal chain between various
nally published by the Swedish Work Environ-
physical and psychosocial exposures is still de-
ment Authority (www.av.se)
141
Chapter 3.3
appendix is impossible to identify the degree of harmful-

models for the assessment of work
ness of individual work postures, because of the
postures, manual handling and
difficulty of segregating individual postures.)
physically monotonous, repetitive
Frequently, there is a single or small number of
work
common work postures with poor ergonomics,
e.g. postures used every day or work requir-
Background ing extreme working positions. The model is
There has long been a need for practical, sys- designed to assess such postures. When these
tematic and simple methods for the identifica- postures have been identified, reference to the
tion and assessment of ergonomically hazardous chart will allow you to see the classification for
jobs or situations. These models should make the postures in question, (red, yellow or green) for
it possible to obtain an initial indication as to one or more parts of the body.
whether or not a certain job or operation entails In principle, identification of only one posture
physical loads dangerous to health, and give a in any square (red or yellow), is sufficient for ap-
basis for remedial action. plication of the suggested remedies. The greater
the number of assessments appearing in a red
Assessment model principles field, the greater the need for remedial action.
The connections between work and the risk of The parts of the body used in the model, are
musculoskeletal disorders are often relatively points to observe but are not necessarily the
complicated so these models have been simpli- parts of the body that are injured. For example,
fied for practical use. The models only consider “unstable underlay” (underlying surface) in the
some of the characteristics of one type of load model means a risk of back disorders rather than
so they cannot be used as exact load limit values. a risk of leg ailments.
But, they should offer sufficient guidance for The model uses a “full” working shift of 4-8
practical changes to existing workstations of for hours per day. Reference to “a significant part
planning new workstations and jobs. of the shift” means that the work posture occurs
Due to their simplified nature, an uncritical with either no, or very short interruptions, for
application of the models may result in overesti- more than half the shift. “Intermittently” means
mates and/or underestimates of the actual risks. that, in total, the identified work posture alter-
A comprehensive assessment would require nates with other work postures for less than half
more factors to be taken into account and for the shift.
more accurate models to be used which would N.B. The model does not take account of the
call for a thorough knowledge of ergonomics. level of exertion required for the job. Any of the
The models are based on a triple-zone system yellow or green jobs can turn red if high levels
(red, yellow and green), for easy identification of of exertion are required.
working conditions which are clearly hazardous or The length of exposure to risk is always impor-
which entail negligible risks, as the case may be. tant in assessments. No work posture which can
be assumed naturally is intrinsically dangerous
Models for the assessment of sedentary, to health, but any posture may become risky if it
standing and walking work postures is assumed too often or for too long.
The following is an assessment model to help
identify unfavourable work postures. (N.B. It
142
143
Chapter 3.3
Sedentary, standing and walking work postures
144
* Leg-operated pedal work = the brake or clutch pedal of a motor vehicle

* Foot-operated pedal work = the accelerator pedal of a motor vehicle
145
Chapter 3.3
Model for assessment of lifting work

The following model for the assessment of lifting work concentrates on two main factors: the weight
of the load and the distance in front of the body, of the centre of gravity of the load. This means that
other important factors (e.g. the frequency, duration, height, and ease of lifts), are not included in the
model so supplementary assessments will be needed. This model is valid for both sexes.
Model for assessment of a symmetrical lifting operation in the standing position, using two hands and
under ideal conditions. Horizontal distance = the distance between the lumbar region and the centre
of gravity of the burden when lifting.
146
Model for assessment of pushing and pulling work
Force is measured in Newton’s [N] using a dynamometer.
This model refers to good ergonomic conditions, i.e. a symmetrical two-handed grip, properly de-
signed handles positioned at a suitable height and good ambient conditions. If, for example, the ob-
ject is to be moved over a long distance, the operation is repeated frequently or for a long time, the
grasping height deviates considerably from about elbow height, then the values in this model should
be correspondingly reduced. The same applies if the work is done using one hand only. Several of the
conditioning factors in the assessment model for lifting work are also applicable to pushing and pull-
ing work.
One conclusion that can be drawn from this Questions about the object:
model, is that handling of loads weighing in • is the object: difficult to grasp? possible to be
excess of 25 kg is unsuitable in the majority of handled close to the body? large? unwieldy?
cases. warm? cold? sharp? wet? smooth?
• is the object: fragile? unstable? mobile or li-
Important factors influencing assessment of able to shift (e.g. a sack of potatoes)?
risk
The following are the most important of the Questions about “the workplace”:
many factors which should be taken into ac- • is the workplace of sufficient size (e.g. have
count in the assessment of risk, especially if the sufficient headroom)?
first assessment comes in the yellow field. The • are there obstructions in the workplace (e.g.
greater the number of “aggravating” factors, the stairs or poorly stored materials)?
lower the recommended maximum weight will • is the floor/underlay slippery, uneven, sloping
be compared with ideal lifting conditions. or unstable?
• are climatic conditions satisfactory?
Questions about tasks:
• is the work: performed for a long period? Questions about the person doing the lifting:
frequently? under time pressure? controlled • does the employee have sufficient physical ca-
by a machine? are employees allowed to take pacity (e.g. muscular strength, aerobic capac-
breaks when required? ity or body control)?
• does the job: require the trunk to be bent or • does the employee have sufficient knowledge
twisted? require the trunk to be both bent and about safe work techniques? Is the employee
twisted? using this knowledge, applying adequate
• is the load carried over a long distance? lifting techniques? is the employee wearing
• does the handling require precision? suitable clothing and/or footwear?
147
Chapter 3.3
Model for identifying and assessing physically monotonous, repetitive work

The following assessment model can be consulted for the identification and assessment of physically
monotonous, repetitive work. A final assessment of risk should always include the total time devoted to
the work and how it is spread out over the day.
148
Aggravating factors: repeated with the next object. It is not unusual

• work that requires a great deal of physical for the same working movements to be repeated
exertion, precision or speed of movement, several times within a working cycle of this kind,
• working with objects that are heavy and dif- i.e. for the “technical working cycle” to consist
ficult to grasp, of several “kinetic cycles”. If kinetic cycles are
• a reward system that pays a premium for not clearly distinguishable, the “technical” work-
quantity rather than quality, e.g. piecework, ing cycle can be used as a starting point. Fingers
• a production process that is subject to fre- and wrists can cope with a higher frequency of
quent and unexpected disruptions that em- movement, without suffering injury, than elbows
ployed cannot control, and and shoulder joints so serious attention should
• poor social relations and social support at the be taken if these larger joints are used for work.
workplace.
Work postures and working movements:
Assessment Reference is made to the assessment model for
The work cycle is the predominant factor. If this strenuous work to aid the assessment of work
is found in a red field, the work is judged to be postures. When assessing working movements,
physically monotonous and repetitive which is attention must be paid to which parts of the
harmful. Remedial measures should be taken body are used.
very promptly. The risk of negative effects fur-
ther increases if one or more of the other fac- Job decision latitude: The concept of “job
tors also come in a red field. If the work cycle decision latitude” relates to the level of control
is found in a yellow field, conditions should be a worker has over their work procedures. For
evaluated more closely. If one or more other example, individuals sitting at a conveyor belt
factors appear in a red or yellow field, the work are unable to influence the speed of the machine
is rated as unsuitable and measures should be and are therefore controlled by someone else.
taken. If the work cycle is judged to come in If employees are confronted by long queues of
the green area, the work is no longer assessed as customers, they can experience mental stress
physically monotonous and repetitive. Where that limits their job decision latitude. Piecework
other factors are concerned, working conditions implies an element of self-determination, in that
improve as one moves towards a green field. the employee can decide how much they will
Aggravating factors must always be included in a produce, however, in practice, piecework often
total assessment. has the opposite effect as there are always mini-
mum requirements for output.
Explanation of the model
The diagram is based on a full working shift, Job content and training/competence re-
which is usually 8 hours a day. quirements: Job content refers (at least in part),
to possibilities to see the ”whole” production
Work cycle: The duration of a work cycle is process and how an individual contributes to
commonly defined by industry as the time that that process. High quality job content means
elapses from the time the machining/processing that employees recognise that work tasks of
of an object starts until the same operation is different character clearly belong together, e.g.
149
Chapter 3.3
because their job content includes elements of ance while time for breaks and recuperation
planning, implementation and inspection. Em- diminishes.
ployees with high quality jobs are able to use and Training/competence requirements refer
develop their competencies/skills to the induction, introduction and subsequent
There are jobs with conspicuously limited job training needed by employees in order to do
content where the only stimulus is the volume a job. More complex tasks cater to the physi-
of product an individual can produce and/or the cal, mental and creative capacities and needs of
associated incentive pay. The mental stimulus employees. Jobs with high quality job content
connected to being ‘good at the job”, i.e. fast, usually require longer training and continuous
actually endangers physical health because the competence development.
load on the body increases with rising perform-
suggestion for further reading
Linton S (ed). New avenues for the prevention Kroemer KHE, Grandjean E. Fitting the task
of chronic musculoskeletal pain and disability. to the human (fifth edition). Taylor and Fran-
Elsevier 2002. cis 1997.
Waddell G, Aylward M, Sawney P. Back pain, Barling J & Frone MR (eds). The psychology
incapacity for work and social security benefits: of workplace safety. American Psychology Ass.
an international literature review and analysis. 2004.
Royal Society of Medicine Press 2002.
Karasek R & Theorell T. Healthy work - stress,
Nachemson A & Jonsson E (eds). Neck and productivity and the reconstruction of working
Back pain - the scientific evidence of causes, life. Basic Books 1990.
diagnosis and treatment. Lippincott Willams &
Wilkins 2000.
150
3.4
Workplace design and evaluation

Roland Kadefors
workplace design definitions

and limitations
This chapter examines the design of the im- cycle length, repetitive tasks, autonomy, and the
mediate environment in which a person works, arrangement of work and rest time.
i.e. a workstation, defined as the “combination Stress can be imposed by poor work organisa-
and spatial arrangement of work equipment, tion and may also increase the risk of muscu-
surrounded by the work environment” (Interna- loskeletal pain syndromes, but this chapter does
tional Standard, ISO /DIS 6385). According to not address psychosocial factors, including men-
the same source, “work equipment” is defined as tal stress, explicitly.
“tools, including hard- and software, machines,
vehicles, devices, furniture, installations and creating new workplaces
other components used in the work system”. The design of workplaces is a critical task in
These definitions underline the fact that work- ergonomics. A well-designed workplace not only
place design needs to take all the relevant factors increases the health and wellbeing of operators
into account in order to ensure that workers’ but also improves productivity and product qual-
health is adequately protected. ity. Conversely, poorly designed workplaces are
This chapter on workplace design principally likely to cause or contribute to the development
addresses “manual work”, focusing on design of health problems or chronic occupational dis-
that aims to avoid physical strain and exposures orders, as well as to problems with maintenance
that cause pain and discomfort in the muscu- of desired product quality and productivity. It
loskeletal system. However, in practical design is surprising that there is a widespread lack of
situations there will always be specific factors awareness internationally among technical per-
that have to be taken into account. For instance, sonnel, supervisors, and managers responsible
in the design of a manual assembly system, it for workplaces with respect to the importance
is essential to consider not only the physical of workplace design. However, there is a grow-
layout of the workstations along the producing trend in both developed and developing
tion line, but also the organisation of the work countries, that emphasises the importance of
system. The distribution of work tasks between ergonomic factors in the increasing demand for
successive workstations in such a system defines product quality, flexibility and precise delivery
important ergonomic characteristics such as schedules, all demands that are not compatible
151
Chapter 3.4
with a conservative view the design of work and whole methodology relevant to systems design,
workplaces. it is valuable to consider the process for work
As mentioned above, this chapter focuses on systems design as recommended in the inter-
physical factors but workplace design cannot be national standard “Ergonomic principles in the
practically separated from the organisation of design of work systems” (ISO 6385:2004). This
work, (as illustrated by the design process de- standard emphasises the need to devote atten-
scribed later in the text). The quality of the end tion to “the human, the social and the technical
result relies on the implementation of three key requirements during the design process”.
factors: ergonomic knowledge, integration with In this context, we concentrate on the “work-
productivity and quality demands, and participa- station and workspace” aspect of design, as it
tion. relates to musculoskeletal strain.
Workplaces are meant for work and any
workplace design process must recognise that Steps in the process
a specified production goal has to be achieved. In the workplace design and implementation
Industrial designers, (often production engineers process, there is a need to inform users and to
or others at middle management level), develop organise the project in such a way that there is
an internal vision of the workplace and then start full participation by users thereby improving
to implement this vision through their planning the quality as well as increasing the chance that
media. The process is repetitive, starting with employees will fully accept the final result. A
a crude first attempt and gradually refining the participatory approach should always consider
solutions. It is essential that ergonomic aspects the following steps, see Figure 3.4.2.
be taken into account as the work progresses. However, in many cases, only some of these
The design process needs a structure that en- steps are actually included in the workplace
sures that all relevant aspects are considered, e.g. design. There are a variety of reasons for this.
traditionally through the use of checklists that For example, if the workplace is of standard de-
contain a series of variables that should be taken sign, such as for work with Visual Display Units
into account. An example of such an exhaustive (VDUs), some steps may be excluded but in
checklist concerning workplace design, the Er- other cases, the exclusion of some steps may re-
goweb, is presented in Figure 3.4.1. The website sult in an unacceptably lower quality workplace.
www.ergoweb.com/resources/reference/guide- This may occur when there are overly stringent
lines/fittingjob.cfm, has checklists covering task economic or time constraints, or because of lack
analysis, hand tool analysis, material handling, of knowledge or insight at management level.
and computer workstations. However, general Another situation arises when a new workplace
purpose checklists tend to be voluminous and is created from scratch and there are no employ-
difficult to use as often only a small part of a ees to involve so the ergonomist needs to articu-
checklist is relevant for a specific design situa- late the potential demands of the end users of
tion. In addition, some variables will be more the workplace. Views on potential user demands
important than others. can then be sought from experienced profes-
sional practitioners.
the workplace design process
The workplace is usually part of a work sys-
tem, but while it is not possible to address the
152
Workstation checklist
A “no” response indicates potential problem • Is the workstation designed to reduce or
areas that should receive further investigation. eliminate raised elbows?
• Does the working space allow for a full • Is the employee able to vary posture?
range of movement? .
• Are hands and arms free from pressure from
• Are mechanical aids and equipment avail- sharp edges on work surfaces?
able? • Is an armrest provided where needed?
• Is the height of the work surface adjustable? • Is a footrest provided where needed?
• Can the work surface be tilted or angled? • Is the floor surface flat?
• Is the workstation designed to reduce or • Are cushioned floor mats provided for em-
eliminate bending or twisting at the waist? ployees who are required to stand for long
• Is the workstation designed to reduce or periods?
eliminate reaching above the shoulder? • Is the chair or stool easily adjustable and
• Is the workstation designed to reduce or suited to the task?
eliminate static muscle loading? Are all task requirements visible from com-
•
• Is the workstation designed to reduce or fortable positions?
eliminate extending the arms? • Is there a preventive maintenance program
• Is the workstation designed to reduce or for mechanical aids, tools, and other equip-
eliminate bending or twisting the wrists? ment?
Figure 3.4.1. A workplace design checklist. Source: Ergoweb.
153
Chapter 3.4
Identification of technical demands

1. Formulation of goals
The planning phase specifies the end product
of the work to be carried out in the workplace.
In large organisations, there is frequently a gap
between design and production so wherever
possible, it is useful to integrate ergonomics into
2. Analysis and allocation of the early phases of product development. This
functions possibility is significantly more likely to eventu-
ate if production and design are part of the same
company or group.
Small companies commonly deliver to a large
3. Design concept company or local workplaces are part of a larger
chain of workplaces, so there is often little pos-
sibility to influence design. Nevertheless, in
all cases, information on ergonomic problems
should be fed back to the designers for consid-
eration. It may also be necessary to take account
4. Detailed design of productivity losses and quality problems as
poor ergonomics often goes together with poor
• Work organisation
production performance.
• Work tasks
• Jobs Collection of user specified demands
• Work environment It is relevant to identify users of the workplace as
• Work equipment, any member of the production organisation who
hardware and software may be able to contribute qualified views on the
• Workspace and design of a new workplace. This includes work-
workstation ers, supervisors, production planners and/or
engineers, as well as safety stewards and mem-
bers of the health care organisation. Experience
shows clearly that these actors all have unique
knowledge that should be used in the process.
The collection of specific demands from users
5. Realization, implementation should meet a number of criteria:
Openness. All points of view should be noted
and validation
without criticism being expressed in the initial
stage of the process.
Non-discrimination. Viewpoints from every
Figure 3.4.2. A work system design process, adapt- category should be treated equally at this stage
ed from ISO 6385:200. of the process. Special consideration should be
given to the fact that some people may be more
154
eloquent than others so there is a risk that they forms a basis for the development of a workplace
may silence other participants. specification. It is essential that these demands
Development through dialogue. There should be are expressed in terms that will help the users,
an opportunity to adjust and develop demands i.e. that they express function rather than only
through a dialogue between participants of dif- specifying technical characteristics, e.g. users
ferent backgrounds. Prioritising should be part might demand that a tool fits in an operator’s
of the process. pocket.
Versatility. The process of collection of specif- QFD techniques are not the only approach
ic user demands should be reasonably economi- for collecting user demands. Another method
cal and not require the involvement of specialist for structuring user demands on the choice
consultants or demand extensive time contribu- and/or development of hand tools is “A Good
tions from participants. Tool – Check Yourself”, see Figure 3.4.3. This
The above criteria may be addressed by using is a very useful method when there is a choice to
a methodology based on Quality Function De- be made between different tools, (or other prod-
ployment (QFD). User demands may be collect- ucts), and in particular, to motivate the purchase
ed in a session, typically 10-15 minutes, involv- of a more expensive tool with better ergonomic
ing a mixed group of actors (not more than 8-10 properties. End users may be interviewed by
people). All participants are given a pad of re- using this guide, and interview results can be
movable self-stick notes. They are asked to write then combined and presented. This process
down all relevant workplace demands using a articulates end user views and helps to increase
separate slip of paper for each. Aspects relating awareness of the importance of ergonomics in
to work environment and safety, productiv- the organisation.
ity and quality should be covered. At the end
of the session, each participant is asked to read
out his or her demands and to stick their notes
to a board that everyone in the group can see.
The demands are grouped in natural categories,
for instance, concerning lighting, lifting aids,
production equipment, reaching requirements,
and flexibility demands. After completion of the
round, the group is given the opportunity to
discuss and to comment on each set of demands,
with respect to relevance and priority. The con-
venor takes notes and makes a report that is used
as the basis for subsequent design stages.
This way of working can be applied in any
situation (service organisations and manufactur-
ing companies alike), where there is an existing
production organisation.
The set of user specified demands collected
in a process such as the one described above,
155
Chapter 3.4
a good hand tool – check yourself 6. What do you think about the surface of the
1. What do you think about the size of the tool? handle?
Very Rather Neither Rather Bad Very Rather Neither Rather Bad
good good good nor Bad Good good good nor Bad
bad bad
10 9 8 7 6 5 4 3 2 1 10 9 8 7 6 5 4 3 2 1
a) Too bulky? yes no a) Good structure? yes no

b) Isolated against cold/heat? yes no
2. What do you think about the weight?
7. What do you think about the usefulness
Very Rather Neither Rather Bad
of the tool?
good good good nor Bad
bad Very Rather Neither Rather Bad
good good good nor bad
10 9 8 7 6 5 4 3 2 1
bad
a) Too heavy? yes no 10 9 8 7 6 5 4 3 2 1
3. What do you think about the balance? a) Can it be used with two hands? yes no
b) Is it comfortable to use? yes no
good good good nor Bad
bad
8. What do you think about the efficiency of the
tool?
10 9 8 7 6 5 4 3 2 1
a) Too much forward inbalance? yes no good good good nor bad
b) Too much backward inbalance? yes no bad
10 9 8 7 6 5 4 3 2 1
4. What do you think about the size of the
handle?
9. What do you think about the appearance of
Very Rather Neither Rather Bad the tool?
bad Very Rather Neither Rather Bad
10 9 8 7 6 5 4 3 2 1 bad
a) Too long? yes no 10 9 8 7 6 5 4 3 2 1
b) Too short? yes no
a) Is the form OK? yes no
c) Too thick? yes no
b) Is the colour OK? yes no
d) Too slim? yes no
b) Is the tool easy to recognise? yes no
5. What do you think about the form of the
10. What do you think about the service and
handle?
maintenance of the tool?
bad
bad
10 9 8 7 6 5 4 3 2 1
10 9 8 7 6 5 4 3 2 1
a) Too round? yes no
b) Too angular? yes no
Figure 3.4.3. A checklist for selection and evaluation of handtools.
156
Prioritising and demand specification An example of a prioritising guide used in “The

With respect to the specification process, it is Swedish Hand Tool Project” is shown in Figure
essential that different types of demands are 3.4.4. This guide was developed to support the
considered according to their respective impor- decision about which one of two alternative tools
tance. This avoids the need for all aspects to be should be prioritised. The weight factors for
taken into account in parallel, which may make each tool were added together and compared.
the design process complex.
It may be difficult to devise a priority scheme Technical and user term specification
that will serve all types of workplaces equally The technical specification of a workplace is
well but if it is assumed that manual handling based on the prioritised technical and user
of materials, tools or products is an essential demands. This document could be given to
aspect of the work to be carried out, there is the appropriate person responsible for imple-
a high probability that aspects associated with mentation or could form the basis for a tender.
musculoskeletal load will be the top priority. The transfer of user specifications to technical
The validity of this assumption can be checked specifications is sometimes easy, but may also
when user demands are collected. Relevant user be complicated. For instance, if workers in a
demands may include work tasks associated with sewing factory need to see what they are do-
muscular strain and fatigue, reaching, poor vis- ing, adequate lighting is required. On the other
ibility, and ease of manipulation. hand, demands to be able to work without get-
It is essential to realize that it is not possible ting back pain require more detailed considera-
to transform all user demands into technical tion if technical solutions are to be found. While
specifications. Some demands relating to more this is a very reasonable demand, there may be
subtle aspects of work such as comfort, may be a number of solutions such as the possibility for
highly relevant and worthy of consideration in individual adjustment of the height of chairs and
some, but not all, situations. tables or a degree of mechanisation to alleviate
heavy or sustained lifting.
Tool problem category Problem Tool Tool
weight 1 2 workplace evaluation
Causes accidents? 5 Evaluation methods
Causes musculoskeletal pain or 5
With respect to physical workload, there are
disorders?
basically three methods used to evaluate existing
Uncomfortable? 3
workplaces,
Used many times during a work 2
shift? • direct measurement,
Low materials quality? 1 • expert observation,
Ineffective? 1 • subjective assessment.
Gives poor product quality? 1
Direct measurement is particularly useful in re-
Unattractive, ugly? 1 lation to workspace evaluation to address ques-
Sum tions such as the distances that operators can see
and reach, and whether work can be carried out
Figure 3.4.4. Guide for prioritising in a workplace
design situation. Example: choice between two in the optimal working zone. Figure 3.4.5 out-
hand tools. lines optimal working zones in relation to stat-
157
Chapter 3.4
ure (typical for males and females), for standing

work. Figure 3.4.6 shows recommended meas-
ures for sitting work. Even though the average
height of populations varies between different
countries, it is possible to normalise and apply
the recommendations to individual cases.
Figure 3.4.7 gives examples of the stature of
men and women in different countries. This
Inner working area
gives a basis for adaptation of the recommended Outer working area
measures to conditions in an individual country.
However, it should be noted that part of these
data are 20 years old or more and the average
stature has increased by 10 mm or more per dec-
ade so it is advised that the stature of the popula- Figure 3.4.6. Working areas for the hands. (Measure-
tion be checked before designing a workplace. ments in centimetres).
Such information can be found for instance in
military conscription statistics.
There are many methods for expert observation
of work e.g., the use of checklists and structured
observational guides. An example of an ergo-
nomic analysis instrument is RULA (Rapid Up-
per Limb Assessment), which makes assessment
based on specification of body posture, handled
load and repetition. It can be used online by
visiting www.rula.co.uk
Expert observation methods are best suited
for analysis of static or repetitive work carried
out in relatively short cycles. Variable work
observation methods tend to be too time con-
suming for work with long cycles because it
is often necessary to analyse several operators
carrying out the same job before conclusions can
be drawn. Individual factors such as stature or
Suitable Less suitable
working techniques, may significantly influence
the ergonomic workload. Expert observation
Figure 3.4.5. Suitable working heights for a large can also be facilitated by video filming work or
and small person respectively. 95 per cent of through analysis away from the production line.
Swedish men are smaller than the man in the In ergonomic evaluations of existing work-
drawing, and 95 per cent of Swedish women are
places, it is reasonable to make use of subjective
bigger than the woman. In normal instances, the
most suitable working height is on a level with assessment by taking account of the experience
the employee’s elbow. (Measurements are in of the workers carrying out tasks. Question-
centimetres). naires and interviews may supply extremely use-
158
Country Men Women

Brazil (industrial workers; 1989) (1595)1700(1810) -
Hong Kong (industrial workers; quoted 1996) (1585)1680(1775) (1455)1555(1655)
India (agricultural workers; 1989) (1540)1620(1700) -
Sri Lanka (workers; 1987) (1535)1640(1745) (1425)1525(1620)
Sweden (16-84 years; 1998) 1790 1655
U.S.A. (19-60 years; 1989) (1647)1756(1867) (1528)1629(1737)
Figure 3.4.7. Stature in some countries in adult men and women (millimetres).
(5th percentile) 50th percentile (95th percentile).
ful information on the physical workload condi-

tions, at low cost. The inclusion of self-reported
assessments is based on a general view (with
some scientific support), that reported high
levels of pain and discomfort during work imply
an increased risk of occupational disorders in the
musculoskeletal system in the long term. Within
the context of ergonomics, the subjective views
of users provide a relevant basis for workplace
design, on the grounds that pain and discomfort
imply a poor correlation between work demands
and capacity. Consequently, the productivity and
quality of work is likely to be improved, which
is consistent with a participatory approach to
ergonomics.
An example of a widely applied instrument
for collecting subjective responses to workloads
is the body map included in Figure 3.4.8 (the so
called Nordic Questionnaire). Subjects are asked
if they feel pain or discomfort anywhere in the
Figure 3.4.8. Body map from the Nordic
body, and if so, to indicate on the map which Questionnaire.
part of the body is painful or uncomfortable.
In addition to location, the degree of pain or
discomfort is also of interest. A useful instru-
ment for severity assessment is shown in Figure
3.4.9. Subjects are asked to identify the number
on the scale that best describes their pain or
discomfort.
159
Chapter 3.4
The Borg CR-10 Scale for psychophysical scaling
0 Nothing at all
0.5 Very, very weak (just noticeable)
1 Very weak
2 Weak (light)
3 Moderate
4 Somewhat strong
5 Strong (heavy)
6
7 Very strong
8
9
10 Very, very strong (almost maximal)
* Maximal
Figure 3.4.9. A scale for subjective reporting of perceived exertion, pain or discomfort.
Maximum allowable holding time (minutes)
Figure 3.4.10. Maximum allowable holding time in minutes, in various body postures. A posture is defined
by the vertical hand position (working height expressed as the percentage of shoulder height in upright
standing position) and the horizontal hand position (working distance expressed as the percentage of
arm reach). For instance, “125/100” means a posture where there is full arm reach and where the hands
are 25 percent above shoulder height. Adapted from Ringelberg and Koukulaki: Risk Estimation for
Musculoskeletal Disorders in Machinery Design.
160
Examples of useful guidelines: static posture for the Revised NIOSH Lifting Equation”, an
Specific guidelines to support expert assessment equation for maximum recommended weight
exist for musculoskeletal strain, in particular in manual lifting is presented. This equation
static posture and heavy materials handling. takes into account the following mediating fac-
In terms of postures for static work, recom- tors: horizontal distance, vertical lifting height,
mendations may be based on 20% of the maxi- lifting asymmetry, handle coupling, and lift-
mum time that a person should maintain a cer- ing frequency. In this way, the 23 kg maximum
tain posture. This level is chosen so as to avoid acceptable load limit, based on biomechanical,
“strong discomfort” (score 5 according to Borg’s physiological and psychological criteria under
rating scale, Figure 3.4.9). Figure 3.4.10 shows ideal conditions, may be modified substantially
the estimated maximum duration that should to take account of the specifics of the working
be allowed without taking a rest, for 19 differ- situation. The NIOSH equation provides a base
ent standing body postures and arm positions. for evaluation of work and workplaces involv-
These measures correspond to 20% of maxi- ing lifting tasks. However, there are limitations
mum endurance time. It should be noted that in to the usefulness of the NIOSH equation: only
this instance, the load is not aggravated by the two-handed lifts may be analysed, and the as-
handling of materials, tools etc. but consists only sessment is strictly based on loading of the lower
of the body itself so if weight is added, the time back, without taking the load on e.g. the arms
will be shortened. These recommendations are and shoulders, into account.
applicable for both one- and two-handed opera-
The basic form of the equation is,
tions.
RWL = LC × HM × VM × DM × AM × FM × CM,
where:
Examples of useful guidelines: manual lifting RWL = Recommended Weight Limit
The Swedish Ordinance (AFS 1998:1, Ergo- LC = Load Constant (23 kg)
HM = Horizontal Multiplier
nomics for the Prevention of Muscular Disor-
VM = Vertical Multiplier
ders) provides relevant guidelines for manual DM = Distance Multiplier
two-handed lifting. As in Figure 3.4.5, the dis- AM = Asymmetric Multiplier
tance between the hands and the body is taken as FM = Frequency Multiplier
CM = Coupling Multiplier
a determinant, but here the weight of the load is
a variable. A model for assessment of two-hand-
ed lifting tasks is shown in Figure 3.4.11. Here, All the multipliers HM through CM are ≤ 1.
the maximum acceptable load ranges between This means that while the maximum recom-
15 and 25 kg depending on the position of the mended mass under optimal conditions is 23 kg,
hands relative to the lumbar region of the body. it will almost always be compromised and set to
The allowable load may be compromised a lower value. The multipliers are calculated on
because the lifting is very frequent, or if twist- the basis of the characteristics of a given task.
ing occurs, etc. A number of such factors are This instrument can be downloaded from
covered in the more complex NIOSH Model www.cdc.gov/niosh/docs/94-110.
for Manual Lifting. In the “Applications Manual
161
Chapter 3.4
cal, physiological and psychological factors.

Muscular force is a variable that is calculated
through measurement of output force demands,
Distance from in terms of handled mass or required force for
lumbar region
an operation e.g., operation of handles. Peak
loads connected with highly dynamic work may
also have to be taken into account.
Working posture demands may be evaluated by
Load mass (kg)
mapping (a) situations where the joint structures
are stretched beyond the natural range of move-
Red
ment; (b) particularly awkward situations, such
as kneeling, twisting, or stooped postures, or
work with the hand above shoulder level.
Yellow The time demands may be evaluated on the
basis of mapping (a) short cycle, repetitive work,
and (b) static work. It should be noted that
Green evaluation of static work may not be exclusively
concerned with maintenance of a static work
posture or the production of a constant output
Figure 3.4.11. Acceptable (green), conditionally
acceptable (yellow) and not acceptable (red) loads or force over lengthy periods of time; from the
in two-handed lifting. point of view of the stabilizing muscles, par-
ticularly those in the shoulder joint, seemingly
dynamic work may also have a static character
Examples of useful guidelines: handling of which may make it necessary to consider lengthy
tools and smaller objects periods of joint mobilization.
In line with the above reasoning, there is a set In practice, a working situation is deemed to
of basic ergonomic variables relating to muscu- be acceptable or not depending on the demands
loskeletal load that need to be taken into account placed on the part of the body under the highest
as a priority in the design process, in order to strain.
reduce the risk of Cumulative Trauma Disorders It is important to note that the above variables
(CTDs). These disorders are pain syndromes must be considered jointly, not separately. For
localized to the musculoskeletal system, which instance, demands for high force or lifting the
develop over long periods of time as a result of arm above shoulder level may be acceptable if
repeated stresses on a particular body part. The they occur only occasionally, but combinations
essential variables are, of these basic variables must be considered.
– muscular force demand; Setting criteria for ergonomics is complex,
– working posture demand; since different exposure variables are very much
– time demand. interrelated. For example, standing in an awk-
ward working position to tighten a screw with a
With respect to muscular force, criteria setting screwdriver may be quite acceptable if the task
may be based on a combination of biomechani- occurs occasionally but it is not acceptable if
162
Force
• Low force demand: two-handed handling of objects
less than 1.0 kg weight
• Medium force demand: two-handed handling of
objects between 1.0 and 4.0 kg weight
• High force demand: two-handed handling of ob-
jects exceeding 4.0 kg weight
For one-handed handling, divide figures by 2.
Posture
• Low postural demand is where the posture is
straight upright standing or sitting and where
hands are in optimal working zones; joint angles are
neutral
• Medium demands are in standing straight or sitting
Figure 3.4.12. The cube model for ergonomic
when hands are outside optimal working zone; evaluation, taking into account force, posture
joints are deviated and time aspects concurrently. Scores <5: A,
• Working positions implying high postural demand acceptable situations; scores ≥9 NA, not accept-
are those with elevated arms, twisted or forward able, scores between 5 and 9 CA: conditionally
flexed positions, and kneeling positions; joint ang- acceptable, depending on, e.g., the user popula-
les are in extreme deviation: tion.
Time
• Low time demand: less than 30 minutes exposure • Acceptable (A): the health risk is considered
per day to be low or negligible for nearly all healthy
• Medium time demand: between 30 minutes and adults. No action is needed.
4 hours exposure of work with work-rest quotient/ • Conditionally Acceptable (CA): there is an
cycle <1
• High time demand: between 30 minutes and increased health risk for some or all of the
4 hours exposure of work with work-rest quotient/ user population. The risk must be analysed
cycle >1; or more than 4 hours exposure per day together with contributing risk factors, fol-
lowed as soon as possible by risk reduction
(i.e., redesign) or if that is not possible, other
required frequently. However, if a work task can suitable measures.
be carried out in an optimal working position, a • Not Acceptable (NA): the health risk is unac-
higher degree of repetition may be acceptable. ceptable for any part of the user population.
In general, independent consideration of force,
posture and time is insufficient. Acceptability is not only based on evaluation of
In the Cube Model, sub-cubes are denoted the risk of acquiring musculoskeletal disorders;
A, CA or NA depending on the acceptability of several instruments also give consideration to
combinations of demands. Definitions are ac- the level of perceived discomfort as illustrated in
cording to the “European Safety of Machinery Figure 3.4.9, where situations imposing “strong
– Human Physical Performance Standard” docu- discomfort” according to the Borg score 5 (or
ment: higher), are termed “always unsafe” and are
unacceptable.
163
Chapter 3.4
Activity Force (N) This example shows what is needed to devise a

Power hand grip 250 workplace for manual MIG (Metal Inert Gas)
welding of medium size objects in alloyed steel
Sitting posture, one arm:
Pushing upwards 50 (up to 300 kg), in a workshop environment. The
Pushing downwards 75 workplace needs to be flexible to cope with a
Pushing outwards 55 variety of objects to be manufactured and there
Pushing inwards 75
are high demands for productivity and quality.
Pushing
– with trunk support 275 Additional technical specifications include:
– without trunk support 62
Pulling
• Value adding welding work (arc time): 3
– with trunk support 225 hours/day.
– without trunk support 55 • Time per welding joint: 2-5 minutes.
Whole body work, standing posture: • Weight of the welding gun package: 3.5 kg.
Pushing 200
Pulling 145
Using the cube model approach, the following
Pedal work, sitting posture, with trunk sup- classifications can be made:
port:
Ankle action 250
Leg action 475 Force variable. The handled mass implies high
force demand.
Figure 3.4.13. Force capacity in optimal working
conditions (general population).
Postural strain variable. The postural strain
depends on the workplace layout and is depend-
Examples of useful guidelines: force capacity
ent on design.
The force capacity varies greatly depending on
the direction of action. Figure 3.4.13 gives force
Time variable. The welding work implies me-
capacity limits according to the European Safety
dium time demands, on the condition that there is
of Machinery Directives. It should be noted that
provision for variation of activity, for instance by
these values may differ depending on local con-
object and tool handling, inspection, grinding,
ditions in an individual country. However, for a
etc, between welding tasks.
mixed user population no work should require
effort exceeding these force capacity levels.
The Cube Model assessment means that if the
welding work is carried out in a position im-
A workplace design example: manual
plying high postural demands, (e.g. working
welding
overhead or kneeling), the work situation is
Welding is an activity that frequently combines
unacceptable. However, if the postural strain can
high demands for both muscular force and man-
be reduced by positioning of the welding object
ual precision. The work has a static character
to achieve low or moderate demands, then the
when welders do no other tasks other than weld-
work situation is conditionally acceptable. Ways
ing. The work environment is generally hostile,
to arrive at an acceptable situation include the
with a combination of exposures to risk factors
introduction of support for the welding cable, a
such as high noise levels, welding smoke, and
lighter welding gun, and work organisation that
optical radiation.
164
allows the welder to rotate to other jobs without constraints, (e.g. economic or space) but ad-
static loading, for instance plate work or work equate measures do not necessarily imply high
with automated equipment. costs. In practice, the achievement of acceptable
Based on the results of the first stages of the solutions nearly always requires a combina-
design process, an acceptable workplace for tion of technical and organisational measures.
welding can be established. Welding work also Licensed welders are hard to come by and they
requires precautions against other hazards in- represent a considerable investment so keeping
cluding welding fumes and noise. a qualified welder on the job is beneficial for all
In a practical design situation, various com- parties involved: welder, company, and society.
promises may have to be made due to various

Ergoweb 2004, www.ergoweb.com/resources/ Pheasant, S., 1996, Bodyspace. Anthropometry,
reference/guidelines/fittingjob.cfm. Ergonomics and Design. 2nd ed. Taylor and
This site contains ergonomic checklists cover- Francis, London.
ing a wide range of applications. Contains a chapter on anthropometry in
Ringelberg, J.A. and Koukulaki, Th., 2002, Risk population groups from different parts of the
estimation for musculoskeletal disorders in ma- world. It also outlines the principles for taking
chinery design – Integrating a user perspective. body measures.
European Trade Union Technical Bureau for Putz-Anderson, V. (Ed.), 1988, Cumulative
Health and Safety (ISBN 2-930003-41-3) Trauma Disorders. A Manual for Musculoskel-
This report consists of a compilation of dif- etal Diseases of the Upper Limbs. Taylor and
ferent instruments for criteria setting and Francis, London.
practical risk analysis. This manual summarises the different sorts of
Safety of machinery: Ergonomic design princi- clinical conditions that may be attributable to
ples. Part 1: Terminology and general principles. exposure to manual work. It also gives sub-
EN 614-1:1995. CEN, European Committee stantial advice on measures at the workplace
for Standardization, Brussels Ergonomic Princi- to alleviate risks.
ples in the Design of Work Systems. ISO 6385.
International Standards Organisation.
These standards outline general principles for
ergonomic design.
165
4
Prevention of physical risks
4.1 Risk and risk control 169

4.2 Accidents 185
4.3 Heat and cold stress 211
4.4 Noise 223
4.5 Vibrations 255
4.6 Radiation 265
4.7 Electrical safety 277
4.8 Fire safety 299
4.1
Risk and risk control

Lars Harms-Ringdahl
concepts of risk and safety and applications which makes the issue rather
confusing and inconsistent. One option to clarify
Risk and related terms
the issue is to make a division according to the
The word risk has no universally accepted defi- context.
nition. It is used in a variety of contexts and in
many senses. However, most definitions have Technical and economic systems
two characteristics in common: In the context of technical systems, the primary
• A negative outcome – unwanted consequences interest is in the reliability, i.e. the probability
or losses, e.g. an accident or some kind of that the system will work as intended. In reli-
disease. ability applications, the term risk is used in a
• An uncertainty – an outcome (e.g. an accident) more narrow sense. Risk is a combination of the
that may or may not happen frequency, or probability, of occurrence and the
consequences of a specificed, hazardous event.
A general definition of risk is the possibility The term hazard is often used to denote a
of an event or situation with undesired conse- possible source or cause of an accident, injury or
quences. In everyday speech, it’s meaning shifts damage to people’s health. “Source of risk” has
according to context. A high risk may refer to been proposed as an alternative term. Harm is
the seriousness of the consequences of an event physical injury or damage to health, property or
that might occur or, to the high probability that the environment.
an event will occur or, to a combination of the For an economist, risk can refer to the possi-
two. The term risk may also be used when out- bility of loosing money or that the actual return
comes are uncertain. In some contexts probabil- on an investment could be negative. In this type
ity aspects are pronounced, and the risk is then of application, there is often a statistical perspec-
defined as a combination of the likelihood of an tive on “risk”.
occurrence of a hazardous event and the severity
of injury. Occupational arena
The terminology and ways of thinking about For risks related to the workplace, the focus
risk vary between different scientific disciplines is usually on potential harm to workers. Here,
169
Chapter 4.1
traditions from medicine exist in parallel with • Occupational accidents—accidents occurring

different types of technical concepts. Figure in the workplace.
4.1.1 gives a general (and abstract) model related • Occupational diseases—harmful effects of
to problems at the workplace. work (not due to accidents), such as silicosis,
The top row indicates a number of potential metal intoxication, muscular and skeletal
“sources of harm” that can negatively influence disorders, and hearing loss.
employees. The second row shows “mecha- • Commuting accidents—accidents occurring
nisms” that can result in negative effects, such as on the way to or from the workplace.
injuries, diseases and psycho-social effects.
One of the mechanisms is defined as “event”, Negative psycho-social effects are included in
used to indicate something that happens quickly. the above model as they are of increasing inter-
Traditionally, the focus has been on unintended est at the workplace.
events, often called accidents. During recent An “occupational accident” is a sudden and
years, the scope has been broadened to include unexpected event that leads to the injury of a
intended events such as violence at the work- human being in the course of their work. Gen-
place. There are three classes of events: erally, the course of events is rapid, only last-
ing seconds, but some accidents, such as those
• Accident – an unintended event.
involving toxic gases or cold temperatures, may
• Intentional violence from a person at the work-
require several hours of exposure before causing
place, and
an acute injury.
• Suicide which can be caused by factors at the
An accident is an undesired event that causes
workplace.
damage or injury. In the medical tradition, the
term injury is often preferred to “accident”. An
Occupational injuries can occur in a variety of
“incident” or “near accident” is an undesired
ways. In general, they can be divided into three
event that almost causes damage or injury. The
categories:
term “major accident” usually refers to a large
Psycho
Sources of harm Physical Chemical Biological
-social
Mechanisms Event Exposure Other
Negative effects Injury Disease Psycho-social effects
Figure 4.1.1. Simplified model of negative outcomes at the workplace. The arrows in the right section are
only indicative.
170
scale accident in a chemical plant or large facility be acceptable. The judgement then concerns
such as an oil refinery. the significance of the risk, what level of risk is
The time scale for occupational diseases is acceptable and who makes the judgement. The
much longer compared to accidents, e.g. it can acceptance of risk depends on judgement and
take 25 years for silicosis or asbestos disease to experience about how hazards are controlled.
manifest in exposed workers. Acceptance of risk may also be related to the
degree of trust in the person or organisation in
General concept of risk charge of the situation.
It is important to notice that the diversity of The term security also has several meanings.
ways in which the concept of risk is used consti- One application of security concerns measures
tutes a problem. This chapter uses the term in taken as a precaution against intentional actions
the general sense, “the possibility of an unde- such theft, espionage or sabotage, as distinct
sired consequence”. from safety concerns about unintentional events
Peoples’ perception of risk is another matter such as accidents.
to be considered. The interpretation of informa- Other meanings are closely related to safety,
tion about hazards and how risks are controlled for example, being free from danger, anxiety or
concerns both decision makers as well as the fear. Social security and insurance are also as-
behaviour of people at risk. Which risks should sociated with safety, (sometimes referred to as a
be considered large enough to require actions? “safety net”), as they offer help when accidents
Such questions have become a branch of psycho- or illness occur.
logical study. Another positive term related to the workplace
Research on risk perception started in the is “health” which is defined as a state of complete
1970’s. One common theme is the study of how physical, mental and social well-being and not
people rank different types of risks, which is merely the absence of disease or infirmity.
compared with statistical data about the risks. It is meaningful to see these aspects in combi-
nation. The management procedures to achieve
Safety, security and health these qualities have many elements in common.
Definitions of “safety” are complicated by a Also environmental aspects can be included. It is
number of alternative meanings. A system or especially common to talk about SHE-manage-
device may be described as safe if it is free from ment, where SHE stands for safety, health and
energy and factors that might cause harm, e.g. environment.
a machine can be said to be in a “safe state” if
there is no energy stored or supplied which can causes of accidents
cause injury. One definition refers to a “safe sys- Explanations for why accidents occur show large
tem” as one free from obvious factors that might variation, there is no uniform, universally ap-
lead to injury of a person or damage to property plicable theory. It is common to look for the
or the surroundings. However, in practice this “the cause” of an accident but this kind of think-
state is not obtainable. ing regards an accident as the product of one
Safety should be seen as a value judgement. event and one cause. However, research has long
A machine or action is regarded as safe if the shown that a number of “causes” and factors lie
level of risk of being injured is considered to behind each accident.
171
Chapter 4.1
Depending on the person’s role in the company, ation is that they may prevent problems from
he or she may pick the explanations found most being effectively solved. Explanations and theo-
useful. E.g. the foreman can blame the worker ries are useful, especially when they provide suf-
who made a mistake, while the union may criti- ficient insight into why accidents occur and how
cise the company for inadequate safety euip- they can be prevented.
ment. Views also differ between types of produc- Figure 4.1.2 gives a schematic view of expla-
tion and industry and depending on the state of nations about the cause of accidents and how
technical and social development. explanations change over time. There are five
Explanations on the cause of accidents can main overlapping categories:
also be based on the level of technical develop-
1) The major problems are technical failures and
ment of the workplace. For accidents that occur
malfunctions. Technical solutions would help.
during traditional, manual work, it is common
2) People and human error cause accidents and
to look for human error or defective tools as the
problems in the workplace. Initially the focus
cause, as initially it may appear that only a small
was on errors by workers, but later, it was
number of people are involved. In a sophisti-
considered that managers also make mistakes.
cated industrial installation, a large organisation
3) The socio-technical perspective takes more of
and intricate equipment is usually involved,
a systems approach, considering the interplay
which makes it necessary to examine more com-
between people, equipment and organisa-
plex relationships in order to find the cause of
tional factors. People make errors because of
accidents.
poor adaptation of technical equipment and
The drawback with simple explanations which
inadequate work organisation.
only consider a selected part of the total situ-
Complexity
of systems
Inter-
organisational
Organisational
Socio-technical
"Human error"
Technical Interaction Unsatisfactory Relationship

between social & management between
Technology Individuals technical systems performance enterprises
1930 1980 1990 1995 Time

Seen as source
of problems
Figure 4.1.2. Schematic diagram of different explanations for the cause of accidents and how such explana-
tions have changed over time. The time scale is only indicative, as different explanations of causes over-
lap.
172
4) Accidents and problems occur because of

Parameter Group A Group B
unsatisfactory company management of daily
Accidents major conse- minor conse-
work, long term planning and design of pro-
quences, infre- quences, occa-
duction and work. quent sional
5) Hazards can be caused by organisational Organisation large, complex small, simple
changes when a production process is divided size
between several enterprises. The division of Regulation precise, strictly general
tasks and responsibilities might be defective enforced
or incomplete, causing hazards. The defects General structured, formal informal
have their roots in outsourcing, organisational management
changes, pressure from other companies, etc. Safety formal safety informal
management management
system
Explanations 3, 4 and 5 focus on traditional
Economy and good poor
workplaces, where it is assumed that employers
resources
are responsible and are willing and able to try
Stability constant frequent change
to prevent injuries. In other situations, workers
need to take care of themselves as well as they Figure 4.1.3. Parameters of management and risks
can. divided in stereotypes A and B. Group A stands
for a well organised large company, and Group
Assumptions about the cause of accidents B for the other extreme.
The above text has given a number of explana-
When discussing advanced safety features, it
tions related to different assumptions and situ-
is easy to be trapped by stereotypical thinking
ations. Figure 4.1.3 gives a summary of param-
related to Group A. Ideas about safety manage-
eters defining different situations. In Group A,
ment systems, (or more broadly, Occupational
the situation is related to a well organised and
Safety and Health Systems), including risk anal-
large company, while the Group B is much more
ysis and other tools, often assume a type A-situ-
informal.
ation exists.
A specific company or organisation may have
In many practical situations, it is essential
parameters in both groups at the same time. For
to be aware of the distinctions made in Figure
example, while a company has a formal safety
4.1.3. One example can be a fancy management
management system, frequent changes allow
system which is suggested. If the approach is
improvisation and informal safety action to play
based entirely on a assumptions, a basic question
a more prominent role.
is if it can be useful also in the actual situation.
Standards for risk analysis and risk manage-
ment usually make an implicit assumption that risk control
there is a Group A situation. On the other hand,
There is a large spread in application areas and
small and medium sized companies have most of
need for efficient approaches to prevent diseases,
the parameters in category B.
accidents and injuries. On one side there are
uncomplicated types of production, where minor
accidents dominate and safety is managed in a
fairly relaxed way.
173
Chapter 4.1
On the other side, industries with major hazards A number of principles and methods can be
have high demands on more sophisticated ap- applied at workplaces in order to make working
proaches for prevention. For example, nuclear conditions safer and healthier:
installations, aviation companies, and large
1) Conscious and safety-oriented planning
chemical industries, are often associated with
procedures will support safe workplaces and
rigorous safety management systems because of
production systems.
their potential for major accidents and loss of
2) Application of established design principles.
life. Several independent, technical barriers are
3) Risk analysis to identify hazards in the system.
often in use so if one fails, the remaining barri-
4) Safety inspections.
ers should give satisfactory protection. Technical
5) Incident studies such as collection of informa-
solutions are often combined with organisational
tion from near accidents.
measures, such as maintenance programs that
6) Accident investigations.
can increase the reliability of the technique
7) Feedback procedures between employees and
and increase protection. One example is the
managers that identify and give information
(so called) Seveso II Directive of the European
about problems and hazards.
Union, which regulates safety management sys-
8) Statistical tools can be used to collect and
tems, risk analysis, and emergency plans in large
analyse information on accidents and health
chemical installations.
problems.
Approaches and tools on risk control and
The principle for many of the tools is to identify
accident prevention
problems and hazards, and the result is used for
There are a number of different approaches for
correction of the system. However, the cost of
risk control and accident prevention.
remediation may reduce interest in carrying out
• Company management and responsibility improvements.
• Methods such as feed-back systems, risk The first two approaches listed above, try to
analysis, etc. find a safe solution from the beginning of the
• Workers’ participation and involvement design of the production system and workplace.
• Intervention by authorities (such as inspector- Risk analysis and inspections might identify
ates), insurance companies, etc. problems before accidents occur or health prob-
lems are manifest.
A life cycle perspective on production systems Incident studies and accident investigations
could also be added considering different phases give information about specific safety deficien-
such as: cies at the workplace. Effective and appropriate
feedback procedures can allow this information
a) Specifications
to be used to correct problems.
b) Design procedure
Larger companies commonly collect and
c) Operating the system
analyse information about occupational ac-
d) System changes
cidents and diseases in order to show the rela-
e) Termination, when the production is closed
tive frequency of accidents and diseases. This
down and the equpipment disposed.
information can be used for comparison with
174
other companies and national mean values and human and organisational aspects and referring
can also help to identify dangerous job tasks and to all the individual activities within the organi-
places where many accidents occur. Results can sation, which tend to be formalised as Safety
be used when setting priorities and identifying Management Systems (SMS).”
areas which need more effort.
Epidemiology is generally defined as the Both these definitions require companies to
branch of medicine that studies the causes, dis- have policies on risk/safety management, a “top
tribution, and control of disease in populations. down” approach that is in line with both qual-
Epidemiological methods can also be applied to ity and environmental standards. However, as
accidents and injuries. Occupational epidemiol- these definitions are based on the existence of
ogy has been defined as the study of the effects policy, there can consequently be a problem if
of workplace exposures on the frequency and safety management policies are lacking. The
distribution of diseases and injuries in the popu- definitions are also normative, (stating how work
lation; it is an exposure-oriented discipline with shall be done), which may be acceptable in high
links to both epidemiology and occupational risk industries, where such practices are com-
health and uses methods similar to those em- mon and compulsory, but will be problematic in
ployed in general epidemiology. smaller enterprises.
While many companies, especially small
The management approach to OSH companies, do not have a formulated policy, they
Most legislation and approaches to OSH are may have OSH management to deal with haz-
based on the principle that the employer or ards. It is also clear that there can be manage-
company operating the workplace are responsi- ment which is not “systematic” so there a more
ble for safety and health at the workplace. There comprehensive and simple definition is required.
are many regulations and management systems A simple definition is suggested below:
that describe what employers should do on “Safety management is a way of managing the
OSH. hazards (safety risks) of a company.”
One definition of risk management, based on
the technical reliability standard states: Policy
“Risk management is the systematic applica-
tion of management policies, procedures and Organise
practices to the tasks of analysing, evaluating and
controlling risk.” Plan and
In some industries the word “safety” is pre- implement
Audit
ferred, e.g. this definition related to major ac-
cident sites: Measure
performance
“Safety management may be defined as the Feed back to
improve performance
aspect of the overall management function that
Review
determines and implements the safety policy. performance
This will involve a whole range of activities,
initiatives, programs, etc., focused on technical, Figure 4.1.4. Examples of elements in OSH management.
175
Chapter 4.1
Many ideas and advice exist on effective safety 7) Auditing is a structured process of collecting
management, even for less formal companies. independent information on the efficiency,
An example of health and safety management effectiveness and reliability of a total OSH
(developed from the Health & Safety Executive management system. Corrective actions may
in UK), is shown in Figure 4.1.4. The model also be proposed if necessary.
contains seven key elements.
The feedback of information and problems can
1) The policy should express the general in-
take many forms from formal, written reports to
tention, aims and approaches, in relation to
informal discussions between individuals. Person
occupational safety and health issues at the
to person communication may be a very impor-
company.
tant source of information in both formal and
2) Organising for health and safety is the process
informal systems.
of designing and establishing the responsi-
bilities and relationships that form the social
risk analysis
environment within which work takes place.
More simply stated: “Organising is having an Risk analysis is a useful tool to systematically
effective management structure and arrange- identify hazards and problems at the workplace,
ments in place for delivering policy.” even if no accidents have occurred (a proactive
3) Planning is essential for effective implemen- approach). The term “safety analysis” is often
tation of OSH policy. Planning requires the used as an alternative.
allocation of human and financial resources, Within the technical field of reliability there
and the setting of precise goals. A number of is a standard from the International Electrotech-
other activities are also related to planning nical Commission, which states that:
including design of rules, accident investiga- “Risk analysis is the systematic use of available
tions, and risk analysis. information to identify hazards and to estimate
4) Measuring is an essential aspect of maintain- the risk to individuals or populations, property
or the environment.”
ing OSH-performance. The implementation
of plans needs to be checked to ascertain This standard also gives a number of alternative
whether a company complies with standards. terms with similar definitions, namely probabi-
Accidents, incidents, and health problems listic safety analysis, probabilistic risk analysis,
need to be monitored. quantitative safety analysis, and quantitative
5) During the review process judgements are risk analysis. The terms “probabilistic” and
made about the adequacy of performance “quantitative” mean that the results are based on
and decisions about improvements and other numerical calculations, estimates of probabilities
changes are made. and (occasionally) consequences. Other terms
6) Feedback is an essential element in all parts of defined in this standard are:
management systems. Managers and workers
need information about activities, accident “Risk estimation is the process used to produce
a measure of the level of risks (a part of risk
rates, etc, to enable them to take effective and analysis).”
positive action.
176
“Risk evaluation is the process in which judge-

ments are made on the tolerability of the risk Prepare
(based on the risk analysis).”
“Risk assessment is the overall process of risk
analysis and risk evaluation.” 1 Structure
Classify job tasks
The term risk analysis is used in many different
applications, e.g. in toxicology, environmental
studies, financial considerations, and insurance. 2 Identify hazards
However, here the definitions might be differ-
ent.
In the chemical industry, risk analysis is the
3 Assess risks
preferred term for all types of methods while in
the nuclear industry, safety analysis appears to be
more commonly used. The term is used in many
4 Propose safety measures
other applications as well, for example:
“Safety analysis is a systematic procedure for ana-
lysing systems to identify and evaluate hazards
and safety characteristics.” Conclude
Job safety analysis Figure 4.1.5. Main stages of procedure in Job

“Job safety analysis” is a simple example of a Safety Analysis.
safety analysis method. Attention is concentrated
on the tasks performed by a person or group In the structuring stage of the analysis, a suitably
in the workplace in order to identify the haz- detailed list of the different phases of the work
ards related to the task, and to find appropriate is prepared. Useful basic material consists of
means to reduce the risks. Basically the method standard job instructions. However, these should
is focused on accidents, but it may also be useful be regarded only as a starting point and should
in identifying other hazards such as exposure to not be assumed to be complete or correct. It is
chemicals. also important to take account of exceptional
The analysis procedure in Figure 4.1.5 con- or rarely performed tasks. The following items
sists of four main stages, plus a preparatory and should be considered:
concluding stage; it is recommended that each • Standard job procedures.
stage is completed in sequence. • Preparations and finishing of work.
Preparation includes defining the job tasks to • Peripheral and occasional activities, such as
be analysed, and gathering information about obtaining materials, cleaning, etc.
the job. Job instructions are often useful. It is • Corrections of disturbances to production
beneficial to involve a team of people from the that might arise.
workplace which may include someone familiar • The job as a whole, including how it relates to
with the job analysis method, a supervisor, and descriptions, planning and other tasks.
a person who performs the job and knows its • Maintenance and inspection.
potential problems. • The most important types of repairs.
177
Chapter 4.1
During the identification of hazards, each item • Elimination of the need for certain tasks
on the list is gone through one at a time. A • Improvements to job instructions, training,
number of questions are related to each item, etc
including: • Planning how to handle difficult situations
• Safeguards on equipment
• What types of injuries can occur?
• Personal protective equipment.
– Pinch/squeeze injuries or blows, mov-
ing machine parts, objects in motion or at
An analysis concludes with a summary of results.
height
In simple cases, the record sheet may be used to
– Cuts, pricks, stabs, sharp objects
report the results. The list of job tasks and the
– Falls, work at height
record of the analysis may also be used to pro-
– Burns
duce an improved set of job instructions.
– Poisoning
This method of job analysis is easy to learn
• Can special problems or deviations arise in and simple analyses can be conducted with
the course of the work? minimal preparation and effort. But, if the work
• Is the task difficult or uncomfortable? to be analysed is more extensive or involves a
• Is the task usually done differently to the lot of variation, a more formal application of the
prescribed procedure? Are there incentives to method may be needed which might require the
deviate from regular procedures? assistance of experienced people.
One advantage of the method is that it is
It is advantageous not to only restrict the based directly on ordinary job tasks that are easy
analysis to accidents. Contact with chemicals, to visualise and on commonly accepted ideas
ergonomic problems, etc. may also be included, about safety and regular safety work. This makes
which may increase the benefits of the analysis it easy to teach the method and to make it ac-
and produce a more integrated approach to ceptable for direct use by job supervisors and
OSH. work teams. However, the fact that the method
In the third stage of the analysis, each hazard is based on standard thinking about safety mat-
or problem that has been identified is assessed. ters may also be a disadvantage because it makes
A variety of approaches to classification and it harder to avoid having a blinkered view on the
risk assessment may be utilised as the method work involved.
itself does not prescribe what kind of assessment
should be made. Relationships between safety management
Safety measures are proposed in the next stage and risk analysis
of the analysis, focused on the hazards assessed It is hard to define general relationships between
as the most serious. Such measures may apply to: accident investigations, risk analysis, and safety
• Equipment that aids workers to carry out management because of the variety of applica-
their tasks tion areas and concepts. However, there are
• Organisation of work many interesting and essential relationships and
• Work routines and methods (Can the work be aspects between these methods.
carried out in a different way?)
178
Prescribes
Management
SMS
Rules RA AI
Operational Report
Report
levels
Figure 4.1.6. Elements and relationships in a “Group A” company.
In this type of situation, the SMS prescribes Accident investigation (AI) can also be regarded
when and how risk analysis (RA) and accident as a learning process. This widens the scope of
investigations (AI) shall be done. These activi- the investigation and can influence conceptions
ties produce reports with observations and rec- about feedback loops and what can be done to
ommendations. (The figure does not show the improve the system.
feedback to the SMS from audits, RA and AI.) Figure 4.1.7 illustrates a number of relation-
Of course there is also great variability in ships which can appear in a learning type of
this type of situation. (The following example AI. It is assumed that a specific event is being
concentrates on the AI aspects, but much of the investigated, and that the AI will raise a number
reasoning also holds for RA.) In principle, the of questions. Some comments on the numbered
SMS defines what is done in the AI, and how links in the figure:
the information should be used. The aim may be
1) The investigator may scrutinize the investiga-
to produce a report about the course of events,
tion process itself, especially earlier investiga-
recommendations, and who is to be responsible
tions which might have disregarded particular
for remedying the situation. This report then
problems.
goes to the manager responsible and is used to
2) There are a number of interesting mutual
inform others.
links between AI and RA (further developed
below).
Prescribes
Management
5 SMS
Rules 3 2
RA AI
Operational
levels
1
4
Figure 4.1.7. Links in a “learning process” type of accident investigation in a “Group A” company.
179
Chapter 4.1
3) The links between the SMS and AI. In one • For employees insurance can offer improved
direction, the SMS gives directives about how social security by compensating for accidents
and when AIs are performed. A key question and ill health caused by work.
is how an accident could occur despite the • Trade unions represent employees interests in
SMS and whether SMS instructions could be order to get good working conditions, and to
improved. A basic question is whether an AI is ensure that employees are covered by insur-
allowed to scrutinize the SMS and its role. ance. (Solidarity and justice are keywords.)
4) The links between AI and operational manage- • Employers usually pay insurance premiums
ment. An AI examines the role of both opera- that are often compulsory through legal re-
tors and line management. However, they quirements and/or formal agreements with
should all share a mutual interest so that all trade unions.
those involved can learn and benefit from the • Insurance companies may be public or private,
both the AI findings and the fact finding proc- and their main task is financial and economic
ess itself. oriented.
5) Company management. The role of leadership • Society as a whole is supposed to provide the
of a Group A company is an essential consid- framework for the insurance system,
eration. While a top-down approach usually
dominates, bottom-up communication could Role of insurance
be equally important. It is necessary to estab- OSH insurance has different characteristics both
lish whether a critical and meaningful investi- between and within countries. The role of insur-
gation will be permitted. ance varies according to a number of factors:
a) Whether insurance is compulsory or volun-
In Group B companies (as defined in Figure
tary.
4.1.3), many of these links might be broken
b) Whether it is a supplement to other insur-
because a formal procedure may be nonexistent
ance, or offers complete coverage.
or ineffective. However, it should not be forgot-
c) Whether insurance covers all, or only some,
ten that informal management systems are also
employees and which OSH-aspects are cov-
very important but, if they are not defined, it is
ered.
hard to know if they are efficient from an OSH
d) Whether causal connections between ill
perspective.
health and work can be proved beyond doubt,
or whether such connections cannot be ex-
perspective on insurance
cluded.
Insurance systems all over the world are regulat- e) If the insurance have blame-free conditions,
ing the costs and consequences of work related or negligence of the employer is regulated in
injuries and ill health. the rules for the compensation.
There are a number of stakeholders related f) If the insurance have blame-free conditions
to occupational insurance, all of whom have a related to the worker’s actions.
particular perspective and interest:
180
The major role of occupational insurance is to way of setting premiums can be through the use
mitigate the economic consequences for em- of a set of indicators for the quality and efficien-
ployees when preventive OSH actions have cy of the prevention program at a company.
failed and lead to injuries and ill health, i.e. to
provide social security. This is universally recog- Dilemmas and problems
nized as a basic human need that contributes to Even if insurance seems a quite straight forward
greater social justice. It is an advantage for em- approach, a number of dilemmas and problems
ployees when they have a right to compensation exist. The advantages and disadvantages of dif-
rather than something they have to make strong ferent insurance solutions have been debated but
claims for. there have not been any broad scientific investi-
Insurance also reduces the economic risks gations of “best practice”. These are complicated
for employers. Traditionally, small insurance issues, the following discussion is only indicative.
premiums have been paid in order to avoid hav- The first dilemma concerns both employers
ing to pay out large sums in damages. In some and employees who get injured and is related to
countries, insurance has conditions attached that responsibility and morality. When an employer
prevent further claims being bought to court. has an insurance based on conditions that free
In situations when OSH insurance is not com- them from blame for negligence, and which has
pulsory, a company can demonstrate care for its’ a fixed premium, it may reduce the economic
employees by offering free insurance, (as is often motivation for preventive work. This disadvan-
seen in employment advertisements). tage may be offset by the fact that workers don’t
One role of insurance is that it offers a clearly have to argue to get compensation.
defined process about how compensation should In insurance situations where guilt and neg-
be dealt with. Insurance companies are respon- ligence are more dominant, conflicts are more
sible for handling this. A major task is com- likely to arise when a person or company needs
munication and payment of compensation to to be blamed. For example, there can be disputes
those who have suffered work related injuries or about whether a victim has been inattentive or
ill health. Another vital task is the collection of violated a safety rule, and therefore questions
premiums and financial planning. arise about whether they should be paid com-
Insurance companies may be involved in pensation. Another possibility is that employers
prevention work to a greater or lesser extent. A can be accused of being neglectful in their OSH
basic service is the provision of statistics on ac- management, and face damage claims.
cidents and ill health for use in general planning. Another dilemma concerns the level of strict-
Insurers may play a more active role and develop ness of the cause and effect relationship, es-
their own expertise in order to give advice and pecially in the case of occupational diseases. A
support to their customers. medical assessment tries to establish whether a
In a number of countries, the size of insurance particular disease is caused by circumstances at a
premiums are set according to the level of risk specific workplace, however, this is complicated
in the company - companies with more injuries by the fact that many diseases take a long time
must pay more. The insurer can give incentives to develop. If an affected person has changed
and penalties by their choice of premium related workplace, the question arises about where the
to statistics from a specific company. Another responsibility should be placed. If the person has
181
Chapter 4.1
changed workplace, the question is where the All three types of organisations may exist side by
“responsibility” should be placed. With a rigid side in a country. Each type of structure has both
insurance policy this can be an essential problem advantages and disadvantages. One advantage
for the sick employee. There have been argu- with public insurance is that it has the potential
ments that this kind of policy is unfair and dif- to take a more holistic perspective on occupa-
ficult to handle for the “weak” part. tional injuries and diseases based on the idea that
A further concern is the ownership structure such injuries and diseases are a societal problem.
of insurance companies. There are three princi- Where the market has several private insur-
pal forms of ownership: ance companies, employers can take advantage
to find lower premiums. On the other hand,
• Public organisation, usually coupled to social
competition may lead to some insurance compa-
security
nies going out of business, and possibly failing to
• Mutually owned and controlled company, e.g. by
fulfil their obligations towards employees suffer-
associations of employees and employers, usu-
ing long term illness or disability.
ally based on a “not for profit” arrangement;
The long term perspective needed for con-
if profits are made, they are used to reduce
sideration of occupational diseases creates a
fees or funded by the company.
dilemma for the insurance system as it may take
• Private company which has commercial agree-
twenty years from the exposure until the symp-
ments with employers. Any profits belong to
toms are observed. It is argued that long term
the owners of the company.
perspectives on insurance solutions are abso-
lutely essential.
182

Surveys of basic concepts and of perceptions of IEC (International Electrotechnical Commis-
risk can be found in the following publications: sion), 1995. Dependability management
– Risk analysis of technological systems (IEC
Andersson, R. and Menckel, M., 1995. On the
300-3-9). IEC, Geneva.
prevention of accidents and injuries - a com-
parative analysis of conceptual frameworks. Principles for safety and health management are
Accident Analysis and Prevention, Vol. 27. pp. given in the references below. The first two are
757-768. on a general level and contain basically the same
approach. The two last are illustrates how large
Harms-Ringdahl, L. 2004. Relationships be-
chemical plants are supposed to be managed.
tween accident investigations, risk analysis,
and safety management. Journal of Hazardous ILO (International Labour Office), 2001.
Materials, Volume 111, pp.13-19. (http:// Guidelines on Occupational Safety and
www.irisk.se/english) Health Management Systems. ILO, Geneva
(http://www.ilo.org/public/)
Sjöberg, L., 2002. Perceived information tech-
nology risks and attitudes. Stockholm School Health & Safety Executive, 1991 Successful
of Economics, Stockholm. (http://swoba.hhs. health & safety management. Health & Safety
se/hastba/papers/hastba2002_005.pdf) Executive, London.
The following textbooks give descriptions of risk European Commission, 1996. The Seveso II
analysis and the principles behind, and the IEC- directive – Council Directive 96/82/EC on
report is an international standard related to risk the control of major-accident hazards. (see
analysis. e.g. http://europa.eu.int/comm/environment/
seveso/)
Harms-Ringdahl, L., 2001. Safety analysis -
Principles and practice in occupational safety Papadakis, G.A., and Amendola A., (eds), 1997.
(Second edition). Taylor & Francis, London, Guidance on the preparation of a safety re-
pp. 320. port to meet the requirements of council
directive 96/82/EC (Seveso II). Joint Research
Kjellén, U., 2000. Prevention of accidents
Centre, European Commission. Luxembourg.
through experience feedback. Taylor & Fran-
(http://mahbsrv.jrc.it/GuidanceDocs-Safe-
cis, London.
tyReport.html)
183
4.2
Accidents
Carin Sundström-Frisk
introduction
Chapter 4.1 deals with the theories, structures, – the establishment of communication channels
concepts and risk control. This chapter focuses – the creation of emergency preparedness rou�
on the prevention of occupational accidents tines
through safety management, giving extra atten�
tion to the role of human behaviour. A multi-dimensional phenomenon
Effective accident prevention at enterprise Accidents cover a broad variety of phenomena
level demands an appropriate management sys� �� ranging from traditional, everyday accidents that
tem, and a range of realistic, multi-faceted safety affect few people and often cause only minor
measures that creatively match safety problems damage, to major accidents that can kill or injure
and preventive strategies. many people, destroy nature and even affect
This chapter outlines and discusses the fol� future generations, e.g. as in Bhopal and Cherno�
lowing safety organization activities: byl. While the majority of occupational accidents
– the formation of policies that reflect inten� are relatively minor, occupational accidents also
tions and goals cause a very large number of fatalities. Globally,
some 250,000 men and women lose their lives
– the creation of a structure and plan that pro�
through occupational accidents per year (2001)
vides appropriate means, personnel, and train�
including 12,000 children. Each year, workers
ing to implement policy
suffer approximately 270 million occupational
– the establishment of routines for identifica� accidents that lead to absence from work for
tion and monitoring of hazards three or more days. The activities with the high�
– the creation and continuous update of plans est rates of fatalities are construction, mining,
for the implementation of remedial actions agriculture, forestry, fishing and transportation.
(technical, educational and organizational) According to European statistics the most com�
mon type of event is falls.
– the initiation of routines for monitoring and The global distribution of injuries due to
checking corrective actions accidents, according to data from by the Inter�
185
Chapter 4.2
national Labor Organization (ILO), is shown in suited for comparisons. Injury statistics usually
Figure 4.2.1. The numbers are estimates based only include insured workers but the majority of
on reports from regions that have reasonably ac� employees in developing countries are not cov�
curate accident records. Conclusions about dif� ered by insurance so under-reporting is believed
ferences between countries must be drawn with to be higher in these countries.
caution. Data on accidents are not available from As can be seen from the figure 4.2.1, the
all countries and where there is data they are not estimated fatality rate in the non-industrialized
fully comparable due to differences in defini� regions is at least double that of the established
tions, recording and notification systems. The market economies. The number of reported
motivation to report accidents varies according fatal occupational accidents, especially in Asia
to the types of incentives built into compensa� and Latin America, is increasing. For example,
tion and social security systems. between 1998 and 2001, fatal accidents at work
In developing countries information about rose from 73 500 a year to 90 500 in China,
accidents in important sectors such as the agri� while there were nearly half a million work-
culture and the informal sector is not available related deaths in 2001. In Latin America, fatal
or limited. These sectors cover more than 50 % accidents moved from 29 500 per annum in 1998
of the world’s active employment. to 39 500 in 2001. According to ILO analysis,
Under-reporting of injuries is a worldwide rapid economic expansion lies behind these
phenomenon, however, the more severe the ac� figures. The construction industry has a dispro�
cidents the more reliable the figures. This means portionately high rate of recorded accidents.
that fatalities are the most reliable category, best
World bank region Economically Fatal accidents Accidents causing Estimated numbers
active popula- (thousand) 3 or more days of fatalities
tion (million) absence per 100,000 workers
(million)
Established Market Economies
(industrialised countries) 419.5 16 000 12.0 3.8
Central and Eastern Europe
and Central Asia 183 17 500 13.5 9.6
India 444 40 000 30.5 9.1
China 740.5 90 500 69.0 12.2
Other Asia and Islands 415.5 77 000 58.5 18.5
Sub Saharan Africa 279.5 53 500 40.5 19.1
Latin America and the Caribbean 219.0 39 500 30.0 18.0
Middle Eastern Crescent 135.0 18 000 13.5 13.3
Total 2 837 251 500 268 10.5
Figure 4.2.1. Global estimates of occupational accidents based on data from International
��
Labor Office,�
2001 (�www.safework@ilo.org )
186
Accidents
Differences in accidents between industrialized associated with injuries. The economic costs for
and developing countries are ascribed to differ� occupational accidents include four main areas:
ences in the types and number of risk exposures cost for prevention, workers compensation,
and differences in production systems. Poorer health care, and production losses. The distribu�
knowledge and awareness of hazards, paired with tion of costs between individuals, companies and
a lack of compensation based systems and legal societies is related to systems for workers com�
control systems, also contribute to the differ� pensation, insurance and general social security.
ences. National compensation systems are generally
Accident prevention is motivated by both hu� focused on ensuring security for injured indi�
man and economic factors. In addition to human viduals rather than on prevention.
suffering, there are considerable economic losses
Research and official statistics describe and characterize occupational accidents in different ways
including the:
– number of persons injured
– number of persons injured related to exposure data e.g. number of work hours,
– the type of injury (fractures, spruces, soft tissue injuries)
– severity of the injury (fatalities, disabling and minor injuries etc)
– type of event (falling, collisions, cuts, explosion, fire, hit by moving objects etc)
– type of hazardous energy (e.g. chemical electrical, thermal, mechanical)
– sector of working life and size of enterprise
– type of production technology (level of automation and complexity)
– type of work tasks (from manual work to demand on higher cognitive activities)
– stationary or mobile work conditions (e.g. industrial production contra construction work)
External influences subjected to severe environmental pressures

A company operates within a context where in a global, dynamic, and competitive society.
legal, economic, political and social prerequi� Rasmussen and Swedung illustrate the external
sites form the basis for what should and can be influences in a model, see Figure 4.2.2. Informa�
achieved. Decisions about how to run a business tion flow and a chain of influences from high
safely are affected by factors such as the pressure societal decision makers to the company shop
from public awareness and public opinion, the floor level are shown. The
��
model illustrates the
market, the power of trade unions, the efficiency interaction among actors and decision-makers
and power of labour inspection, and incentives at different levels of risk control, in a context of
imbedded in insurance policies. Companies are rapid societal change and technical development
187
Chapter 4.2
Inadequate investigations of accidents will result

in wasted effort and money spent because the
wrong causes will be addressed.
Already in 1964 the legendary, safety
scientist Haddon concluded that “Virtually any
bystander in any sort of accident seems to have
his own theory of its cause and its prevention”.
Explanations vary between persons and over
time. Different types of bias predominate
depending on the position of the person
attributing the cause. An external observer is
more prone to explain other person’s behaviour
(generally a failure) by referring to permanent
personality traits of that person. A person who
has been involved or injured in an accident may
perceive own failure as something resulting from
a specific situation and as a temporary deviation
from the normal behaviour.
Explanations vary between stakeholders.
Workers or their trade union may indicate that
accidents are caused by factors beyond a workers
own control, such as non-ergonomic machinery
and tools, poor maintenance, stress, deficiencies
in planning, and other bad working conditions.
Employers regard accidents as events that result
Figure 4.2.2.� Hierarchy
��
of factors influencing from carelessness, negligence and improper
safety work at the company level. Source: behaviour of workers, including violation of
Rasmussen and Svedung, 2000. safety rules and non-compliance with working
instructions. Economic, legal and ethical issues
The figure illustrates that many levels of deci� can all provide reasons for the attribution of
sion making are involved in the control of haz� blame.
ardous processes. Effective prevention at com� Causes of accidents are more or less visible
pany level thus relies on a proper co-ordination depending on number of cases available for
of decision makers at all levels to ensure that analysis. A single accident may seem totally
everyone is working in the same direction. unique and random but when many accidents
are aggregated and analyzed over time, common
Why do accidents occur? elements and basic causal patterns emerge and
The way we look at accidents and their causes randomness partially disappears. Only then do
directs the choice of preventive strategies. Strat� indirect causes such as safety routines, bonus pay
egies will vary according to those causes that we systems, work schedules, design of tools, or work
choose to pay attention to. organization become visible
188
Accidents
Perceptions and explanations for accidents have for a small number of accidents. Secondly, all
changed over time. Historically, there was a pre� individuals may become temporarily prone to
dominate culture where accidents were seen to accidents due to certain bad work conditions
result from a single cause, namely worker care� or because of personal life events such as grief,
lessness. Today causation is related to interaction divorce or illness.
between human behaviour and the physical and Accidents are often explained by the so-called
organizational context of the workplace. It is ac� “human factor”. The other main explanation,
cepted that accidents often result from a number “technical failure”, gives the impression that
of causes, including indirect causes. New cat� technology lives a life of its own without
egories of actors receive attention. Previously human intervention; however, technical
the behaviour of the person exposed to a risk, failures are generated by humans somewhere
normally a worker, was the primary focus but in the chain of events prior to an accident.
now there is more emphasis on management and The decisions and behaviour of managers,
organizational behaviour. This approach enlarg� supervisors, and designers also determine risk
es options for preventive measures and increases levels in a workplace. A designer who neglects
the probability for root causes to be addressed. ergonomic principles will create machines,
A more systematic analysis of accidents tools and systems that are not adapted to users
emerged when accidents were no longer increasing the risk of inducing human errors.
regarded as “fate” or an “act of God”. Human A manager who buys badly designed products
performance then came into focus and accidents will increase workplace risks. The same goes
were seen to be caused by human failure (“act for a supervisor who fails to intervene when
of man”). The theory of accident proneness unsafe work methods are used to speed up
emerged assuming that some individuals production, or when maintenance staff gives
were uncoordinated, careless or born with a priority to production at the expense of safety.
personality trait that made them more likely These errors, remote in time and space from an
to have accidents. This idea made it very easy accident event, are defined as latent or indirect
to blame the victim and to consider their errors. The error that triggers a risk is called
misfortune to be their own fault. This attitude an active error or direct cause. Deficiencies
made it easier for some employers to resist in knowledge, skills and motivation among
the provision of compensation and demands all those involved in remote operations will
on safety measures as it was presumed to contribute to the potential risk, but the person
be pointless to improve work conditions as who triggers the risk, normally a worker, will
accidents would inevitably occur to accident often be held to be morally and/or legally
prone persons. The only possible way to reduce responsible.
injuries was to get rid of these people. For example, when an operator makes a
The search for an “accident prone profile” mistake (defined as an active or direct error)
generated considerable research. Two he/she is personally blamed. When a latent
conclusions can be drawn from this research. error causes an accident, responsibility is
Firstly it is doubtful that a permanent individual depersonalized and the event described as a
disposition for being involved in accidents technical or organizational failure. Earlier
exists, and even if it did, it would only account mistakes remote in time and space from an
189
Chapter 4.2
accident often become the cause of the active areas? What safety issues need to be addressed
errors made by front-line personnel. to cover all risks? What cooperation between
Now the focus has been enlarged to include various staff members is required? To ensure
latent, indirect causes as well as active, direct that knowledge from all levels in the company is
causes. Companies in the front line of safety and used in the search for good preventive strategies,
risk management emphasize ideas such as “safety there must be arrangements for joint labour-
culture” and “organizational performance” as management efforts. These two parties should
the basis for accident prevention. Organizational have regular meetings to review problems and
characteristics and context are taken into to find measures to correct unsafe working
account. Issues such as leadership styles, conditions. The resources required to ensure
communication, norms and sanction systems are practical safety operations will obviously vary
all regarded as determinants of the risk level of a with the size of an organization and the nature
company. of its activities and risks, but, all organizations
The role of senior managers becomes critical must be systematic and truly proactive. Safety
as they more or less consciously communicate prevention measures based on urgent, half-
the safety culture of the company through their baked measures taken in panic after dramatic
personal behaviour and management practices. events tend to be costly and unsustainable.
Workers’ behaviour is a reflection of a company’s A policy document defining company
safety culture. Human errors are seen as the intentions, goals and implementation methods
results of an interaction between individual, concerning safety is a good start. Such a
situational and organizational characteristics document should include a commitment to
that shape human performance and account for comply with current applicable legislation
variations in capacity and performance. and standards. It should be communicated to
everyone concerned, including employees and
safety management be based on realistic, obtainable objectives
Organization and policy that everyone understands. Sometimes there
are accusations that policy documents are no
Preventive work requires an organizational
more than bureaucratic pieces of paper loaded
structure that articulates clear responsibilities
with empty clichés and no binding promises.
and systematic routines for identification and
However, if adequately elaborated, they have a
handling of safety issues. Responsibilities related
clear function as they give all those concerned
to safety should be made clear to all concerned,
something to refer and relate to. Policies
including top and middle management, first line
also offer the opportunity to identify double
supervisors, maintenance departments, purchas�
standards, e.g. the gap between what is said and
ers, planning departments and operating staff.
what is done.
The necessity to merge production and safety
questions becomes more obvious.
Identification and monitoring hazards
When responsibility is allocated it is also
The identification of hazards and risk character�
necessary to allocate appropriate resources.
istics define targets for a prevention program.
Questions to be considered include - which
This is not a one shot activity but a continuous
function is responsible for taking care of specific
process. Knowledge about accident risks may be
190
Accidents
generated by more or less sophisticated meth� there is “something in it for me” the reporting is
ods, demanding different levels of resources more likely to take place.
and expertise. Three different methods in the To improve reporting habits the following
risk-identification process will be described here: activities are recommended:
learning from earlier events by accident report�
ing and investigations, identification of potential Give clear definitions (with examples) of what type
of events to report.
risks by safety analysis and safety checks.
The use of drawings and videos is recommend�
Learning from earlier events ed.
The reporting and investigating of accidents
Use a simple reporting formula that is easily
generates knowledge about hazards at the available. Ensure easy access to computers if a
worksite and identifies weaknesses in the safety computer based routine is used.
management system. Involving workers in dis�
If a work force has problems with literacy,
cussions on these events will increase workers’
writing or reading, a reporting formula can
awareness of risks. Reports and discussions on
be designed using signs, symbols and illustra�
near accidents will give information about risks
tions and the possibility to answer questions by
related to defined situations and experiences
marking fixed answers instead of writing free
about the way hazardous events have been avoid�
text. Pre-printed formulas usually offer a mix of
ed by recovery operations. Discussions about
standardized questions that include both preset
near accidents are generally less emotionally
response alternatives and opportunities for writ�
charged and more open to constructive analysis
ten descriptions. Reporting procedures may be
of causes, because nobody has been injured.
on computer.
The need for formal reporting routines de�
The report may serve as a first step in a more
pends on the size and type of an enterprise.
detailed analysis. An in depth investigation is
Knowledge about an injury due to an accident in
a systematic and more elaborated method to
a small enterprise will soon reach management
ensure that all contributing factors are identi�
by informal channels but a large company needs
fied, and might require teamwork with safety
formal accident reporting routines to provide
professionals and other experts such as chemists,
management with information.
working together.
To establish a reporting routine there is
a need to be explicit about its purpose and goal. Train workers how to complete reporting forms.
Workers must be given good reasons as to why
The main purpose of a reporting regime is to
they should report. Clear information about the
get information about the chain of actions and
fact that data will be used for prevention rather
causes of the accident or near accident event.
than punishment must be given. In order to en�
Repeatedly questioning “why” until a root cause
courage the reporting of events it is also neces�
has been identified is a simple but effective way
sary to ensure that there are more incentives to
to analyze what caused an event.
report than disadvantages. If workers are likely
An accident investigation should cover the
to be blamed or punished for an accident, their
following data and activities:
willingness to report will be much reduced. If
191
Chapter 4.2
Figure 4.2.3.Timeline for a sequence of events.
Background data
information about where and when the event oc� contributing factors are taken into account. For
curred, what type of activity or work task was in� each human failure contributing to the event,
volved, type of injury, the sex and age of the injured further analysis should be performed asking why
person and physical objects involved. the actual behaviour took place. All behaviour
must be understood in context. The tendency to
A description of the factual sequence of events
primarily ascribe an accident to the personality
a description is facilitated by a flow chart that
of an injured person must be avoided in favour
graphically depicts a “time-line”. The analysis
of looking for conditions that produce human
must not only describe the last event but work
errors and risk-taking behaviour.
backwards in the chain of events, like reversing a
To perform a systematic and complete data
film sequence, see Figure 4.2.3.
collection when investigating into accidents .a
Data is collected by interviews and technical
checklist or observation structure is a helpful
observations at the worksite.
and practical way to ensure that all contribut�
Drawings and photos help to support memory
ing factors are considered. An example of such a
and make a common picture of the event. The
structure is the
sequence of events should be presented without
TRIPOD DELTA observation schema, based
subjective value judgments and premature spec�
on the TRIPOD accident model. (TRIPOD
ulations about causes.
was developed by James Reason for Shell Com�
A systematic search for direct and indirect causes pany and TRIPOD means three feet. It refers to
This should preferably be based on a “MTO the three–part structure on which the accident
perspective” (M for man, T for technique, and model is based: general failure types, unsafe acts
O for organization), that ensures all types of and negative outcomes.)
Figure 4.2.4. Chain of causes. Causes added to each event.
192
Accidents
Basic risk factors or failure types according to the TRIPOD investigation schema.
1 DESIGN
A poor plant layout or a non-ergonomic design of tools equipment (user-unfriendly)
2 HARDWARE
Material failure due to poor quality or aging, suitability or availability of tools, equipment and com-
ponents
3 MAINTENANCE MANAGEMENT
Failures in the system aiming at maintaining inadequate performance of maintenance tasks and
repairs
4 HOUSEKEEPING
No or insufficient attention given to routines for keeping the plant tidy and clean, and for dispose
of waste
5 ERROR ENFORCING CONDITIONS

Poor design and poor working conditions (e.g. heat, noise, awkward working positions, shift
schedules that produces adaption problems, or a remuneration system that promote rule viola-
tions
6 PROCEDURES
Insufficient quality or availability of procedures, guidelines, instructions and manuals
7 TRAINING
Insufficient or inadequate knowledge, skill or awareness due to poor training
8 COMMUNICATION
Ineffective communication of necessary information between the various sites, departments or
employees of a company or with the official bodies
9 INCOMPATIBLE GOALS
The situation in which employees must manage the conflict between safety and productivity, or
between safety and individual goals, such as saving time and money
10 ORGANISATION
Shortcomings in the organization´s structure, organization´s philosophy, processes or manage-
ment strategies resulting in warning signals being overlooked, and inadequate or ineffective
management of the safety issues
11 DEFENCES – BARRIERS
No or insufficient protection of people, material and environment against the consequences of
operational disturbances
193
Chapter 4.2
Figure 4.2.5. Barriers in the sequence of events.
The last point in the TRIPOD DELTA schema the future. Some of these methods are highly
refers to the analysis of deficiencies in safety bar� sophisticated and require computer modelling
riers such as machine guarding, inadequate work such as fault tree analysis, hazard operability
procedures, and management support. A barrier studies or human error analysis. These methods
analysis addresses the following aspects: calculate probabilities, sometimes based on data
• barriers that were in place and how they per� banks, and demand expertise to perform. They
formed are mainly used in high-risk systems such as nu�
clear plants, aviation, military systems, and proc�
• barriers that were in place but not used ess industries, and may include economic losses,
• barriers that were not in place but were re� production losses, cancelled deliveries, losses of
quired public opinion and environmental damage.
In industries where minor accidents are the
• the barrier(s) that, if present or strengthened,
main problem, less complicated techniques are
would prevent the same or similar accidents
used. A two step model is normally applied,
from occurring in the future.
starting with a rough selection and analysis of
which risks need to be further addressed. A sim�
Proposals of remedial measures
ple and cheap method is to use a brainstorming
Well reasoned and realistic suggestions for
session to ask group members to come up with
remedial measures can be identified if there is a
plausible scenarios about what could happen
scrupulous matching of problems and potential
with what consequences by asking “What would
measures that address both indirect and direct
happen if....?”
causes. The potential effects of suggested meas�
Involving workers in a risk analysis procedure
ures must be assessed in order to avoid the crea�
creates an excellent opportunity for learning for
tion of new risks.
both safety professionals and workers. It might
Identification of future risks also create curiosity and engagement among
exposed workers thereby increasing safety con�
With hindsight injuries usually appear to have
sciousness. A risk analysis session offers a good
been easy to prevent but they are harder to
opportunity to teach workers about risks, and
imagine before they happen. There are analyti�
how to detect and cope with them.
cal tools developed to support the process of
looking for risks that may cause accidents in
194
Accidents
Safety checks sharp points and edges:

physical objects, sharp enough to puncture or
A widely used method for risk identification is
cut a person’s skin
the safety check (safety round, safety inspection),
where the work place is physically inspected and
catch points:
screened by a group. objects with sharp corners or rough surfaces ca�
A safety check can be general, addressing all pable of snagging skin or clothing, or potentially
types of risks, or focused directly on a specific pull a person into another hazard e. g. getting
caught between moving machine parts
problem, area, work tasks or piece of equipment.
Common issues for general safety checks are
squeeze points:
housekeeping, maintenance of machinery and points were human body parts could be
equipment, physical safety devices, emergency squeezed between moving objects
exits, and the availability, maintenance and use
of personal protective equipment (PPE). moving and falling objects:
Directed inspections normally generate deep� objects in motion with sufficient kinetic energy
er knowledge. They focus on a specific type of to cause injury.
event such as fire, explosions, working at height,
traffic injuries, or on technical components as Record keeping and feedback
lifting equipment, scaffolding ladders, or ma� A monitoring system is necessary to keep track
chinery. Incident and accident reports may serve of the safety status of an enterprise and to fol�
as a basis for selecting the targets. low up on any measures that have been taken.
Some members of an inspection group should Records from incident and injury reports can be
preferably take part only occasionally to ensure kept and accident statistics aggregated. How�
that inspections are performed with new eyes ever, record keeping has no value per se so if
that reduce the risk of becoming blind to de� information generated from reports is not for�
fects. warded to those in control of the risks, they are
Safety checks can be performed with or useless documents. Routines for feed-back and
without a checklist. The use of lists can help to information must be established to ensure that
remind those inspecting of important items or critical knowledge reaches those concerned e. g.
dimensions to focus on, but it may also impair production planners, maintenance staff, purchas�
the creativity required to find new risks. There ers of equipment, training officers and exposed
are standard checklists for use on safety inspec� workers.
tion rounds. For example, if there are many cut
and squeeze injuries in a workplace, an inspec� plans for remedial actions
tion checklist might focus on mechanical risks A plan for implementing safety measures should
such as: be developed based on information from ac�
cident investigations, risk analyses, and safety
shear points: checks. No decision about actions should be
where objects with sharp edges come together, taken before a thorough analysis of the problem
cutting body parts is completed as the matching of problems and
safety measures is crucial in order to get a good
195
Chapter 4.2
result and to avoid spending money and resourc� Inadequate analysis of work place and work��
organi-
es in vain. zation��
characteristics
There are three mistakes to avoid when look� It is important to understand why people create
ing for appropriate remedial actions: their own way of managing risks instead of fol�
lowing expert recommendations or orders from
Inadequate or incomplete attribution of causes management. The reasons are usually found in
The tendency to stop an analysis too early and analysis of the individual”costs” associated with
focus only on direct causes leads to a choice of adopting safer behaviour.
preventive efforts with limited value. Inadequate These costs compete with those for action to
analysis of reasons for human errors misdirects promote safe behaviour and may totally coun�
strategies for behaviour change. The wider the teract the safety promotion efforts. These costs
analysis, the greater the number of available have to be identified and “disempowered” for a
strategies. safety program to have an effect. For example,
payment on a piece work basis can reward time
Wrong lesson learned saving and risk-taking and can more strongly
Feedback of information from incidences and influence behaviour than a safety informa�
accidents is a key element in efforts to prevent tion campaign. A supervisor, who accepts – or ��
their recurrence. The implicit assumption be� rewards an employee for using unsafe work
hind this strategy is that learning by experience methods in order to increase production, also
and from mistakes will generate knowledge that communicates the attitude that unsafe work
benefits accident prevention. While this often practices are ok.
is the case, it is not always what happens. One Any action plan must be a living document
event may result in different people learning that is continuously updated to deal with new
different lessons, primarily for less serious events risks that will always arise. Employees should be
such as a near accident or a minor injury. While consulted and involved whenever safety activities
one person may learn to be more cautious, an� are developed in order to increase the probabil�
other person may feel that he has controlled the ity that suggested actions will be accepted and
outcome and don’t need to change his behaviour. implemented by those in charge. Consultation
Reports on “lessons learned” from individu� also guarantees more realistic proposals as em�
als who have been involved in accidents report ployees normally have more knowledge about
vary from extremes such as perceiving less risk the informal infrastructure and work procedures
after an accident, to a total refusal to perform than safety professionals. They know what meas�
the same work task again. People usually change ures are reasonably acceptable when completing
their behaviour temporarily, reverting to the a work task.
same pre-accident behaviour after a while. Fur� A time schedule and staffing plan that assigns
thermore, it is of interest to know who is learn� responsibility for each remedial action completes
ing what: a decision-maker with power to take an action plan.
preventive action, or a worker with no control
over root causes. Because of this, there is a need haddon´s principles
to identify circumstances that facilitate and sup� Preventive measures can be divided into passive
port learning that benefits prevention. or active. Passive measures are those that func�
196
Accidents
tion without human intervention, regardless of can be released in an unintended way (a passive
the skill or motivation of people involved, e.g. a approach). Ten strategies are divided into three
fence, an airbag, sprinkler system, light curtain, groups related to energy source, barriers, and
or machine guard. Passive measures eliminate or to the vulnerable target. Haddon’s structure for
modify harmful energies or separate the human controlling energy release is a useful framework
body from them. They are effective because they for how to think about the problem.
function in situations of acute risk, regardless of
human behaviour and regardless of the capacity
and risk perception of actors involved. For ex�
Haddon´s principles:
ample, they are effective with all types of work�
ers from novice to experienced, tired or alert, Strategies related to the energy source
strong or weak, educated or ignorant, cautious 1 Prevent build-up or accumulation of energy
or careless. On the other hand, active measures 2 Modify the qualities of the energy
3 Limit the amount of energy
such as education, training and motivational
4 Prevent uncontrolled release of energy
approaches aim to equip a worker with the abil� 5 Modify rate and distribution of the released
ity to cope with risk by being attentive, skilled, energy
knowledgeable, and risk conscious.
Passive measures should be the first choice as Strategies related to barriers
human capacity varies over time and everyone 6 Separate in time or space the energy source
makes errors sometimes as the main focus of at� and the target
tention is normally directed towards a work task 7 Separate by physical barrier
rather than at the risk.
Strategies related to the vulnerable target
In 1970 Haddon published his principles for 8 Make the target resistant
accident prevention where safety strategies are 9 Limit the injury or damage (counter damage)
related to sources of damaging energy. He con� 10 Stabilise, repair and rehabilitate the victim
ceives an accident as an unintended release of
energy resulting in an injury. Consequently the Haddon´s ten principles are illustrated in Figure
ideal is to channel energy away from the indi� 4.2.6.
vidual or to minimize the amount of energy that
197
Chapter 4.2
Type of strategy Rotating machinery Toxic chemical Motor vehicle

(Circular saw) (Oil Vapour) (Car traffic)
and mist from drilling
mud in shale shaker
Prevent build-up Eliminate use of Eliminate oil in mud Avoid car driving
circular saw by by using water based
ordering pre-cut mud
pieces of wood
Modify the qualities Modify saw blade Use of low toxic oil Softening of hard
teeth objects in the cabin
Limit the amount Limit rotational speed Smaller evaporation Speed limits
area
Prevent release Design of start button Not applicable Sanding and salting
which prevents of roads
accidental start
Modify rate and spatial Emergency stop Ventilation Cars with shock
distribution absorbing zones,
safety belts
Separate in time or Automatic sawing Remote control Separate lanes for
space machine meeting traffic
Separate by barriers Machine guarding Air curtain Cars with safety
cage
Make the victim more Eye protection Respirators Helmet
resistant
Counter damage First aid Not applicable First aid
Rehabilitation Depends on type of Depends on type of Depends on type of

injury illness injury
Figure 4.2.6. Application of Haddon’s strategies on three examples of damaging energy.

Source: Kjellén U. Prevention of accidents through experience feedback.
198
Accidents
Safety engineering An example of “forgiving” design in normal set�

Safety engineering��
includes��
measures concern� tings is a knife furnished with a parry guard - the
ing equipment, workplaces and the physical user might slip, but there is no injury thanks to
environment. Safety engineering targets two the parry.
goals: the elimination or reduction of exposure Layout of workplaces
to damaging energies and the reduction of prob� Poor layout of workplaces and workstations
ability of human errors. contributes to many accidents. If there are
Design of tools and machinery many sharp points and edges the risk of cuts or
It is much easier and normally more cost- squeeze injury is obvious. If working areas are
effective to eliminate or reduce exposure in the too narrow or confined, awkward work positions
design of a new machine than it is to modify an cause strains. Bad housekeeping increases the
old machine. The same goes for tools and work risk of accidents.
equipment. Machines and tools should be de� One of the most common tasks associated
signed taking both safety and operational relia� with injury is material handling. The risk can
bility into account. Machines that stop frequent� be reduced by transporting materials on pallets
ly create irritability and stress in users provoking or in containers or by using lifting devices like
human errors and risk-taking behaviour. Poor cranes or elevators. The layout of workplaces is
design of tools demands more attention from the particularly important where workers and heavy
user and generate human errors. transport share the same access paths. The selec�
If safety cannot be built into the basic de� tion of appropriate transport equipment, such
sign of machines and equipment, some type of as forklifts, is important when trying to prevent
safeguards must be installed, such as shielding accidents.
against rotating parts of machinery or lockouts Occupational hygiene conditions
that allow operators to switch off the power. Physical conditions such as bad lighting, dust,
Detailed recommendations on machine safety noise, and hot climate impair human perform�
are given in the EU Machine Directive. ance and hinder the ability of workers to detect
Poor design of tools and machinery provokes risks or control an event. A well-lit workplace
human error; that is increases the probability with a diffuse light source is generally safer than
for unintentional behaviours such as slips and a dimly lit workplace. Glare or excessive shadow
mistakes. The safety philosophy in high-risk tends to make the workplace less safe despite
activities such as nuclear power stations, proc� higher levels of illumination. Noise may hide
ess industries, and aviation, adopts a “forgiving” signals from warning devices, and/or disturb
perspective. Basic design of production systems communication at the workplace.
and the interface between humans and processes
allow for normal human errors and deviations to Organizational measures
take place without disastrous consequences. It is widely understood that if safety manage�
The insight and acceptance of human beings ment is to be truly effective it must become part
as creatures with high but fluctuating capacity of the culture and everyday business practice of
should be transferred to safety engineering in an organization. A good safety culture is fostered
“normal-risk activities”. in organizations with open communication, that
199
Chapter 4.2
integrate safety and production planning and Maintenance and housekeeping

that understands safety as a management task. A crucial element for a safe workplace is the
organization of maintenance activities, as many
Work routines, safety rules, and instructions
safety problems result from poor or inadequate
Furnishing workers with appropriate equipment
management of maintenance and housekeeping.
is only a beginning because if instruction and
Damaged machinery and tools creates new haz�
training on the safe operation of the equipment
ards. Disturbances in the production flow due to
is not given, the safety effect is reduced. Writ�
bad maintenance give rise to improvisations. that
ten instructions usually reflect the thoughts
create acute risk situations. Bad organisations
and language of the designer or manufacturer.
of keeping and storing tools and equipment and
Instructions must be designed using ergonomic
poor housekeeping reduces availability and pro�
principles that are adapted to suit the attitudes
duces stress. Accident risks can occur due to the
and reading abilities of users. English instruc�
work situation and conditions of maintenance
tions are of little use to non-English speakers.
work itself. Management include physical design
When introducing new equipment or practices
of the workplace, planning of the activities, tim�
hands on demonstrations and training should be
ing, ensuring sufficient trained personnel, defin�
compulsory.
ing responsibilities, and investing in adequate
Second hand equipment and machinery
hardware.
bought or donated from other countries should
be furnished with instructions and guidelines in Safety audits
the workers own language. The same goes for An action plan will be pointless if it is not imple�
warning signs. mented. Plans and suggested measures have to
Safety rules are necessary when risks cannot be carried out and evaluated. Audits are system�
be eliminated by technical measures but they atic examinations that assess whether activities
must be compatible with efficient work prac� at the floor shop level have been properly imple�
tices, otherwise they will probably be violated. mented.
If rules delay a work operation or place new
Emergency preparedness
demands and extra loads for a worker, they may
When accidents occur there must be clear rou�
resist applying the rule.
tines and an established organization for taking
There might be reasons for not using PPEs
care of injured people. The type of injury suf�
other than lack of knowledge or poor aware�
fered depends on the type of energy that caused
ness about risks, e.g. PPEs are not provided, are
the injuries: electricity, fire, chemical substances,
poorly designed, or workers are not given ad�
and/or mechanical force. Emergency procedures
equate information and training about their use
and equipment should organization cover first
and maintenance. In addition, PPE sometimes
aid, special equipment such safety showers, first
creates substantial problems related to physical
aid kits, and equipment for emergency calls,
load, heat stress and restrictions of movement.
and training of all personnel. In cases of severe
In this way the “cost” of prevention is shifted
trauma, there may be a need for debriefing of
to the worker who must pay for the enhanced
personnel who may suffer from post traumatic
safety by expending more energy, lowering their
effects.
comfort, and losing productivity.
200
Accidents
Addressing human behaviour prior to choosing a behaviour directed strategy

The promotion of safe behaviour is a challeng� to accident prevention. Engineering measures,
ing task particularly when established unsafe such as eliminating or modifying exposure to
working practices need to be replaced by safer harmful energy source or setting up barriers
practices. The greater the perceived benefits between the human body and an energy source,
of unsafe behaviour, the greater the resistance are effective as they function regardless of the
to change - this maxim applies equally to em� capacity and risk perception of the individual
ployers and employees behaviour. It is possible, involved. It is more efficient to put up a fence
however, to influence human performance. It re� to prevent people from falling into a hole in the
quires general knowledge of factors shaping risk ground than to put up a warning sign saying
perception and risk behaviour and a familiarity “Caution!” It may be easier to get people to use
with organizational prerequisites such as safety personal protective equipment by making the
culture, behavioural norms and the informal PPE comfortable and easy to use rather than by
sanction systems that operate within individual describing how dangerous it is not to use PPE.
workplaces. Traditionally, the problem of incorrect be�
The “human factor” in accident causation haviour has been addressed by legislative or
almost always carries negative connotations. In information strategies only, often with less effect
fact, humans are extremely reliable when you than hoped for. A need to reinforce such strate�
take into account the immense quantity and gies for instance by motivational techniques has
variety of actions they perform. However, there been demonstrated and today multi–method
are limitations to consider: programs are recommended. There is also a
shift from focusing on attitudes to focusing on
• human capacity varies over time depending
behaviour because there is no perfect correlation
on workloads and stressors
between reported attitudes and behaviours. The
• there are other immediate human basic needs very same person who believes that it is impor�
to satisfy that compete with the need to avoid tant to use scaffolding when working at height
injuries might never the less work at height without
adequate scaffolding. In other words, even if a
• humans are more prone to choose behaviours
change in attitude is reported, one cannot take
that are known to give immediate satisfaction
for granted that behaviour will be affected.
(e.g. saving time), in favour of behaviours that
Methods to promote safe behaviour range
might reward in the future (e.g. complying
from the use of force to willing participation.
with a safety rule)
The methods used to influence behaviour tend
• humans rely more on their own experience to be chosen because they appear to be effec�
than on information about unsafe acts given tive rather than because they have empirically
by safety experts. “I have used this work prac� demonstrated effects. To avoid basic mistakes
tice for years and never had an accident, so when choosing a promotion strategy for safer
this won´t happen to me” behaviour, three critical questions should first be
considered.
Taking the above factors into account means
• What category of human behaviour is to be
that engineering measures should be considered
addressed?
201
Chapter 4.2
• Whose behaviour is to be affected? or acquired. Strategies that consider individual

limits are selection, supportive devices, and
• How to deal with unsafe behaviour?
training. For example, bad eyesight is compen�
What category of human behaviour is to be ad- sated by spectacles, and heavy workloads can be
dressed? reduced by using lifting devices.
Different types of behaviour demand different Capacity limits may fluctuate due to external
strategies to shape performance. Behaviours and internal stressors and over time. This means
that are critical for safety can be summarized in that while people are able to perform a task on
two categories: unintentional mistakes and cal� one occasion, they cannot perform the same
culated risk-taking. Unintentional mistakes are task at another time. Reaction time and cogni�
unplanned acts such as slips, lapses or errors due tive skills vary related to stress, fatigue, alcohol
to inadequate knowledge or misdirected atten� intake, noise, heat etc. The elimination or re�
tion. On the other hand, calculated risk-taking duction of these stressors might be necessary to
takes place when a person decides to behave in moderate such behavioural fluctuations.
an unsafe manner despite knowledge of the risk Calculated risk-taking refers to planned be�
e.g. by dismantling a safety device. haviour. Examples of risk-taking at management
Everybody makes unintentional mistakes and level include the intentional neglect of safety
great efforts have been made trying to under� regulations during designing, planning, and
stand how and why they occur. A vast number of staffing. Examples of risk-taking by front-line
factors deteriorate human performance increas� personnel include an intentional neglect of safe
ing the probability for mistakes e.g. noise, heat, work practices, non-use of PPE, and dismantling
bad ergonomics, poor design, stress, fatigue, safety devices.
and inadequate training. These factors must be Explanations for risk-taking vary from biolog�
targeted in the search for appropriate strategies ically based theories (the born sensation seeker)
to reduce the effects of human error. to psycho dynamic causes (self-destructive
Limitations related to human capacity should needs, warped perception of reality); however, it
be considered. There are inherent human char� is more common to see risk-taking as a result of
acteristics that put absolute limits on our abilities, a learning process. Most people have a positive
e g reaction time, physical strength, perception experience of risk-taking with no resulting inju�
and cognitive functions. If there are demands ry. On the contrary, unsafe acts are rewarded by
for actions that go beyond these human capacity immediate benefits of faster, less strenuous work
limits, any individual will fail regardless of their that aids production. Basic needs outweigh the
ability or motivation. For example, it is impos� need for self-preservation, e.g. the need to make
sible to look in two directions simultaneously or money outweighs the need for safety.
to deal with too much information at the same A positive experience of risk-taking that
time. The adaption of the demands of a situation doesn’t result in injury can create the false im�
to suit human capacity is the only way of dealing pression that we can control risk situations. The
with these limitations. idea that “it-won’t-happen-to-me” is strength�
In addition to universal limitations there are ened, and important risk information is regarded
individual differencies in capacity, inherited and/ as being valid only to others, not to ourselves.
202
Accidents
Safe behaviour means not making unintentional portant actors who create risks at the workplace.
errors and not deliberately taking risks. To be� These actors include supervisors, production
have safely requires knowledge, skills and moti� planners, designers etc whose risk-taking behav�
vation. iour is often the indirect causes of accidents e.g.
Knowledge provides a basis for anticipating a manager who intentionally gambles on safety
hazardous sequences of events, and selecting ad� by neglecting safety standards when equipping
equate coping strategies. Knowledge is required the workplace or training workers. The com�
about: mitment, attitude and behaviour of top manage�
ment towards safety issues are the critical factors
– the work process
in a good safety culture.
– the types of hazards to be expected
How to deal with unsafe behaviour?
– the cues that indicate the presence of a hazard Unsafe behaviours are often “naturally” reward�
– how to cope with hazards ed as they are followed by gains in time, money,
comfort and increased production. These re�
– own behavioural limitations wards are reinforced by arrangements such as
bonus pay, promotion and other kinds of recog�
Knowledge is not enough. An actor must also nition. Such reward systems should be identified
have the capability to perform any necessary ac� and modified so they don’t compete with efforts
tion. If a situation demands action beyond work� to encourage safer behaviour. A single approach
ers capacity they will fail regardless of the extent to promote safer behaviour is normally not
of their knowledge. enough. A combination of methods that support
Besides knowledge and capability additional and reinforce each other is recommended. Seven
motivation may be required to get people to take strategies for improving safety performance are
the necessary action. A person may know what summarized below.
to do and be able to do it, but for some reason
simply doesn’t want to. Correct and safe behav� Information
iour must reward a person in one way or another Information about risks and their consequences
otherwise the behaviour will not take place. is meant to increase the desire to avoid hazard�
The three dimensions are interrelated; for ous situations and to the adoption of self-pro�
example, knowledge and ability might serve as tective behaviour. A considerable part of the
motivators. If you are motivated you are likely to acquisition of knowledge and skills comes about
look for knowledge and resources to foster your through unorganized, non-intentional learning
ability. The reason for separating the three di� processes in everyday work settings. For this
mensions outlined above is that once the causes reason, planned information endeavours have to
for a specific unsafe act have been identified, it is compete with contradictory signals that occur
easier to select strategies to shape performance. in everyday life. The way people perceive risks
from this “learning from experience” must be
Whose behaviour is to be affected? taken into account when designing information
Normally the behaviour of front line personnel programs on risk.
is initially focused upon but there are other im�
203
Chapter 4.2
Rewards for safe behaviour ing” and practical exercises in how to cope with
Safer acts and changes in risk perceptions can accident risks.
be achieved through the use of external “artifi�
Design measures
cial” rewards or incentives. This can be the case
Facilitating the adoption of safe behaviour can
independent of the risk perception of an exposed
be achieved by educational, engineering and
individual as a behaviour is adopted to get a
organizational measures. Beside education and
reward rather than to avoid an accident. This
training in safe practices, good ergonomic de�
behaviour change can be sustained even after the
sign facilitates and promotes safer behaviour,
reward is removed.
and reduces human errors. A comfortable, light,
Award programs based on a comparison injury
or ventilated helmet is more likely to be used
statistics between departments or companies are
rather than a heavy and uncomfortable one.
controversial as they may cause under-report�
Safety guards that aid production are more likely
ing. They also place the emphasis on the worker
to be used than devices that obstruct production.
rather than on the responsibility of the employer
to provide a safe working situation. Award pro� Participation
grams where a specific safe behaviour is moni� In general two sources of knowledge have to be
tored are reported to be more successful. exploited to create relevant and realistic promo�
tion programs, i.e. the expert knowledge of safe�
Compelling
ty professionals and the knowledge of workers
Efforts to change behaviour are normally more
exposed to the actual risks about informal struc�
effective and long lasting if they rely on positive
tures, work practices and behavioural norms. In�
consequences instead of negative. In some cases,
volving workers activates risk consciousness and
there is not sufficient time for an individual to
increases the probability of behaviour change as
voluntarily internalize a safe behaviour so behav�
we are more inclined to accept and implement
ioural rules are made compulsory. Management
decisions that we have been involved in making.
insist on strict adherence to the rules and when
rules are violated negative sanctions follow. Behaviour based safety
Technical arrangements and product design BBS or “Behaviour Based Safety” refers to a
can also be means for enforcing specific safe wide range of programs using behaviour analysis
behaviour, e.g. by making it impossible to enter principles and positive feedback mechanisms to
a danger zone while a moving machine part is in change unsafe behaviour.
operation. BBS identifies behaviours required to carry
out tasks safely, provides training and facilitat�
Training
ing, and organizes for observation, feedback &
Training may be necessary for the acquisition of
reinforcement the targeted behaviours.
specific skills and safe practices. Many accidents
The causes behind unsafe behaviour, such as
occur when there have been changes in work
noncompliance with safety rules, are analyzed
and working conditions (new work tasks, new
and the information used to redesign the work�
machinery, and new production methods) so
place, equipment, organization, safety rules,
such changes should be accompanied by safety
and/or work tasks to facilitate the use of safe
training. Newly hired workers and those given
behaviours.
new work tasks should be given “hands-on train�
204
Accidents
Safe behaviours are taught and positive feedback affect workers, communities, the general public,
given to those who perform the requested be� the environment, and potentially, future genera�
haviour. These programmes have been widely tions.
applied and reported successful in scientific Major accidents can, and do, happen in high-
evaluations. The use of behaviour modification risk sectors of working life such as the chemical
principles to promote safer behaviour has also industry, nuclear plants, public transport sys�
generated controversy, mainly due to observed tems, the airline industry, space shuttles, mining
tendencies to focus only on workers behaviour operations, and shipping.
rather than on conditions that shape human The globalization of the last 20-30 years has
performance. seen the exchange of technology between indus�
trialized and developing countries, subcontract�
major accidents ing, and outsourcing, as well as an increase in
Accidents range from minor incidents that cause the transport of toxic and explosive substances
minor or no injury to large-scale accidents re� within and between countries. These develop�
sulting in many fatalities and injuries and cause ments have contributed to the spread of risks
large scale damage to public health, the environ� for major accidents to most countries of the
ment and economic losses. Much of what this world whereas before 1970, major accidents
chapter has been said about the prevention of occurred mainly in the industrialized countries
accidents is applicable to component failures in where the greatest number of large industrial
enterprises of varying size, with variable accident plants was found. There has been a considerable
risks. This part of the chapter focuses on the na� increase in the number of accidents in develop�
ture and occurrence of major accidents including ing countries since 1970. The countries of Asia
the systematic prevention of such accidents. and Latin America had the greatest number of
According to the ILO convention no. 174 fatalities. Between 1960 and 1970, India, Mexico
of 1993 on “Prevention of Major Industrial and Brazil adopted similar development models:
Accidents”, the term major accident means “a intensification of economic growth at the cost of
sudden occurrence - such as a major emission, enlarging their overseas debt, increase of partici�
fire or explosion - in the course of an activity pation by multinational enterprises in the indus�
within a major hazard installation, involving trialization process, and heavy state intervention
one or more hazardous substances and leading in their economies. During the 1980’s these
to a serious danger to workers, the public or the three countries experienced some of the most se�
environment, whether immediate or delayed.” rious chemical industry accidents that ever have
The OECD defines a major accident as one happened, namely at Union Carbide in Bophal,
that causes the death of five or more people, India; Pemex in México and Petrobras in Brazil.
causes injuries to 25 people and/or the evacua� Perrow makes a distinction between compo�
tion of 400 people. The terms ‘major accident’ nent failures and system accidents. Both types
and ‘major risk’ have been widely used in the of accidents start with component failures, (e.g.
literature, by health and safety professionals and in a valve or by an operator error), but in system
by the media. Public understanding of the terms accidents “multiple failures occur which interact
generally refers to an accident or risk that has in ways unanticipated by systems designers and
become a catastrophic force whose consequences by those trained to operate them, whereas in
205
Chapter 4.2
component failures, single or multiple failures So, how can system errors and accidents in high-
are anticipated and comprehensible”. Perrow risk technologies be prevented? That question
defines system accidents as those that occur in is answered in the vast number amount of tech�
systems with ‘tight coupling´ where a failure in nical and scientific literature available.
one point of the system will have consequences On the next page, an example is presented
for the rest of the system. based on the ILO Convention and the Seveso
Directive.
206
Accidents
Actions to be taken by enterprises where major accidents may occur.

The list of actions is based upon two documents: ILO´s convention no. 174 of 1993
On ‘Prevention of Major Industrial Accidents’, and the Seveso Directive (Seveso II)
of 1996 on “Control of Major-accident Hazards Involving Dangerous Substances’.
The enterprise has to have a Policy and a Safety management system, for major accident
prevention. The policy and the management system shall include the following
components:
Organisation and personnel

The employer is responsible for providing means to ensure the abilities and skills
to the personnel involved in the management of major hazards. Personnel who
perform or control work affecting safety shall be given clear roles and mandates by
the management. Contractors shall receive information and training to be aware
of the hazards.
Identification and evaluation of major hazards

The employer shall have a system for identification and evaluation of hazards
emanating from activities, production and handling of materials.
Operational control
The procedures and instructions for safe operation of the plant, processes
and equipment shall cover both normal circumstances (incl. test running and
maintenance) and special circumstances (like emergencies). The procedures
shall be developed in cooperation with the workers concerned. Training on the
procedures shall be given.
Management of change
There shall be procedures for planning and controlling all changes having an
influence on the major accident hazards (processes, materials, staff, etc).
Planning for emergencies

Procedures for emergency cases shall be in place, including training of key
persons.
Monitoring performance
The employer shall monitor the safety performance and compare with the
objectives defined. The monitoring shall be both proactive (preventing risks) and
reactive (when a hazard is detected).
Audit and review

An audit shall be carried out by persons independent from the management, and
its result be used to improve the hazard prevention system. An audit compares the
system in place with the defined system, while a review is more fundamental and
may be extended to consider modification of the policy or the defined system.
Besides what is said in the ILO convention about the enterprise (employer) obligations
to prevent major accidents, the convention also states the obligations of the workers and
governments.
207
Chapter 4.2
International conventions and standards

Machinery Directive 98/37/EC. Convention no.174 of 1993. International Labor
Provides the regulatory basis for the har� Organization. Prevention of Major Industrial
monisation of the essential health and safety Accidents.
requirements for machinery at European Available as Pdf -file on
Union. The manufacturer is responsible for http://www.unitar.org/cwm/publications/
verifying whether a particular product falls cbl/synergy/pdf/cat3/ilo_agreements/con�
within the scope of the Machinery Directive. vention174/convention174/convention174_
A revised Machinery Directive - Directive en.pdf
2006/42/EC of the European Parliament and
Directive 96/82/EC (The Seveso Directive)
of the Council of 17 May 2006 on machin�
1996. Control of Major-accident Hazards In�
ery, - will be applicable from 29th December
volving Dangerous Substances.
2009. http://www.sis.se/DesktopDefault.
European Council http://ec.europa.eu/envi�
aspx?tabName=@DocType_97&Doc_
ronment/docum/01624_en.htm
ID=45557
SIS OHSAS 18 001: 2007 International Stand� Websites
ard Organization, Geneva. European Agency for Safety and Health at
OHSAS 18001 has been developed to be Work http://osha.eu.int
compatible with the ISO 9001 (Quality) and The aim of the Agency is to provide the
ISO 14001 (Environmental) management European Community bodies, the Member
systems standards The (OHSAS) specification States, the social partners and those involved
gives requirements for an occupational health in the field with the technical, scientific and
and safety (OH&S) management system, to economic information of use in the field of
enable an organization to control its OH&S safety and health at work. Best practises in
risks and improve its performance In addi� OHS work are presented in relation to differ�
tion to the standards themselves, The OHSAS ent problem areas covering both safety and
18000 Toolkit includes a whole range of sup� health issues.
porting items and materials. These are de� International Labour Organization:
signed to assist not only in understanding the www.ilo.org
standards, but in implementation.
http://18000.drkeyboard.com/ Textbooks
18000standards.htm Geller S. Keys to behavioural based safety. ABS
Consulting, 2000.
Describes experiences from different ways to
work with BBS and their prerequisites and
traps in practical applications
208
Accidents
Kjellén U. Prevention of accidents through organizational outlook. It explains the con�

experience feedback. Taylor and Francis 2000. cepts of Organisational Accidents and Human
New York. Error and includes practical guidance to error
This book gives a comprehensive insight in management.
accident prevention theory and practices. It
Ridley J and Pearce D Safety with Machinery
covers a wide range of approaches and could
2005 Second edition. Elsevier. London.
be used as a book of references .
This book provides a basic grounding in ma�
Perrow C. Normal accidents – Living with chinery safety and covers safeguarding phi�
High-Risk Technologies, Basic Books. 1999. losophy and strategy, typical hazards, risk as�
2nd edition. Princeton University press, Prin� sessment and reduction, guarding techniques,
ceton USA. ergonomic considerations, safe use of equip�
This is a seminal contribution to the under� ment and plant layout. All types of safeguards
standing of causes and consequences of mod� are discussed – mechanical, interlocking, elec�
ern high-tech industrial accidents. Due to trical / electronic / programmable, hydrau�
systems complexity and “tight couplings” Per� lic, pneumatic. Target groups are engineers
row perceives accidents as nearly inevitable involved in machinery design, purchasing and
consequences of the way the launch industrial maintenance, health and safety professionals,
ventures. Based on a number of real cases he students and employee representatives.
describes what could have been done to pre�
vent unfortunate occurrences. Articles and reports
Rasmussen J & Svedung I (2000) Proactive Risk
Reason J. Human error. Cambridge University
Management in a Dynamic Society. Karlstad, Swe�
Press. New York. 2000.
den: Swedish Rescue Services Agency.
Explores the nature of human error and its
relation to stress, ergonomics and other ex� Sklet, S. Methods for accident investigation.
ternal performance shaping factors. Based on (2002) Norwegian University of Science and
knowledge from the cognitive sciences error Technology, NTNU Trondheim.
management techniques are outlined. Despite Describes 15 established and commonly used
a academic style this is reading not only for methods for in depth accident investigation,
human factors specialist but also for reliability
Galli E. A sociological approach to major chemi�
engineers and risk mangers. Familiarity with
cal accidents.(1999) Internal report IDC 1999:2,
concepts and theories from the cognitive sci�
Swedish National Institute for Working Life.
ences facilitates the reading.
Based on an example from a petrochemical
Reason J. Organisational Accidents. Ashgate industry in Brasil. Galli characterises
1997. major accidents as socially produced errors.
A systematic organizational approach to safety The report can be obtained through
replacing hitherto piecemeal
��
approaches. The ester.g@uol.com.br
book uses four linked case studies to reach the
209
4.3
Heat and cold stress

Ingvar Holmér
Thermal conditions, either hot or cold, effect natural ventilation may be well in excess of
human health, functioning and performance. 30 °C.
Effects vary from subjective annoyance to death. Problems related to cold stress are found in
Diminished human performance can result in countries which have cool to cold seasons. All
increased accident risks and significant produc- countries have cold stores and rooms, in which
tivity losses. people work temporarily at temperatures as low
Effective prevention requires elimination or as –25 °C.
reduction of exposure to extreme thermal con- Many categories of workers are exposed to
ditions by technical and organisational means both hot and cold conditions, e.g. in agriculture,
combined with measures to strengthen indi- forestry, building and construction.
vidual resistance.
adjustments to thermal extremes
exposure to heat and cold Heat stress results when there is excessive thermal
Many developing countries have a tropical or load that the body cannot get rid of. Cold stress
desert climate with daytime air temperatures is a result of excessive, unbalanced loss of heat
well exceeding 30 °C. Conditions are worsened from the body.
by the presence of intense solar radiation and The primary strategy applied to cope with
high humidity. In certain workplaces additional abnormal thermal conditions, (hot or cold) is
heat from industrial processes further aggravates a behavioural one. For example, exposure to
the local thermal climate. hot or cold is avoided or shortened, activity is
Indoor climatic conditions vary throughout reduced, clothing is put on or taken off, or heat
the world depending on geographical and eco- radiation is shielded. Over time people have sur-
nomic factors. In industrialized countries where vived and adapted to cold and hot environments.
most buildings are ventilated, air temperatures Specific local climatic conditions are often the
in dwellings and offices are usually in the range basis for the development of people’s thermal
20-25 °C. In tropical and hot countries the preferences.
prevailing indoor temperature in buildings with When behavioural adjustments are insuf-
ficient, automatic physiological adjustments
211
Chapter 4.3
take over to facilitate the maintenance of heat risk assessment

balance and a stable and controlled body core A series of international standards have been
temperature. In response to heating, superficial developed for assessment of thermal environ-
blood vessels are dilated and peripheral blood ments. They describe strategies, measurements
circulation enhanced. In addition, sweat glands and methods for evaluation of thermal condi-
are activated allowing for evaporative cooling of tions and the associated risk of adverse effects.
the skin. The philosophy adopted in the strategy is that
In response to cooling, vessels constrict and simple, quick and practical methods should be
redirect peripheral circulation to deeper vessels, used for the first estimation of thermal condi-
e.g. those in the extremities. Excessive cooling tions. Preferably, these methods should be easy
results in shivering, an involuntary muscle con- to use and be understood by workers themselves
traction primarily producing heat. at the workplace. This approach is more likely to
The purpose of behavioural and physiologi- engage all workplace partners as initial costs are
cal adjustments by the body is to control heat small and controllable.
exchange with the environment. The same Only when assessment becomes complex, dif-
amount of heat must be emitted to the environ- ficult or ambiguous, expertise should be consult-
ment to ensure heat balance and a stable body ed to define more reliable and accurate methods
core temperature. The cost of adjustment to to deal with thermal stress.
thermal extremes is an increasing strain on the Appropriate international standards on both
human body that compromises the body’s ability heat and cold stress are quoted and briefly de-
to work and function properly. When the capac- scribed below. The given information should be
ity of the thermoregulatory system is exceeded sufficient for a first screening of thermal prob-
the body is unable to cope with the conditions. lems in the workplace and for advising on more
Indirectly, failure to adapt degrades human per- complex methods of evaluation.
formance, resulting in productivity losses and an ISO standards are internationally agreed
increased risk of occupational accidents. documents describing procedures and methods
for example for evaluation of properties of prod-
individual factors
ucts or machinery but also of thermal conditions
Tolerance of heat and cold largely depend on of the workplace. Standards must be purchased
individual factors such as physical fitness and from the national standardisation body, but may
health status. Cardiovascular disease, impaired be borrowed at major libraries in the country.
renal function, obesity, poor health status (infec- Experts and consultants that are engaged for
tions, tropical diseases, etc.), and alcohol and more complex evaluations must be familiar with
drug abuse are contributing factors to increased and trained in the use of the standards. The
thermal intolerance. Poor physical fitness related relevant ISO standards are:
to physical exhaustion, dehydration, and starva-
tion makes people more susceptible to the ef-
fects of heat and cold stress.
212
ISO7243, Hot environments – Estimation of the heat of 1 l/h or more, equivalent to a cooling rate of
stress on working man, based on the WBGT-index. 680 Watts if it evaporates at the skin surface.
ISO7933, Hot environments – analytical determina- Clothing complicates the heat transfer proc-
tion and interpretation of thermal stress using calcu- ess. Efficient sweat evaporation requires clothing
lation of predicted heat strain, PHS. to be permeable to the passage of water vapour
ISO9920, Ergonomics – Estimation of the thermal so the water vapour resistance of clothing mate-
characteristics of a clothing ensemble. rial is critical. Warm weather clothing is often
ISO11079, Ergonomics of the thermal environment open and porous. Protective clothing may com-
– Determination and interpretation of cold stress promise vapour transfer and worsen evaporative
when using required clothing insulation (IREQ) and
local cooling effects.
cooling of the body.
ISO13732, Ergonomics of the thermal environment Effects of heat

– Assessment of human responses to contact with
surfaces. Part 1 – Hot surfaces. Initially, deviations from normal climatic con-
ISO13732, Ergonomics of the thermal environment ditions cause subjective discomfort and com-
– Assessment of human responses to contact with plaints. This is the predominant problem in
surfaces. Part 3 – Cold surfaces office buildings and similar environments.
ISO15265, Ergonomics of the thermal environment: Depending on the severity of the heat stress,
risk assessment strategy for the prevention of stress or the effects on humans vary from subjective an-
discomfort in thermal working conditions
noyance, performance degradation, fatigue and
ISO15743, Ergonomics of the thermal environment exhaustion to heat injuries. The risk of severe
– Working practices for cold environments
and irreversible effects rises with increasing
thermal stress. Figure 4.3.1 lists different effects
hot environments associated with heat stress.
Heat exchange tissue and body heating
In a hot environment, sweat evaporation be- discomfort/pain
comes the ultimate determinant of successful mental performance, vigilance and arousal impaired
thermal adjustment. Heat losses by convection cardiovascular load
(warming of air) and radiation decrease with – increased heart rate
increasing air temperature. At high air tempera- – orthostatic intolerance, fainting
tures of 35 °C or more, and/or in the presence fluid imbalance
of heat radiation, the body may gain heat by ra- – dehydration
diation and convection. This can be compensat- reduced work capacity
– increased workload
ed only by increased sweat evaporation. In warm
– decreased endurance
and humid climates, conditions for sweat evapo-
heat injuries
ration are worsened and effective heat transfer – heat stroke
reduced. A dry, hot environment is often better – heat collapse
tolerated than a warm, humid environment. – heat exhaustion
Heat production at rest is approximately 100 – heat cramps
– heat rashes
Watts, but may rise to more than 500 Watts dur-
ing heavy work. At high air temperatures, such Figure 4.3.1. Effects associated with heat stress in
high work rates may require a sweat production humans.
213
Chapter 4.3
The increased cardiovascular load experienced criteria. Medical effects are commonly used.
during heat stress compromises the capacity for People should not be injured at work, however
physical work. Significant water losses due to in heat and cold fatigue and exhaustion may be
sweating aggravate the physiological strain. A more relevant risk criteria as they directly inter-
given workload requires more effort (e.g. higher fere with work ability. Work must be stopped if
heart rate), and endurance is reduced. Pooling people become fatigued or exhausted. For office
of circulatory blood in lower extremities makes a work, thermal sensation and discomfort reac-
person more susceptible to fainting. tions are relevant criteria for assessment. The
Heat stroke is a severe condition caused by relationship between thermal conditions (stress
high core temperatures and failure of adequate level) as defined by the climatic factors, and the
thermoregulatory responses. Damage to vital specified effects (strain) must be known for the
organs may occur and eventually result in death. setting of limit values.
Immediate body cooling is necessary. Heat col- Effects on mental performance such as re-
lapse may result from cardiovascular failure, due duced vigilance and arousal, indirectly affect
to the inability of the body to maintain adequate motor performance and increase the probability
circulation, cardiac work and central blood pres- of human error. Figure 4.3.2 shows the number
sure. Heat exhaustion is caused by physical fatigue of unsafe and erratic behaviors as reported by an
due to dehydration and insufficient muscle blood observation team visiting industrial workplaces
supply. Heat cramp is localized to muscle tis- with different ambient temperature conditions
sues, caused by uncompensated salt loss through as measured by the WBGT index. Deviations
sweating. from optimal climatic conditions, (around 20 °C
Repeated exposures to heat may cause the WBGT), increase the frequency of erratic be-
body to develop positive functional adjustments havior.
(acclimatisation). With daily repeated sessions of
physical work, sweating and circulatory adjust-
ment becomes more efficient, thus enhancing
thermoregulatory control. The ability to sustain
physical work under hot conditions is greatly
enhanced when preceded by a 7–10 day acclima-
tisation period. During this period the person is
gradually exposed for a couple of hours to more
and more severe heat stress.
In many developing countries working and
living conditions are such that workers may be
more or less fit to work in hot climates, however,
Figure 4.3.2. Deviations from optimal, climatic
health and nutritional status and access to drink- conditions increase the frequency of unsafe
ing water are decisive factors. Family conditions behaviour. Modified from Ramsey et al. J. Safety
and transportation are other factors that may af- Research, 1995.
fect the overall physical capacity of an individual.
In order to prescribe acceptable working Productivity is strongly dependent on thermal
conditions, various effects can be used as risk conditions, in particular during physically de-
214
manding work, Figure 4.3.3. Up to a certain Observation checklist

temperature thermal stress can be compensated The most apparent and immediate risk factors
for and work capacity is relatively well main- are listed in Figure 4.3.4. The figure provides
tained. As soon as heat stress becomes over- a checklist for quick assessment of thermal risk
whelming, workers become exhausted and can factors and their severity.
only sustain work output by taking frequent,
intermittent breaks to recover. How do you perceive the risk of 0 – no risk
adverse effects associated with the 1 – small risk
following factors? 2 – high risk
air temperature
humidity
thermal radiation; sunshine
air movements
work load
clothing, protective equipment
contact with hot surfaces
other factors (specify)
The severity of each risk factor is estimated from 0-2:
0 – no risk
1 – small risk (conditions should be improved when ap-
propriate)
2 – high risk (conditions should be improved immedi-
ately)
Figure 4.3.4. Checklist for observation of thermal

Figure 4.3.3. Productivity loss (in percentage) risk factors in hot environments (modified from
in hot mining work, modified from Axelsson, ISO 15265).
Scand J Work Environ health, 1974.
ISO 15265 och ISO 15743 provide numerous
Losses at minor heat stress expressed by WBGT examples of simple, preventive measures that
are small, but they increase exponentially at can be immediately applied at low cost, with-
higher temperatures principally because physi- out consulting external expertise. As previously
ological strain and heat exhaustion develop and mentioned, external expertise for the risk assess-
call for reduced work pace and frequent pauses ment is only needed when conditions cannot be
for recovery. Acclimatisation of workers and bet- solved the easy way.
ter ventilation improve conditions. More accurate and complex risk assessment
The graph in Figure 4.3.3 was derived from requires an expert to undertake detailed meas-
experiences in the mining industry, primarily in urements to quantify thermal stress. The impor-
hot and humid conditions. Such conditions can tant climatic factors to consider for both cold
also apply to other types of manual work, such as and heat stress are listed in Figure 4.3.4. These
agricultural, forestry, building and construction factors need to be quantified by measurement or
work in similar climates. estimation before the evaluation can be done.
215
Chapter 4.3
Measurement of heat stress 35

When measurements are required, several indi-
ces are available for the assessment of heat stress.
WBGT (ISO 7243) provides a screening 30 25 % work-75 % resting
WBGT, °C
method that reasonably estimates thermal effects. 50 % work-50 % resting
PHS is an analytical index that more accurately
75 % work-25 % resting
determines the conditions for heat balance. 25
Continuous work
The WBGT (Wet Bulb Globe Temperature)
index has long been used world-wide and is an
low moderate high very high
empirical index based on measurements of globe 20
temperature (tg), natural wet bulb temperature 100 200 300 W/m2
(tnw) and air temperature (ta).It is calculated by 100 200 300 400 500 600 W
the two formulas shown below. The globe tem- Metabolic rate
perature is measured with a sensor placed inside Figure 4.3.5. Recommended limit values according
a 5-15 cm hollow, black sphere, preferably made to ISO 7243 for continuous and intermittent
of copper or aluminium. Measurement time is at work-rest regimens (redrawn from ISO 7243).
least 10-20 min for equilibrium (shorter for the Values refer to 1 hour time weighted averages.
small globe). The natural wet bulb is measured
with a 0.5x2 cm cylinder-type sensor that is fully Examples of WBGT-values for some industries
covered with a cotton cloth extending a few cm in Thailand and Tanzania are given in Figure
outside the sensor area on both sides. The cot- 4.3.6. A comparison of the values and the graph
ton cloth must be fully wet and must not dry shows clearly that all the workplaces frequently
out during measurements. Measurement time is exceed these values.
approximately 5-10 minutes. Industry Thailand Tanzania
WBGT is recommended as a screening index Ceramics factory 20-33 --
for the identification and control of potential Steel factory 21-37 25-37
places, times and conditions for adverse heat Glass factory 27-34 27-37
effects.
Corrugated sheet factory -- 27-31
WBGT= 0.7 tnw + 0.3 tg Agriculture 20-32 --
WBGT= 0.7 tnw + 0.2 tg + 0.1 ta (outdoors with Construction site 22-30 25-30
solar load)
Figure 4.3.6. Examples of measured WBGT in
workplaces in two countries. Values from Tan-
The recommended exposure limits as defined in zania are calculated from tabulated values for
ISO 7243 are illustrated in Figure 4.3.5. The globe and natural wet bulb temperature.
limits are activity dependent. For high work
rates conditions may quickly become strenu- In general, internal heat loads in the building
ous, in particular during continuous work. Since add to the ambient climatic conditions since
most continuous work (1 hour average) falls in most such workplaces has no mechanical ventila-
the low to moderate category, the limit values to tion. In the furnace area of a steel plant located
apply are in the range 26-30. in a dry hot climate, the WBGT is predicted to
216
vary between 28-44 °C for the air temperature Heat radiation can easily warm surrounding
range of 20-35 °C (from Emes et al. Am Ind Hy- surfaces creating new sources of low tempera-
giene Assoc J, 1978). ture infrared radiation. Shielding is most effec-
The WBGT index may be sufficient for most tive close to the radiation source. Shields can
routine assessments but when more accuracy be insulative or reflective. Surfaces towards the
is needed, expertise should be sought and the radiation source must be clean and polished for
PHS-index (Predicted Heat Strain) should be effective reflection.
used (ISO 7933). This method is based on a heat Increased convection (air speed), e.g. through
balance calculation which considers all the rel- the use of large fans, improves cooling of the
evant climatic and individual factors. Core body body by enhanced sweat evaporation. The posi-
temperature increases are predicted for given tive effect is greatest when air temperature is be-
conditions that allow determination of appropri- low or close to skin surface temperature (around
ate exposure times when risk criteria are ex- 35 °C). This measure is particularly useful in
ceeded. The method also allows simulation and warm and humid environments.
calculation of the effects of various preventive Workers must be provided sufficient amounts
measures, rendering it suitable for cost-benefit of potable water that should be drunk frequently,
analysis. not only due to thirst. Salt tablets are required
Another international standard provides data when heat stress prevails for long periods per-
on surface temperatures of different materials haps even during leisure or at night time. The
that can be safely touched by bare hands without provision and drinking of water is crucial to
risk of burns (ISO 13732). In particular, metal maintaining work ability over a working shift.
surfaces at temperatures above 45-50 °C may Studies have shown that productivity of agricul-
result in burns after a few seconds on contact tural and forestry workers was strongly depend-
with unprotected skin. ent on the availability of drinking water. The
costs involved to provide clean water at remote
Prevention of heat stress work places may easily be repaid by longer peri-
Technical measures to reduce exposure, e.g. ods of productivity. A person working at a me-
shielding of radiant heat, reflective panels or dium to high rate looses about 1 l/h or 5-6 litres
cooling arrangements at the workplace, will during a working shift, which must be balanced
improve conditions for body heat balance and by frequent intake of water and salt throughout
reduce heat stress. In addition, organisational the working shift.
measures such as work rotation and adequate Protective clothing may be needed for certain
breaks can be used to reduce and control the jobs. This type of clothing often greatly reduces
heat stress of individual workers. Solar radia- heat loss, in particular that due to sweat evapora-
tion is a common source of heat load in out- tion. Control of work and rest pauses are essen-
door work. The human body may absorb up to tial in order to prevent rapid increases in body
100 W of incident radiation on a clear day. This temperatures. Use of an ice-vest underneath
solar load can be less than 50 W if white and clothing is a cheap and simple method for the
loose-fitting clothing is worn. Working in the reduction of heat stress in hot industries. Special
shade is preferable. equipment for the provision of cool air or liquid
cooling under clothing is available.
217
Chapter 4.3
Education and training of workers, foremen and cold environments

employers is an essential component of an effec- In cold environments the large temperature
tive and functional risk management program. gradient between the body surface and the envi-
Measures that reduce thermal stress without ronment facilitates convective and radiative heat
compromising performance and productivity are losses. The combination of wind and low tem-
more likely to be accepted by both employers peratures provides significant cooling power and
and employees. may represent a major risk factor in cold work-
Technical measures places but in most situations there is no need for
1. increased circulation of air increases evaporation evaporative cooling. In fact, it is strongly recom-
and convection at air temperatures below approx. mended to avoid sweating in cold climates in
35 °C
2. shielding of radiant heat order to keep clothing dry and warm. Clothing
3. reflective panels is a significant factor for control of heat balance.
4. provision of shade from sunshine The build-up and variation of insulative layers
5. cooling of indoor air by compressor or evaporative allows adjustment of convective and radiative
cooling systems
heat losses according to the needs of the wearer.
Organisational measures
1. provide breaks for recovery and cooling
2. improve methods and equipment to reduce work rate
Adjustments to cold stress
3. rotate workers between work and workplaces If behavioral measures are insufficient to main-
4. avoid work at peak temperature of day tain heat balance, peripheral circulation, in
5. instruct workers for pair wise observation for heat
particular to the extremities, is reduced in order
symptoms (buddy system)
to conserve core body heat. With more pro-
Individual measures
1. provision of drinking water for frequent replacement
nounced tissue cooling, core temperature drops
of sweat losses and evokes compensatory heat production by
2. salt tablets shivering (involuntary muscle contractions).
3. light, loose clothing
4. protective clothing Effects of cold stress
– reflective garments must be clean and glossy
– thick, insulating garments for short extreme expo- Early responses to body cooling are discomfort
sures and annoyance. In particular the onset of shiv-
– check compliance of special protective equipment ering is perceived to be extremely unpleasant
5. microclimate cooling
– compressed air
and serves as a strong alert for intervention.
– liquid cooling Vasoconstriction leads to lowered heat input
– ice vests or similar and a drop in temperature, particularly in the
Other measures hands and feet. Pain is perceived at finger skin
1. inform, train and educate workers on heat effects temperatures around 15-20 °C and numbness
2. health controls at employment and at regular inter- (sensory loss) at 7-8 °C. Tissue freezing occurs
vals
3. acclimatisation programs at skin temperatures below 0 °C. When temper-
ature drops in the hands and feet, function and
Figure 4.3.7. List of actions that can be taken to performance deteriorate. Manual dexterity is
reduce or prevent heat stress.
affected, e.g. precision work is affected at finger
skin temperatures around 20-25 °C, and gross
218
muscular performance at finger temperatures How do you perceive the risk of 0 – no risk
below 15 °C. Vasoconstriction also contributes adverse effects associated with the 1 – small risk
to increased blood pressure. High ventilation following factors? 2 – high risk
rates means that cold air may irritate the airway air temperature
mucosa eventually leading to inflammatory reac- wind
tions. contact with cold surfaces
Profound body cooling results in hypother- water, liquids, moisture
mia, a condition that severely affects the ability cold protective clothing
to function and perform. With deep body cool-
protection of head, arms and feet
ing there is an imminent lethal risk.
interference with protective equipment
tissue and body cooling other factors (specify) ……….…………
thermal discomfort, pain For each factor a risk level between 0-2 is estimated:
mental performance, vigilance, arousal impaired 0 – no risk (no action needed)
1 – low risk (conditions should be improved when
cardiovascular load
appropriate)
– increased blood pressure 2–h igh risk (conditions should be improved imme-
respiratory effects diately)
– mucosal irritation,
neuro-muscular performance and work capacity
Figure 4.3.9. Checklist for observation of thermal
reduced risk factors in cold environments, modified from
– manual function and dexterity impaired ISO 15743.
cold injuries
– hypothermia For many conditions classified as 1 or 2, ap-
– local cold injuries propriate measures should be applied and evalu-
– freezing injuries
ated. These measures may be suggested by the
– non/freezing injuries
workers themselves or see the examples in figure
Figure 4.3.8. Effects associated with cold stress in 4.3.11. When appropriate measures cannot be
humans. found or are insufficient, an expert should be
asked to undertake measurements and evaluation
Cold stress assessment
of the conditions.
As a first step a simple checklist can be used to
observe the workplace. The checklist can be Measurements of cold stress
used by a supervisor, a specially trained worker A more detailed evaluation of cold stress re-
or any other person familiar with production quires assessment of the following effects:
and workplace conditions.
One example of a checklist is given in Figure • whole body cooling
4.3.9. • local cooling
– extremity cooling
– wind cooling
– contact cooling
– respiratory cooling
219
Chapter 4.3
Whole body cooling is evaluated using a heat It is clear from figure 4.3.10 that work in a cold
balance calculation to determine the required store at –25 °C can continue for long time but
clothing insulation for defined criteria (levels only with an ensemble providing more than 3.5
of strain). The value is called the IREQ-index clo. If the ensemble used by the worker is 2.5
(Insulation REQuired) (ISO 11079). When clo, the appropriate working time should be less
available clothing provides sufficient insulation, than 1 hour.
exposure time is infinite. With less thermal insu- Wind increases heat loss in cold environ-
lation, a recommended exposure time to prevent ments. The head and the extremities are par-
body cooling is calculated. Figure 4.3.10 gives an ticularly vulnerable and tissues may cool rapidly.
example of exposure times for light work. Each The face is often unprotected so the risk of
curve represents a defined level of clothing insu- developing frostbite is imminent at temperatures
lation (from 1 to 4 clo). The clo-value for an en- below –20 °C at 10 m/s and below –30 °C at
semble can be obtained from tables in the stand- 2 m/s or more.
ard, or from ISO9220. The clo-unit provides a The most prevalent risk factor in cold work
simplification of the more complex SI-unit – 1 is extremity cooling, in particular cooling of the
clo = 0.155 m2°C/W. Typically a 2-layer long- hands and fingers. Measurement of finger skin
sleeved clothing ensemble provides 1-1.5 clo, temperature provides an easy measure of the
a 3-layer ensemble 1.5 to 2.5 clo and a 4-layer risk. At finger temperatures below 15 °C expo-
ensemble 2.5 to 4 clo. Cold protective clothing sure should be interrupted and hands allowed to
must also provide air impermeable outer layers warm up.
when protection against wind is required. Contact cooling can be evaluated on the
20
basis of surface temperature and the properties
light work 115 W/m 2 of contacted material. Metals are dangerous to
Wind 0.2 m/s
10
1 clo handle with bare skin at temperatures below
1.5 0 °C. Frostbite may occur within a few seconds
Ambient temperature, ¡C
0 2 if the surface temperature is lower than –5 °C.

2.5
At very low temperatures significant cooling
-10
of the airways may take place. The use of simple
3
filter breathing masks improves heat retention
-20
3.5 through respiration and helps to reduce respira-
-30 4 clo tory symptoms.
-40 Prevention of cold stress

Similar basic principles apply to the design of
-50 preventive measures for both hot and cold work.
0 1 2 3 4 5 6 7 8
Technical and organisational measures can be
Exposure time, hours
applied to improve heat balance by affecting
Figure 4.3.10. Exposure time at various air tem- conditions for heat exchange, heat production
peratures for clothing ensembles with different during work, and the time and intensity of work.
insulation values (see text). Curves apply to light Individual measures are designed for similar
work and no wind, modified from ISO 11079.
purposes, for example by the use of protective
220
clothing for reduction of physiological strain. of work is slow so the temperature of hands and
The capability for an individual to cope with feet gradually falls. Adequate gloves or boots
thermal stress is improved by training, education may sometimes be insufficient to prevent this
and medical surveillance. drop but only slow down the cooling rate. Fin-
The key element to protection from cold is gers, toes and face are the most frequent loca-
adequate, insulative clothing that must be flex- tions for injuries from cold.
ible so that the actual insulation can be adjusted Due to the bulk and weight of protective
to variations in climate and work intensity. clothing against cold, physical work becomes
Sweating should be avoided at all times. Sweat more cumbersome and strenuous. Compared to
evaporation is very inefficient in cold environ- more temperate climate conditions, the pace of
ments and most sweat will accumulate in cloth- work is reduced and productivity is lower.
ing layers. Wet and moist clothing is not only In very cold workplaces (below -10 °C), even
uncomfortable but also threatens body heat the best protective clothing against cold may be
balance as insulation by the clothing reduces. insufficient, particularly when the work rate is
Body cooling may accelerate during subsequent low, see Figure 4.3.10. In that case work must
periods of light work or rest. be organized so that acceptable periods of cold
Workplaces should be shielded against wind work are interspersed with breaks for warming
and precipitation. Wind increases convective up and recovery. Many countries enforce regula-
heat losses and wind penetration into clothing tions of this kind for work in cold stores
greatly reduces its insulative capacity. Accord- (-25 °C). Suitable work rest regimens can be
ingly, the outer layer of clothing must be highly determined on the basis of ISO 11079.
windproof. Measures that reduce thermal stress without
Cold outdoor work conditions are often un- compromising performance and productivity are
predictable due to changes in weather. Careful more likely to accepted by both employers and
advance planning is needed and alternative pro- employees.
cedures should be scheduled. Sudden weather
changes during the day also justify alternative
action plans. Coverage of specific areas or even
complete workplaces, (e.g. building sites), has
become common and may pay off the extra costs
because weather conditions are controlled.
The human head is highly susceptible to heat
loss and should be properly protected, particu-
larly in windy conditions. If the body gets hot
during intensive work, the bare head and bare
hands, may eventually lead to significant heat
loss.
Hands and feet are highly susceptible to cool-
ing due to their remote location from central
heat sources. In particular the available energy
for peripheral heating is limited when the rate
221
Chapter 4.3
Technical measures suggestions for further reading

1. provide protection against foul weather
Parsons, K. C., 2003, Human thermal environ-
2. provide wind breaks
3. provide local heating ments. (Taylor & Francis, Hampshire, UK).
4. insulate against cold ground Comprehensive and up-dated textbook for
5. tools, equipment and machinery learning and understanding the interaction
pre-warm or keep warm
of humans with the thermal environment.
– insulate knobs, handles and bars
– must allow operation with gloves Detailed presentation of assessment methods,
6. insulate cold surfaces in particular ISO standards, and preventive
Organisational measures measures.
1. allow more time per task
2. reduce time in the cold
Holmér, I. 2001, Assessment of cold exposure
3. provide breaks with warm up facilities International Journal of Circumpolar Health 60:
4. reduce work in light and stationary work 413-422.
5. avoid coldest part of the day (morning) Describes a systematic step by step strategy
6. use buddy system
for assessment of the various types of effects
Individual measures in cold work.
1. clothing
– optimize insulation ILO Encyclopedia of Occupational Health,
– avoid bulky and stiff materials
1998, Stellman, J. (ed.). Heat and Cold, volume
– check compliance of special protective equipment
2. insulation 2, pages 42:1-55, ILO Geneva.
– flexible and adjustable Thorough presentation of problems of heat
– minimize needs for sweating and cold work. Description of methods for
– avoid moisture in clothing
assessment and preventive measures.
3. Micro climate heating
– use heated vest, gloves or socks
– use pocket heaters for hands etc.
4. provide double glove system for warmth and dexterity
5. provide footwear with insulation against ground and
anti-slippery sole
6. adjust work rate
7. provide warm food and drink
Other measures
1. inform, train and educate workers on cold effects
2. health controls at employment and at regular intervals
3. allow for gradual adaptation to work
Figure 4.3.11. Examples of preventive measures

applicable to cold work.
222
4.4
Noise
Ulrik Sundbäck
Mechanization of work through the use of and other psychological effects. Noise can also
machines is a predominant factor in the proc interfere with communication, cause tiredness
ess of industrialization. Mechanisation results in and reduce efficiency. Interference with speech
an increasing number of noise sources at work communication can be an accident risk because
places, in homes and in the general environ warning signals are less audible.
ment. We are rarely exposed to a single, isolated
Noise can be defined in different ways but the sound but usually exposed to a variety of sounds,
most simple and frequently used definition is often referred to as “background noise”. If the
that “noise is unwanted sound”. frequency components of background noise are
Millions of workers are constantly exposed to sufficiently loud compared with those of the
very high noise levels in a variety of industries sound we wish to hear, sound reception and in
including manufacturing, transport, mining, telligibility of speech may be impaired or masked.
construction and chemical processing. High
noise levels have three main effects, i.e. it is nature of noise
harmful to health, hinders speech communica The ear
tion and is annoying. Noise-induced hearing The human ear consists of three main parts:
loss is the highest reported occupational disease the outer or external, middle and inner ear.
in many countries and occurs in both developing The outer and middle ear both collect airborne
and industrialised countries. sound waves and conduct them to the fluid-filled
inner ear. The outer and middle ear transform
effects of noise mechanical vibration signals into neural im
Noise causes physical, psychological and social pulses which then transfer acoustic information
effects. Noise can be annoying but the most to the brain.
serious adverse effect resulting from exposure to The inner ear has two separate systems: semi-
excessive noise is permanent hearing loss caused circular canals that are primarily related to
by damage to the sensory organs of the inner ear. balance and the cochlea, primarily related to
Noise not only damages hearing but can hearing.
also influence cardiovascular functions such as The fluid-filled cavity of the cochlea is di
blood pressure and heart rate and cause stress vided into two longitudinal canals by the basilar
223
Chapter 4.4
measured in Pa, very large numbers would be

required, so, (in order to avoid this), the decibel
(dB) scale is used.
The decibel is not an absolute unit of measure
ment but a ratio between a measured quantity
and an agreed reference value. The dB scale is
logarithmic and uses the hearing threshold of
20 mPa as the reference level – defined as 0 dB.
When the sound pressure in Pa is multiplied by
10, 20 dB is added to the dB level. 200 mPa cor
responds to 20 dB and 2000 mPa corresponds to
40 dB and so on.
Figure 4.4.1. The human ear.
The mathematical
definition of sound pressure level,
Lp
p 2
membrane. When sound enters the outer ear Lp = 10 log ( –– )
po
and is transferred to the inner ear, the fluid
disturbance passes through the canals and causes Lp is sound pressure level, dB,
different parts of the membrane to vibrate. p is the measured value in Pa
po is the reference sound pressure, which has a
There are thousands of hair cells on the basilar value of 20 µPa.
membrane and these register the vibration and
transform it into nerve impulses that are trans
mitted to the brain. When a person is exposed
to high sound levels, there is a risk that these The advantage of using the dB scale is clearly
very fine hair cells will be destroyed. This risk seen in Figure 4.4.2.
is especially high if a person is exposed to high On the left, the sound pressure is shown in
sound levels over a long period of time, e.g. the Pascal unit, (Pa), 0.00001–100 Pa and on the
for those working in a very noisy environment. right, the pressure is shown in decibel, dB,
Unfortunately, when the fine hair cells die they 0 – 140 dB.
cannot repair themselves, resulting in permanent
hearing damage. What we hear
Sound is defined as any pressure variation which
dB and Lp can be heard by the human ear. The number of
A main quantity used to describe noise is the size pressure variations per second is called the fre
or amplitude of the pressure fluctuations. The quency of sound and measured in Hz. A young
most quiet sound a human ear can detect has person has an audible range of frequencies from
an amplitude of 20 mPa, (approximately 5 000 20 Hz to 20 kHz.
million times less than normal atmosphere pres The audible range of hearing in terms of
sure), but the human ear can also tolerate sound sound pressure level starts from threshold of
pressures more than a million times higher than hearing at 0 dB and ends at the threshold of pain
normal atmospheric pressure. If noise were which can be over 130 dB.
224
Noise
allowable noise levels

“Allowable” noise levels at a workplace are a
question of level and duration and refer to levels
related to health risks.
Sound from a noise source usually fluctuates
and is not constant over a period of time.
Figure 4.4.2. Sound pressure level.
Figure 4.4.3. Fluctuating noise.

While an increase of 6 dB represents a doubling
of the sound pressure, an increase of about 10
dB is required before the sound is perceived to In order to determine the health risk caused by
be twice as loud. The subjective loudness of a fluctuating noise, it is necessary to measure the
sound is determined by several factors, one of average value, equivalent value Leq, of the noise.
which is the fact that the human ear has a non- The equivalent level, Leq is an electronically
linear frequency response. The ear is most sensi calculated mean rms level which integrates all
tive to sounds with frequencies between 2 kHz the energy in a signal measured over a certain
and 5 kHz. time period – t. Leq can be considered to be the
The distinction in sensitivity to different continuous noise with the same total acoustic
frequencies is more pronounced at low sound energy as the actual fluctuating noise measured
pressure levels. over the same period of time.
Inaudible sound
Inaudible sound also exists. Sound with fre The mathematical definition of Leq
quencies below the hearing range is called infra
∫( )
1 T p(t)2
sound. Sound with frequencies beyond the range Leq = 10 log10 –– 0
––– dt
p0
T
of hearing is called ultrasound.
T is the total measurement time
p (t) is the instantaneous sound pressure
pois the reference sound pressure, 20 µPa
225
Chapter 4.4
Most often, the instantaneous sound pressure is

A-weighted so the unit of Leq becomes dB(A).
For steady, continuous noise, a good correla
tion has been demonstrated between the risk
of hearing damage and A-weighted sound level
measurements so this unit is now universally
employed when rating noise for this purpose.
But, the duration of exposure also has to be con
sidered in addition to the noise level.
Noise “dose” is defined as the A-weighted
equivalent noise level, (the A-weighted Leq), to
which a person may be subjected for a working
day of 8 hours, or a working week of 40 hours,
before there is a significant risk of permanent
Figure 4.4.4. Halving rate.
hearing loss. The allowable dose varies slightly
between countries but is usually 85 or 90 dB(A).
“Allowable” exposure to noise is a question tor had spent 8 hours in an environment with a
of level and duration; a high level of noise is noise level of 91 dB(A).
acceptable as long as it is compensated for by
periods of low levels. This trade-off between Masking
noise level and exposure time, creates the main The sound of interest to us normally occurs
divergence of opinion between different stand with several others sounds, usually referred to as
ards but both iso and osha specify a halving rate, background noise. This combination of sounds
i.e. they specify a rise “q” in noise level for each may impair or mask the reception of sound,
halving in exposure time, see Figure 4.4.4. especially the intelligibility of speech, if the fre
This means that if the criterion level is 90 quency components of the background noise are
dB(A) in both cases (iso and osha), iso will allow
an exposure of 93 dB(A) and osha an exposure
of 95 dB(A), for 4 hours a day if the remainder of
the day is spent in an area where the noise level
is below 80 dB(A). If the exposure is reduced to
2 hours, iso will allow 96 dB(A) and OSHA 100
dB(A).
The following example illustrates the Leq for
a full working day. The operator spends 1 hour
in a workshop where the noise level is 100 dB(A)
and the remainder of the day in an office, with a
noise level of 80 dB(A). The Leq for the 8 hour
working day will be approximately 91 dB(A)
which means that the operator is exposed to the
same risk of hearing damage as if the opera Figure 4.4.5. Example of Leq
226
Noise
sufficiently loud compared with the sound we age has already occurred but should not replace
want to hear. The following is an example of the work to reduce harmful noise levels.
“masking” phenomenon. If someone is exposed The essential issue in the fight against noise
to a pure tone of 1000 Hz, the result will not induced hearing loss, is the assessment of expo
only be a masking of any signal at 1000 Hz but sure to noise. Hearing loss can occur immedi
a shift in the threshold of hearing for the whole ately after exposure to extreme sound levels such
range around 1000 Hz. This reduction in hear as explosions, but more generally results from
ing ability may result in the loss of important constant exposure to noise over a long period of
information. time. Harmful noise levels do not always cause
Masking is not solely restricted to pure tones pain, so usually there is no immediate reaction or
but occurs with all types of noise, pure tone, complaint from exposed workers. Unfortunately,
narrow band, or wide band. by the time someone realises their hearing is
severely impaired, it is too late to do anything
Annoyance about it.
Low-level sound can be annoying or disturbing If a workplace hearing protection programme
even if it won’t cause hearing damage. The level is to be successful, it is important to know how
of annoyance depends not only on the quality of noise levels are distributed throughout a work
the sound but on our attitude towards it as illus site. Authorities often request a noise map from
trated in Figure 4.4.6. Some members of a thea companies suspected to have excessive noise
tre audience listening to a performance can have levels. The data for a noise map is obtained by
their enjoyment of the show destroyed by even a the use of sound level meters.
very low level of noise from another member of Different noise sources emit sounds of vary
the audience. ing frequencies but the total range of hearing
is limited by the threshold of hearing and the
measurements threshold of pain. The normal range for music
Audiometry and speech extends from approximately 100 Hz
Permanent hearing damage is mainly caused by
excessive exposure to high noise levels. Audiom
etry is an important way to check whether dam
Figure 4.4.6 Annoyance. Figure 4.4.7. Hearing range.
227
Chapter 4.4
to a few kHz. The range for normal speech has

the shape of a “banana”.
The threshold of hearing shifts because of
masking from background noise or hearing im
pairment. A part of the normal range of speech
is cut off, which reduces the understanding of
spoken information, see Figure 4.4.8.
Figure 4.4.9. Principle of an audiogram.
The audiometer automatically records the lev

els during the test and the resulting audiogram
shows the hearing ability of both ears, for differ
ent frequencies.
Periodic audiometric review will give early
warning of hearing damage and indicate that
measures to reduce noise should be implemented.
Figure 4.4.8. Shift of the threshold of hearing.
Noise measurements
Figure 4.4.9 illustrates the way in which an au Noise mapping
diogram is used to show hearing ability. A reduc The preparation of a “noise map” is often one
tion in hearing is shown here as a downwards of the first steps taken for a noise abatement
shift in the hearing level, where 0 dB hearing programme. A reasonably accurate sketch should
level, hl, corresponds to the hearing of young show the relative positions of all machines and
people with normal hearing. The normal range other items of interest. This map will imme
of speech is also included in the coordinate diately show which areas have excessive noise
system used for recording the audiogram. The levels and provide a starting point for planning
diagram clearly shows that a part of this range is what steps need to be taken.
cut off by a large shift in the threshold level. Noise measurements are the most important
A hearing test can be carried out with an audi starting point when either planning noise con
ometer which plots the audiogram directly. The trol measures for existing plants or for estimat
person being tested is given a pair of earphones ing the noise levels of new plants being planned.
and a hand-operated switch. When the opera Without existing measurements or predictions
tor initiates the test, an increasing sound level at from existing measurements, objective decisions
the first test frequency is first heard in the left about the need or effectiveness of installed noise
ear and, as soon as the person hears the signal, control measures cannot be made.
they press the hand switch and the intensity of Because of the variety and number of charac
the sound will decrease while the switch is being teristics related to noise and the corresponding
pressed. By alternatively pressing and releasing large number of measurement and assessment
the switch, the person being tested is able to techniques, great care is required when deciding
maintain a sound level very close to their thresh which measurements to take and how to inter
old of hearing. pret them. The sound pressure level read on a
228
Noise
sound level meter doesn’t always give sufficient Sound level meters
information for judgements about whether there The sound level meter is an instrument designed
is a danger to hearing or for use as a basis for a to respond to sound in approximately the same
noise control program. way as the human ear in order to give objective,
Both experience and special training are re reproducible measurements of sound pressure
quired to be able to carry out measurements levels. Many different sound measuring systems
in complicated situations but in many cases a are available and although they differ in detail,
standardized sound level meter and relatively all have a microphone, a processing system and a
simple measurement methods are adequate. read-out unit. The signal from the microphone
There are many different reasons for carrying may pass through a weighting network, sensitive
out noise measurements in industry. The most to various frequencies. There are three differ
usual are: ent internationally standardized characteristics
identified as “A”, “B”, and “C” weightings.
• to determine whether noise levels are high
enough to cause permanent hearing damage
• to establish a basis for noise control measures
to be applied to machines and equipment
• to determine sound radiation from individual
machines
• to ensure that noise levels do not disturb sur
rounding areas, e.g. in residential areas.
Measurement instruments and methods should

comply with the appropriate standards applica
ble to the specific noise measurements to be car
ried out. These standards include requirements Figure 4.4.10. Frequency weighting filter.
for instruments and methods used to measure
noise from different types of machines and for There is also a specialized characteristic, the “D”
assessment of the annoying and harmful effects weighting, standardised for measuring aircraft
of noise. noise, see Figure 4.4.10.
The most important international standards The A-weighting curve is the most com
are those published by the International Stand monly used because it gives the best correlation
ard Organisation (iso). iso is primarily con between the measured values and the annoyance
cerned with measurement techniques, experi and harmfulness of the sound signal.
mental conditions and measurement parameters. In addition to these weighting filters the sound
Many of these standards have been adopted as level meter also has a “Lin”, (linear), network that
national standards by countries, (either directly doesn’t weight the signal but enables it to pass
or with minor changes). through unmodified.
229
Chapter 4.4
Time weighting either one octave or one third of an octave. The

Noise level fluctuates so it is necessary to re audible region is divided into 10 octave bands
duce the fluctuations to give readings that can whose centre frequencies and bandwidth are
be followed. This is the reason why the sound defined in accordance with international stand
level meter contains one or more internationally ards. The centre frequencies of each consecutive
standardized time weightings or time constants. octave band are twice the centre frequency of
The most common time weightings are F (fast) the previous one, e.g. 125 Hz, 250 Hz, 500Hz,
and S (slow). etc. The upper frequency of each octave band is
If the sound to be measured consists of iso twice the lower frequency. The octave bands are
lated impulses or contains a high proportion usually referred to by their centre frequencies.
of impact noise, the rise time of normal F and The illustration shows the spectrogram for a
S time weightings of the sound level meter are noise signal measured with very narrow filters,
not sufficiently short to give a meter indication 1/3 octave filters and octave filters.
representative of the subjective human response.
A sound level meter with a standardized “I” (Im
pulse) characteristic is needed for such measure
ments. The ”I” characteristic has a time constant
which is short enough to enable detection and
display of transient noise.
Although the perceived loudness of a sound
of short duration is lower than that of steady,
continuous sound, the risk of damage to hearing
is not necessarily reduced. For this reason, some
sound level meters include a circuit for measur
ing the peak value of the sound, independent of Figure 4.4.11. Noise spectrogram.
its duration.
A hold circuit is also incorporated into sound Figure 4.4.12 shows a noise measured in oc
level meters to store either the peak value or the tave band. The left part shows an unweighted
maximum rms value. Some standards require the spectrogram of the noise and the right shows an
peak value to be measured while others ask for a A-weighted spectrogram of the same noise. The
measurement using the ”I” time constant but the column to the right of each diagram represents
hold circuit makes it easy to read the measure the dB(A) value.
ment in either case. The spectrogram shows the level measured
for each frequency band plotted as a horizon
Octave band and third octave band
tal line representing the level within the band.
When more detailed information about a sound
However, this does not mean that there will be
is required, the frequency range from 20 Hz to
frequency components at all frequencies within
20 kHz can be divided up into sections or bands
the band. The level measured with a filter will
through the use of electronic filters that reject
be equal to the sum of the levels of the individu
all sound with frequencies outside the selected
al frequency components within the bandwidth
band. These bands usually have a bandwidth of
of the filter.
230
Noise
Figure 4.4.12.
Unweighted and dB(A)
weighted spectrogram.
Noise Rating curves

It is necessary to evaluate the annoyance value
of the noise in almost any noise abatement pro
gramme, particularly when the measured dB(A)
values are above an allowable limit. Octave or
third octave band frequency analyses must first
be obtained for this purpose. Several methods
for determining the level of annoyance are rec
ommended in various standards. The simplest
method is the use of noise rating (nr) curves
given in an iso standard. The nr curves are used
by plotting the octave band noise spectrogram
over them. It can then be seen which nr curve
lies just above the spectrogram and the noise is
then assigned that particular nr number. In the
example in Figure 4.4.13 it is nr 78.
The shape of the curves shows that much more
importance is given to the higher frequencies
than the lower ones because high frequency sounds
are more annoying than lower frequency sounds.
Noise measurement procedure
The ideal way to fight noise problems is to lo
cate the noise sources and reduce the noise emit
ted. While it can be easy to identify machinery
that emits noise in an industrial environment, it
can be much more difficult to pinpoint exactly
where the noise is generated from, particularly
when trying to measure the noise level in a Figure 4.4.13. Noise rating curves
with noise spectrogram.
factory building. The sound levels in a factory
231
Chapter 4.4
space do not depend solely on the noise emitted • Carry out the measurements noting down
from machinery and manufacturing processes relevant equipment settings such as A-weight
but largely depend on the acoustic properties ing, etc.
of the building. The essential parameter is the • Keep a log, noting changes made to equip
reverberation time. The problem in factory ment settings, unusual occurrences, and make
buildings is the very long reverberation time. notes where relevant.
Concrete floors and large surfaces, (walls and
roof), cause sound to linger as they have very Valid measurements require the noise from un
little damping ability. Noisy machinery placed wanted sources, (i.e. background noise), to be at
close to reflecting walls, or in corners, can result least 10 dB below the level of the noise emitted
in excessive sound levels throughout a plant. by the source being measured. If this is the case,
The same machinery may not cause the same the measurement is accurate to within 0.5 dB.
problems in a factory with better acoustic prop The background noise must always be checked
erties because the noise levels will only be high before measurements are made. If the differ
close to the source. ence between the measured noise source and
Spatial decay describes the way in which a the background noise (measured separately), lies
constant level from a sound source propagates. between 3 and 10 dB, a correction may be made
Noise decays very slowly with distance in a fac using the following diagram, see Figure 4.4.14.
tory building with hard, sound reflecting floors, If this difference is less than 3 dB, the measured
ceilings and walls. A noisy machine at one end of noise source level is less than the background
a factory can produce deafening noise levels at noise level and a reliable and separate value for
the other end of the building. the noise source cannot be obtained.
The purpose of noise measurement is the pro
vision of reliable, accurate and thorough meas
urements which are dependable and accurately
describe the noise situation. To ensure depend
ability and accuracy, the following procedure is
recommended:
• Always calibrate all instrumentation before
and (preferably) after measurements.
• Record the instrumentation used and note
reference numbers.
• Make a sketch of the position of noise sourc
es, measurement position and local reflecting
surfaces which may affect measurements.
• When working outdoors, note the meteoro
logical condition, especially wind direction Figure 4.4.14. Background noise, correction curve.
and strength, temperature, and humidity. The x-axis shows the difference in dB between
• Check the background noise level to ensure a measured noise source, measured in presence
that it is sufficiently below the measurements of background noise, (LS+B) and the background
being taken or correct if necessary, see Figure noise, (LB). The y-axis shows DL which must be
4.4.14.
232
Noise
subtracted from the noise source measured in are potential economic advantages from reduc
the presence of background noise. ing noise.
For work areas with a particularly severe noise
programmes to eliminate or problem, it may be advantageous to attack the
reduce noise problem in a number of stages. By systematically
It is important to state that noise exposure can mapping the existing noise situation, a good pic
be controlled, no matter what the noise prob ture can be obtained. Noise often comes from a
lems may be. The best opportunity to achieve a number of sources and background noise is fre
working environment with low, non-hazardous quently found to significantly contribute to the
noise levels is during the planning stage for a total noise level. Noise levels for each machine
building or workshop and when purchasing new and working process need to be measured sepa
machinery. In the early stages of planning, im rately in order that informed decisions about in
portant details about the acoustics of a building dividual noise control measures are to be made.
can be calculated. The possibilities to influence The work processes and machines that produce
the design and layout of a workshop are also the highest noise levels should be noted.
good at this time. The purchase of new machin When attempting to reduce noise, considera
ery also offers the opportunity to achieve quieter tion must always be given to the fact that most
production and material handling. noise sources simultaneously produce both
There are many ways to implement noise airborne and structure borne noise. Most situa
control projects in factories but there are (at tions need a number of noise control techniques
least) three main ways to reduce noise. to be applied.
It is necessary to determine the individual
1. Reduce the noise at the source, e.g. with en
sound level at each frequency in order to deter
closures.
mine the degree of hazard from noise exposure
2. Prevent or reduce sound propagation, e.g. and to decide on the correct remedial measure.
through the use of sound absorbent materials. To determine this level, the sound signal is sent
3. Changing work or technology e.g. quieter through a filter that only allows passage of either
methods of work or new production a single frequency or a narrow band of frequen
technology. cies. The amplitude of the filtered signal is a
measure of the sound level at that particular
If attempts to reduce noise levels using the above frequency or frequency band.
methods are not sufficient, it will be necessary to While the technology to reduce noise exists,
protect workers in other ways, e.g. by building in some cases the necessary measures are expen
monitoring rooms or through the use of person sive and complicated. A noise control project
al protective equipment such as ear muffs. should result in the elimination or reduction of
It is important to ask why any noise control noise without increasing production costs. As
project is being carried out. There are a number noise problems are often closely related to other
of relevant motivations including the protec production deficiencies, the solution of noise
tion of workers from excessive noise, the need to problems may also result in increased produc
reduce noise being transmitted to a community tion and economic benefits.
surrounding an industrial site or because there
233
Chapter 4.4
Noise control in the planning stage 4. Office areas should be separated by a joint of
Noise control in new projects elastic material from building elements where
There are valuable possibilities for the achieve vibrating equipment is installed.
ment of good acoustical conditions when plan 5. Walls and ceiling construction, windows, and
ning new projects. It is usually possible to reduce doors should be chosen so the required sound
the noise generation from machinery and proc insulation is achieved.
esses in new plants through the use of known 6. Avoid mounting noisy equipment on light or
control techniques. Compared with older plants, movable partitions.
it is easier to control noise in new plants but Noise reduction measures in rooms
acoustic problems should be considered from The shape and size of an industrial workshop is
the earliest planning stage of a new building. largely determined by the production processes
When choosing new machinery, equipment, and flow of materials. The best possibilities to
or material handling methods, consideration influence the design and layout of a workshop
must be given to the potential noise disturbance. are in the early stages of planning but unfortu
Persistent efforts should be made to change to nately, work environment questions are seldom
quieter processes and working methods through discussed during this phase.
the introduction of more remote control so Some suggested guidelines on the layout of a
workers can spend part of the working day in new plant include:
relatively quiet control and operation rooms. 1. Workstations and machines should be placed
Planning a building in a way that exploits the reduction of noise
Important details of the load-bearing structure through distance.
and work areas of a building should be cal 2. Ensure that particularly noisy machines are
culated and fixed early in the planning stage. installed in separate areas.
These details are important for the acoustics of 3. Quiet work or work requiring a quiet work
a building as the need for noise control depends ing environment, should be removed to a low
first and foremost on the design and lay-out of noise area.
a production plant. The structural design of a 4. If noisy work is carried out close to a wall or
building frequently depends on the placement another reflecting surface, the wall or surface
of machinery and the need for insulation against should be covered with absorbent material.
airborne and structure borne sound. There are 5. Workshop offices, rest rooms, etc., should be
some important guidelines: provided with sufficient sound insulation.
1. Load-bearing structures, floors and machine 6. Fixed installations such as ventilation equip
foundations in a building should effectively ment or cooling systems should be construct
isolate all noise and vibration sources. ed with sound attenuation and mounted so
2. Powerful noise sources should be enclosed by that sound from fans, etc, is prevented from
structures which adequately isolate airborne spreading via ducts, pipes and the building
sound. structure.
3. Rooms with sound sources or where person
nel are present should be provided with clad
ding to absorb the incident sound.
234
Noise
Purchase and installation of machinery An easier method is to use this simple curve for
Whenever new machinery is purchased, quieter the addition of dB levels.
production and material handling must be con If there are two noise sources, L1= 55 dB and
sidered. Suppliers should state the sound levels L2= 51 dB, find the total noise level from both
produced by new equipment and indicate the sources. The difference between the sources is
feasibility of further noise reduction. DL = 4 dB. Using the curve in Figure 4.4.15, the
L+ axis shows approximately 1.5 dB, which is
Reducing noise at source then added to the highest level of the two sourc
Maintenance es. The total noise level from the two sources is
Before starting a noise reduction project it is 55dB + 1.5dB = 56.5 dB.
necessary to investigate whether maintenance of Note that a difference of D = 0 corresponds
machinery is properly carried out. Lack of main to the situation of two equal sound sources and
tenance can cause impact and rattle between 3 dB is added to the level caused by one source
machine parts. Periodic inspection and effective alone. In other words, if the noise is doubled,
maintenance of machines will reduce the noise the total noise level will rise by 3 dB. On the
at source and prevent unnecessary noise radiation. other hand, if noise control measures success
Information on the measures needed to main fully reduce the noise by 50 per cent, the total
tain and install machines is useful when choos noise level is only reduced by 3 dB.
ing the most cost-effective noise control meas
ure. Individual noise control projects should
be described as noise often comes from a large
number of sources. It is important to define the
noise level emitted by each part of any equip
ment or machinery. Any noise control project
should start with work on the source of the
highest noise level.
If the work process itself causes high noise
levels and alteration or enclosure of machines is
not successful in reducing noise to a safe level,
changes to the work process might be preferable. Figure 4.4.15. Addition of dB-levels.
The following example illustrates the impor
tance of finding the source of the highest noise
levels. If two noise sources emit 90 dB and 100 Machines
dB respectively, the total noise level is approxi Noise sources in machines or parts of machines
mately 100 dB. If the source of the 90 dB noise need to be identified if they are to be control
is reduced to 70 dB the total noise level is still led. It is important to avoid or reduce impact
approximately 100 dB, see Figure 4.4.15. and rattles between machine components, e.g.
If the contribution from two sources differs, by exchanging metal components with quieter
the total sound pressure level can be found by plastic parts. Another measure is the enclosure
converting the individual dB values to linear or screening of particularly noisy components
values, adding them and converting back to dB. or processes. Reduction of noise radiation from
235
Chapter 4.4
Fig 4.4.16. Vibration damping.
machines, equipment or materials handling is The four examples in the figure have the same
frequently achieved by the use of sound absorb fundamental frequency. If the machine base is very
ing panels and silencers on air outlets. heavy or very rigid, the fundamental frequency
Machines should be isolated so that vibra is determined entirely by the machine and base
tions that enter the structure and cause structure weights together with the rigidity of the spring.
borne sound are reduced. These vibrations can The lighter the machine and the more rigid the
be significantly reduced if a machine is mounted spring, the higher is the fundamental frequency.
on flexible supports or placed on a concrete base
Enclosure of machines
separate from the rest of the building.
If it is not possible to prevent or reduce noise at
Any machine mounted on a flexible support
source, it may be necessary to enclose all or part
always has a characteristic resonant frequency
of the machine. For enclosure to be satisfactory
determined by the weight of the machine and
it is necessary to:
the rigidity of the mountings. Vibrations pro
• Use sealed material, e.g. metal panels for the
duced by the machine at lower frequencies than
outer surfaces
its mounted resonant frequencies, are not iso
• Provide the inner surfaces with a sound ab
lated. However, vibrations at frequencies close
sorbing material
to the resonant frequency are greatly amplified.
• Mount noise attenuators on any openings for
Vibrations at higher frequencies than the reso
cooling air
nant frequency are isolated.
• Fit easily opened doors for inspections or
It is clearly important to select the correct
maintenance.
type of isolators.
236
Noise
The following example, Figure 4.4.17, illustrates Figure 4.4.17c shows the noise reduction if an
the effect of an enclosure, step by step. enclosure is built around the machine.
A machine is mounted on a concrete floor. The last step shows the combined effect of
The diagram to the left shows the noise level vibration dampers and enclosure.
measured in octave bands. The y-axis shows the The installation and purchase of new equip
noise level in dB within each octave band. ment opens possibilities to install quieter com
The first remedial measure (Figure 4.4.17b) is ponents, machine parts, and electric motors.
to mount the machine on vibration dampers to Another preventive measure to reduce noise is to
stop structure borne sound. The diagram shows ensure that cover panels on machines are rigid
a small reduction in the low frequency bands. and well damped.
Figure 4.4.17a.
Machine mounted on the
floor.
Figure 4.4.17b.
Machine mounted on
vibration dampers.
Figure 4.4.17c.
Machine on the floor
with an enclosure.
Figure 4.3.17d.
Machine mounted on vibra
tion dampers and with an
enclosure.
237
Chapter 4.4
Materials handling
Materials handling is often a very noisy activity.
Impacts between materials and parts cause very
high noise peaks. Existing plants can be changed
to avoid impacts between materials during man
ual or mechanical handling and transport by:
Figure 4.4.18. Materials handling.
• Minimizing the drop height for items col
lected in bins or containers
• Increasing the rigidity of panels that materials tubes fall into a bin. When the drop height is
strike. 0.8 meters, the sound level is 130 dB. When the
drop height is reduced to 0.2 meters, the sound
When new transportation equipment is pur level is 115 dB. To reduce the noise level below
chased, consideration should be given to equip 110 dB, the drop height must be reduced to a
ment which: value less than 0.05 meters.
• Transports material on conveyor belts rather
than rollers Preventing or reducing sound propagation
• Controls the speed of conveyor belts. The total noise level in a workplace is mainly
compromised of a small number of intense noise
sources. Those people working with quieter
The influence of drop height on noise level is
equipment are unnecessarily disturbed by noise
illustrated in Figure 4.4.19. The diagram shows
from other sources.
both calculated and measured values when steel
Calculations
Measurements
Figure 4.4.19. Drop height.
238
Noise
Attenuation by distance known as the absorption coefficient, a. Porous

Sound that propagates from a point source in materials intended to absorb sound are called
free air, attenuates by 6 dB for each doubling absorbents, and usually absorb 50 to 90 per cent
of the distance from the noise source, however, of the incident sound energy, depending on its
sound which is propagated inside a building is frequency. In a room with large amounts of ab
attenuated to a lesser value because of contribu sorbent material the sound level reduces steadily
tions to the total sound level from reverberant with distance from a sound source. If a room is
sound reflected from walls and ceilings. acoustically hard, i.e. with insufficient absorp
A small sound source, i.e. a point source that tion, the overall sound level can be just as high
radiates freely into free air, produces 90 dB at anywhere in the room as in the vicinity of the
one metre. The sound level at 2 metres will be sound source.
84 dB, at 4 metres 78 dB, etc.
Reverberation time T
An important characteristic affecting the acous
tic environment of a room is the reverberation
time, i.e. the time that a sound lingers within a
room after the original sound source has ceased
to generate. Sabine’s original definition: the
reverberation time is the time taken for a steady
sound pressure level within a room to decay by
60 dB, measured from the instant the sound Figure 4.4.21. Reverberation time.
source is stopped. The relationship between the
reverberation time and the absorption of a room Attenuation by using absorbents
is given by Sabine’s equation. Varying either the In a workplace with hard materials on the ceil
volume, V, or the absorption, A, can alter T. (A = ing, floor and walls, nearly all the sound which
a1S1+a2S2+…a6S6, and ai is the absorption factor reaches these surfaces is reflected back. The
for each area). Reverberation time is of special diagram in Figure 4.4.22 shows how the sound
interest for noise control projects in workplaces. level from a machine first falls relatively quickly
and then remains more or less unchanged as you
V move away from the noise source. This occurs
T = 0,163 –– because the noise level close to the machine
A

falls approximately as if it were in a free field,
Figure 4.4.20. Sabine’s formula. but at a certain distance the reverberant noise
level in the room becomes more intense and
dominant than the direct sound from the single
Sound absorption and absorbents
noise source. In such circumstances the noise
Sound energy is absorbed whenever sound meets
environment can be improved if the ceiling is
a porous material. One part of the sound wave
covered with sound absorbing materials that will
will be reflected back, another part will be ab
not reduce the noise level at the operator’s work
sorbed in the material and another part will pass
station but will reduce the noise level in the rest
through the material. The ratio of the sound
of the workshop. The reduction depends on the
energy absorbed to the sound energy incident is
239
Chapter 4.4
distance from the sound source. Figure 4.4.22 level measured, (or heard), at a specific distance
shows the sound pressure level at different dis from the source, results partly from direct sound
tances from a source in a room without absorp and partly from reverberant sound. The less
tion and then in the same room after a large area reverberant a room is, the more one has to move
of absorbent material has been mounted on the away from the source before entering the region
ceiling. dominated by the reverberant field.
The distance from the noise source can be
Reverberation
read in meters, (m), on the x-axis and the noise
Sound energy reflected back into a room creates
level in dB on the y-axis, see Figure 4.4.23. The
a reverberant sound field. The sound pressure
diagram also shows that the
noise level closest to the noise
source will decrease by 6 dB
when the distance to the source
is doubled. Far away from the
noise source the value will be
the same even if the distance
to the source is increased. The
breakpoint is determined by
the amount of absorbent mate
rial in the room.
Figure 4.4.22. Attenuation by the use of absorbents. The x-axis shows The calculated sound level
the distance from the source. is shown in the formula in the
box.
Figure 4.4.23. Reverberation.
240
Noise
An analysis of the diagram on ”Reverberation”

shows two extremes (the upper and lower figure
in the diagram). The first is a room with very
high absorption where the absorption will ap
proach unity. The second is a very hard room
where the absorption will approach zero.
Both these extremes are used in laboratories
(anechoic and reverberation chambers) but in
practice most rooms fall between these extremes
(the middle figure in the diagram), which makes
it difficult to find a correct measuring position.
It is normal to divide the area around a noise
source into four parts: A: near field, B: far field,
Figure 4.4.24. Workshop.
C: free field, D: reverberant field. The dimen
sion of each part depends on the absorption in The sound reduction coefficient, (sound insula
the room. In area C the sound attenuates by 6 tion), of the wall determines what proportion of
dB for each doubling of the distance from the the incident sound is transmitted.
noise source, see Figure 4.4.24. A wall with 10 dB insulation allows 10 per
If noise sources are screened or enclosed, the cent of the sound energy to pass through, (20 dB
noise level is reduced in areas A and B (near field corresponds to 1 per cent, 30 dB corresponds to
and far field). 0.1 per cent, etc). The sound insulation ability of
Sound insulation and sound reduction coefficient a partition separating two rooms is called the sound
When a sound meets a wall or partition, a small reduction coefficient and is expressed in dB.
proportion of the sound energy passes through, (Material characteristics are described in a
a proportion of the sound is reflected and a pro number of handbooks on sound insulation ma
portion is transformed into heat, i.e. absorbed. terials).
Attenuation through the use of screens

{
Γ
4m
4 (1−αm )
L P = L w 10 log ––––2+ –––––––
S . αm
} It is important to know the wavelength of a
sound when investigating the effect of a screen
placed in the sound field. The rule says “an ob
L w = sound power, dB ject which is much bigger than the wavelength
r = distance to the source, m
S = total area of the walls, m2
will have a screening effect on the propagated
αm = mean value of absorption coefficient sound, whereas an object which is smaller than
Γ = 1 if the sound source is a point source the wavelength will have little or no effect”.
radiating energy in all directions
Γ = 2 if the sound source is close to a
single reflecting plane
Γ = 4 if the sound source is close to
two reflecting planes
Γ = 8 if the sound source is close to
three reflecting planes, (corner)
241
Chapter 4.4
Figure 4.4.25 shows the screening effect when

the wavelength, λ , is much smaller than the
screen, d, (see a), and when the wavelength is
approximately of the same order as the screen,
(see b).
Similarly, the sound field at the other side of
a “leak” in a wall or a screen will be modified,
see Figure 4.4.26. If the diameter of the hole is
smaller than the wavelength, the sound field on
the other side of the hole will be similar to the
Figure 4.3.25a. Screen, λ<< d. sound field from a point source with the hole as
a source. On the other hand, if the diameter of
the hole is bigger than the wavelength, a beam
of the original sound field will pass through the
hole. In both cases the field behind the screen
will be heavily attenuated.
Figures 4.4.25 and 4.4.26 (screen and leak)
are examples of diffraction, a characteristic of all
wave motions. Diffraction is of special impor
tance when attempting to prevent noise propa
gation or when building an enclosure.
Structure borne sound
A typical cause of vibration within a machine
is clatter from loose bolts and screws. In this
case it is relatively easy to reduce the structure
borne noise by repairing the machine, however,
Figure 4.4.25b. Screen, λ ≈d. it is more difficult to reduce vibration emanat
Figure 4.4.26. Leak.
242
Noise
ing from a working machine in good condition. Figure 4.3.27 illustrates three steps to attenu
Structure borne sound can often be reduced by ate structure borne sound.
preventing the transmission of vibration from a a. before the floor is cast, a thick strip of foamed
machine to the load bearing structure of a build plastic is placed in all the joints between the
ing. The following principles can be applied to floor and the rest of the building structure.
prevent this transmission: b. after the floor has been cast, the foam is
• Isolate the floor from the machine by placing pulled or burnt out and the joint inspected
the machine on a stable foundation with an and cleaned out (if necessary). There must be
elastic separating layer, e.g. on rubber or steel no connections between the two structures.
springs. c. the joint is then filled with a flexible mate
• Place large, heavy machines on special ma rial and sealed completely with a high density
chine foundations completely separated from elastic material.
the building.
• Isolate vibrating machine panels wherever Changing work or technology
possible to minimise radiation of structure In many cases, the only way to achieve an ac
borne sound. ceptable, low noise level is to change the method
of work. This often requires a replacement of all
Heavy, vibrating machines require separate or part of the production equipment. Examples
foundations and isolation joints between floor of such measures are:
slabs to prevent the propagation of structure • changing the pump in hydraulic equipment
borne noise. In this case, two joints are used for • replacement of noisy compressed air nozzles
more effective separation. with quieter types
Figure 4.4.27.
Attenuation of structure borne sound.
243
Chapter 4.4
• mounting of attenuators in gas and air outlets be fixed to the edge of the frame with narrow
• alteration of equipment to avoid impact brackets which reduces noise. The side panels
• changes to machines to reduce noise genera can also be made of wire mesh to further reduce
tion noise (if the size of the items allows).
• provision of ventilation ducts with sound at
tenuators
• changes of mountings of fans in ducts to mini
mize turbulence
Alteration of equipment to avoid impacts
Two examples illustrate how equipment can be
altered to reduce the noise level. Many manufac
turing processes collect items in different bins.
The first example, Figure 4.4.28a, shows how
equipment can be altered to avoid impact when
manufactured items fall into a collection bin.
When the bin is empty, the fall height is large
and the noise level is high, (see the comparison
of drop height in the section on materials hand Figure 4.4.28b. Low fall height.
ling). If the conveyor is constructed in a way
that allows adjustment of the drop height and if In addition to the above measures, another way
it is fitted with rubber flaps on the inside of the to reduce noise levels is through the development
collection bin, the drop height can be minimized and construction of new technical solutions.
and the noise level reduced. The conveyor rises Such solutions boost competence and awareness
automatically as the bin fills, Figure 4.4.28b. of the interaction between the work environ
Figure 4.4.29a shows a material bin with welded ment and financial matters on the part of man
panels which cause very high noise levels when agement, designers, planners and operators.
items are collected in the bin. Figure 4.3.29b The development of new technical solutions
illustrates an example of another solution to a is often a difficult and expensive option, how
noise problem, a bin where the side panels can ever, this focus may reduce noise levels and also
Figure 4.4.28a. Long fall height. Figure 4.4.29a. Old material bin.
244
Noise
Figure 4.4.29b. New material bin.
improve company finances. The results of many

case studies show that in addition to improved
noise levels, other work environment hazards
such as physical workloads and accident risks
are reduced with new technical solutions. Case
Figure 4.4.30a. Undisturbed airstream.
studies also show that financial improvements
may result from a reduction in the number of
rejects, higher productivity and improved product
quality.
Changes of mounting of fans in ducts
to minimize turbulence
The following example illustrates fan noise and
how to control it. Fans generate turbulence that
radiates noise. Existing turbulence in incoming
air is made worse by the fan and the noise is am
plified. If there is sufficient distance between the
source of turbulence and the fan, the turbulence
has a chance to die down and the noise level is
reduced. Fans should be placed well downstream
of obstacles, corners, and changes of cross sec
tion. Figure 4.4.30b. Disturbed airstream.
In Figure 4.4.30a the airstream is undisturbed
with only minor turbulence formed after the fan.
In Figure 4.4.30b the airstream is disturbed with
major turbulence and a high noise level after the
fan.
245
Chapter 4.4
Figure 4.4.31 gives some guidelines for mount

ing fans in ducts. In the top of 4.4.31a the fan is
too close to an obstacle and in the bottom part,
the fan is too close to a bend. Both situations
form air disturbances which cause increased
noise after passing through the fan.
Figure 4.4.31b. Fans with low noise level.
damage is to provide them with hearing protec

tors. Two types of hearing protectors are avail
able: ear plugs made of fine mineral fibres,
silicone or plastic, or earmuffs, which completely
Figure 4.4.31a. Fans with high noise level.
enclose the ear and fit closely to the side of the
head.
The effectiveness of ear protectors varies with
Figure 4.4.31b shows a solution to the noise type and manufacturer. Manufacturers have
problems pictured in Figure 4.4.31a. In the first information on the typical values of the attenu
case, the regulator is moved further from the ation at different frequencies. It is important
fan so that the turbulence has a greater distance to check various manufacturers’ specifications
in which to settle down. In the second case, the before choosing a particular type of ear protector.
bend is made gentler to reduce the strength of Areas where the use of ear protectors is
the turbulence. The fan has also been moved obligatory must be clearly marked and people
further downstream to increase the settling working in these areas informed about the con
distance. sequences of ignoring the directives.
Industry developments are increasingly
Protection of exposed workers directed towards automation of machines and
Persons exposed to continuous noise levels processes. Automation allows remote control
above the statutory limit, should undergo regu from a control room which makes it possible to
lar audiometric checkups. The simplest way to limit the noise exposure of machine operators
protect workers from noise induced hearing and process controllers, to shorter periods
246
Noise
Figure 4.4.32. Control room.
required to service, repair and maintain ma • hydraulic system, a noise source which needs
chines. To reduce the noise exposure time a few an enclosure
important rules of thumb are: • elevator, vibrations that enters a structure
• Build control rooms with good sound insula • pipe mounting, vibrations from small objects
tion properties. • vibrating panels, protective cover which give
high noise levels
• Choose door and window designs with effec
• machine mounting, low frequency vibrations
tive seals.
• industrial workshop, a variety of noise problems
• Provide ventilation openings with attenuators
and ensure that cable cut-outs are properly Air compressor
filled with suitable acoustic sealants. Compressors with interior diesel engines pro
duce strong low frequency noise. Low frequency
Noise problems in control rooms and workshop noise radiates at the same level in all directions
offices can be caused by direct airborne sound,
(e.g. caused by gaps around doors), or from the
transmission of structure borne sound.
practical noise abatement measures

To conclude, a number of practical examples of
noise abatement measures are given for some
specific situations. The examples are:
• air compressor, a low frequency noise source
• workplace, with a high frequency noise source
• machine tool, different types of airborne and
structure borne sound sources Figure 4.4.33. Air compressor without noise con
trol.
247
Chapter 4.4
Figure 4.4.34. Air compressor with noise control.
because it travels around corners, through

holes, and then continues to travel, see Figure
4.4.33. A normal sized shield has little effect so
it is necessary to install effective mufflers at the
intake and exhaust points to reduce noise from
compressors.
A number of control measures have been
installed to control noise, see Figure 4.4.34. The
compressor is completely enclosed in dampening
material, air and exhaust passes through mufflers
and the inspection doors close tightly.
Figure 4.4.35. Workplace without noise control.
Workplace
A riveting hammer produces very high frequency
noise into a workplace, se Figure 4.4.35. When
high frequency sound strikes a hard surface, it is Machine tool
reflected. High frequency sound does not easily Figure 4.4.37 shows different types of airborne
travel around corners. and structure borne sound prevention methods.
Figure 4.4.36 shows a sound isolating hood It is important to localize all noise sources and
constructed with an inside lining of sound absorb to find appropriate measures.
ent material. There is an opening near the base of
the machine and the operator opening is covered
with safety glass.
248
Noise
Figure 4.4.36. Workplace with noise control.
Figure 4.4.37. Machine tool.
249
Chapter 4.4
Figure 4.4.38. Hydraulic system.
Hydraulic system
Some examples of enclosures of machines were
presented earlier. Figure 4.4.38 shows the main
problems that can arise with enclosures. An en Figure 4.4.39. Elevator.
closure is built around a hydraulic system. The
enclosure requires sound attenuated ventilation
openings because both sound and heat are radi
ated by the motor, pump and oil tank. A sealed
inspection cover must also be provided.
Elevator noise
Vibration that enters a structure such as a con
crete building travels a very long way because of
the very low internal damping of the structure.
Vibration and stop/start shocks can be heard
throughout the building, see Figure 4.4.39.
The winding machinery must be completely
isolated from the structure, e.g. by the use of
spring supports, see Figure 4.4.40.
Pipe mounting Figure 4.4.40. Elevator motor.

The vibration from a small object will generally
not produce a high noise level because the area
of air set into motion by the object will also be tion over a much greater area which gives a high
small. However, connecting a large panel trans noise level.
fers the vibration energy into airborne sound Structure borne sound in a pipe has little
much more efficiently by spreading the vibra opportunity to develop airborne sound as the
250
Noise
Figure 4.4.41.
Pipe mounting,
solid mounting.
Figure 4.4.42.
Pipe mounting,
isolated mounting. Figure 4.4.43. Protective cover.
area is small but when a pipe is fixed to a wall or

panel, the vibration can activate a larger area of
air or structure, generating a high level of air
borne sound, see Figure 4.4.41.
Pipe work must be properly mounted and
isolated from the wall or panels so that they do
not vibrate, see Figure 4.4.42.
Vibrating panels
It is not always possible to avoid the use of large
panels which vibrate and give rise to high noise
levels, but, in many cases, they may be replaced
by a panel with perforations or a broken surface.
The protective cover over the flywheel and
belt drive of a punch press radiates noise effi
ciently, see Figure 4.4.43.
A replacement cover of wire mesh reduces the
noise radiation, see Figure 4.4.44.
Figure 4.4.44. Wire mesh cover.
251
Chapter 4.4
Figure 4.4.45. Figure 4.4.46a. Figure 4.4.46b.

Machine mounting. Stiffened floor. Support from pillars.
machine mountings industrial workshop

Figure 4.4.45 shows a heavy machine produc Figure 4.4.47 illustrates a workshop with a vari
ing low frequency vibration. This vibration may ety of noise problems. The noise sources simul
cause the floor itself to resonate even though taneously produce both airborne and structure
isolators of the correct rating are used. borne noise.
Optimum isolation requires the natural fre The figure illustrates the fact that it often is
quency of the machine, (on its isolators) should necessary to apply several noise control tech
not only be well below the exciting frequencies niques.
from the machine, but should also be lower than
the resonances of the floor. In practice, this may
be achieved by reinforcing the floor structure
to provide a more rigid and solid base, see Fig
ure 4.4.46a. Alternatively, the machine may be
mounted on pillars mounted directly into the
ground, see Figure 4.4.46b.
252
Noise
Figure 4.4.47. Workshop.
253
Chapter 4.4

Most of the illustrations and some other materials
in this chapter are taken from the three follow
ing references:
• www.bkhome.com
• Noise Control. Principles and Practice, Brüel
& Kjær, 1982
• Bruel & Kjær Lectures:
ba 7040-11 Sound Level
ba 7214-11 Frequency of Sound
ba 7016-11 Psycho Acoustics and Audiometry
ba 7219-11 Leq – Noise Dose – sel
ba 7220-11 Noise Evaluation and Documentation
ba 7102-12 Introduction to Building Acoustics
The references provide outstanding and com

prehensive information on noise control. Brüel
& Kjær is a world-wide Danish company, able
to supply any equipment needed for noise and
vibration projects. Brüel & Kjær’s home page
has links to electronic Primers which will pro
vide the reader with introductions to subjects
relevant to sound and vibration measurement as
well as links to Brüel & Kjær’s internet courses.
254
4.5
Vibrations
Rauno Pääkkönen
basic concepts lower back and stomach problems. It is estimat-

Exposure to vibrating bodies such as handheld ed that worldwide 2–6 % of workers are exposed
tools and vehicles is a cause of occupational in- to harmful hand transmitted vibration and about
juries and diseases. The ongoing transition from 4–7 % of workers are exposed to harmful whole
handheld manual tools to power tools and mo- body vibration. In Europe questionnaires have
torised vehicles in developing countries demands shown a subjective individual estimations of ex-
attention to be paid to this work as an environ- posure to both types of vibration varies between
ment problem. 15–35%.
Vibration is a series of mechanical waves The main control measure to prevent adverse
generated from a vibrating body. In terms of effects from vibration is consideration of the
exposure and its effects to humans, vibration problem during the design and construction of
can be divided into whole body vibration and hand tools and equipment, vehicles, buildings etc.
transmitted vibration. The reduction of vibration exposure by improv-
Whole body vibration can give symptoms in ing of equipment and vehicles is usually more
the back and stomach areas, generate resonance complicated and costly, and normally less effec-
in different organs of the body and cause motion tive. Education and work organisation measures
sickness. The main sources are vibrating bodies are complementary actions.
such as buildings, machines and vehicles.
sources of exposure
Hand transmitted vibration gives rise to white
finger syndrome (VWF), neurological and mus- Hand transmitted vibration is a common problem
cular disorders. VWF is a typical occupational in occupations that demand the handling of tools
disease among users of handheld tools such as and the operation of equipment, e.g. in forestry
drills and machine saws and the health effects and construction work, mining, and manufactur-
vary from serious consequences leading to am- ing industries. Tools that frequently expose users
putation of fingers to milder symptoms of an- to vibration include chain saws, percussion tools
noyance. that use pressurised air, nailing tools, grinders,
Both types of vibration can impair human vibrating machinery, rock drilling devices, or
performance. Whole body vibration causes chip-hammers.
255
Chapter 4.5
Machinery such as lawn movers, tractors, and frequency ranges are considered to be more
vibrating machinery used in forestry and road dangerous than others.
work are typical sources of whole body vibra- Vibration is analysed with respect to frequency,
tion. Transportation vehicles such as aircraft, amplitude, direction and exposure but as some of
helicopters, trucks, all terrain vehicles and ships these dimensions interact, analysis might involve
also expose people to vibration. Even a private more than one dimension.
car can cause problems if a road is bumpy and
Frequency
curvy. Some structures like floors and mainte-
Frequency is expressed in Hertz (Hz). Oc-
nance platforms can vibrate when vibration from
cupational problems related to vibration are
processes or machinery is transmitted to those
normally found in frequencies from 0.1 to 1000
structures.
Hz. There are extremes beyond this range, e.g.
Vibration can appear as impulses. An impulse
low frequency vibration (sway) that causes mo-
is defined as lasting less than a second but im-
tions sickness, and high frequency vibration,
pulses usually occur at regular or irregular inter-
e.g. from high speed tooth drills, causing white
vals of more than a second. Vibration impulses
finger diseases (Figure 4.5.1).
that flow from hand held tools to hands, feet or
other parts of the body can cause adverse effects.
Type of vibration Frequency, Critical range,
In cases of whole body exposure, impulse vibra- Hz Hz
tion is caused by shocks and bumps. Limit values
Whole body 1–8 1–10
concerning human tolerance towards impulse
Hand transmitted 5–1 250 80
vibration have been calculated based on collision Low frequency 0.1–1 0.2
research, however, these limits are normally not High frequency
included in information on vibration induced (high speed drills) 1 000–10 000 5 000
occupational injuries.
Figure 4.5.1. Frequencies of vibration.
An extreme form of vibration is the G-force,
a phenomenon connected with acceleration e.g. Amplitude
in aviation. Effects from g-forces are similar to Amplitude is expressed as acceleration values
those from vibration, but g-forces are not usu- (m/s2) of certain frequency ranges or frequency
ally related to occupational settings. bands. Figure 4.5.2 shows typical equivalent
acceleration values of some vibration sources.
Dimensions of vibration The acceleration values for hand held tools have
Vibration is caused by continuous or fluctuat- been measured from the handle of a tool. This
ing reciprocal movement in solid structures that acceleration is focused mainly on the upper
move in their rotating or percussive paths. It is extremities of the human body. The whole body
comprised of mechanical waves and is closely vibration from vehicles has been measured from
related to structural noise. The vibrating waves the seats.
spread in materials in different directions and
with different frequencies. Vibration can change
direction and even frequency where there are
joints. Newton´s second law states that force,
mass and acceleration are interrelated. Certain
256
Vibrations
Sources Total equivalent acceleration, Direction

m/s2 Vibration normally occurs simultaneously in
several directions so it is often measured and
Hand held tools
Impact drill 10–110 analysed in three dimensions (x, y and z). Some-
Rock drill 5–13 times rotating angles are considered. Different
Rail saw 3–6 rules have been set up for analysing the axes
Steel plate cutter 4–20
of vibration and determining the correlation
Chain saw 2–5
Grinder 1–3 between harmful effects and the directions of
Bench grinder 15 vibration.
Bolt and nut wrench 5–15
Concrete vibrators 5–20 Exposure
Exposure is assessed as an integration of dura-
Vehicles tion and acceleration. Work with most vibrat-
Excavator 1–5 ing tools will mean that guideline values are
Caterpillar with push plate 1–3
Motor sledge 2–5
exceeded at some time, however, these tools are
Terrain vehicle 3–5 not used all the time so exposure should be cal-
culated as a daily vibration exposure on the basis
of the following equation
Figure 4.5 2. Some examples of equivalent ac-
celeration (m/s2) values of vibrating tools and ahv(eq, 8h) = ahv(eq, T) √(T/8 h),
vehicles as measured by the Finnish Institute of
Occupational Health. where ahv(eq, 8h) = daily vibration exposure (8 hours),
The highest values of acceleration are found ahv(eq, T) = equivalent acceleration value over time
when hand tools like drills, cutters or vibrators
T = time period
are used. Most of the vehicles cause vibration
values that exceed limit values as measured at the How to measure
seat of the vehicle during normal use. Figure 4.5.3 shows a three axial measurement
Certain frequency ranges are considered more and analysis system for vibration that weights
dangerous than others. Therefore, frequency frequency according to ISO standards and can
weighting networks have been constructed to be used in field conditions to analyse work expo-
facilitate the analysis of vibration measured by sures.
systems that give only one acceleration value for
the specific vibration source under examination.
This type of acceleration is called frequency-
weighted acceleration. Fluctuating vibration
can also be time-weighted and integrated, and
in such cases the values are called “equivalent
acceleration values” measured over a particular
time period.
257
Chapter 4.5
Mitigating and aggravating conditions

Adverse effects from vibration are not only relat-
ed to the inherent characteristics of the vibration
but to a combination of other risk factors such as
the type and length of exposure, other physical
work conditions including the nature of work
tasks, and individual human characteristics. The
following summary shows how these conditions
can mitigate or aggravate the effects of vibration:
• the connection between the human body and
vibrating device
• duration of exposure and rest breaks
Figure 4.5.3. Vibration measurement from the
• work posture and muscle tension
handle of a drill. The figure illustrates the in-
sertion of acceleration sensor to the handle of • weather conditions, smoking, drugs and noise
a drill. A three axial acceleration sensor can be
fixed in a handle by tightly screwing or gluing so • individual susceptibility
that the drill can be used for practical work. • individual protective behaviour
Vibration is usually measured by accelerometers guidelines

that change mechanical vibration into a charge The European Union directive on human vi-
or voltage form. The signals are then ampli- bration (effective from 2005), sets the limits
fied and tape-recorded or analysed in many for hand transmitted vibration and whole body
ways. For occupational health purposes vibra- vibration at 5 m/s2 and 1.15 m/s2, respectively.
tion is usually measured and analysed according The action values for hand transmitted vibration
ISO standards (ISO 2631 series, 1985-2003). are 2.5 m/s2 and 0.5 m/s2 for whole body vibra-
Measurement of vibration is usually more com- tion. These values are measured as frequency
plicated than measurement of noise. In many weighted total vibration for an 8 hour workday.
countries, specialists or engineering offices are The American Conference of Governmental
experienced in undertaking these measurements. Industrial Hygienists annually publishes rec-
In addition, these specialists measure structural ommendations for hand transmitted (4 m/s2
vibration, e.g. bearing vibration, building vibra- for exposures 4-8 h) and whole body vibration.
tion, and ground vibration. It is important to Vibration is also measured to provide helpful
analyse structural vibrations during the proto- information for machinery maintenance, to ana-
type phase for new vehicles or equipment, not lyse the condition of ball bearings, and to ana-
only because of potential human exposure but lyse structural vibration and the environmental
also to avoid potential damage to structures and spreading of vibration through the ground. The
equipment. measurement of human vibration is only a small
part of overall vibration measurements.
258
Vibrations
adverse effects
Hand transmitted vibration

The most prevalent adverse effect related to
hand transmitted vibration is white finger dis-
ease (VWF) (also known as traumatic vasospas-
tic disease (TVD) or Raynard´s phenomenon).
VWF is usually caused by motor driven tools
like chain saws that operate within the fre-
quency range of 40-300 Hz. VWF is associated
with blocked or reduced blood circulation in the
small blood vessels of the fingers. If the blood
does not circulate properly, the fingers become Figure 4.5.4. An example of vibration white finger
in fingertips (left).
permanently white (Figure 4.5.4). Nerves are
affected and cause pain, numbness, and tingling
The Stockholm Workshop scale is an interna-
in the hand. These vascular attacks are provoked
tionally accepted grading system for classifying
and aggravated by cold.
Raynard´s phenomenon and VWF induced by
In the worst cases, the blood circulation of
cold. The hand-arm vibration syndrome is divid-
a finger can be totally destroyed necessitating
ed into vascular and sensorineural components.
amputation of the finger. This only happens very
Figure 4.5.5 sh ows the grading of symptoms re-
rarely, and only occurs after a very long period
lated to vascular and sensorineural components,
of severe vibration exposure.
ranging from mild to very severe attacks.
Grade Description of vascular component Description of sensorineural component

– no attacks exposed to vibration but no symptoms
mild occasional attacks affecting only the tips if intermittent numbness with or without tingling
one or more fingers
moderate occasional attacks affecting distal and middle intermittent or persistent numbness, reduced
phalanges of one or more fingers sensory perception
severe frequent attacks affecting all phalanges of intermittent or persistent numbness, reduced
most fingers tactile discrimination and/or manipulative
dexterity
very severe frequent attacks affecting all phalanges of
most fingers and with trophic changes (tissue
damages or necrosis) in the fingertips
Figure 4.5.5. Stockholm workshop scale (ISO 5349-1, 2001).
259
Chapter 4.5
Whole body vibration movement. Symptoms usually disappear within a

Whole body vibration is thought to cause symp- few hours after the exposure has ceased. Motion
toms and disorders of the joints and muscles, sickness can deteriorate work ability substantial-
especially in the spine and stomach areas, but ly but there are significant differences between
the scientific evidence is not strong. Some Eu- individuals. There is little information on indi-
ropean countries have accepted the combination vidual susceptibility to this phenomenon.
of low back pain, sciatic pain and degenerative
changes in the spinal system as an occupational prevention
disease related to whole body vibration. Other The best way to control or avoid or minimize
reported effects are cardiovascular changes, such exposure to vibration, is to consider the problem
as elevation of blood pressure, and changes of from the very beginning, when planning and
respiratory, endocrine and metabolic systems, equipping new work processes and worksites.
however, the scientific evidence for these effects Long standing requirements to reduce vibration
is also weak. have been addressed by manufacturers of chain
Whole body vibration might impair human saws, pneumatic tools and transportation de-
performance such as visual perception and bal- vices. It remains to be seen what effect the new
ance. Resonance frequencies can reduce opera- European vibration exposure directive (2002/44/
tional and visual capabilities (e.g. symptoms in EC) will have on the development of vibrating
the chest area at 25 Hz, and in the eye ball at machines and tools. This kind of development
60 Hz) and may interfere with human activities takes time, with the results of improvements
that demand fine motor skills and reading. Writ- being measured only after 10 - 20 years. Simi-
ing becomes impossible if vibration is strong larly, a directive giving standards for machine
enough. Other reported effects are annoyance vibration (98/37/EC) has begun to influence
and discomfort. All these effects form a complex manufacturers and sales figures. Legislation is
phenomenon that can only partly be explained often considered to be the most important way
by vibration. to influences the development of tools and ma-
Human tolerance of the impact from vibra- chines, increasingly resulting in work becoming
tion has also been addressed through biody- automated. To improve and reduce the vibration
namic models based on human responses. These of existing objects such as tools, equipment, ma-
models combine the duration of vibration chinery, vehicles and buildings is usually more
impact and uniform acceleration and classify costly, complicated and less effective.
the exposures causing adverse effects into three As already mentioned, there are other condi-
classes: no injury, moderate injury and severe tions that might influence exposure to vibration,
injury. According to Gierke and Coermann the including the duration of exposure, working
limit for a 0.1 s impulse to cause a moderate posture, and weather conditions etc, so a com-
injury is about 100 m/s2. bination of modifying factors might be needed
Motion sickness is caused by the low fre- to control vibration exposure. A management
quency vibration or sway of ships and vehicles system should include a range of control meas-
such as aircraft, buses and cars. Symptoms ap- ures such as:
pear more easily if a person has to read, write or
focus the eyes on certain areas while exposed to
260
Vibrations
• hazard identification and monitoring of expo- Attention should be paid to:

sure
• workers with symptoms caused by vibration
• technical hazard elimination and engineering
• workers who complain about vibration.
modifications
• sources or activities associated with com-
• routines for maintenance of vibrating equip-
plaints or symptoms
ment
• work organisation methods e g separating Data could be collected by direct observation,
workers from the source of exposure and checklists, by consultation with workers and/or
reducing the duration of exposure supervisors, and by the review of injury and
medical reports.
• education and training of safe practices
• the use of personal protection equipment Technical hazard elimination and
(PPE). engineering modifications
Having assessed the problem preventive actions
Hazard identification and monitoring must be taken. Prevention at source is the first
The first step in assessing the problem is to option to consider. When a new tool or vehicle
identify where people might be exposed to vi- is being purchased, consideration of the vibra-
bration and to describe the sources. This can be tion level can be one of the criteria for purchase.
done by a walk through the worksite to identify Once a vibrating machine or vehicle has been
and record the type and number of vibrating purchased, there are limited possibilities to re-
machines, tools, vehicles and other vibrating duce vibration by technical means. Appropriate
structures. A combination of conditions deter- design of tools and vehicles is therefore of the
mine the intensity of adverse effects so all those utmost importance.
conditions have to be properly addressed. Such The price of a product is a decisive parameter
conditions are: and unfortunately vibration dampened prod-
• acceleration, frequency and direction of the ucts are often more expensive. Currently there
vibration are cheap copies of tools and machines one the
market and these cheap versions vibrate more
• activity being performed by the exposed per- than the original model because lighter materials
son (work posture and muscle tension) are used and they are more poorly assembled. In
• duration of exposure and breaks addition these copies usually have a shorter life
time and are less cost effective in the long run.
• the connection between the human body and
It is important to highlight the benefits of using
vibrating device
high quality tools.
• weather conditions, smoking, drugs and noise Guidance about what to consider when pur-
• individual susceptibility chasing equipment can be found in the Machine
Directive of the European Union (98/37/EC).
• individual protective behaviour The directive states that if a machine causes hand
transmitted vibration of more than 2.5 m/s2 or
whole body vibration of more than 0.5 m/s2, the
261
Chapter 4.5
manufacturer must provide information on the Principles for reducing vibrations are:
vibration of the machine. The machine instruc-
• increasing the mass of the vibrating body
tions must give the weighted acceleration value
to which the arms are subjected if it exceeds 2.5 • minimising tolerances of systems
m/s2 as determined by the appropriate test code. • better balancing machines and reciprocating
If the acceleration does not exceed 2.5 m/s2, no parts
mention is required. The instructions must also
give the root-mean-square acceleration value to • design of forms to reduce turbulence.
which the body (feet or posterior) is subjected if
it exceeds 0.5 m/s2. Where the acceleration does Figure 4.5.7 shows the development of vibration
not exceed 0.5 m/s2, no mention is needed. Man- reduction in the handle of a chain saw over a pe-
ufacturers may also give guidelines on the selec- riod of 10 years. From the figure it can be seen
tion of vibration damping devices. For example, that lower frequencies are harder to reduce than
Figure 4.5.6 shows a forestry clearing saw that higher frequencies. At the lowest frequencies
has been designed to reduce vibration. the vibration accelerations have even increased.
This is how materials usually isolate differ-
ent frequencies. The resonances are caused by
spring-mass type vibration systems in machinery
that can attenuate or amplify certain frequencies
or frequency areas.
Chain saw vibration measured in the

handle
120
acceleration, m/s2
100
80
Vibration
60
40
20
0
30 60 125 250 500 1000 2000
Frequency Band, Hz
Figure 4.5.6. Forestry clearing saw in action. The no damping vibration reduction
manufacturer notifies purchasers that the equiv-
alent vibration acceleration is less than 5 m/s2, a Figure 4.5.7. Vibration acceleration in the handle
level that will not exceed limit values. of a chain saw without vibration damping and
after vibration reduction.
While it is difficult to reduce vibration by rede-
sign, some possibilities exist, e.g. recoilless ham-
mers, damped handles and insulation solutions
for chain saws.
262
Vibrations
In vehicles whole body vibrations can be damped sure to vibration. For example changes in work-
by: ing methods and organisation, such as separation
• installing better isolated seats of workers or job rotation can be effective. The
possibility of more automated systems can be
• isolating the cabin from the structure of the considered.
machine Reducing the duration of exposure (e g. by the
• improving suspension through active damping reduction of work periods or an increase in the
systems number of breaks during work shifts), can elimi-
• using pneumatic tyres nate or reduce adverse effects. It is also impor-
tant to observe whether workers must adopt
• ensuring that roads and work surfaces are
poor ergonomic postures while they are exposed
smooth
to vibration.
Improvement by technical redesign requires
technical understanding. Unsuitable materials, Education and training
structures that are too light or some other choic- Workers must be given information about how
es can generate resonances that amplify vibra- to detect, avoid and manage exposure to vibra-
tion levels at certain frequencies and increase tion. Concerning whole body vibration, training in
workers’ exposure to vibration. In unfavourable how drivers can adjust their driving to the ex-
conditions these resonance frequencies exist at ternal circumstances will be helpful in reducing
the resonance frequencies of the human body, exposure. Such training should include informa-
increasing discomfort. tion about what causes rough rides and what
Sometimes there is a danger that technical constitutes damaging vibration. Exposure to
changes deteriorate ergonomic conditions by hand transmitted vibration can be avoided if work-
increasing the mass. Vibration of a structure can ers learn how to operate and maintain tools. The
also be amplified through the use of vibration following is a summary of practical hints that
isolation. This can shorten the lifespan of a ma- workers can use to reduce exposure to vibration:
chine so this is not always a possible alternative • avoid unnecessary tight grip force from the
solution. Improving the balance of machinery handle of a vibrating tool
demands careful design, but it can reduce vibra-
tion levels significantly. • use only good quality tools and cutting ma-
chines with properly sharpened teeth
Routines for maintenance of vibrating • have regular breaks so that the hands have the
equipment possibility to recover
Most tools and vehicles deteriorate over time,
• keep your hands warm and do not smoke
particularly suspension systems in vehicles,
when working
regular planned maintenance routines must be
established. • avoid all smoking, particularly when working
• take regular breaks
Organisational efforts
The planning and organisation of work tasks and • keep gloves dry
working conditions are a means to reduce expo-
263
Chapter 4.5
Personal protection equipment (PPE)

Gloves do not usually reduce vibration signifi-
cantly but they do help to keep hands warm as
well as protecting the hands, Figure 4.5.8. It is
also important to take note of symptoms that
may be caused by vibration, (e.g. tingling, loss of
grip force, or white finger) and to take remedial
action. While personal protective equipment is
usually cheap and easy to provide it is of very
limited value.
Figure 4.5.8. Gloves protect hands from sparks and

help to keep hands warm but they do not pro-
tect hands from vibration.
ISO Standards
ISO 2631-1: vibration and shock - evaluation of human exposure to whole body vibration Part 1: general
requirements. Geneva: International Organization for Standardization; 1997. 36 p.
ISO 2631-2: mechanical vibration and shock - evaluation of human exposure to whole body vibration.
Part 2: Vibration in buildings (1 Hz to 80 Hz). Geneva: International Organization for Standardization;
2003. 11 p.
ISO 2631-3: evaluation of human exposure to whole-body vibration - Part 3: evaluation of exposure to
whole-body z-axis vertical vibration in the frequency range 0.1 to 0.63 Hz. Geneva: International Organi-
zation for Standardization; 1985. 4 p.
ISO 5349-1: mechanical vibration - measurement and evaluation of human exposure to hand-transmit-
ted vibration. Part 1: general requirements. Geneva: International Organization for Standardization;
2001. 24 p..
suggestions for further reading http://www.ccohs.ca/oshanswers/phys_agents/

vibration/vibration_intro.html
Griffin M. Handbook of human vibration. Lon-
don, Academic Press; 1990. http://www.humanvibration.com/EU/VINET/
pdf_files/Appendix_H1A.pdf
Pelmear PL, Wasserman DE. Hand-arm vibra-
tion. A comprehensive guide for occupational http://www.humanvibration.com/EU/VIB-
health professionals. 2nd ed. Beverly Farms, GUIDE/HAV%20Good%20practice%20Guide
(MA): OEM Press; 1998. %20V7.7%20English%20260506.pdf
http://www.humanvibration.com/EU/VIB-
General Web-sites on vibration GUIDE/WBV%20Good%20practice%20Guid
http://www.hse.gov.uk/vibration/ e%20v6.7g%20English%20070606.pdf
264
4.6
Radiation
Kjell Hansson Mild &Ulf Bäverstam
There are two main types of radiation from wards developing countries. International bod-
electric and magnetic fields, non-ionizing and ies including the International Commission on
ionizing radiation. Ionizing radiation consists Non-Ionizing Radiation Protection, (ICNIRP),
of subatomic particles or electromagnetic waves and the International Commission on Radiation
that are energetic enough to detach electrons Protection, (ICRP) produce guidelines that are
from atoms or molecules, ionizing them. applied all over the world. The USA is an excep-
The first part of the chapter, written by Kjell tion having its own set of rules, although there
Hansson Mild, covers occupational exposure are only minor differences from the rules ap-
related to non-ionizing radiation from sources plied in other countries.
such as large electric motors, generators, power
supplies and cellular phones. This part starts non-ionising radiation
with definitions and a general description of the Electromagnetic fields
concepts and acronyms related to the electro-
Electromagnetic fields, EMF, is the general term
magnetic spectrum.
for electric and magnetic fields with frequencies
The second part by Ulf Bäverstam addresses
from 0 to 300 GHz.
ionising radiation. The main occupational sourc-
An electric field (E) is created as soon as there
es are X-rays used in hospitals and workplaces,
is a voltage difference between two points, e.g.
and gamma radiation emitted from radioactive
around the cable of a lamp that is turned off but
nuclides (e.g. used to irradiate patients undergo-
still plugged into an outlet. Electric fields are
ing cancer therapy or for sterilising foodstuffs).
easily shielded. The E field is given with the unit
The chapter does not discriminate between
volts per meter, V/m.
developing or industrial countries as the use of
A magnetic field (B) is created when there is
both non-ionizing and ionizing radiation are
a current flowing. For example, magnetic fields
strictly coordinated globally. For example, the
(and electric fields), are found around the cable
Atomic Energy Agency (IAEA) has made it a
of a lit lamp. Magnetic fields are more difficult
priority to support the development of non-
to shield.
military use of radiation in developing countries.
The magnetic field is given by the flux den-
Many IAEA publications are also directed to-
sity, B, with the unit Tesla (T).
265
Chapter 4.6
Both E and B are vectorial quantities, i.e. they The electromagnetic spectrum
have both magnitude and direction. The fields The behaviour of electromagnetic (EM) radia-
are usually displayed by means of field lines, tion depends on its wavelength. Higher fre-
and Figure 4.6.1 gives an example of this. The quencies have shorter wavelengths, and lower
E field always starts with a positive charge and frequencies have longer wavelengths.
ends with a negative charge. The B field forms When EM radiation interacts with single at-
closed loops, i.e. the field lines have no begin- oms and molecules, its behaviour depends on the
ning or end. amount of energy per quantum it carries.
The most familiar form of electromagnetic
energy is sunlight. The frequency of sunlight
(visible light) constitutes the dividing line be-
tween the more potent ionizing radiation (x-ray,
cosmic rays, etc.) at higher frequencies and the
more benign non-ionizing radiation at lower
frequencies. Generally, EM radiation is classified
by wavelength into:
– electrical energy
– radiowave
Figure 4.6.1. Electric and magnetic fields. Two – microwave
large plates are separated by 1 m and the poten- – infrared
tial difference between them is 1000 V (1kv). – the visible region we perceive as light,
The E field between the plates is than E=1000 – ultraviolet
V/m = 1 kV/m. A current of 10 A is running in
– X-rays
a straight conductor. The magnetic field at a dis-
tance of r m from the conductor is given by the – gamma rays.
formula B=0.2xI/r (mT), and this gives for 10A
and 1 m B=1 mT, and at 2 m B=0.5 mT.

Figure 4.6.2. Radiation sources related to frequency and wavelength.

266

Radiation
Low frequency fields include those that are in- health effects
duced around standard electric installations with
Rather high exposure to electromagnetic fields
a frequency around 50 Hz.
may occur in many occupations, especially
Intermediate fields are those in the range of
during work near electrical equipment that
300 Hz through approximately 1-10 MHz.
uses a large amount of electric power such as
Radio frequencies are between 1 MHz and
large electric motors, generators, power sup-
300 GHz. Microwaves are frequencies in the up-
ply equipments or electric cables in buildings,
per part of this range (300 MHz-300 GHz).
radiofrequency heaters and sealers, glue dryers,
– Naturally occurring fields, like the earth’s
and induction heaters. International guidelines
magnetic field, are static fields with extremely
from ICNIRP and national safety standards for
low frequency (ELF).
EMF are set on the basis of current scientific
Electromagnetic fields are usually divided
knowledge in order to ensure that exposures to
according to their frequency. Figure 4.6.2 il-
EMF are not harmful to health. Currently such
lustrates how radiation sources are related to
guidelines are based on levels that will prevent
frequency and wavelength.
acute effects such as nerve excitation from low
The wave propagates with the speed of light,
frequency fields and thermal effects from radiof-
in vacuum c=3x108 m/s, and the relation be-
requency fields.
tween wavelength, l, and the frequency, ƒ, is
Exposure to intense low frequency electric
c= ƒl. The electromagnetic spectrum is usually
and magnetic fields may cause nerve excitation
divided into different frequency bands.
due to induced current in tissues. Uncontrolled
excitation of the central nervous system is of
International classification of electromagnetic special concern in occupations with potentially
field frequencies high exposure such as welding, high voltage
Name Acronym Frequency range switchyards, or work near induction heaters or
MRI equipment in hospitals. Nerve excitation
Extremely low ELF 0 - 300 Hz
frequencies through the use of an intense magnetic field is
Voice frequencies VF 0.3 - 3 kHz being used for therapeutic purposes in electro-
Very low frequencies VLF 3 kHz - 30 kHz medicine (for instance Transcranial Magnetic
Low frequencies LF 30 kHz - 300 kHz Stimulation, TMS) but it is not something that
Medium frequencies MF 300 kHz - 3 MHz should occur in an uncontrolled fashion in the
High frequencies HF 3 MHz - 30 MHz working environment.
Very high frequencies VHF 30 MHz - 300 MHz Exposure to intense microwaves may also lead
Ultra high frequencies UHF 300 MHz - 3 GHz to harmful heating of the whole or part of the
Super high frequencies SHF 3 GHz - 30 GHz
body. The heating effect of microwaves is also
Extremely high EHF 30 GHz - 300 GHz
frequencies being used in electromedicine in the form of
shortwave and microwave diathermy, but there
are guidelines that limit unwanted heating in the
working environment.
Such limits incorporate a large safety margin
so that exposures above the guideline limits may
267
Chapter 4.6
not necessarily be harmful to health. In most IARC, evaluated magnetic fields and cancer in
cases normal exposure levels are much lower 2002 and classified the low frequency magnetic
than the guideline limits, however, these limits fields as a class 2B, i.e. a possible carcinogen.
have been disputed and there are health and This is of specific concern in countries using
safety concerns about occupational exposure to child labour.
EMFs below present guidelines. Epidemiological reports have also suggested
Epidemiological studies, particularly regard- associations with adverse health effects from
ing EMF in the low frequency range, such as exposure to radiofrequency fields at levels lower
that experienced by people living near power than the basic limits, however, causation has not
lines, have been reviewed by a number of health been shown.
agencies including the International Agency Research is continuing in many countries into
for Research on Cancer (IARC) in 2001. Many possible health effects from EMF exposure, and
studies report small increases in leukaemia or new results will be reflected in standards, how-
brain cancer in groups of people living or work- ever, there will always be some degree of un-
ing in magnetic fields of extremely low frequen- certainty because even scientific risk assessment
cy (ELF) with intensity above about 0.4 µT. A cannot provide absolute certainty about what is
few studies have also associated workplace EMFs a safe limit. While science provides the starting
with breast cancer and some have suggested a point for risk assessment, a decision on what is
possible link between occupational EMF ex- an acceptable risk is essentially a value judge-
posure. Recently, there has also been a link to ment. A “better safe than sorry” approach that
residential magnetic field exposure and mortality takes precautionary measures to cope with re-
from Alzheimer´s disease. Recent clinical stud- maining uncertainties or weak evidence of risks
ies have reported that EMF can effect heart rate to health, can be a useful substitute for absolute
variability and cause sleep disturbance. proof. What type of precautionary approach is
The adverse health effects with respect to chosen is critically dependant on the strength of
working with video display units (VDU) are the evidence for health risks and the scale and
mostly related to symptoms in joints, muscles nature of potential consequences.
and eyes. Based on today’s knowledge there are
no health hazards associated with EMFs emitted prevention
from VDUs. The precautionary principle
A magnetic field inside a building in excess What action should those take who are con-
of 0.5 µT may cause perceptible jitter in VDU cerned about the potential health effects from
displays and a prudent avoidance strategy may long term exposure to EMF while scientists
also serve to mitigate this effect. seek to improve information of adverse health
The US National Institute for Environmental effects? The precautionary principle is socially
Health Sciences recently concluded the follow- and politically attractive and continues to be
ing about the risk of children developing leukae- applied in situations even where risks have been
mia, “ELF EMF exposure cannot be recognized established. The principle is a relatively recent
as entirely safe because of weak scientific evi- term used to characterize a “better safe than
dence that exposure may pose a leukaemia haz- sorry” approach towards potentially hazardous
ard”. The World Health Organization agency technologies. The term has already appeared
268
Radiation
in many international environmental treaties. EMF and as a distinction from the precautionary
For the countries of the European Union, the approach. Since then it has gained wider rec-
Precautionary Principle is explicitly enshrined in ognition first in Sweden and later elsewhere in
the Treaty of Maastricht. In Title XVI it states the world. Although it is widely agreed that the
that “Community policy on the environment potential health risk from low level EMF expo-
shall contribute to protecting human health and sure is small, it is difficult to quantify. Many peo-
“shall be based on the precautionary principle”. ple feel that workers should be exposed to lower
As part of the declaration signed at the 1999 levels of EMF until additional research provides
Third Ministerial Conference on Environment better information about possible health con-
and Health, WHO was encouraged to take sequences. Prudent avoidance means taking
into account “the need to rigorously apply the simple, easily achievable, low cost measures to
precautionary principle in assessing risks and reduce EMF exposure, even in the absence of a
to adopt a more preventive, proactive approach demonstrable risk. The terms “simple”, “easily
to hazards”. The precautionary principle itself achievable”, and “low cost” are not defined.
remains undefined. It has been interpreted to Prudent avoidance was initially proposed to
require prudent action to be taken when there is cover the actions of individuals, whereas the
sufficient scientific evidence (but not necessarily precautionary principle could be interpreted as a
absolute proof) that inaction could lead to harm regulatory measure.
and where action can be justified on reasonable
judgements of cost effectiveness. In the case of How have policies promoting caution been
EMFs, application of the precautionary principle applied?
is particularly problematic. It is not clear which One way is to try to put the recommended ac-
aspect of exposure, i.e. duration or field intentions into perspective by enunciating priorities.
sity, should be avoided. Furthermore, whether For example, the Swedish National Institute for
there is “sufficient scientific evidence” that Radiation Protection stated in their policy about
exposure to EMF could lead to harm remains EMF that reduction of exposure to EMF should
subject to debate. Cost effectiveness is impossi- have a lower priority than protection from ra-
ble to demonstrate in the absence of established don; natural UV radiation; leakage from nuclear
risk factors, however, risk-benefit analysis can be power plants and radiation from the medical
made using assumptions about existing risks. use of radioactive sources. Preventive measures
Specific interpretation of the Maastricht for protection from magnetic fields should have
Treaty requirements evolve as they are applied, the same priority as measures taken in areas like
sometimes through courts of law. So far the dental and veterinary radiography and industrial
precautionary principle has only been officially use of radioactive sources. Protective measures
applied in Sweden for low frequency fields and should be considered for those exposed to long
in New Zealand for radiofrequency fields. term high magnetic fields provided costs are
reasonable.
Prudent avoidance A high magnetic field is considered to exist if
The concept of “prudent avoidance” was initially the values are ten or more times what is “nor-
developed a decade ago in the United States mal” for that particular type of environment.
specifically in the context of concerns about
269
Chapter 4.6
Examples of precautionary approaches in “If measures generally reducing exposure can be

occupational exposure taken at reasonable expense and with reasonable
consequences in all other respects, an effort should be
Just as individuals can exercise prudent avoid- made to reduce fields radically deviating from what
ance, government regulators, electric power could be deemed normal in the environment concer-
ned. Where new electrical installations and buildings
companies and other companies where EMF
are concerned, efforts should be made already at the
exposure may occur, can also exercise prudence. planning stage to design and position them in such a
The following examples are divided into two dif- way that limits exposure.“
ferent categories according to EMF frequencies.
A first step for an individual concerned about
ELF Extremely low frequencies 0 - 300 Hz possible health effects is the provision of all
Certain occupations are associated with high available information about the workplace and
field exposures. For example, the Swedish Trade the possible exposure to EMF. A very efficient
Union Confederation (LO) demands that all way of reducing exposure is to increase the
workplaces should be surveyed for ELF magnet- distance to the EMF sources. As a magnetic field
ic fields and practical measures should be taken often drops off dramatically about 1 m from the
to reduce high exposures so that no one will be source, workers can work away from electri-
exposed to more than 0.2 µT as an average over cal equipment, and work stations can be moved
the workday. This can be achieved by measures out of the 1 m range of stronger EMF sources.
including: marking of high radiation zones, Wherever possible machines designed to emit
reduction of magnetic fields, relocation of work- low EMF should be used and the length of expo-
places and changes of the organization of work. sure time to EMF reduced.
They also encourage manufacturers of electric Anti-theft devices can emit localized fields in
appliances to consider alternatives that reduce excess of the given reference values (guidelines)
magnetic fields at minimal cost. The National so a precautionary approach could be to keep a
Institute of Environmental Health Sciences in distance between these apparatus and the work-
the U.S.A. also encourages these alternatives. ers, a factor that should also be taken into ac-
Recently a European standard on the emission count when planning new workplaces.
of electromagnetic fields from machines was
adopted. These should be labelled according the RF and microwaves
levels of emissions: Level 0 - No restrictions, Most guidelines for occupational exposures state
Level 1- Only for use by professionals, and that exposure should be kept low and must not
Level 2 - requiring special working instructions exceed the limit values. However, in many situ-
to avoid overexposure. ations there may be a very negligible distinc-
In 1995 the Swedish National Board of Occu- tion between being within the limits or above
pational Health and Safety (the current Swedish them making it even more important to apply a
Work Environment Authority), together with precautionary principle in order to stay within
four other Swedish authorities, issued a guide- the limits. This is especially true for work near
line on how to apply the precautionary principle RF dielectric heaters and sealers and glue dry-
to ELF magnetic field exposure. They recom- ers, which usually operate at 27 MHz so it is
mend the following: very important to strictly adhere to good work
practices including maintenance and operating
270
Radiation
procedures. Improper maintenance may lead to specific absorption rate (SAR) for the various
excess leakage from a machine, and small chang- phone models, i.e. how much of the microwaves
es in the immediate environment may also lead are absorbed by the user’s head. It is known that
to higher exposure levels. A 1998 International the differences between various makes and mod-
Labour Office (ILO) publication gives several els with respect to the SAR values can be twenty
practical examples for the application of shield- fold or more. A precautionary approach would be
ing devices and their effects on ground planes to buy a phone with a low value rather than one
and reflectors on operator exposure. that only just meets the recommended standard.
For most people the most common source of Choosing a mobile with a low SAR-value is also
RF exposure is connected to mobile phone use. beneficial from the point of view of communi-
In the absence of conclusive information about cation as a low SAR phone doesn’t need to up-
any possible risk, concerned individuals can take regulate the power as much as a high SAR device
a few simple steps to minimize potential risks. resulting in longer battery life and reach.
Time is a key factor in how much exposure a
person receives. Those who spend long periods Information needs
of time on hand-held mobile phones may con- If they are to act prudently, individuals need a
sider holding lengthy conversations on conven- better understanding of the sources of EMF in
tional phones and only use a mobile for shorter order to identify options to limit their exposure.
conversations or when other types of phones are Education material on EMF provides this kind
not available. Those who must conduct extended of information and gives people and organiza-
conversations on a mobile phone every day tions the opportunity to make informed choices.
could switch to a type of mobile phone that plac- The WHO International EMF project provides
es more distance between their bodies and the a good starting point to obtain more information
source of the RF, since the field strengths drop on the various aspects of EMF exposures and
off dramatically with distance. For example, a health. Their web page has several facts sheets
headset and hands-free device can be used and a (for instance on ELF and RF) as well as general
mobile phone carried at the waist or in the hand. information on EMF (www.who.ch/emf).
The Food and Drug Administration (FDA) in The exposure to RF and microwaves is increas-
the U.S.A. has urged the mobile phone industry ingly dominated by mobile phone use. However,
to design phones that minimize the user’s expo- in occupational settings high exposures some-
sure to any RF fields that are not essential for the times occur so information about the sources
function of the device. The UK Committee on and various factors that may influence exposure
Science and Technology has also given the same levels is needed for an individual to act pru-
recommendation: We recommend that the in- dently. This information should be included in
dustry and the National Radiological Protection the instructions and the maintenance practice at
Board explore ways in which the design of the each workplace.
mobile phones might limit personal exposure to During the last decades several new technolo-
radiation as a means of assisting consumer choice. gies (e.g. VDUs and mobile phones) have been
There have also been demands from members introduced into everyday life, often without
of the Swedish Parliament for the manufactur- proper information about the technology and
ers of mobile phones to publish the values of the its potential hazards. This lack of information
271
Chapter 4.6
Figure 4.6.3. Radiofrequency plastic sealer used in Figure 4.6.5. Radiofrequency plastic sealer in the
the tarpaulin industry. The operator gets high clothing industry. The operator is working
whole body exposure, and the hands are highly with her hands in very close proximity to the
exposed. It would be desirable for the machine electrodes that results in a high exposure of the
to be operated by remote control so that the hands. Some machines also give rise to high
worker could step back from the machine. A whole body exposure, especially if the head and
substantial RF current can also flow into the knees are close to the electrodes. This type of
body of the operator depending on the material work place must measure electromagnetic fields,
in the floor – i.e. how much RF ground the floor and most will require special working instruc-
is. tions on safety.
Figure 4.6.4. Radio frequency glue dryer. In most

cases the electrodes are well shielded so expo-
sure is low, but in some cases.
272
Radiation
has raised concern among people who feel that health effects
the new technologies were imposed on them. Ionising radiation can be highly dangerous and
Those who suffer from ill health the cause of can cause cancer and death. The concept of
which is unknown often blame EMF. In the “dose” is central to any discussion about the
future we will see many more new developments probabilities of cancer from radiation.
and applications that will lead to an increase in
our everyday exposure to EMF making it very
“The dose concept”
important to devote sufficient resources to in-
forming the people about EMF and its possible The basic dose unit for ionising radiation is the ab-
effects on human health. sorbed dose (D), defined as the energy absorbed per
mass of irradiated tissue. The absorbed dose of ionis-
ing radiation is thus different from a dose of a medical
ionising radiation substance (for example), which is not normalised to
Ionising radiation is the collective name for mass.
different kinds of radiation, but all have the
If energy is measured in joule (J) and mass in kilogram
common property of being energetic enough (kg), absorbed, dose is given in gray (Gy). Thus, 1 Gy =
to be able to ionise biological tissue. The high 1 J/kg. The absorbed dose is used in connection with
risks associated with the use of ionising radiation acute, deterministic damages of radiation.
necessitate special precautions. A basic prereq-
When calculating risks for late effects of radiation, the
uisite for protection of workers is a good formal kind of radiation (X-ray, beta particles etc.) and the radi-
organisation of the work. ation sensitivity of the irradiated organs (lungs, stomach
The most common types of radiation in etc.) must be taken into account. When the absorbed
dose is corrected for these factors, it is called the
workplaces are X-rays and gamma radiation, and
effective dose (E). The effective dose is measured in
this discussion deals mainly with these two kinds sievert (Sv).
of radiation. The X-rays used in hospitals and
workplaces are generated in X-ray machines, Since dose is defined per unit of mass, one can define
whole body doses and organ doses.
whereas gamma radiation is emitted from com-
mercially available radioactive nuclides. Uses
of strong radioactive sources that emit gamma In sum, when defining doses differences are
radiation include the irradiation of patients in made between absorbed dose given in Gray (Gy)
cancer therapy, and for sterilising foodstuffs. used when assessing acute damages and effective
Beside medical and dental applications, expo- dose given in Sievert (Sv) related to late effects.
sure to radiation can also occur through the use Furthermore, doses can be defined as whole
of radioactive materials and radiation genera- body doses or organ doses.
tors in the nuclear industry; in manufacturing; If a person is given a local absorbed dose of
construction; engineering; paper; offshore drill- around 0.5 Gy or more, burn damage will be
ing; education, research, and in non-destructive acute and severe but local.
testing. If the whole body receives such high doses or
People can be exposed externally to radia- more, different systems of the body such as the
tion from a radioactive material or a generator stomach and intestines or the central nervous
such as an X-ray set, or internally, by inhaling or system will be acutely affected since tissue will
ingesting radioactive substances. be destroyed. Above around 5 Gy, death is likely
273
Chapter 4.6
to occur within weeks. The acute effects that ap- Finally, it is necessary to have routines for
pear after high doses of radiation are determinis- monitoring exposure levels, and regular medical
tic, i.e. they will occur, and the severity depends surveillance examinations.
on the dose. Cancers may evolve years later, with
a probability that is proportional to the irradia- Shielding
tion received. X-rays and gamma radiation penetrate into and
Much lower doses – also a few thousands of through matter - this is the basis for much of
a sievert - may also cause cancer, often after its use. A physical shield in the path of radia-
several years. The probability of cancer is pro- tion blocks only part of the radiation while part
portional to the dose, but the dose says nothing of it passes through. The thicker and heavier
about the outcome of the disease. When dis- the shielding material, the more radiation is
cussing the probabilities of cancer and radiation stopped. Lead is commonly used as a shielding
dose, the concept of effective dose is used rather material because of it great specific weight. If the
than absorbed dose. Calculation of the effective radiation source is stationary, it can be placed in
dose must not only take account of the energy a room with thick concrete walls to shield the
but also the type of radiation and the radiation surrounding area.
sensitivity of the irradiated organ.
However, the received dose, (measured in Time and distance
sievert), is not a measure of how severe the ill- In a constant radiation field the total dose re-
ness will be but an indicator of the probability ceived is the dose received per unit time (the
of harmful effects, mainly cancer. For radiation dose rate) multiplied with the irradiation time.
protection purposes it is assumed that there is a Reducing the time to half reduces the dose by
linear relationship between the received effec- the same factor. X-ray machines and other ra-
tive dose and the probability of cancer develop- dioactive sources radiate more or less uniformly
ing later in life. The International Commission either in all directions (radioactive sources) or
on Radiation Protection (ICRP) assumes that into a certain spherical angle (X-ray machines).
there on average is a five percent increase in the This means that the amount of radiation hitting
probability of getting cancer after a dose of one a certain area at a distance from the source is
sievert. inversely proportional to the square of the dis-
tance. Thus, doubling the distance to the source
basic protection will reduce the dose by four times.
Most countries have national laws and regula-
tions governing the use of ionising radiation. radiation protection when
International guidelines are published by the working with x-ray equipment
International Atomic Energy Agency (IAEA). X-ray tubes are designed to emit radiation in a
The three main protective actions are: shield- narrow beam through a narrow collimator, usu-
ing, reduced exposure time and distance. Three ally placed in a metallic shield. Various types of
other actions are common to all protective work: shields are used to protect workers and patients
good organisation (including maintenance), undergoing medical treatment from radiation.
good education and good discipline. It is necessary to be concerned not only with the
radiation in the primary beam, but also the ra-
274
Radiation
diation scattered from the target and the shield- a short half-life are used for example, in medical
ing used. The higher the energy of the primary diagnostics.
X-ray, the more scattered radiation is produced. Examples of the use of strong radioactive
The best shielding that allows only minimum sources that emit gamma radiation are the ir-
scattered radiation, is achieved through the use radiation of patients in cancer therapy, and the
of heavy material shields such as sheets of lead, sterilisation of foodstuffs. Since a radioactive
iron or copper, or lead glass. Lead aprons can source cannot be turned off, these strong sources
also be used. must be completely shielded when not in use. A
While an X-ray machine is dangerous when safe mechanical device must also be employed
it is turned on, it is completely safe when turned when opening and closing the collimator. It is
off. Therefore, one of the most important pro- also very important to keep radiation sources
tective actions is to ensure sure that it is abso- (including old sources) in safe custody so that
lutely clear when the machine is on and when they cannot be stolen or lost. All staff handling
it is off, and to prevent people from entering any type of radiation source must be informed,
the radiation field when the machine is on. The trained and equipped to work in a safe way.
simplest and cheapest system is to use warn- Radioactive nuclides are often handled in
ing signs, however, such by themselves provide laboratories prior to their use. Unsealed sources
rather poor safety so they should be comple- are handled, and to avoid both external and
mented by warning lights and automatic door internal contamination through inhalation, or
locks coupled to the power line of the machine. oral intake, special care must be taken. Protec-
To achieve good radiation protection when tive clothing, gloves and goggles should be used
X-ray are being used it is important that those and all work should be performed in fume cup-
using the machines have a good knowledge of boards or, if possible, in glove boxes. It must be
how the machines work and how they should be absolutely forbidden to eat, drink or smoke in
maintained. Employees should be provided with the laboratory.
sufficient information, instructions and training
to enable them to understand the risks and the
importance of working according to given rules
and safe work practice.
radiation protection when

working with radioactive nuclides
Radioactive nuclides are used for various pur-
poses, mainly for medical and technical appli-
cations. All radioactive nuclides have different
half-lives (the time it takes for the radiation
intensity to decrease to half its original value),
and this property is used in the application of
these nuclides. Nuclides with a long half-life are
used in radiation equipment, while nuclides with
275
Chapter 4.6

The health effect caused by different kinds of Hansson Mild, K. The Electromagnetic Spec-
radiation is a controversial field of research, trum: Basic Physical Characteristics. Electro-
continuously providing new insights and doubts. magnetic Spectrum. Encyclopaedia of Occupa-
The facts in this chapter are valid as of April tional Health and Safety 49.4, 1998.
2009, when the text was finalized. The following
Hansson Mild, K. Radiofrequency Fields and
suggestions for further reading cover both writ-
Microwaves. Radiofrequency Fields and Micro-
ten texts and useful websites.
waves. Encyclopaedia of Occupational Health
and Safety, 49.18, 1998.
Non-ionising radiation
www.who.ch/emf. www.who.ch/emf for more information and facts
The WHO International EMF project pro- sheets about EMF.
vides a good starting point to obtain more Epidemiological studies, particularly on EMF
information on the various aspects of EMF in the low frequency range, (e.g.for those living
exposures and health. The site has several fact near power lines), have been reviewed by several
sheets (e.g. on ELF and RF) as well as general different health agencies. For a recent review
text on EMF. See also: see:
WHO Fact Sheet No 183,1998. Electromag- Schuz J and Ahlbom A. (2008). Exposure to
netic Field and Public Health. RF electromagnetic fields and the risk of child-
WHO Regional Office for Europe. Electromag- hood leukemia: a review. Rad Protect Dosimetry
netic fields. Local authorities, health and envi- doi:10.1093/rpd/ncn270.
ronment briefing pamphlet series, 32,1999.
Ionising radiation
WHO Fact Sheet No 205,1998. Electromag-
netic Field and Public Health. ELF www.iaea.org/Publications
This website contains scientific and technical
website: www.who.ch/emf
reports, standards and guidelines.
For further information about electromagnetic
www.iaea.org/Publications/Training
fields see the standard physics text books by
This website contains training material, in
Barnes and Greenbaum (2008) or information
many cases adapted to the need of developing
texts by Hansson Mild:
countries.
Barnes FS and B Greenebaum (2008) Handbook
www.icrp.org
of Biological effects of electromagnetic fields.
Material for education and training and ab-
Biological and medical aspects of electromag-
stracts of International Commission on Radia-
netic fields. Third edition. CRC Press. ISBN
tion Protection (ICRP) publications can be
10-0-8493-9358-0.
downloaded.
Barnes FS and B Greenebaum (2008) Handbook
www.IAEA.org
of Biological effects of electromagnetic fields.
The website of Atomic Energy Agency (IAEA)
Bioengineering and biophysical aspects of elec-
contains information about legislation on ionis-
tromagnetic fields. Third edition. CRC Press
ing radiation in various countries.
ISBN 10-0-8493-9359-0.
276
4.7
Electrical safety
João José Barrico de Souza
Some of the risks associated with proximity or and accidental stimulus on the nervous system
contact with electricity, or even the use of elec- due to the circulation of an electrical current
trical equipment, are immediate. Others, howev- above certain limits. We should remember that
er, are only seen later, even after the contact or we have an “instrument system” on the surface
proximity with the equipment or electrical wir- of our body that is sensitive to temperature,
ing has ended. For example, contact with electri- moisture, pressure and other physical stimuli
cally charged items, which causes an electrical and that transforms them into electrical impuls-
shock, leads to immediate reactions, but can also es. These electrical impulses are sent directly to
have long-term effects due to the circulation of a central organ that coordinates and supervises
electricity in the body’s internal tissues. Electri- this entire “instrument system” through electric
cal arcs have immediate effects and cause burns signals received from every part of the body’s
because of the heat involved. They can also lead surface. This “instrument system’s” electrical
to later damage through loss of liquid, exposure signals circulate through a marvellous and im-
of internal tissues, contamination, kidney prob- mense network of “conductors” that, loosely
lems, etc. Remaining close to equipment parts or speaking, we could say make up our nervous
wiring that generate intense electrical or mag- system. The central organ of our nervous system
netic fields is also a condition that in the long- reacts to these electrical stimuli, determining
term can cause problems within the body. This the necessary reactions: involuntary (those that
matter is still being researched. happen without a conscious decision), or volun-
tary (which happen because we make a conscious
electrical shock decision). This system’s reaction is seen in the
Definition production of pulses of electrical current ap-
plied in a gradual and coordinated manner in the
There are many definitions we could give to
muscle tissue. This tissue reacts by contracting
electrical shock in trying to explain that un-
to these very light “electrical shocks” (in micro-
comfortable sensation that nearly all of us have
amperes, which are millionths of an ampere).
already experienced. For our purposes, we can
simplify, saying that an electrical shock is a rapid
277
Chapter 4.7
Health effects
Shocks, which can be more or less serious, can
have these direct effects on the body:
• Muscle contractions, the extent of which is
related to the intensity of the shock, and is
often responsible for the victim’s inability to
release from the electrified item that is pro-
ducing the shock, although others may be able
to save the victims.
• Tetanisation, similar to a cramp, leaving the
muscle tense and stiff, for some time, even
after the shock has ended.
• Burns, which occur because of the heat gener-
ated by the flow of the electrical current. This
can cause redness, blisters, deep burns and
even char the tissue. These are more serious
with high-voltage shocks, and deterioration of
the epidermis is worse with higher electrical
frequencies.
• Respiratory arrest, which can result from
Figure 4.7.1. Muscle contraction due to external electrical current passing through the dia-
stimulus. phragm, which is the muscle responsible for
breathing. It can also occur indirectly when
A system that operates both for sensitivity (in- the electrical shock affects the respiratory
strumentation) and muscular activity (command) control centre. In either case, the body loses
through extremely low-intensity electrical sig- its ability to oxygenate the blood, compromis-
nals will suffer terribly if subject to electrical ing the functioning of organs and, in a few
shocks hundreds or thousands of times more minutes, of the brain, with irreversible dam-
intense than those for which it is prepared. That age.
is why we decided to include “above certain
limits” in the definition of an electrical shock: • Cardiac arrest, which occurs when the flow
our nervous system is based on the circulation of the electrical current causes the fibres of
of extremely low electrical currents and we do the heart muscle to flex excessively, “locking
not consider these to be shocks. Live muscle it”. Unable to beat, the heart stops circulating
tissue tends to contract when an electrical cur- blood, depriving the organs of oxygen, includ-
rent travels through it. (This was Galvani’s great ing the brain, leading to the same irreversible
discovery.) damage as mentioned above.
278
Electrical safety
• Electrolysis, which can occur in the blood and • The size of the contact area between the body
in other liquids in the human body. This is and the conductor through which the current
an important phenomenon where the shock enters the body.
comes from exposure to direct current. It • The pressure established between the body
causes the agglutination of mineral salts, and the conductor, which determines how
coagulation and thrombosis that can lead to good the contact is, thereby impeding or fa-
death. The change in the body’s potassium cilitating the passage of the electrical current.
balance is also important and can cause car-
diac arrest. • The nature of the electrical current, since the
sensitivity is different for alternating current
• Fibrillation, which occurs when the heart and direct current. Figure 4.7.3 shows that
muscle “loses its beat”. The heart stops beat- our bodies are most sensitive to frequencies
ing in an orderly manner and starts to vibrate between 15 and 100 Hz. This figure also
between 170 and 300 times a minute, but shows the amount of current capable of stop-
without pumping blood to be oxygenated by ping someone from being able to open their
the lungs and without carrying the oxygen- hand because of the electrical current flowing
ated blood to the organs. After a short time through the muscles that contract the fingers.
this causes respiratory arrest.
• With sufficiently high current there can be a
Factors of seriousness muscular spasm which causes the affected per-
Factors that determine the seriousness of the son to grip and be unable to release from the
shock include: current source. The maximum current that
can cause the flexors of the arm to contract
• The electric current’s path through the body. but that allows a person to release his hand
What path the electricity takes, through from the current’s source is termed the let-go
where the electric current mainly passes and current.
what organs it goes through.
• The voltage, which is what causes the move-
• The intensity of the electric current. The ment of the electrical charge (the current),
more intense it is, the more serious the effects and therefore the shock, through the body.
of its passage through the body will be and • The way in which the current is distributed
the more intense the muscular contractions through the body as it goes through it.
will be.
• The level of moisture on the skin, which
• The time the shock lasts, even if measured in increases or decreases the contact and flow of
milliseconds and seconds, is of fundamental electrical current.
importance in determining its seriousness.
• Individual factors, such as health, physical
constitution, body size, etc.
279
Chapter 4.7
Figure 4.7.2. Zone 1: No perceptible effect. Zone 2: Generally non-harmful physiological effects. Zone 3:
Generally reversible notable physiological effects (cardiac arrest, respiratory arrest, muscle contractions).
Zone 4: High probability of serious and irreversible physiological effects (cardiac fibrillation, respiratory
arrest). Source: IEC Publication 479-1
280
Electrical safety
Figure 4.7.3. Influence of the frequency: 1. Conventional limit of the amount of current from which no
reaction normally results. 2. Beginning of perception for 50% of people. 3. Beginning of perception for
99.5% of people. 4. Current at which 99.5% of people let go. 5. Current at which 50% of people let go.
6. Current at which 0.5% of people let go.
0 % 9.7 % 2.9 % 1.8 % 7.9 %
Figure 4.7.4. The percentage of the shock current that goes through the heart in some of the possibilities
of contact between the body’s extremities and conductors at different voltages.
281
Chapter 4.7
When and how does it occur? bar or any other part of the wiring or equipment
Electrical shocks happen whenever a person that is a conductor (outlet screws, receptacles,
simultaneously touches two points with different etc.) while simultaneously in contact with an-
voltages. This may occur when one touches two other object with a different voltage or with the
conductors of an electrical circuit at the same ground itself (to which the neutral conductor is
time, or touches one conductor while another also connected), the voltage of which is consid-
part of the body is in contact with a conductor ered equal to zero.
having a different voltage. Since in the great Electrical shocks caused by indirect contact,
majority of cases one of the conductors from the on the other hand, are those that occur when a
source, generally called the “neutral conductor”, person touches any conductive part that was not
is connected to the ground at the origin of the designed to be energized but that is so tempo-
wiring, and since we walk with our feet on the rarily because of some failure or defect in the
ground, we are always connected to the ground wiring or the equipment. Examples of this are
and, through it, to the source’s grounded neutral shocks from motor casings, doors and casings for
conductor. electrical equipment and casings for machinery
Electrical shocks can be divided into shocks or electrical tools.
caused by direct and indirect contact. Electrical
shocks through direct contact are those caused Who is exposed to shocks?
by the body’s contact with an energized part that Everyone, by simply using electrical equipment,
was designed to be energized when the wiring is prone to shocks through indirect contact
is in normal operating condition. Direct shocks because of defects in the equipment or wiring or
occur when a person touches a wire, cable, bus- from using electrical instruments, apparatuses
Figure 4.7.5. Direct shocks occur when a person touches an electrical wire and the ground, or another
object with a different voltage; at left one hand on each wire, at right an indirect contact..
282
Electrical safety
and tools improperly. Electricians and people but creates an area of air that has been ionized
involved with electrical wiring and services are by the arc itself. This ionized air, being a better
naturally more prone to shock through direct conductor, can establish a path for the electri-
contact for obvious reasons: they do their work cal current between close parts with different
near energised parts, from which the protective voltages, creating the conditions for conduction
casing has been removed to allow the examina- from one metal conductor to another in a gener-
tion and handling of the equipment and tests on alized manner. When this happens, the current
electric circuits. in the arc can reach very high levels.
Characteristic situations for the occurrence of
electrical arc dangerous, but frequent, electrical arcs include
Definition accidental contact between conductors (short-
circuits); opening switches on charge; errors in
An electrical arc consists of the passage of an
the insertion or removal of removable parts in
electrical current from one conductive point to
energized circuits; or errors or the inappropriate
another through a gaseous medium. The inten-
use of testing equipment to measure voltage or
sity of the arc depends, among other things, on
look for defects. Arcs can also happen in certain
the voltage, the capacity of the source and of the
climatic conditions because of sudden changes in
resistance of the medium in which occurs.
environmental conditions, such as when opening
Danger of electrical arc the doors of electrical cabinet panel boards.
When there is a defect in which an arc oc-
The temperature of electrical arcs is extremely
curs, the high temperature first melts the metal
high and the heat they generate is propagated
conductor, which is usually copper or an appro-
by conduction, convection and radiation. An
priate alloy, and then vaporizes the metal. When
electrical arc has enough energy to burn clothes
it melts, the metal’s volume increases slightly.
and cause fires. It emits vaporized materials,
When it vaporizes, however, its volume increases
infrared, luminous and ultraviolet radiation, as
several thousandfold (more than 50,000 times).
well as causing a large pressure surge when it
Although only a small amount of copper is in-
happens in an enclosed space, such as electrical
volved, the rapid expansion releases a great deal
panel compartments and the area around them.
of energy in the form of a mechanical wave (the
This great internal pressure increase results in
pressure surge). In addition to the strong pres-
the parts and material of the cabinet itself being
sure resulting from the change in the material’s
blown out, in what we normally call an explo-
state (from solid to vapour), extremely high tem-
sion.
peratures warm the air in the same way as light-
Where does it occur? ning, and like lightning they are accompanied by
An electrical arc occurs whenever there is a a sound caused by the rapid expansion of air that
break in an electric circuit, which can occur is heated by the lightning current. Lightning is
safely in perfectly controlled conditions or nothing more than an electrical arc in which the
totally out of control, with very serious conse- voltage and the current are extremely high and
quences. When an electrical arc is not controlled the duration extremely short.
it does not extinguish itself quickly and safely,
283
Chapter 4.7
Exposed groups and expected. What causes the damage how-

Workers who operate, maintain or work near ever is overheating – heating beyond normal
energized equipment without adequate protec- limits near combustible materials such as wood,
tion or in any way that is not recommended are paper or fabric, or flammable liquids, to electri-
exposed to electrical arcs. It bears remember- cal equipment or wiring. This is why ways are
ing that some operational processes, precisely always created to dissipate the heat generated in
because of the high temperatures they cause, the normal operation of electrical devices and
involve electrical arcs, but in fully controlled equipment.
situations. These include arc welding, special There are various ways to dissipate the heat.
lighting and certain types of electrical furnaces. They include fans attached inside the motors,
which dissipate the heat generated in the coils;
secondary or indirect injury ventilation slats in the casing for semiconductors
in electronic equipment; placing lighting ballasts
Falls after shock
on supports made of resistant and non-flam-
Falls should be considered an indirect effect ag-
mable materials; or radiators of liquid-insulated
gravating the direct effect of the passage of the
transformers. These ensure operation at a tem-
electrical current through the body. There are
perature that is not harmful to the surrounding
a considerable number of accidents in which
area.
electricity was merely the triggering event that
momentarily caused a loss of muscle control and Explosion
equilibrium, the serious consequences – which
An explosion is simply an extremely violent
may result in irreparable harm – being due
oxidation reaction that happens when there is
to falls from substantial heights. The impacts
a particular mixture of oxygen (present in the
caused by the violent and uncontrolled muscular
atmosphere) and a flammable or explosive sub-
reaction during a shock causes sore muscles, and
stance. For the reaction to take place there must
frequently fractures. In some cases it can extend
be a source of ignition. This can be the abnor-
the effects of the shock beyond the first victim,
mal heating of a surface or a spark that begins
as for example when tools or materials being
the combustion, which propagates through the
used for work are involuntarily thrown.
entire mixture in the environment.
electrical risks to property
Electrical arc occurring in potentially
Fire explosive atmosphere
Fire is one of the most serious property risks and Certain measures should be taken to guarantee
can cause very large losses. Electrical fires are safety when equipment that causes arcs, such
almost always associated with conductor over- as isolating switches, contactors, general use
heating caused by overloads; deficient contacts; switches and circuit breakers, need to be in-
or sparks, which are also small electrical arcs. stalled in environments containing potentially
These events, which are the initial cause, are explosive mixtures, or when electrical equipment
multiplied and intensified as the fire develops. that generates heat needs to operate in these
The heating of the conductors by the passage environments. There are various methods for
of the electrical current is completely natural installing electrical wiring and equipment in
284
Electrical safety
hazardous locations. The methods are described and others to be considered through analysis,
in standards and the materials used follow strict in each particular case). When other methods
manufacturing, assembly and use guidelines. are used to protect people, additional measures
Not only gases and vapours from flammable should also be taken: at least one kind to protect
liquids require special wiring. There are also against direct contact and one other against indi-
certain types of dust and fibres that, when sus- rect contact. There are also situations of greater
pended in the air, create a potentially explosive susceptibility to shock that require additional
mixture. Chemical plants, oil refineries and gas protective measures to guarantee people’s safety.
plants, grain processing plants and many others
may contain areas considered hazardous loca- Protection of people against direct contact
tions. Strict procedures should be adopted for People can be protected against the effects of
the materials, services and tools used in areas direct contact with measures such as:
subject to the occurrence of explosive mixtures.
a) Live parts insulation, which consists of ap-
This is the case even when electricity is not in-
plying an insulating material to conductors
volved since tools can cause sparks on falling and
that impedes all contact with the wiring’s live
hitting other hard materials.
parts. This insulation must be such that it
can only be removed by destroying it. Paint,
preventive actions
varnish, lacquers and similar products applied
Preventive action against electrical shocks can directly to conductors are not sufficient insu-
be divided into those that ensure the safety of lation to protect people against direct contact.
people against shocks coming from direct (with
live parts) or indirect contact. b) Shields and enclosures are also meant to block
One of the most effective measures to ensure all contact with the live parts of the wiring.
people’s safety against direct or indirect electri- The live parts (voltage different from the
cal shocks is to use extremely low voltage that ground) must be inside enclosures or behind
cannot harm the body. This method requires barriers that do not allow fingers (12 mm di-
taking a number of steps in regard to the source ameter) to be inserted to touch any energized
of the current, separation of the conductors
and nature of the electrical current (direct or
alternating). Called safety extra low voltage, this
method is used in laptop power sources (15 to 19
VDC), fixed-line telephones (48 VDC), swim-
ming pool lighting (12 VAC) and many other
applications that make it safe to use the equip-
ment in any situation regardless of the users’
actions. These measures protect people in cases
of both direct and indirect contact and therefore
do not require additional protection measures.
The use of these protection measures is inti-
mately related with the environmental condi-
Figure 4.7.6. Example of insulation of electrical
tions (moisture, proximity with conducting parts conductors.
285
Chapter 4.7
part. The barriers and enclosures must be work close to installations that have only this
securely attached and sufficiently robust and type of protection.
durable to maintain the appropriate degree
d) Placing them out of reach (which can also be
of protection and separation from the live
a partial protection measure) consists of keep-
parts in normal service conditions, taking into
ing conductive parts with different voltages
account the relevant external influence condi-
at a distance. In other words, the conductive
tions. It should not be possible to suppress the
part with a different voltage should not be
shields or to open the enclosures or covers or
placed within normal reach. Placing them out
to take off parts of the shields or covers ex-
of reach is only intended to impede accidental
cept with a key or tool; or until after the live
contact with live parts.
parts protected by these shields, enclosures or
Parts that can be accessed simultaneously
covers have been disconnected from power
must always (whether in a normal situation or
and cannot be reconnected until the shields,
defect situation) be at the same voltage.
enclosures or covers are put back in place; or
horizontal above the floor ............... 1.25 m
until a second shield or installation that can-
horizontal beneath the floor ............ 0.75 m
not be removed without the help of a key or
vertical above the floor .................... 2.50 m
tool and that blocks any contact with the live
vertical beneath the floor ................. 1.25 m
parts has been put in place.
These measurements can be changed accord-
c) The use of obstacles, which are items meant
ing to the use of the locations and objects
to block accidental contact with live parts, is
handled.
another protective measure against indirect
contact. The obstacles should block an unin- e) The installation of ground fault current inter-
tentional physical approach to the live parts rupter (GFCI) DR devices is an additional
(for example, through screens or panels over protection based on monitoring the currents
the isolating switches), but not intentional that flow in a circuit’s conductors. They work
contact by a deliberate attempt to get around in such a way that when there is a differ-
the obstacle. Obstacles may be disassembla- ence between the current that “enters” and
ble, even without a tool, but must be fixed the one that “exits” through the conductors
and cannot be accidentally removable. Note of the same circuit above a certain amount,
that this protective measure is considered the device immediately isolates the conduc-
partial and that its effectiveness depends on tors. These devices are especially necessary
the knowledge and training of the people to protect outlets installed in moist locations
being protected. It does not protect just any- or feeding equipment meant to be used in
one, only those who have been told, which is moist locations or outdoors. This is not a
to say those who have sufficient information complete protection measure and in no way
and knowledge to avoid the harmful effects makes it unnecessary to also employ other
of electricity. These are normally operating protection measures against direct contact.
and maintenance personnel and technicians in The use of these DR devices is more effective
general who have been trained and instructed for protection against indirect contact. Using
and are therefore authorized to remain and a DR with a minimum sensitivity of 30 mA
286
Electrical safety
Together with keeping parts that can be touched

at the same time at the same voltage, and de-
pending on the grounding system of the wiring
that supplies electricity, some variations of pro-
tection measures can be used that result in an
automatic break of the power supply.
Automatic break of the power supply,
which consists of establishing a good path (with
low electrical resistance) between the external
conductive parts that are not meant to conduct
the electrical current and a point at the origin
of the wiring, properly grounded (normally the
earth). This causes the necessarily rapid opera-
tion of the fuses and circuit breakers, and thus
the disappearance of the dangerous voltage
between the accessible surfaces. This is certainly
Figure 4.7.7. Conductive parts with different volta- one of the most-used protection measures be-
ge should not be placed within normal reach. cause it uses devices that are already necessary
and that are in the wiring for protection against
overcurrents, overloads and short-circuits. It
protects against cardiac fibrillation and a DR
should be observed that for this method to func-
with a minimum sensitivity of 10 mA protects
tion satisfactorily, the protection elements and
against the victim being unable to let go.
the conductors of the earth (protection) system
Protection of people against indirect contact must be adequate to each other and the protec-
tion earth conductor must actually be connected
Grounding, as a precondition for protection,
to the neutral point of the power source, making
consists of actually and intentionally grounding
the operation of the protection elements oper-
all the casing and conductive parts that are not
ate in the shortest possible time and within the
part of the wiring and that may, in a defect situ-
limits of the standards established as a function
ation, become dangerous. Grounding is used in
of the contact voltage and local conditions (dry
a number of techniques for protection against
or moist).
indirect contact. The basic principle of this
Fuses and circuit breakers operate more rap-
protection method is to maintain the conduc-
idly when the current flowing through them is
tive parts that can be touched at the same time
higher. This is why we say the operating time is
by any part of the body at the same voltage,
inversely proportional to the amount of the cur-
which is to say equipotentialized, such that a
rent. Therefore, if we establish a good path (low
simultaneous contact between any two points,
resistance) for the earth loop impedance electri-
whether between two objects or an object and
cal current between the energized casing and
the ground, does not lead to a current flowing
the grounded neutral point, we are able to make
between these points since they are already at
the current assume very high values, and thereby
the same voltage.
cause the rapid operation of the protection de-
287
Chapter 4.7
Figure 4.7.8. Automatic break of power supply.
vice. This eliminates the dangerous condition by

automatically breaking the power supply. There
are variables to be considered when the origin of
the wiring is not directly grounded or when the
casings are connected individually or in groups
to independent grounds.
Use of equipment class two or equivalent
insulation. This is equipment that has been
tested and given double or reinforced insulation
(Class II) or manufactured with complete in- To this class belongs also equipment that has
stallation. This equipment is marked with the received additional insulation over its basic insu-
symbol to the right (red pictogram on white lation or that has received reinforced insulation
bottom) on its identification label together with and that guarantees safety conditions equivalent
its nominal data. to those required for double insulation. The
same principle applies to fixed wiring within
buildings when associated with the choice of
enclosures that, in addition to impeding access
by fingers, are made of an insulating material.
The case is an enclosure that protects against di-
rect contact, and the plastic material of the case
– because it is an insulator – impedes an internal
288
Electrical safety
defect from causing a shock to someone who ac- Protection against thermal effects
cesses the case from the outside. Electric currents always involve the heating of
Some situations and equipment require the conductors. Therefore, electrical equipment in
use of non-conducting locations. This consists which currents pass will heat up. These tem-
of guaranteeing some of the characteristics of perature rises are acceptable within specific
the place and the wiring, so that these locations limits, but are undesirable when they are able
can be used for class zero (0) equipment, which to harm people. They must therefore, just like
requires only basic insulation. In these environ- the fixed components of an electrical installa-
ments it should be impossible for people to tion and adjacent materials, be protected against
simultaneously touch two exposed parts or con- the harmful effects of heat or thermal radiation,
ductors that may have different voltages should and especially the risk of burns, produced by the
the basic insulation fail. It should not be possible electrical equipment. Other risks involve com-
to connect equipment with the protection earth. promising the safe functioning of wiring com-
Obstacles – preferably insulating – should be ponents, and the combustion or deterioration of
interposed if necessary; walls and floors should materials.
have high resistance (50 kW for voltages of up to Because fires can be caused by wiring mal-
500 V and 100 kW voltages higher than 500V.) functions, the recommendations of the electrical
Finally, if two or more pieces of equipment are equipment’s manufacturer should be observed.
used close to each other in these locations, they Installations should be performed so that the
should be connected using an equipotiencial part whose external surfaces could reach temper-
bonding conductor. This means of protection atures that are dangerous to the vicinity should
involves many variables and is difficult to put be assembled using heat-resistant supports or
into practice. For this reason, it will be restricted separated by heat-resistant materials or so that
to highly specific situations. However, some of the heat this equipment generates is dissipated.
its requirements are used as additional protec- When the equipment generates arcs in nor-
tion, such as placing mats around places for mal operation, it must be covered with resistant
handling switches and circuit breakers, in front material, separated by resistant material or have
of electricity cabinets, work and test benches. a device to contain and/or extinguish the arcs,
Another measure used to protect against in- as shown in the previous item. Safe distances
direct shocks is protection through electrical should be ensured when there are focalization
separation, at which the origin of the wiring – effects, so that exposure to the thermal radiation
the source – is a Class II separation transformer. does not cause a potentially dangerous tempera-
Here, there are limits to the operating voltage ture increase. This happens with heating resis-
and circuit length. This means of protection is tors placed in reflectors that direct concentrated
useful in critical processes such as those in oper- heat over surfaces. When using inflammable
ating theatres or critical industrial processes that insulating liquids, as with transformers in oil
electrical faults must not be allowed to interrupt. baths, measures must be used to prevent inflam-
On first failure, the equipment can continue to mable liquid from spreading in the event of a
operate safely until this first failure is repaired. leak. Protective measures should be taken at the
installations to prevent flames, smoke and toxic
gases and liquid spillages. People can also be
289
Chapter 4.7
burned as a result of heat that occurs normally avoid undesired exposure to the effects of elec-
due to the flow of electric current. Therefore, tricity. A plan report should describe the protec-
the accessible parts of electrical equipment that tion methods, the principles, the characteristics
are located within normal beach must not reach of the equipment that composed the installation,
temperatures that could cause risks within the as well of the conditions of usage and materials
vicinity, but must remain within the temperature that are expected to be manufactured, handled
limit stated in the equipment’s technical specifi- and stored in the respective buildings, since
cations. this will be the condition for usage, and safety
begins with the plan when the installations are
Protection in the installation designed.
Protection against overcurrents (overloads and When working with electricity, procedures
short circuits) is a basic requirement for instal- are fundamentally important. The procedures
lations. It is of fundamental importance that the should be developed after a risk analysis that
installation’s design conditions are preserved, should involve the workers. The procedures
maintaining the compatibility between conduc- should also contain all material and human
tors and protection devices (circuit breakers and resources for the safe performance of the tasks,
fuses). By doing so, if overcurrents occur, the with a step-by-step description and a list of
protection devices come into operation, averting safety steps and measures in a single document.
damage to the conductors and avoiding heat- The conditions preventing the performance of
ing or mechanical forces that could compromise the tasks should also be mentioned in the proce-
the safety of the installations. The installations dures.
should also be protected against surges caused The main protection measure for services in
by atmospheric discharges and interference from the electrical installations is undoubtedly de-
manoeuvres or from other, higher voltage cir- energisation, which ends up being part of other
cuits, to protect the safety of people and pre- specific procedures. De-energisation is a group
serve property. Tools or machines that have been of coordinated, consecutive and controlled ac-
switched off due to an accidental loss of power tions that guarantee the shutdown of power in
should contain devices that prevent them from the circuit, section or work station during the in-
automatically operating once power returns, tervention and under the control of the workers
avoiding potential electrical and mechanical risks in question. For an electrical installation to be
to workers. de-energised and released for service, the pre-
established sequence shown in the picture below
planning and procedures must have been followed:
When planning, the wiring blueprint should
take into account not only the aspects related to
correct and safe operation, but also conditions
for maintaining and conserving the installations,
maintaining adequate lighting, work space, using
devices that provide temporary earthing, lock
out and tag out and access and locations that
are compatible with the needs of electricians to
290
Electrical safety
1. Actual shutdown (disconnection) of the electrical energy;

2. Preventing re-energisation (Locking the electrical energy shutdown device);
3. Proving the absence of energy (using an appropriate tool);
4. Earthing the circuit or electrical assembly with equipotentialization of the circuit conductors;
5. Warnings.
Disconnection devices. De-energisation one or all of the cir-

Is the act of fully discontinuing the electricity by cuits in an installation should always be sched-
manually or automatically removing the electri- uled and widely publicised. This should prevent
cal voltage through an appropriate device (dis- problems and accidents that might otherwise be
connect switches; switch; circuit breakers). An caused by a sudden power stoppage. Re-energi-
alternative means is to use an appropriate tool sation should also be authorised after notifying
following specific procedures. everybody involved.
Preventing re-energisation Proving the absence of energy

This involves guaranteeing that the disconnec- This is verifying the actual absence of any volt-
tion is not reversed, to ensure the worker’s safety age in the circuit conductors. This check should
in controlling the disconnection. In practice this be carried out using measuring devices that
means using mechanical locking using locks, have been tested before and after the check.
padlocks and other locking devices or equiva- The check can be carried out through physical
lent IT systems. The trained and authorised contact or approximation using specific proce-
professional should use a disconnection device dures. The category of the instrument being
locking system to guard against the circuit being used should be observed due to the possibility
involuntarily or accidentally re-energised dur- of electrical arcs being caused by measuring and
ing the power stoppage. In large-scale buildings, checking live parts.
in which there may be more than one electri-
cian carrying out repairs in different places, the Installing temporary earthing with
risk of inadvertently energising the circuits is equipotentialization of the circuit conductors
extremely high. The risk in this situation can be Having proved there is no power, a temporary
eliminated by using the same number of pad- earth conductor should be connected to earth
locks as there are electricians working on-site. and the system’s neutral – if applicable – and to
By doing so, the circuit can only be switched other accessible structural conductors. Follow-
on again when the last worker finishes their ing this, the earth groups should be connected to
task and unlocks the switch(es), circuit breaker, the phase conductors that have been previously
cabinet, panel, etc., after finishing the services switched off, therefore creating the same voltage
the clearance procedures should be used and the between all of the conducting parts at the work
circuits switched on again after checking that all location.
equipment is switched off through its command
291
Chapter 4.7
Warning signs advising of cuts in the power potential system users. Only after the services
supply have been concluded and no abnormalities have
Appropriate safety warnings should be used to been found will the worker remove the tools,
warn people and to state the reason for the de- equipment and utensils and finally, the individu-
energisation and the details of the person real locking device and corresponding sticker. The
sponsible. Cards, notices or stickers warning of person responsible for the services, after general
the locking or lock-out must be clear and prop- inspection and certification of the removal of
erly attached. If an alternative method is used, all locks, cards and lock-outs, will remove the
specific procedures must ensure communication earthing wiring and then follow the procedures
of the condition that prevents energisation to all for clearing the electrical system for operation.
Summary comments
1) Disconnection should be carried out using the established procedure with communications and
other protocol measures.
2) Whenever possible, the earth grips connected to the switched-off circuit phase conductors
should be of a type that prevents the worker from getting close to them.
3) All energised elements existing in the vicinity of the work place (places that are simultaneously
accessible) should be protected against accidental contact. They should be insulated using wraps,
piping, or covers made of insulating material.
4) Other warning signs should be used to perform electrical services and the area should be cor-
doned off.
5) If there are irregularities or it is impossible to proceed in the manner expected, the person re-
sponsible should be informed immediately.
6) The wiring should be kept de-energised until the authorisation is received to re-energise.
Re-energisation should only take place following these procedures:
a) Removal of all tools, equipment and utensils.
b) Removal of all workers not involved in the energisation process.
c) Removal of the energisation prevention warnings.
d) Removal of the temporary earthing of the equipotentialization and of the
additional protections.
e) Unlocking, if any, and switching on of the disconnection devices.
292
Electrical safety
safety inspections the company’s functional and organisational

A safety inspection is an excellent tool for man- capacity. Safety inspections should be planned
aging health and safety. It is made up of checks and carried out individually or in groups, using
or inspections (observations, tests, measure- standardised documents such as checklists and
ments, evaluations) following systematic pro- forms, or simply by a visual inspection at the
cedures. These procedures are aimed to ensure established or required frequency. They should
that procedures, systems, equipment and devices always produce trustworthy and reliable records.
are always kept in perfect operating conditions, Inspections are normally carried out on wiring,
or other methods and actions taken personally equipment, devices and procedures, to verify the
meet the set standards or requirements. This set specifications, to discover abnormal opera-
equates to preventive measures to guarantee tion, imperfections, improper behaviour, etc.
Examples of inspections
• Work environments in classified areas (fires and explosions), aggressive areas (corrosion,
humidity, toxic, asphyxiants, contaminating and radioactive)
• Electrical wiring where the services will be performed (rooms, cabins, cabinets, panels, posts,
towers, systems, wiring, cases, platforms, etc.)
• Vehicles, machines and equipment (electrical and mechanical)
• Manual equipment and tools
• Personal protective equipment, PPE (gloves, shoes, etc.)
• Collective protection devices (earthing connections, cherry pickers, gas detectors, voltage
detectors, rods, lighting equipment, insulating floors, work platforms, ladders, locking devices
for dangerous energy sources)
• Material for signs (stickers, banners, trestles, identifying tape, cones, etc.)
• Inspection of fire extinguishers, hydrant systems and sprinklers
• Inspection of order, tidiness and cleanliness
• Final inspection of removal of materials, tools and equipment
• Elimination of the risk conditions
• Removal of warning signs.
293
Chapter 4.7
personal protective equipment Whole body protection

Although personal protective equipment (PPE) Work clothes
is an extreme resource used when collective pro- This is safety clothing to protect the whole
tection measures do not guarantee the necessary body. To protect the body against electric arcs,
levels of safety, it is often used with electricity clothes should be chosen by taking into account
by workers who need to remove the screen and the thermal energy that could potentially be
shield or also needs to be close to live parts to generated in the many work places within the
perform their tasks. PPE is used when the col- company’s premises. The regulations provide
lective measure is not technically viable, when it that the clothes’ characteristics must last their
is being implemented, when the existing meas- useful working life. These characteristics include
ures are not entirely dependable or for emergen- resistance and flame resistance, as well as ther-
cy situations. Therefore, all workers (assistants, mal insulation for its user. For protection against
electricians, technicians, engineers, managers) other agents, the PPE must also be appropriate.
involved in activities that are subject to electri- Remember that, for outdoor tasks, clothing must
cal risks must use personal protective equipment have reflectors and be of an appropriate colour.
that is appropriate for electrical risks, and other Where there are bees, wasps, etc. on posts or
equipment when there are other risks at the structures, clothing that is appropriate for insect
workplace. Personal protection equipment, or removal should be used to free the area for the
PPE, means all devices all products for personal electrical services. Glasses and visors with safety
use used by the worker to protect him or herself lenses are also mandatory to protect against
against risks that could threaten his or her health sparks from electric arcs.
or safety at work. Similarly, combined personal
protective equipment means all equipment made Conducting clothing for power source services
up of several devices which the manufacturer has (live wire)
designed to protect against one or more risks Aimed at protecting workers against the effects
that could occur simultaneously and that could of the electric field when performing service
threaten health and safety at work. with live parts. A jumpsuit made of metallic
Appropriate PPE must be provided to work- material, gloves, hat and wellington boots made
ers for free and in a perfect state and operating of the same material. It must also have a flex-
condition. Use of the PPE should be imple- ible mesh fixed to an insulating stick that will
mented with worker orientation and training be connected to the wiring to keep the worker
on appropriate use, safekeeping and conserva- equipotentialized with the voltage of the wiring
tion. Cleaning, maintenance and tests should in all its points. It should be used with voltages
be performed periodically following specific of 66 kV or more.
procedures. Workers should use the PPE only Head protection
for its intended purpose, and be responsible for Safety helmet to protect against impact and
its upkeep and conservation, informing the em- electric shocks aimed at protecting against head
ployer of any changes that make it unsuitable for injuries from falling objects and to insulate it
use. To perform their functions, workers should against electric shocks of up to 600 Volts. Should
use their PPE in the situations and activities be used with the harness tightly securing the top
described below.
294
Electrical safety
of the head and the strap passing under the chin Leather gloves
to avoid the helmet falling off. They should be Made using the appropriate leather and with fine
replaced when they are cracked, have holes, are stitching to ensure the maximum flexibility for
out of shape or have excessive abrasions. The the user’s fingers. Leather gloves are used on top
harness should be replaced when it is out of of the insulating gloves to protect against punc-
shape or in poor condition. tures and cuts from sharp and abrasive objects.
These gloves have a fastening device with adjust-
Eye and face protection
ment clips above the wrist.
Safety glasses aimed at protecting workers
against eye injuries from flying particles or Safety gloves for protection of hands against abrasive
exposure to harmful radiation. Every electri- agents
cian should have safety glasses with lenses that Made from leather filings or thin, lining leather
protect against the specific risks of each activity. with reinforced stitching, these gloves protect
This could involve transparent lenses to protect the hands against cuts, punctures and abrasions.
against flying objects or coloured lenses to pro- Workers should use these gloves when they han-
tect against bright light or other rays, be they dle abrasive or sharp materials but do not need
sun’s rays or potential arc flashes from working great dexterity or precise finger movements.
with devices or on live wires.
Safety sleeves for arm and forearm protection against
electric shocks
PPE for upper limb protection
Made from insulating material, these are to
Insulating safety gloves protect workers against arm and forearm contact
Insulating safety gloves for protection against with energised wiring or parts. Sleeves normally
electric shocks, aimed at protecting workers’ offer insulation up to 20 kV and come in several
hands from touching energised wiring or parts. sizes. They have straps and buttons that fasten
Gloves not only come in a variety of sizes but to each other around the worker’s back. They
offer different levels of insulation, which should should be used with insulating gloves. The
be specified to ensure the glove is used cor- sleeves should be inspected before use and peri-
rectly. They should be used with leather gloves odically tested to ensure their insulation capac-
to protect against puncturing and other injuries. ity.
Neutral talcum powder should be used inside
the gloves to make them easier to put on and Protection of lower limbs
take off.
Safety shoes for protection against mechanical agents
Insulating gloves should be inspected before
and electric shocks
use and periodically tested to ensure their insu-
Aimed at protecting workers against accidents
lation capacity. Gloves that have punctures, are
caused by ground irregularities and instability,
torn, out of shape or in poor condition or have
avoiding slipping and providing insulation up
failed the electrical tests should be rejected and
to 1 000 Volts (touch voltage and step voltage).
replaced. There are 6 classes of gloves: 00, 0, 1,
Safety shoes for electrical tasks should not be
2, 3, and 4, and they come in 9 sizes (8; 8.5 to
made of metallic components that could reduce
12).
their insulation.
295
Chapter 4.7
Safety leggings for leg protection against electric priate PPE should be used to protect against
shocks. those agents. These include:
Made from insulating material, leggings aim to
• Purifying air respirator to protect respiratory
protect workers against thigh and leg contact
system against dust, mist, gases, smoke etc;
with energised wiring or parts. Leggings nor-
• Ear protectors to protect the hearing system
mally provide insulation up to 20 kV and come
when the worker is exposed to sound pressure
in a variety of sizes. They should be used with
(noise) that exceeds regulatory recommenda-
shoes appropriate for the electrical tasks. The
tions;
leggings should be inspected before use and
• Clothing that is appropriate for the chemical
periodically tested to ensure their insulation
risks, moisture, heat, cold, etc., that may be
capacity.
present in the environment;
• Safety shoes that protect against humidity;
PPE for protection against falls from heights
• Safety gloves to protect against mechanical,
Safety harness with lanyard chemical and biological risks;
The safety harness/lanyard system is aimed at • Others due to the specific nature of the addi-
protecting employees against vertical falls. Their tional risks.
use is obligatory when working at heights of
more than 2 m from ground level. The safety work tools
belt should be placed around the pelvis (a little All tools used on energised wiring or that could
higher than the buttocks) so that if the worker be accidentally energised must have handling ar-
does fall, the force of the impact will not injure eas (handles, gauntlet) covered with appropriate
his or her spine. insulating materials. Electricians’ normal work
“Parachute jumper” safety harness tools include pliers and screwdrivers. These, in
This harness is made of highly resistant nylon fact, become extensions of their arms and must
strips with high-resistance stitching and fasten- be appropriate for the task, be properly main-
ings. The support is spread out using straps that tained and be in perfect condition for their func-
are fixed around the thighs, thorax and back. tions, (sharp for cutting, adjusted for grasping,
The support is located in the strips over the screwdrivers are sharp to prevent them slipping
back and front of the body. Together with a falls off screws). Pliers’ handles and screwdriver han-
locking device, workers can safely and efficiently dles and stems must be properly insulated.
perform climbs, descents or rescues. To perform their tasks safely, electricians also
need this equipment:
Falls locking device
The falls lock safety device is aimed at protect- • Extendable ladders and step ladders (insu-
ing users against falls from vertical or horizontal lated);
operations, and must be used with safety har- • Cases and bags to transport tools;
nesses that protect against falls. • Rubber mats with special insulation or wood-
en platforms;
PPE for protection against other risks • Insulating rods and sticks;
For electrical services at locations where there • Temporary earthing groupings;
are other risk agents, other specific and appro- • Cherry pickers;
296
Electrical safety
• Safety harnesses and tool belts or jackets, and suggestions for further reading
• Measuring equipment (ammeters, voltmeters,
IEEE (1998). Guide for Maintenance, Opera-
voltage detectors etc.)
tion, and Safety of Industrial and Comercial
Power Systems. The Yellow Book, IEEE, Std
The tool used in electrical tasks must be appro-
902-1998
priate for the voltage, be periodically inspected
This guide provides plant engineers with
and, in some cases, be tested and certified, in
a reference source for the fundamentals of
accordance with statutory provisions.
safe and reliable maintenance and operation
of industrial and commercial electric power
first aid and training
distribution systems.
Being prepared to provide first aid is very impor-
tant. However, it is of fundamental importance Fordham Cooper, W (1986). Electrical Safety
that those who work with electricity understand Engineering. Butterworths.
how electric shocks can injure them, how shocks Concerning electrical engineering and safety
travels through the body, as well as their effects. measures.
They must also clearly understand how protec-
tive and safety measures work and operate and
why they are necessary, at installations as well as
in electrical activities and services.
Training includes educational and organised
activities that aim to improve ability. Ability is
nothing more than an amalgamation of teach-
able skills and actions. Training for electricity
should include understanding responsibili-
ties and should be systematic and continuous.
It should include risk analysis techniques and
develop the ability to predict occurrences, an-
ticipating the risk. Training should focus on
operational procedures and provide for condi-
tions that make the training more efficient. It
must be comprehensive and include the many
types of worker involved in the tasks. Train-
ing for electricity is of paramount importance
because identifying risks essentially depends on
having a technical understanding of electricity.
This is because our senses are unable to spot the
risks of serious harm that electricity can cause.
Therefore, training for electricity must be based
on technical knowledge and safety, so that the
worker can then be authorised to work with
electrical installations or in their vicinity.
297
4.8
Fire safety
Håkan Frantzich
causes and consequences of fires
Causes
Fire not only causes fatalities amongst man • ensure the stability of a building in case of fire
and animals but also damages property and the
• ensure the safety of rescue operation person-
environment. There are many examples of fires
nel.
resulting in large numbers of victims, including
fires in occupational settings that have resulted
Most countries have similar objectives, e.g. those
in a disproportionately large number of fatalities
adopted by the European Commission Con-
due to blocked or locked escape routes. Fires
struction Product Directive (CPD, Directive
also cause injuries such as burns and complica-
89/106/EEC). However, the implementation
tions due to smoke inhalation. Property loss is
of these objectives varies between countries as
generally related to damage to buildings and
fire safety strategies have developed differently
contents.
due to historical reasons. In some countries,
In occupational settings, fire can disrupt or
fire safety demands the installation of sprinkler
stop production, creating delivery problems that
systems but in others fire separation barriers or
may have very serious economic consequences.
management are more common. The fire safety
Fire prevention and protection is very impor-
systems installed in buildings depend on the
tant. General goals are to ensure the safety of
tradition in a specific country and consideration
building occupants and to protect property and
of the occupants.
the environment. More detailed objectives in-
Protection against fires must be based on
clude action to:
knowledge about how fires are caused. Fires
• prevent the outbreak of fire occurring in buildings are generally accidentally
triggered by humans, typically by smoking,
• limit the spread of fire and smoke within a
open flames, kerosene heaters, sparks, welding
building and its immediate surroundings
and electrical faults. Arson is also a common
• ensure that people can escape safely from a cause of fire. The basic approach to fire safety
building in case of fire takes fire hazards into account during the design
299
Chapter 4.8
of buildings, workplaces and technical equip- The frequency of fatality is also relevant when
ment. The most important factor in fire protec- discussing the hazards to fire services personnel
tion, however, is related to fire safety manage- as it is not uncommon that they become victims
ment procedures. It is necessary to maintain the of the fire they are fighting.
fire safety equipment and in order to do that Fire also causes damage to property and to
efficiently this should be performed in a system- the environment. Information on the cost of fire
atic way, using a fire safety management system. losses is available from the World Fire Statistics
presented by The Geneva Association Bulletin
Consequences 22 (2006), indicates a general property damage
Fire is the type of accident that most people cost between 0.07 and 0.28 percent (generally
fear but in fact, the risk of being killed by fire for 2001-2003 with some exceptions) of the
is rather low compared to other risks, however, gross domestic product (GDP) of a country,
the frequency of fires is still very high in some related to building damage and loss of contents.
countries. The prevention or reduction of the conse-
It is difficult to compare fire risks between quences of fire can be considered either in the
countries as statistics may not be reliable or exist planning phase for a new building or when
in every country. operations are carried out in an existing work-
Figure 4.8.1 presents statistical data on fatality place. Fire safety design is traditionally based on
rates in different regions of the world. guidelines issued by a fire safety authority and
The variation in fire frequency is rather large. if these prescriptive regulations are followed,
Africa has the highest risk for fatalities followed buildings will generally have an acceptable level
by South East Asia and the Eastern Mediterra- of fire safety. Engineering solutions for fire
nean. The figure includes fatalities in all sectors safety are increasingly used for very tall, large
in society, not only in occupational settings. or complex buildings. Traditional solutions are
still the most commonly used and are applicable
for most buildings. The following paragraphs
Region Deaths per
100 000 persons present general guidelines that describe the way
Africa 11
in which prescriptive design regulations can be
formulated and how owners of workplaces can
North and South America 1
act in order to reduce the risk of fire. The design
Eastern Mediterranean 3
solutions presented generally follow the EU fire
Europe 1-2
safety structure and are influenced by similar
South-East Asia 10 guidelines from Sweden.
Western Pacific 1-2
World 5 prevention of the outbreak of
fires
Figure 4.8.1. Fire death rate per 100,000 persons
based on WHO World Health Report 1999. The protection strategies for a building and
An interval indicates a variation due to different its users can be divided into two parts: general
income groups. A low death rate is associated strategies and specific actions. General strategies
with high income. are very much related to management activities
300
Fire safety
while specific actions mostly relate to practical random evacuation drills may be performed in
issues; there is no clear border between them as shopping malls with customers participating.
they both serve the same objective. People in occupational settings should also be
given training about how to extinguish fires.
General strategies
• Another important training activity is how to
In many ways, a fire safety system can be con-
call the fire department and how to warn others in
sidered to be a technical system that needs to be
a building in case of fire. Many countries have
correctly installed, operated and maintained in
a special telephone number to call in case of
order for it to work as intended. General strat-
fire but it is important to provide the opera-
egies are based on planning for an unwanted
tors with accurate and useful information,
event, i.e. how can damage be reduced if a fire
e.g. knowledge on where the fire started, how
starts. General strategies may include the fol-
many people have been injured and the name
lowing:
and phone number of the caller so they can
• A fire management plan should be part of the call back for additional information if neces-
design of the fire safety system and be included sary.
as part of the fire safety documentation for the
building. The plan describes how fire protec- Finally, employees can also be trained in first aid
tion is intended to work. so they are able to help those injured by fire. If
first aid is administered quickly, it often helps
• A well designed maintenance plan will help to
the recovery time of victims.
overcome a major problem related to mainte-
nance, i.e. that tenants or building owners do
Special actions
not fully recognise the need for regular safety
Separating the fire source from combustible
checks, e.g. of the fire detection system.
materials is of primary importance to prevent
• Safety checks, as defined in the maintenance fires as it is not always possible to eliminate fire
plan, should be performed to ensure escape hazards completely. For example, management
doors are not blocked, emergency lighting is actions would typically include: ensuring that
working in case of power failure, portable fire there are lids on trash containers, forbidding
extinguishers are operative, etc. Figure 4.8.2 the storage of combustible materials close to
shows an example of a checklist of critical the outside walls of a building, or training staff
points that need to be attended to. It is im- members how to handle flammable liquids and
portant to clearly state who is going to do the gases. The same strategy can be used to prevent
checks and how faults will be handled. arson.
• Regular evacuation drills and education about how
to act in case of fire can reduce the risk of fatali-
ties and injuries. People that have participated
in such education or experienced a real fire,
have a better chance of acting correctly if a fire
occurs. In order to be effective, drills need to
be realistic but not frightening. For example,
301
Chapter 4.8
Part in the fire safety system Description of what should be checked

Evacuation: Routine monthly inspections. Weekly inspections in public
• doors buildings. No blocked escape routes. Doors able to be
• emergency exit signs opened easily. Signs in proper places. Emergency and
• emergency lights normal illumination working. Snow removed from outside
• escape routes escape doors.
Fire compartment barriers Routine monthly inspections. Weekly inspections in public
buildings. Fire doors not held open. Every six months,
check that barriers have not been penetrated by cables,
pipes or ducts, (especially after work has been performed
in the building).
Access for rescue services Regular checks to ensure that there is access around buil-
ding perimeter. Hospitals should be checked every day.
Automatic fire alarm system Regular inspections by authorised personnel from the in-
• detectors stallation company. Most equipment should be tested every
• alarm bells (and similar) month. Orientation plans should be checked on a yearly
• controls basis. Many fire alarm suppliers recommend that detectors
• power supply are replaced every 6 years.
• alarm transmittance to fire department
• orientation plans
Evacuation alarm Evacuation alarm systems should be tested every month.
• alarm bells, loudspeakers and flashing lights Systems combined with automatic fire alarms should be
• alarm push buttons tested at the same time.
• power supply
Automatic sprinkler system Regular inspections by authorised personnel from the
installation company. Most equipment should be tested
every month.
Smoke extraction system Vents at ground level, (venting basements), should be
• vents checked every week for blockages. Vents at roof level
• fans should be checked every month. Snow should be removed
from vents. Smoke extraction fans should be tested at least
four times per year. System for supply air should be tested
at the same time.
Fire protection in heating, ventilating, and air Dampers should be operated at least once every 48 hours.
conditioning system
Manual fire fighting equipment Portable fire extinguishers and indoor fire hydrants should
be inspected at least once a year. In public places they
should be checked at least every six months. Water pipes
specially provided for the fire services (usually vertical
pipes) should be inspected every year.
Systems control Systems that work together should be tested at the same
time in order to ensure that they are able to function
together. This could be performed as a total fire safety
systems check, including operations by management and
other members of the staff.
Figure 4.8.2. Example of a checklist for regular safety checks of technical installations.
302
Fire safety
Heat producing equipment of the fire. Usually, not much can be done to
A fireplace, hot machinery or other hot surfaces change the contents in a room but the surface
should be physically separated from any com- material used to line the room can be regulated.
bustible lining both above, behind and below Higher demands should be placed on the ceiling
the installation. To prevent sparks from ignit- material as it is more important to the develop-
ing items outside a fireplace, a non-combustible ment of fire than the material used on the walls.
materiel should be placed in the vicinity of the A less combustible (more fire resistant) material
opening to the fireplace. should be chosen for use in places where the risk
Chimneys should be insulated from com- to occupants is higher, e.g. in places handling
bustible construction materials, etc. Steel pipe fire hazardous material or in rooms containing
chimneys can be insulated with mineral wool to the building electrical centre.
limit the temperature on the surface of the sur-
rounding material. A temperature of 80 °C on Classes of surface lining materials
the exposed surface is a rational level to prevent In the European Union, a classification system
ignition of most combustible materials. Ensur- (EUROCLASS) is used to regulate different
ing that material is not stored close to hot sur- surface lining materials. This system is based on
faces should be a part of the maintenance plan. the material’s fire development magnitude (A
– E), its smoke production property (s1 – s3) and
Electrical sources and sparks its dripping or melting property (d0 – d2). Usu-
Malfunction of electrical appliances is also a ally, polystyrene and other similar plastics have a
known source of fire. Correct electrical instal- tendency to both produce thick black smoke and
lation is required and electrical wires should be to melt, forming a pool of melted material below
regularly inspected and maintained. the virgin plastic.
Sparks in industrial production plants or from The lining material that is classified is the sur-
welding can also be source of fire so it is neces- face material, i.e. the paint, wallpaper or the vir-
sary to physically separate combustible materials gin material e.g. wood. Wooden surface material
from sparks or welding. Special care must be typically has EUROCLASS D-s1, d0. Material
taken when metal is welded or cut as heat can be with less fire protection properties (class E and
transferred to other parts of a metal construction those dripping and producing a lot of smoke),
and ignite material at a distance from the place should definitely be avoided, e.g. low-density
where the work is being done. Control of such wooden boards and most expanded polyurethane
hazards requires good management. boards. Lining a room with these materials will
result in a very rapid fire development creating
limitation of the consequences hazardous conditions within seconds.
of fire Figure 4.8.3 shows the regulation of wall and
ceiling linings in Sweden. It is also assumed that
Limit fire spread within a fire compartment
the lining material is attached to a wooden sur-
If a fire starts in a room (and is not extinguished
face or even better a surface made of concrete,
by the occupants), the type of contents and type
mortar, gypsum plaster board, etc. ‘B’ indicates
of surface material used on the walls and ceil-
a better performance than a ‘C’ and ‘s1’ is better
ings, will significantly influence the development
(producing less smoke) than ‘s2’ and so on.
303
Chapter 4.8
The following are typical material classifications: pipes for the heating, ventilation and air condi-
tioning (HVAC) system.
• B-s1,d0: gypsum board
• C-s2,d0: gypsum board with wallpaper
Examples of fire compartments
• D-s2,d0: unprotected wood, MDF-board,
Typical rooms that should be in a separate fire
plywood
compartment are: staircases, hotel corridors,
hotel rooms, assembly rooms or groups of as-
Escape route Other areas
sembly rooms, groups of school classrooms,
Building Ceiling Wall Ceiling Wall
hospital wards, elevator shafts, other shafts in
class
multi-storey buildings, groups of office rooms,
Class 1 B-s1,d0 B-s1,d0 B-s1,d0 C-s2,d0
rooms for handling of hazardous material, ga-
Class 2 B-s1,d0 B-s1,d0 C-s2,d0 D-s2,d0 rages, and some laboratories. Each floor in a
Class 3 B-s1,d0 C-s2,d0 D-s2,d0 D-s2,d0 multi-storey building is normally a separate fire
Figure 4.8.3. Requirements for lining materials in compartment. In addition, building owners may
Sweden according to the EUROCLASS system. also want rooms used for essential services, such
as computer rooms or archive storage rooms,
Class 1: Buildings with more than 2 floors, buil- to be in separate fire compartments in order to
dings with 2 floors and hospitals, hotels or limit the property damage in case of fire.
buildings with 2 floors and places of assembly on In the above list, some fire compartments
2nd floor.
consist of several rooms grouped together; they
Class 2: Buildings with 2 floors and places of
assembly on ground floor. Buildings with 2 do not all have to be separate fire compartments
floors and 2 dwellings. Buildings with 2 floors with specially designed barriers. The maximum
and a building area of more than 200 m2 or fire size of a fire compartment is usually determined
compartments of more than 200 m2. Buildings by the longest distance from the most remote
with 1 floor, hospitals or places of assembly on place in the fire compartment to an escape route.
ground floor or below. This means that larger fire compartments must
Class 3: Other buildings. have more than two escape routes in order to
meet the requirements of maximum allowed
Limit fire spread between fire compartments
distance to an escape route. Another reason to
A large building, such as a multi-storey office limit the fire compartment size is related to the
building, should be provided with fire compart- possibilities for the fire brigade to extinguish a
ment walls and other constructions which form fire because a fire in a large fire compartment is
fire separation barriers. The idea behind the fire normally very difficult to extinguish.
barriers is to limit the spread of fire within a
building or at least to decrease the velocity of Fire separation class
the spread of the fire which gives more time for Figure 4.8.4 shows the various fire separation
the evacuation of the building, to fight the fire classes, described as EI xx, where xx stands for
and to generally limit damage. The requirement the length of time the barrier should be able to
is that all components in a fire separation barrier resist a fire load, according to EN 1363-1:1999
should have the same resistance, i.e. windows, (similar to ISO 834) fire resistance test. The
doors and any penetrations, e.g. for cables or letters EI stands for integrity (E) and insulation
304
Fire safety
(I). This means that, for example, a door limits extra care. This is a safety control that should be
the smoke spread for the required time (E) and installed during construction.
limits the heat transfer to the non-exposed side
Fire loadb (MJ/m2 surrounding area)
of the door (I). The temperature limit is usu-
Building class < 200 a < 400 > 400
ally set to 140 °C on average and 180 °C as the
maximum temperature. These levels are then Class 1 EI 60 EI 120 EI 240
assumed to minimise fire spread to the next fire Class 2 or 3
compartment. – in general EI 30 EI 30 EI 30
In some cases, only the integrity is desired i.e. – between EI 60 EI 60 EI 60
no requirement is defined for insulation. This dwellings
partition receives a class E xx where xx indicates Figure 4.8.4. Fire compartment resistance (minu-
the time in minutes that the protection is sus- tes) for walls, floors, doors etc.
tained. Typically, protection levels for this type a
Can be used if the building is equipped with an
of construction are 15 or 30 minutes and are automatic sprinkler system, even if the fire load
normally a requirement for some doors or win- is higher.
dows where less fire protection is necessary. Fire
b
Fire load is defined as the total heat of combus-
tion of the contents in the room divided by the
spread is then assumed to be limited by the E-
total surrounding area, i.e. the area of the floor,
requirement and a separation distance, for exam- ceiling and walls.
ple between two buildings. The duration of the
fire separation is also determined by the use of Another weak point is the intersection between
the building. As for the lining material, the fire walls and the ceiling which needs special atten-
separation time is determined by the building tion as smoke moves upwards.
class. The requirement for separation between The fire separation must be checked regularly
fire compartments for Sweden is described in in order to ensure that contractors have not
Figure 4.8.4. Similar requirements can be found damaged the barriers. Appropriate instructions
in most other countries but perhaps with some for maintenance staff and contractors can be
differences in the length of the resistance time. part of the maintenance plan. Doors and other
According to Swedish regulations, a fire mechanical parts in the fire separation barrier
compartment with more than two floors must should also be checked regularly. Problems usu-
be equipped with a sprinkler system. Staircases, ally occur when self-closing devises are used and
shafts and similar rooms are not required to have doors don’t close accurately.
this installation.
The biggest problem with fire barriers in a Building structure fire safety
building occurs when the walls, floors, etc are Buildings must be able to withstand a fire for
penetrated for piping, electrical wires, etc. The some time without collapsing. Higher protection
fire separation may be damaged and special care is normally required on the fundamental sup-
must be taken in order to avoid a reduction in port structure to ensure that a total collapse can
resistance; there are methods of passing wires, be avoided but the protection required differs
venting pipes, etc through a separation wall depending on the type of construction material
without any loss of integrity but they require used. Steel is a good material in many ways but
305
Chapter 4.8
has disadvantages in case of fire as the strength than it takes to evacuate the building. For ex-
of the material decreases quickly when exposed ample, if the response time for rescue services is
to higher temperatures. Steel structures have to around ten minutes, the building must be pro-
be protected with fibre insulation board, gypsum tected at least for 30 minutes for smaller build-
plaster board, or something similar, in order to ings and longer if the building is more complex
withstand fire. Alternatively, while a concrete or has several floors.
girder is better able to withstand fire, problems
with spalling may arise, i.e. when material falls escape in case of fire
off a concrete beam due to tension caused by If fire breaks out in a building, occupants must
heat. Any protection added to a construction have access to escape routes that permit them
structure must be carefully mounted if it is to be to leave the building safely. This means they
effective but unfortunately poor workmanship is must have access to a minimum number of
common. escape routes with sufficient flow capacity. Many
As structural safety is a vital part of fire safety, countries have developed standards. (e,g, British
construction should be designed according to a Standard 5588 series), that provide very detailed
high quality design standard. The EUROCODE guidance on how an evacuation system should be
design guide provides rational and practical designed. Below, such guidance is presented fol-
design advice. lowing parts of the prescriptive design method
Fire safety requirements on construction used in Sweden.
stability are normally defined by the time a
construction needs to withstand a fire load. A Escape route
normal resistance time for traditional buildings The escape route is either an exit that leads
in Building class 1 (see Figure 4.8.3), and with directly outside or a path within the building
a fire load less than 200 MJ/m2, is 60 minutes that leads to an exit. The latter type of escape
(this requirement is expressed as R60). Longer route must be protected by fire separation walls,
times of 120, 180 or 240 minutes are required i.e. the escape route must be in a separate fire
for higher fire load and for fundamental parts compartment. The maximum distance for such
of the construction. For buildings in Class 2 or an escape route is discussed below. The final
3, a normal requirement would be R30 or even destination of an escape route must be a street or
R15. Stairs inside an escape route should be at similar safe place outside a building’s perimeter.
least R30 to ensure stability in case of fire. If a People tend to use familiar routes to get out-
sprinkler system is considered, it is normal to side in case of fire, even if there are specially
reduce the requirement on the construction designed escape routes. It is important to plan
stability but not to remove all the protection as escape routes that are used during normal, eve-
sprinkler systems are not 100% reliable and fire ryday life in a building, which also saves money.
protection should never rely on a single system.
Redundancy is vital for fire protection. Number of exits
It is important that a building is constructed In order to provide fire protection to occupants
in a way that assists the ability of rescue services in all parts of a building, they should have access
to make safe rescues. This can be done by ensur- to at least two totally independent and separate
ing building stability for a longer period of time escape routes so that if a fire blocks one of the
306
Fire safety
exits, occupants will still have a safe way out. routes are also used to transport goods between
In buildings with many occupants, more than different parts of the building, (e.g. in shop-
two mutually independent exits must be pro- ping centres), however, such transport should
vided in order to keep the total evacuation time be minimized in order to keep the escape routes
to a reasonable length. clear.
In smaller premises, e.g. small shops with a
direct visual access to the outside, one exit lead- Location of escape routes
ing to the outside may be sufficient provided the To minimise the risk of a single fire blocking
distance to walk to the outside is less than 15–20 all the escape routes, they should be located
meters. In this case, it is important that people remotely from each other. As mentioned above,
in a small premise can see what is going on in the normal communication routes in a building
other parts of the room and are able to be noti- should also be used as the escape routes as occu-
fied if a fire occurs. pants are more familiar with them and consider
them safer than exits that are seldom used.
Escape routes on all floors
If a fire compartment has more than one floor, Separation between escape routes
any additional floors should have direct access to While escape routes must be mutually inde-
an escape route. pendent, in many cases, the possibility must still
remain for movement between them. The mini-
Elevator evacuation mum requirement is a self closing door separat-
In high buildings it can be difficult to evacuate ing the two routes and if the escape routes serve
everyone through stairways so specially designed more than 150 persons, there should be a sepa-
elevators, that can sustain fire, can provide rate room between the two escape routes. Both
an additional evacuation route. However, as doors to the escape routes from this room must
the general rule is that elevators should never be fire rated and equipped with a self-closing
be used in case of fire, people in any building device in order to avoid smoke spreading from
equipped with a special fire resistant elevator, one of the escape routes into the second escape
must be aware that it is possible to use it dur- route. Higher protection is required for build-
ing fire conditions. It should also be noted that ings where a large number of people use the es-
a special fire elevator can be an alternative to cape routes because the potential consequences
evacuate elderly or physically handicapped peo- are more serious.
ple who have difficulties using stairs. The use Staircases used for evacuation must always be
of fire elevators as an evacuation strategy is not separated and fireproofed from the floors they
common but exists in some Western and South are serving, particularly in very tall buildings
East Asian countries with many very tall build- where many people will need to use the stairs to
ings. escape from the building. Such staircases need
to be specifically planned, e.g. for phased evacu-
Objects blocking escape routes ation. In the case of very long horizontal escape
As an escape route is considered to be a relative- routes it may be a good idea to separate a cor-
ly safe place, no goods or other items should be ridor with a simple smoke separating wall and
present in the area. Unfortunately, many escape door.
307
Chapter 4.8
Windows as an escape route Condition Example Distan-

In some cases, windows may be considered as ce, m
one of a number of mutually independent escape Good overview in the Some mechanical in- 60
routes, but should only be permitted for use by room and fire load less dustries or concrete
than 50 MJ/m2 and low production factories
a small number of people, e.g. in apartments, or risk of fire start. No risk of
small offices. It is essential that the people sup- a rapid fire development.
posed to use this escape route are able to crawl Low occupant density Dwellings, office 45
through the window opening, so this is not a and it can be assumed buildings, and similar
safe option for hospitals, hotels, or places of that occupants are aware like garage, storage
assembly. Any window used as an escape route of the premises. buildings, industrial
buildings in general.
must be simple to open and be large enough, i.e.
Not low occupant density Assembly buildings 30
with a minimum opening of 0.7 m width and 0.8 or people are within a in general (warehou-
m height. The window must swing open around caring facility or have less se, shop, restaurant,
a vertical axis. knowledge of the premi- education, theatre,
ses or the risk of a rapid cinema and similar).
Walking distance to an escape route fire development cannot Industries for wood
be neglected. or plastic manufac-
The primary objective of evacuation safety is turing. High rack
to ensure that occupants are able to leave the storage buildings.
fire compartment in which the fire has started. Hospital.
Calculation procedures can be used to compare Building with high risk Buildings with hand- 15
of fire start or if high ling of flammable
the time available for evacuation with the time
probability of evacuation goods.
taken for untenable conditions to be reached in problems.
the room on fire. The building codes in most
developed countries require such a perform- Figure 4.8.5. Allowed walking distance to the nea-
rest emergency exit.
ance objective but the way in which safety is
achieved may differ from country to country.
If the room is equipped with a high quality
For example, in Sweden two methods are used:
automatic suppression system (sprinkler) (e.g.
the prescriptive method and fire safety engi-
satisfying ISO 6182-1 or NFPA 13), the allowed
neering. The fire safety engineering method
distance may be increased by 1/3rd. The sprin-
demonstrates safety by calculation methods. The
kler system is assumed to be a quick response
prescriptive solution is used most frequently
type sprinkler i.e. having a Response Time Index
because it is simple and quick to use. The pre-
(RTI-value) of less than 50 m ⋅ s and to have
scriptive method limits the maximum walking
a full coverage of the building. The RTI-value
distance to reach the closest exit from a place in
is a measure of how fast the sprinkler bulb will
the fire compartment, depending on the use of
activate exposed to a fire. If the escape route is a
the building i.e. the fire risk associated with the
window, the allowed distance is only 1/3rd of the
building use, Figure 4.8.5.
value in Figure 4.8.5.
If a stair is part of the walking path to the es-
cape route, the stair is assumed to be equivalent
to four times the vertical distance.
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Fire safety
If the walking path within a fire compartment, must be not less than 1.2 meters for each door.
to the mutually independent escape routes, is The total escape width can be calculated as 0.67
the same or can be the same, then this distance cm/person but this figure varies between coun-
should be equivalent to double its length, see tries. If the widest one escape route is blocked by
Figure 4.8.6. The reason for this is to have the the fire, the other exits must have a width equal
different escape routes located as far away from to 0.33 cm/person and be designed to cope with
each other as possible. Furniture, machines etc the maximum number of people in the room.
should be considered in calculating the walking
distance. Doors
Escape route must always be able to be used and
doors must never be locked when people are in
the building. A locking system connected to any
automatic system, such as a fire detection sys-
tem, must not be used. Generally, doors in any
escape route should swing in the direction of
travel and be equipped with a self-closing de-
vice. However, in small rooms, e.g. hotel rooms,
doors may open inwards and should be able to
be easily and rapidly opened with a handle. In
rooms serving a large number of people, e.g. as-
sembly rooms, door handles can be designed to
cope accordingly (see EN 179 or EN 1125).
If escape doors must be locked when no one
is in the building, the locking system must be
designed to prevent the operation of vital equip-
Figure 4.8.6. Measuring the walking distance. 1)In a ment (e.g. cash registers, lights), while the doors
dwelling, office or garage 1.5 times the physical are locked. Care should be taken to ensure that
distance is sufficient. doors leading to the outside are never blocked.
Walking distance within an escape route Exit and evacuation signage
The walking distance within an escape route Exit signs can be used to mark escape routes and
should be limited (normally to 30 metres) so that to guide occupants to exits. Exit signs should be
rapid access to a safe location outside the build- similar throughout a entire building (this is nor-
ing can be achieved. mally regulated in countries). Figure 4.8.7 shows
a typical exit sign, i.e. the European Community
Width of escape routes
standard for such signs.
Safe evacuations require escape routes of suf- Signs need to be large enough to be clearly
ficient size to avoid long queuing times in the seen – a sign height of 1% of the assumed view-
room on fire. Normally, a door leading to an ing distance is sufficient if the sign it lit by an
escape route must be at least 0.8 meters wide external light source. If the sign is lit from be-
and in assembly rooms the unobstructed width hind, through a plastic or glass sign, a height
309
Chapter 4.8
can be assumed to know the meaning of the

evacuation alarm, e.g. in a small office or similar,
a simple bell alarm can be used, complemented
with flashing lights to increase the significance
Figure 4.8.7. Standard EC exit sign (green with a of the alarm and to help people with hearing
white pictogram).
disabilities. In other places where members of
of 0.5% is sufficient as back lit signs give better the public gather, a spoken message alarm may
visibility. Signs must be located above all exits be a better solution because occupants need to
leading to escape routes while additional signs be informed about what has happened and what
can be provided to improve orientation within they are supposed to do. Human behaviour plays
the building. a dominant role in this situation and occupants
may feel very insecure about what to do if they
Lighting are unfamiliar with the building.
General lighting must be provided so that dark- A typical spoken message would contain the
ness does not limit safe evacuation. In some following information:
cases, emergency lighting will be provided in 1. Tone signal for approximately 5 seconds
addition to normal lighting in both rooms and 2. ”Important message. There is a fire situa-
escape routes, as is the case in many hospitals, tion in the building. Please leave the building
hotels and assembly rooms. All escape route through the nearest exit. Follow the instruc-
signs should also be equipped with emergency tions given by management and proceed to
lighting. Battery operated emergency lights are the outside. Don’t block the exits.”
recommended even though they require higher 3. Repeat from step 1.
maintenance. Maintenance can be limited by
good design, e.g. by having a central battery The alarm should continue until it is safe to shut
pool for a group of rooms. Emergency power it off. If necessary, the verbal message should
generators may be the electrical source for be spoken in a number of languages, e.g. in an
emergency lighting but generators normally airport, and should be longer than 30 seconds.
have a long start-up phase and must be com- See EN 60849 for more detailed information on
plemented by battery operated lights. Visibility verbal evacuation alarm systems.
is helped by the use of light colours for floors, In some places such as hospitals and elder care
walls and ceilings. homes, an audible evacuation alarm may not
be the best option. Silent alarm signals to staff
Evacuation alarms members may be a good solution that avoids
An evacuation alarm helps rapid and efficient upsetting patients /residents.
evacuation by notifying people of a fire. Such Smoke detectors are a simple form of auto-
alarms can be triggered manually or by an automatic evacuation alarm that can be used to in-
matic detection system, i.e. a fire alarm. Hotels, crease safety at low cost.
hospitals and assembly rooms should normally
be equipped with an evacuation alarm, however,
other premises such as offices may also install an
evacuation alarm. In premises where occupants
310
Fire safety
training for rescue operations to put out a clothing fire as that may harm the
If a fire occurs, action must be taken to try to victim even more. The use of a CO2 extinguisher
extinguish it. This can be done manually by oc- on a person can cause severe cold damage.
cupants or professional fire fighters. In general there is little need for personal
In many countries, part of building fire safety is protection equipment for people fighting a small
provided by a professional rescue service paid fire as the threat is minor and there is not much
for by citizens. The main objectives for rescue harmful smoke produced if fire fighting can be
services are to assist with evacuation and limit initiated early on. If a fire gets out of control,
fire from spreading. The earlier fire services harmful smoke is produced and fire fighting
arrive after detection of a fire, the higher the should be handled by professional fire fighters.
possibility for a successful operation. This is the Typical training exercises for non-profes-
reason for promoting the installation of auto- sional fire fighters involve fighting fires with
matic detection systems in buildings. portable extinguishers, the use of hoses mounted
Unfortunately, in many cases fire develops on indoor fire hydrants and putting out a fire in
rapidly before professional rescue services ar- a person’s clothes. The training should involve
rive. People already in the workplace have the all personnel and be repeated regularly, at least
best opportunity to limit a fire from growing by every second or third year. New employees
extinguishing it early but they need education on should be given this training as soon as they are
what to do in case of fire. hired. It is also useful to combine this practical
training with evacuation procedures and infor-
Non-professional fire fighters mation about how to warn others, call the fire
Well trained people are a good investment as and emergency services, etc.
they can take measures to limit a fire from grow-
Professional fire fighters
ing and possibly extinguish it. A successful op-
eration needs both good equipment and people Fighting a serious fire is dangerous work that
who know how to handle the equipment. Typical should be handled by professional fire fighters.
equipment that workers can handle includes Professional fire fighters have access to neces-
portable fire extinguishers, fixed hoses on indoor sary protective clothing and breathing apparatus
fire hydrants and fire resistant blankets that can (BA) preventing the inhalation of toxic fire gases
be used to smother fire. Another major advan- and burns that can result from being close to
tage of fire resistant blankets is that they are ex- the source of a fire. If toxic fumes from a fire
cellent for putting out fire in a person’s clothes. are inhaled they can have both acute and long
Depending on the type of occupancy, differ- term consequences. People who are not trained
ent types of extinguishers can be considered. and/or equipped with BA should stay at a safe
Dry powder extinguishers are very efficient, es- distance from a fire.
pecially for untrained people, but the powder is Professional fire fighters are trained to extin-
difficult to clean away afterwards, however, fire guish fires, particularly to control and extinguish
itself creates a mess. Water or foom extinguish- small scale fires, e.g. in apartments and smaller
ers are other effective alternatives. It is not rec- premises. Fire fighters are also trained to use BA
ommended that a portable extinguisher be used inside buildings as even small fires can produce a
311
Chapter 4.8
lot of smoke. Smoke venting or sprinkler sys- use the BA also when finalizing the extinguish-
tems help to extinguish fires rapidly. ing phase but it may be sufficient to use lighter
Fire fighters are trained to be aware of and equipment instead of the heavier BA equipment.
able to detect the “flashover” point of a fire as it
rapidly change from a small local fire to a fully Equipment for professional fire fighters
developed one. When a flashover occurs all per- Fire fighters are usually equipped with tradition-
sonnel must withdraw as no one can stay more al extinguishing equipment like fire hoses, noz-
than a few seconds in a fully developed fire, but zles, BA, and protective clothing. Other equip-
trained fire fighters can also prevent a flashover ment like chain saws and high water pressure
by cooling the fire gases. (Such training is po- nozzles may also be used. Foam concentrates
tentially dangerous and must be conducted in a can be mixed with water in order to increase its
controlled environment). wetting effects, making it easier to extinguish a
Fire fighters must also be trained to deal with fire. Other extinguishing media that can be used
“backdraft” that can occur if a fire develops in are expanded foam, inert gases and dry powder.
an under ventilated environment, e.g. a closed Dry powder can also be used in portable hand
room. If smoke is hot and a vent such as a door extinguishers. Water is the most commonly used
is opened, oxygen enters the room. Because the extinguishing media. It is essential to have fire
smoke is hot and rich in fuel, it can rapidly catch hydrants located outside buildings as the amount
fire and send a large plume of flame through the of water carried by rescue service vehicles is
exit/vent, endangering nearby fire fighters. limited and transporting water takes time and
A basic requirement for a successful fire fight- energy resources.
ing operation is good access routes to a building. But, in the end it is far much better to prevent
If fire develops in larger sites such as indus- the fire from even start. Prior prevention activi-
trial complexes, it may be very difficult for fire ties must, therefore, be the first objective in fire
fighters to handle this fire as the fire fighters are safety. The fire services is called when all other
not always sufficiently trained to extinguish such fire safety barriers fail.
large fires. The first priority is usually to prevent
the fire from spreading to other buildings by
cooling neighbouring buildings by wetting the
walls from outside.
Toxic smoke is not only produced in a fully
developed fire but also occurs after the fire has
been extinguished but may is still be smoulder-
ing. Extinguishing these small smouldering fires
should also be done with some form of breathing
protection equipment. At this time the fire poses
no threat to the fire fighters and they mostly
only need to use a filter mask to avoid the most
harmful substances. The amount of toxic gases
and small soot particles is lower compared to
the fully developed fire. The best is of course to
312
Fire safety
Fire safety standards Regulations, Testing and Approval. Hanser

Gardner Publ, Cincinnati, 2004.
ADB, Approved Document B, Fire Safety. Department
of Environment, Transport and the Regions, London, World Fire Statistics. Geneva Association Infor-
2006. mation Newsletter 22, The Geneva Association,
BS 5588 series – Fire precautions in the design,
Geneva, Oct 2006.
constructions and use of buildings. British Standards
Institution, London, 1999. Billington M.J. Means of Escape from Fire.
EN 179 Building hardware – Emergency exit devices
Blackwell, Oxford, 2002.
operated by a lever handle or push pad - Require-
ments and test methods, 2008. The book provides further practical and de-
EN 1125, Building hardware – Panic exit devices tailed recommendations on evacuation design.
operated by a horizontal bar – Requirements and test It is highly influenced by British traditions.
methods, 2008.
EN 1363-1:1999 Fire resistance tests – Part 1: Gene-
ral requirements. 1999.
Useful Internet-links
EN 60849, Sound systems for emergency purposes. www.nfpa.org; National Fire Protection Associa-
1998. tion, USA.
Eurocode 1: Basis of design and actions on structure.
Provides information about fire prevention.
Actions on structures exposed to fire. ENV 1991-2-
2:1995. European Committee for Standardization, Produces standards for fire safety design.
Brussels, 1995
Eurocode 2, part 1-2: Design of concrete structures.
www.iafss.org; International Association for Fire
General rules, Structural fire design ENV 1992-1- Safety Science.
2:1995. European Committee for Standardization, The non-profit organisation promotes fire
Brussels, 1995 safety research and cooperation. The organi-
Eurocode 3, part 1-2: Design of steel structures. Gene-
ral rules, Structural fire design ENV 1993-1-2:1995.
sation has a free e-mail list discussing various
European Committee for Standardization, Brussels, fire safety related subjects.
1995
European Commission Construction Product Directive
http://iafss-es.brunamal.is
(CPD, Directive 89/106/EEC) Free lecture material on fire dynamics pro-
ISO 6182-1, Fire protection - Automatic sprinkler vided by IAFSS.
systems - Part 1: Requirements and test methods for
sprinklers. 2006 www.ife.org.uk/; Institution of fire engineers.
NFPA 13, Standard for the Installation of Sprinkler Sys- International (originally from the UK) fire safety
tems. National Fire Protection Association, Quincy, organisation.
2007.
Provides general fire safety information.
www.sfpe.org; The Society of Fire Protection
Engineers. International (originally from the
Bengtsson L-G. Enclosure fires. Swedish Rescue USA) fire safety organisation.
Services Agency. Karlstad, 2005. Provides general fire safety information.
An excellent description of the way in which a Good book shop.
fire in a compartment developed from a pre-
flashover fire to a fully developed fire. www.raddningsverket.se; The
��
Swedish Rescue
Services Agency.
Sundström B. European Union, in Troitzsch The web-pages contain information relevant
J, Plastics Flammability Handbook, Principles, for training professional fire-fighters.
313
5
Prevention of chemical risks
Introduction 317
5.1 Risk assessment and control 319
5.2 Pesticides 327
5.3 Solvents and gases 345
5.4 Dusts and metals 363
5.5 Skin disorders 375
5.6 Epidemiology 389
Suggestions for further reading 394
Introduction
Gun Nise & Catharina Wesseling
The world production of chemicals is increasing. places. A survey of workers in Europe in 2003
In 2001, 80% of all chemicals were produced in found that 16% handled hazardous products and
16 countries, (in decreasing order): US, Japan, 22% were exposed to toxic vapours. Exposure to
Germany, China, France, the UK, Italy, Korea, dangerous substances can occur in a wide variety
Brazil, Belgium/Luxembourg, Spain, the Neth- of workplaces, e.g. farms, car repair shops, prin-
erlands, Taiwan, Switzerland and Russia. How- ting plants, hairdressing saloons, etc.
ever, by 2020, developing nations are expected Working with hazardous chemical substances
to lead the world in growth rates for high-vol- always involves an element of risk of ill-health or
ume industrial chemicals, i.e. those produced at accidents because of
more than 1000 tons per year, increasing their • irritating, toxic, and sensitizing properties
share of the world’s chemical production to • radioactivity,
31% (OECD Environmental Outlook for the • displacement of atmospheric oxygen and
increased risk of fire, explosion or some other
Chemicals Industry, 2001). Since many devel-
dangerous chemical reaction.
oping countries have not yet put legislation on
chemicals in place, no one knows exactly which Chemicals can affect workers’ health in many
or in what amounts chemicals are in use there. ways, e.g. may cause fatigue, headache, dizzi-
Along with other risk factors such as smok- ness, irritation of eyes, airways and skin, asthma,
ing and alcohol, exposure to toxic substances neurological problems, cancer, endocrine and
is an important contributor to chronic disease. reproductive problems.
Furthermore, ILO estimates that occupational A polluted work environment is often harm-
exposure to hazardous substances causes some ful not only to workers but also to production.
340,000 deaths per year globally, not to men- For example, high levels of dust, oil, and paints
tion the number of workers who become ill or can interfere with efficient production, and
injured by chemicals. require extra cleaning operations and inspection
While there are tens of thousands of synthetic as well as spoiling materials or final products.
chemicals produced worldwide, the great ma- The health effects from chemical exposure may
jority of them lack adequate safety information. reduce productivity and quality, and increase
Hazardous chemicals are widely used at work- absenteeism and staff turnover. Improved con-
317
ditions increase labour output creating potential
for higher productivity and quality.
The key issue for a better working environ-
ment is knowledge among both employers and
employees. Knowledge about the possible risks
from exposure is necessary when planning a safe
working environment. Gaining acceptance of
the need to work in a safe way may perhaps take
more time because it requires understanding of
the motives for such way of working.
Many of the problems caused by chemical
hazards can be solved with little or no cost and
there are often savings in materials and energy.
5.1
Risk assessment and control

Gun Nise & Linnéa Lillienberg
To protect workers from exposure to danger- hazards are highly dependent on the amount of
ous substances requires risk assessment, action contaminant and the type of exposure. Irritat-
to remove or reduce the risks, and monitoring ing substances usually affect workers directly in
of the effectiveness of the measures taken. Risk association with the exposure, however, some
assessment identifies potential health problems exposures may not produce effects for many
and is the basis for control measures. years, e.g. asbestos may cause lung cancer many
years after exposure. Some chemicals (toluene,
chemical exposure and uptake white spirit) produce both acute, sub-acute and
routes long-term effects.
It is important to understand how a chemical
gets into the body in order to understand po- Pesticides can enter the body by dermal absorp-
tential risks of exposure. The most important tion, inhalation or ingestion. Dermal absorption
uptake routes are inhalation or through skin is the most relevant uptake route for work with
absorption. All substances reaching the work- pesticides. Absorption through the skin is more
ers’ breathing zone are inhaled as vapours, e.g. likely when a pesticide is a liquid and comes into
solvents, gases or dusts from work operations contact with sensitive skin areas like the scrotum
such as grinding, sawing, mixing, and packing and eyes. Fumigants and granulated nematocides
or liquid aerosols from e.g. spray painting and with high vapour pressure and fine particles can
by using compressed air for cleaning wet prod- readily be inhaled, especially when used in en-
ucts. The amount taken up by skin absorption closed spaces. They are then easily absorbed into
depends on the characteristics of the contamina- the bloodstream from the small airways. Parti-
tion. Skin (dermal) absorption can occur when cles that are too large to enter the small airways
the substances are in direct contact with the skin can be absorbed through the upper respiratory
or contaminated clothes. Some chemicals pen- tract. Absorption from oral exposure occurs after
etrate the skin easily, e.g. many pesticides and eating or drinking with contaminated hands,
several organic solvents. Ingestion can occur in splashes into the mouth, smoking during work,
dirty workplaces where people are allowed to swallowing large inhaled pesticide particles or
eat, drink or smoke close to the work operation from run off on the face.
area. The occupational exposures and health
319
Chapter 5.1
Occupational exposure to organic solvents The risk assessment approach to chemicals

may be through inhalation or through the skin. Make an inventory: Define the tasks to be as-
Uptake through ingestion is negligible under sessed, learn which chemicals are used, find out
normal working conditions. Inhalation into whether new chemicals are generated during the
the lungs is the most important uptake route. work process.
The solubility of a solvent into the bloodstream
Collect information: Find information about
impacts on the amount taken up. While several
chemicals in e.g. Safety Data Sheet (SDS); iden-
solvents are easily absorbed through the skin,
tify their hazardous properties.
the amount taken up is usually much less than
the amount inhaled. Assess exposure: Identify the duration, intensity,
Workers may also be exposed to dust or frequency, and uptake route (inhalation, skin
aerosols (inorganic and organic) through inha- uptake, and ingestion) of any exposures.
lation, skin contact or by ingestion. Inhalation
Rank the problems: Make a list of the identified
is the most important route of entry. Skin ab-
risks in order of severity for use in an action plan
sorption can occur when water-soluble materials
on risk reduction.
dissolve in sweat and pass into the bloodstream.
Depending on the size of the particles, dust will Several models have been suggested to specify
be deposited in different parts of the respiratory and classify the elements required for sound risk
system. Small particles (< 5µm) will primarily management. One simple model based on ISO
be deposited in the alveoli in the lung. Particles 9000 series is a four step model representing a
of 5-10 µm will predominantly deposit in the feedback loop: PLAN, DO, CHECK, ADJUST.
tracheobroncial tract, while large particles will Resources and administrative support must be
be deposited in the nose and upper airways. De- provided for risk management. Specific control
pending on the reactivity or solubility of a par- measures should not be applied in an ad hoc
ticle, small particles can also be deposited higher manner but integrated into comprehensive and
up in the respiratory system. well managed hazard prevention and control
programmes. At a specific workplace a decision
risk management
making ladder can be used to analyse the process
Risk assessment is the identification of hazards concerning hazard control, Figure 5.1.1.
that may cause adverse health effects. Proper Common sense must be used in all work with
risk assessment is a basis for appropriate preven- risk management or prevention. Can an industry
tive measures and risk management. Further- afford to do all the necessary preventive measu-
more, training workers in safe work practices is res at one time or is it better to implement them
an important part of risk management. Trained in prioritised steps? Is it worth installing equip-
workers can apply safety rules as well as promote ment for prevention or is it better to build a new
a healthy and safe work environment. Rotation safer plant? It might be better to use personal
of workers may reduce the average exposure of protective equipment for a short period rather
workers during the working day, but they will than starting preventive measures very quickly
still be exposed to high concentrations during but inefficiently.
some part of the day and therefore at risk of
adverse health effects.
320
ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ 9.ȱEvaluateȱ
ȱ ȱ ȱ ȱ ȱ ȱ ȱ 8.ȱMeasureȱ
ȱ ȱ ȱ ȱ ȱ ȱ 7.ȱFinanceȱ ȱ
ȱ ȱ ȱ ȱ ȱ 6.ȱFindȱaȱsupplierȱ ȱ ȱ
ȱ ȱ ȱ ȱ 5.ȱAcceptȱsolutionȱ ȱ ȱ ȱ
ȱ ȱ ȱ 4.ȱDevelopȱsolutionȱ ȱ ȱ ȱ
ȱ ȱ 3.ȱFindȱtheȱcauseȱ ȱ ȱ ȱ ȱ ȱ
ȱ 2.ȱAcceptȱtheȱproblemȱ ȱ ȱ ȱ ȱ ȱ
1.ȱBeȱawareȱofȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ
theȱproblemȱ
ȱ 5.1.1. The decision making ladder shows the important steps for a successful risk management
Figure
Source: A-B Antonsson, IVL, 1984.
control of hazardous substances Eliminate or replace dangerous chemicals
Hazardous chemicals or chemical products iden- The most efficient way to avoid hazardous expo-
tified during risk assessment have to be control- sure is by avoiding all use of dangerous chemi-
led. There are often simple and inexpensive ways cals. For example, it may be possible to rivet two
to control many problems and improvements of- pieces of work together instead of using glue.
ten result in cost savings and production benefits. Organic solvents are often used for cleaning and
degreasing in many work situations. Organic sol-
A plan for intervention may include the follow- vents can cause ill health and they are expensive.
ing steps: It is often possible to replace organic solvents
• Design the work process to avoid or minimise the with less dangerous substances. There are several
emitting of dangerous substances to the workers’ water-based degreasing systems available that are
environment.
as efficient as solvent-based ones and less expen-
• When possible, eliminate or substitute hazardous
substances with non- or less hazardous alternatives. sive, safer and better for the environment. When
• Change the form of dusty substance to less dusty, using water-based systems it is important to dry
e.g. pellets, flakes or liquid suspension. Use wet the cleaned products properly to avoid rust. Less
methods.
ventilation is needed except when warm alkalis
• Inspect and supervise the function of work process
regarding e.g. ventilation and temperature. are used. Respirators are not normally needed,
• Organise work so that the number of workers and though gloves and goggles should be used with
the time spent in a contaminated area are mini- alkalis.
mised.
• When exposure cannot be reduced properly, provide Use lids, covers, maintenance and enclosure
workers with appropriate personal protective equip-
ment, and ensure that they are trained to use and of processes to control hazards and reduce
maintain the equipment. losses
• Communicate the risks and the preventive meas- Substances evaporating from open containers
ures planned and implemented to all personnel.
or leaking from containers or pipes constitute
• Make up a maintenance scheme for machinery and
exhaust systems. a risk to workers health and increase costs. The
321
Chapter 5.1
Figure 5.1.2. Use of lid and cover to reduce emission and exposure.
use of special lids can reduce vapours from or- fume clearance and a through draught, Figure
ganic solvents, glues and paints. The dispersion 5.1.3. Such ventilation systems are not designed
of aerosol from operations such as grinding and to dilute hazardous emissions, and are therefore
mixing, Figure 5.1.2, can be reduced by the use only applicable to factories, stores and general
of covers. Poor machine maintenance can also workshops where no significant hazardous emis-
create health risks and material losses. Dripping sions occur. If the purpose is to dilute known
oil can affect workers skin, make floors slippery workplace emissions to safe concentrations in
and constitute a loss of expensive oil. Some risks situations where local exhaust ventilation cannot
can be reduced by enclosure of a process e.g. in be applied, clean air can be introduced at ceiling
metal cutting operations using metalworking level with diluted emissions extracted at floor
fluids. Exposure can then be limited to work level. Open windows and doors are often used to
tasks during short time periods, e.g. changing dilute emissions. When placed properly, a simple
tools or process controls.
Good housekeeping reduces exposure

Working procedures, such as grinding, sawing,
mixing and packing, generate dust. The particle
size varies and so does the hazard. A dusty envi-
ronment badly affects materials and machines
as well as the health of workers. Dust should
be removed as soon as possible after it appears.
Residual dust should be removed daily and more
comprehensive cleaning should be carried out
when needed.
Dilution and general ventilation

General ventilation in industrial settings is nor-
mally provided by means of extract fans at roof Figure 5.1.3. The principle of good general venti-
level. Good general ventilation means rapid lation.
322
fan can be used to reduce hazardous emissions Local exhaust ventilation

from a worker’s breathing zone, Figure 5.1.4. Local exhaust or ventilation devices are often
very efficient��
methods to��
eliminate chemical
emissions at source. Hoods that are designed to
draw the air upwards are best suited to capture
pollutants that rise naturally, e.g. hot gases or
vapours. Hoods can also be placed at the side
or behind the source. It is important that the
distance between the source and the hood is
as small as possible, since the face velocity will
quickly decay with distance. Furthermore, it is
important that the air flow moves the pollutant
away from the worker’s breathing zone,
Figure 5.1.5.
Enclosures
Total enclosures under negative pressure, are
systems designed to reduce the risk of expo-
sure from the most toxic substances. Inside the
enclosure, the pressure is maintained below
atmospheric pressure in order to ensure that if
the enclosing fabric is broken, air will flow in-
Figure 5.1.4. The use of a fan to reduce hazardous wards so that nothing will escape to the outside.
emissions. Examples of such devices are hot cells, glove
boxes, and blasting cabinets.
Wrong Right
Figure 5.1.5. It is important that the worker don’t have to stay between the hood and the source of the
emission.
323
Chapter 5.1
Partial enclosures with exhaust ventilation are improved by using a small fan to push clean air
devices where the source of emission is enclosed in the direction to the exhaust fan, Figure 5.1.7.
on all sides except the one where access is need- In order to avoid turbulence, the capacity of the
ed. An air velocity (face velocity) is maintained push fan shall be 10-20 per cent of the exhaust
at the opening, which must be sufficiently high fan. Push-pull ventilation can work either hori-
to prevent the substances from escaping through zontally or vertically.
the opening. The direction of the air added to
the opening area is important to avoid distur- Displacement ventilation
bances in the air flow around the worker, Figure With displacement systems, air is introduced at
5.1.6. low velocity through floor terminals or other
diffusers. Cool air floods the floor and the room
Push-pull ventilation heat sources lift the air up past the occupied
The capability of exhaust devices or fans to zone and is then exhausted at high level. The
remove contaminated air is limited. Exhaust principle is to flood the working area with clean
systems used in operations such as welding, air, which moves the emission towards extract
degreasing or spray painting, are often not suf- grilles or fans placed at the opposite wall or at
ficient to remove emissions. The systems can be the ceiling level, Figur 5.1.8.
To remember when looking for hazards:
Caused by the process: Open processes, e.g. mixing in

open containers, painting big surfaces.
Processes generating dust or aerosols, fumes, vapours,
e.g. welding, grinding, spray painting
Related to the chemicals that:
lead to high exposure of workers
result in many workers being exposed
ȱȱȱ are highly volatile
are dispersed in the air
an cause health risks, either acute (e.g. poisons,
c
irritants) or chronic (e.g. allergy, asthma, known oc-
cupational diseases)
are toxic for reproduction
Personal protective equipment

ȱ If exposure cannot be adequately controlled in
Figure
ȱ 5.1.6. With the air supply at the opposite any other way, workers must wear personal pro-
wall there is risk of whirls around the worker tective equipment (PPE). PPE consists of devic-
(above). Air supply above the worker minimises es provided to workers and required to be worn,
this risk (bottom). while they perform job tasks that risk hazardous
324
ȱȱȱȱ ȱ
ȱ
Figure 5.1.7. Push pull ventilation; improved ventilation with help of a small fan.
exposure. PPE should only be used for a short

time until other control measures have been
installed or when there are no other alternatives
to prevent hazardous exposure.
The workers may need to wear one or more of

the following:
• ��
Protective overalls;
• Appropriate gloves which have been selected to pro-
tect from adverse contact with specific chemicals;
• Face shields;
• Respiratory protective equipment, where ventilation Fig 5.1.8. The principles of displacement ventila-
doesn’t provide adequate control; tion; cool air is supplied at low velocity near the
• Air-purifying respirators, half-mask respirators fitted floor and spread over the floor. Convection from
with the appropriate filter will often be sufficient. If heat sources creates vertical air motion into the
work includes spraying or work in a confined space, upper zone where contaminants are exhausted.
atmosphere-supplying respirator that provides breath-
able air from a clean air source may be necessary. (Health & Safety Executive, UK). The IPCS
established (2003) an international group that
Workers who need to wear PPE should be trai- has further developed a “Workplace Chemicals
ned in its proper use and on its limitations. It is Control Kit” designed for Small and Medium-
also important to store PPE away from chemi- sized Enterprises (SMEs) in developing coun-
cals, to maintain it and to keep it clean. tries. The aim was to provide simple and practi-
cal means to prevent/reduce risks of chemical
ilo chemical control toolkit exposures. The toolkit includes five stages:
(icct) Hazard classification
IOHA (International Occupational Hygiene Includes determination of the hazards presented
Association) has prepared an “International by the chemicals (based on Globally Harmo-
Toolkit” for ILO from COSHH Essentials, HSE nized System of Classification and Labelling of
325
Chapter 5.1
Chemicals, GHS). There are six hazard groups,

five for inhaled chemicals and one for skin
contact. A three-step reference table is used to
assign a hazard group to the chemical.
Scale of use
A matrix helps to determine the amount of
chemicals used or handled.
Ability to be airborne
The physical form of the chemical has an impact
on the likelihood of the chemical to get into the
air. Three levels are chosen both for solids and
liquids.
Finding control approach
Using steps 1-3, it eral ventilation, engineering
controls, containment and special controls.
Finding the task-specific control guidance sheet(s)
A general guidance sheet for each approach
is currently available and task specific control
guidance sheets will be developed.
More information can be found on website of
the SafeWork programme www.ilo.org/safe-
work, under the topic Control Banding.
326
5.2
Pesticides
Catharina Wesseling
Pesticides are one of the most important chemi- Today dependence on chemical pest control
cal hazards in developing countries. This in- is ubiquitous and pesticide use continues to
trinsically dangerous technology is promoted in increase, mainly in developing countries. Pesti-
settings that lack resources to control it. This cides production has been estimated at 2.6 mil-
chapter aims to: provide an overview of the oc- lion tons of active ingredients in 1998, of which
cupational exposures and health risks associated 25% ends up in developing countries. There are
to pesticide use, emphasising pesticide use in some 750 distinct active ingredients in common
agriculture; critically examine current risk as- use globally. Pesticides are usually grouped into
sessment and risk management processes, spe- categories with certain common chemical, and
cifically the “safe use approach”; and to propose toxicological, characteristics. Examples are or-
strategies to effectively reduce pesticide-related ganochlorine, organophosphate, carbamate, and
Occupational Safety and Health (OSH) risks. pyrethroid insecticides; chlorophenoxy, triazine,
and bipyridyl herbicides; and inorganic and
what are pesticides? dithiocarbamate fungicides, Figure 5.2.1. How-
Pesticides, literally, are pest killers and they are ever, as new pesticides continue to appear on
designed to interfere with a variety of biological the market, categorization by chemical groups is
targets in living organisms. Inorganic substanc- becoming very complex. Some important pesti-
es, such as sulfur and arsenic, were already used cides are difficult to classify or can be classified
as pesticides 2,000 years ago, but it was not until into several categories.
DDT was developed in 1939 that the economic
potential of pesticides was fully discovered. The workers exposed to pesticides
term “pesticide” usually refers to insecticides, Pesticides are primarily used in agriculture,
nematocides, herbicides, fungicides and roden- the most important economic sector in many
ticides, but also includes agents regulating plant developing countries. The proportion of farm-
growth and fruit thinning agents. Since living ers that uses pesticides, and the extent to which
organisms share many biological systems, pes- they use them, varies widely between and within
ticidal action also commonly affects non-target countries, depending on the types of agricul-
species, including humans. tural production and other socio-economic and
327
Chapter 5.2
Chemical group Biocidal action Examples of specific pesticides

Organochlorines (OC) Insecticides DDT, methoxychlor, dicofol, BHC, lindane, aldrin,
dieldrin, endrin, chlordane, heptachlor, endosulfan,
toxaphene, chlordecone, mirex
Organophosphates (OP) Insecticides, nematocides Methyl parathion, chlorpyrifos, diazinon, me-
thamidophos, terbufos, malathion, coumaphos,
dichlorvos, ethoprophos, fenamiphos, monocro-
tophos, oxydemeton-methyl, phorate, temephos,
azinphos-methyl
Carbamates Insecticides, nematocides Aldicarb, carbaryl, carbofuran, methomyl, oxamyl,
propoxur, thiodicarb
Pyrethroids Insecticides Permethrin, tetramethrin, allethrin, fenvalerate,
deltamethrin, cypermethrin
Biological pesticides Insecticide Bacillus thuringiensis
Insecticide-fumigant Nicotine
Anilides Herbicides Alachlor, propachlor, propanil
Bipyridyl compounds Herbicides (nonselective, Paraquat, diquat
desiccants)
Chlorophenoxy acids Herbicides (broadleaf weeds) 2,4-D, MCPA, 2,4,5-T
Nitrophenols Herbicides (some multiple Dinoseb, dinitrophenol, dinitrocresol
biocidal action)
Phosphonates Herbicides Glyphosate
Picolinic acid Herbicide Picloram
Thiocarbamates Herbicides Vernolate, tiobencarb
Triazines Herbicides Ametryn, atrazine, cyanazine, metribuzin, propazine,
simazine, terbuthylazine
Triazoles Herbicides Amitrole
Uracils Herbicides Bromacil
Urea derivatives Herbicides Diuron, flumeturon, linuron, methabenz-thiazuron,
monuron, tebuthiuron
Anticoagulants Rodenticides Warfarin, superwarfarins
Inorganic compound Rodenticides Thalium sulfate
Fungicides Copper, arsenic, cadmium compounds
Fumigants Zinc phosphide, aluminum phosphide
Dithicarbamates Fungicides Maneb, zineb, mancozeb, nabam, ferbam
Thiophtalimides Fungicides Captan, captafol, folpet
Organotin compounds Fungicides Fentin acetate, fentin hydroxide
Organomercury compounds Fungicides Methyl mercury, methoxyethyl mercury compounds
Miscelaneous fungicides Fungicides Benomyl, chlorothalonil, metalaxyl, thiabendazole,
triadimefon, imazalil
Fumigants Chloropicrin, dibromochloropropane, 1,2-dichlo-
ropropane, 1,2-dichloropropene, ethylene dibro-
mide, methyl bromide, hydrogen cyonide, carbon
disulfide, phosphine
Figure 5.2.1. Selected chemical groups of pesticides with examples of specific pesticides.
328
Pesticides
cultural factors. The production of ornamental tion with a backpack, or distribute a powdered
plants, tropical fruits, vegetables, and other cash formulation by means of a closed-cabin tractor.
crops are particularly reliant on chemical inputs, Tasks involving direct handling of pesticides are
but pesticide use is generally widespread. As most often carried out by men, whereas women
an example, in Costa Rica, close to 100% of workers usually perform tasks with indirect
the farmers use pesticides and on average, each exposures. However, sometimes women work
agricultural worker uses over 20 kg of active as pesticide applicators, for example spraying
ingredient. fungicides on banana crowns in the packing
Women’s participation in agricultural export plants of banana plantations in Central America,
production has increased worldwide. Women or spraying the herbicide paraquat on coconut
frequently perform unpaid agricultural tasks on plantations in Malaysia.
family farms. Rural women also have an impor-
tant role in the informal agricultural sector, for routes of exposures and uptake
example as temporary workers in coffee and fruit Pesticides can enter the body by dermal, inhala-
harvests. Pesticide exposures among women may tion or oral exposure routes. Dermal exposure
be much more frequent and higher than previ- is the most relevant route of exposure and, in
ously believed. a majority of pesticide exposure situations, re-
Many workers are also exposed to pesticides sponsible for most of the body burden. Absorp-
outside the agricultural sector. Examples include tion through the skin is especially high, when
industrial workers in factories manufacturing or the pesticide is in liquid form and when con-
formulating pesticides, workers in commercial tamination occurs in skin areas that easily absorb
establishments that sell pesticides, applicators pesticides, for example the scrotal skin or the
controlling industrial or domestic pests, vector eyes. Fumigants, granulated nematocides with
control workers, gardeners, workers in food a high vapour pressure, and powdered formula-
processing plants, and hotel and domestic serv- tions with fine particles can be readily inhaled,
ice workers. especially when used within enclosed spaces,
and are then easily absorbed into the blood from
pesticide related tasks in the small airways. Particles too large to enter
agriculture the small airways can be absorbed through the
Exposures occur primarily by handling pes- mucous membranes of upper respiratory tract.
ticides during mixing, loading and spraying. Absorption from oral exposures occurs after
Exposures also occur during transportation, eating or drinking with contaminated hands, by
maintenance of spray equipment, flagging, at fu- means of splashes into the mouth, smoking dur-
migation airports, in pesticide storehouses, and ing work, and through swallowing big inhaled
during work close to fields being sprayed or after pesticide particles or run off from the face.
re-entry into recently sprayed fields (harvesters
or trimmers), or during selection and packing of health risk profiles of pesticides
freshly sprayed fruits and vegetables. Within job The risk profiles of pesticides are concerned
categories, exposures vary widely. Applicators with the relationships between exposures, toxic-
may distribute a granulated nematocide with ity, host factors and the consequent probability
bare hands, spray a liquid pesticide formula- of health effects. Along with the chemical heter-
329
Chapter 5.2
ogeneity, the toxicity of pesticides differs greatly tions, are largely unexplored but becoming an
and a diversity of health effects may occur, issue of increasing concern. Host susceptibility
including systemic poisonings; topical lesions factors such as age, gender, and nutritional status
of skin and eyes; respiratory, immunological, also influence the occurrence of health effects.
neurological, and developmental effects; re- It has been demonstrated that genetic polymor-
productive dysfunction; cancer; and disruption phisms may influence individual susceptibility
of different hormonal pathways. The risk that for poisoning, the development of chronic pesti-
a health effect will occur is basically defined cide-related ill health, or cancer. Illiteracy, poor
by the inherent toxicity of a compound and sanitation, high prevalence of infectious diseases,
the characteristics of exposure. Adverse health environmental pollution, and general conditions
effects may be reversible or irreversible, the of poverty are external factors that also influ-
onset may be immediate or delayed, the mag- ence the health risks for workers, by increasing
nitude of an effect may be mild or severe, and the probability of exposures, synergistic effects
the duration may be short or long-term. Dif- between toxic agents, or weakening of the im-
ferences in types of exposures (routes, intensity, mune system.
duration, peak and cumulative exposures) to the
same compound may relate to different health chemical classes of pesticides and
outcomes. Thus, the risk profiles of pesticides health effects
are often complicated by the diversity of possible
toxicity-exposure combinations. Organochlorine pesticides (OCs)
In addition, the health effects of exposures to OCs are composed of the following subgroups:
mixtures of pesticides, (simultaneously or at dif- DDT and its analogues (methoxychlor, dicofol),
ferent moments in time), and toxic effects from cyclohexanes (BHC, lindane) and cyclodienes
the “inert” ingredients in the pesticide formula- (aldrin, dieldrin, endrin, chlordane, heptachlor,
E x p o su re s H e a lth effe c ts
U n iq u e m a ssive d o se
e n z ym a tic c h a n ge s
p o iso n in gs
T o x ic ity
p ro p e rtie s sk in , e ye le sio n s
re sp ira to ry e ffe c ts
H o st n e u ro to x icity
fa c to rs im m u n o to xic ity
re p ro d u c tive e ffec ts
cancer
L o n g -te rm re p e ate d lo w d o se s
O n se t: im m e dia te ----- d e la ye d
R o u te s o f a b so rp tio n D u ra tio n : sh o rt ----- lo n g te rm
M ix e d e x p o su re s M a gn itu d e : m ild ----- se ve re
P ro gn o sis : re ve rsib le ----- irre ve rsib le
Fig 5.2.2. A schematic illustration of the complex relationship between different characteristics of exposure
and a range of health outcomes.
330
Pesticides
endosulfan), toxaphene and related compounds, sure. OCs have estrogenic or anti-androgenic
and others (chlordecone, mirex). Important properties. Their endocrine disrupting effects
characteristics of OCs are their lipid solubility have been associated to cancer occurrence in
and slow degradation resulting in persistency experimental animals and reproductive effects
and bioaccumulation. OCs can be stored in body in wildlife, and these toxic pathways may play a
fat deposits for decades. Neuronal hyperactivity role also in humans. OCs have been associated
is the main and common acute poisoning symp- with leukemia, non-Hodgkin’s lymphoma, soft
tom of most OC compounds. tissue sarcoma, multiple myeloma, and cancer
OC pesticides were the first group of chemi- of the pancreas, lung, liver, skin, and breast.
cals synthesized to kill pests and have been Endosulfan has been identified as the cause
extensively used worldwide after World War II of reproductive and developmental effects in
up to the 1970s. Many OCs are now recognized exposed human populations in India.
as Persistent Organic Pollutants (POPs) by the In addition, there are many organochlorine
Stockholm Convention of 2001 and are being pesticides classified elsewhere, for example,
phased out globally. However, endosulfan is chlorothalonil (an irritant, allergen, and possible
widely used in developing countries, although its carcinogen), captafol (a carcinogen), chlorpyrifos
listing in the Stockholm Convention has been (a neurotoxic cholinesterase inhibitor), chlo-
proposed recently. In addition, intense discus- rophenoxy acids (carcinogens), and chloropicrin
sions are ongoing on renewed use of DDT for and 1,3-dichloropropeno (respiratory irritants).
malaria control.
Organophosphate pesticides (OPs)
Acute poisonings OPs currently in common use include chlorpy-
Acute poisonings by DDT are infrequent but rifos, coumaphos, diazinon, dichlorvos, ethopro-
are characterized by neurological symptoms of phos, fenamiphos, malathion, methamidophos,
gradually increasing severity (paresthesias, head- monocrotophos, oxydemeton-methyl, phorate,
ache, dizziness, irritability, confusion, tremor, temephos, terbufos, and in some countries me-
up to convulsions and coma) and non-specific thyl-parathion. OPs are cholinesterase inhibitors
general malaise (nausea, vomiting and fatigue). and the main toxic action is on the nervous sys-
Cyclodienes, among them endosulfan, are eas- tem. Under physiological conditions the enzyme
ily absorbed through the skin and considerably acetylcholinesterase controls the transmission of
more toxic. Convulsions are often the first poi- the nerve impulses at the cholinergic synapses
soning symptom. Although banned OCs are no throughout the nervous system by hydrolyzing
longer a problem with regard to acute toxicity, the neurotransmitter acetylcholine. In exposed
endosulfan is still the cause of numerous occupa- organisms, OPs serve as alternative substrate
tional poisonings including fatal poisonings. for acetylcholinesterase, causing accumulation
of the acetylcholine and overstimulation at the
Chronic and delayed health effects receptors with the appearance of a cholinergic
Neurobehavioral impairment and increased syndrome. OPs form stable complexes with
reporting of neuropsychological symptoms acetylcholinesterase and recovery of the phos-
have been observed among Costa Rican vector phorilated enzyme may depend on new protein
control sprayers with long-term DDT expo- synthesis. Many OPs are classified by the In-
331
Chapter 5.2
ternational Program on Chemical Safety of the Chronic and delayed health effects
World Health Organization (WHO-IPCS) as It has been demonstrated that damage of the
highly (Ib) or extremely (Ia) toxic. central nervous system remains after occupa-
OPs, mostly insecticides and nematocides tional OP poisonings with impairment of a
used as substitutes for OCs, are less persist- broad spectrum of functions, including memory,
ent but more acutely toxic pesticides. They are concentration, and psychomotor and visuomotor
among the most used pesticides in develop- functions. Neuropsychiatric symptoms, among
ing countries. Parathion (ethyl and methyl) is them depression and suicidal ideation, are more
the only example of a pesticide that has been frequent among workers with a previous OP
restricted in many developing countries after poisoning. It is uncertain whether repeated low-
WHO-IPCS, based on its history of hundreds of dose OP exposures without poisonings cause
fatal occupational poisonings, classified it in the similar deficits among workers.
Ia (extremely toxic) category instead of in the Some OPs (for example, methamidophos,
lower category corresponding to its acute toxic- chlorpyrifos, fenthion, trichlorphon and par-
ity in rats. athion) can cause an organophosphate induced
delayed neuropathy (OPIDP). OPIDP is a de-
Acute poisonings generation of the large diameter axons of the pe-
OPs are easily absorbed through the skin and ripheral nervous system and spinal cord. OPIDP
some OP nematocides such as terbufos are also a is associated with the inhibition and “aging” (ir-
considerable respiratory hazard with a very high reversible inhibition) of another enzyme in the
vapour pressure. OPs present the most frequent nervous system, the neurotoxic target esterase
cause of occupational poisonings in most de- (NTE). OPIDP is characterized by weakness,
veloping countries. Acute poisoning symptoms ataxia and paralysis, and sensory disturbances of
include central nervous system symptoms (head- the extremities. OPIDP appears several weeks
ache, dizziness, anxiety, confusion, convulsions, after the acute poisoning crisis has resolved and,
coma), autonomic nervous system (contracted in severe cases, leaves permanent damage. A
pupils, blurred vision, sweating, salivation, lacri- so-called Intermediate Syndrome has also been
mation, bradicardia or taquicardia, bronchial se- described, characterized by muscle weakness
cretions, bronchoconstriction, nausea, vomiting, of proximal limb and respiratory muscles, days
abdominal cramps, diarrhea, increased urination, after the acute poisoning episodes. Epidemio-
loss of control of sphincters), and of the skeletal logic studies have found persistent weakness,
muscle myoneural junctions (muscle fascicula- increased vibration thresholds, or slowed nerve
tions and cramps, muscle weakness, paralysis). conduction among workers with previous OP
These symptoms may evolve into respiratory poisonings.
failure and death. Although there is an antidote In addition to the effects on the nervous
(atropine), occupational OP poisoning can be system, OPs have been associated with occupa-
fatal, especially in regions with poor access to tional cancers, in particular non-Hodgkin’s
adequate health care. lymphoma (dichlorvos, diazinon, malathion),
leukemia, and lung cancer; endocrine disruptive
properties (malathion, methylparathion, dichlor
vos, diazinon, chlorfenvinphos and others), and
332
Pesticides
to male reproductive effects (chlorpyrifos). due to carbofuran could not be ruled out, overall
Prenatal parental occupational exposures to OPs such effects do not seem to be very common or
have been linked to childhood leukemia among severe. The nematocide aldicarb has been asso-
their children. Many OPs are also skin sensitiz- ciated to immunotoxic responses.
ers, for example chlorpyrifos and malathion.
Pyrethroids
Carbamates Pyrethroid insecticides cause a repetitive neuro-
Carbamate insecticides and nematocides include nal discharge by delaying the closure of the so-
aldicarb, carbaryl, carbofuran, methomyl, ox- dium channel in the nerve fibres after the action
amyl, propoxur, and thiodicarb. Carbamates are potential. Pyrethroids can be grouped in two
also cholinesterase inhibitors, but differ from classes in accordance with chemical structure
OPs in that the carbamylated acetylcholineste- and symptoms. Both Type I (permethrin, te-
rase enzyme combination does not “age” and tramethrin and allethrin) and Type II (fenvaler-
the enzyme is spontaneously reactivated. Car- ate, deltamethrin, cypermethrin) cause increased
bamates are in common use in most developing hyperexcitability of the peripheral nerves.
countries, in agriculture, vector control and for Since the 1980s, pyrethroid insecticides have
domestic pest control. been marketed as a less toxic and non-persist-
ent chemical alternative to OCs, OPs and car-
Acute poisonings bamates. Pyrethroids are more expensive than
Exposure routes are the same as for OPs. Many the highly toxic OPs and carbamates, so the
carbamates are also highly or extremely toxic cholinesterase inhibitors are often preferred by
(e.g. aldicarb, methomyl and carbofuran) and farmers with scarce resources. Yet, use of pyre-
poisonings have the same clinical manifesta- throids is widespread in many developing coun-
tions as OP poisonings but are usually of shorter tries, in agriculture, vector control and control
duration and therefore less severe. Occupational of domestic pests.
fatalities are rare. In the late 1980s and early
1990s, aldicarb was used as a nematocide on ba- Acute poisonings
nana plantations in Central America and caused Dermal absorption and inhalation of pyrethroids
several thousands of mild and moderate occupa- is low. Acute poisonings are less frequent than
tional poisonings. Carbofuran has caused poi- poisonings with cholinesterase inhibiting pesti-
soning epidemics in Nicaragua and Costa Rica. cides but do occur regularly. Type I pyrethroids
cause tremor and increased body temperature.
Chronic and delayed health effects Type II pyrethroids cause tingling, stinging and
It is generally assumed that carbamates do not burning skin sensations (paresthesias), irritant
produce chronic central or peripheral nerv- respiratory symptoms, salivation, and writhing
ous system effects, because of lack of aging, but of the limbs and trunk (choreoathetosis). There
there are a number of case reports documenting are several reports, in China and the USA, of
such effects, for example in relation to carbaryl workers with abnormal skin sensations. In par-
and carbofuran. So far, only one small epidemio- ticular the face is affected by paresthesias. In
logical study has been carried out in Costa Rica. China, several systemic occupational poisonings
Although mild chronic neurobehavioral deficits
333
Chapter 5.2
with decreased consciousness and seizures have Swedish government sued the Commission for
also been reported. deficient assessment of the health risks.
Chronic and delayed health effects Acute poisonings

Several pyrethroids are corrosive to the eyes. Little is known about systemic absorption of
Long-term neurotoxic effects in humans have paraquat during occupational exposures. It is
not been reported. Immunotoxic responses have likely that exposures during work that result
been demonstrated for several pyrethroid insec- in systemic absorption often involve oral con-
ticides in experimental studies, but no data exist tamination. Paraquat can also enter the body
in exposed workers. through the skin, especially in the presence of
skin lesions or after paraquat has damaged the
Bipyridyl compounds skin barrier. Respiratory exposure has been
This group consists mainly of the contact herbi- considered negligible based on big particle size,
cides paraquat and diquat. Paraquat is classified low vapour pressure, and low measured inhala-
by IPCS-WHO as toxicity category II (moder- tion levels. However, this has been questioned
ately toxic) based on acute oral toxicity data in by several studies that observed systemic effects
rats, although the toxicity of paraquat in humans from respiratory exposures. In addition, frequent
is known to be much higher. Independent on the episodes of nosebleeds indicate that paraquat
route of entry, paraquat accumulates in the lung, particles reach the upper airways. It remains
where free radical-mediated membrane damage uncertain at which inhalation levels nosebleed
of the alveolar cells seems to be the determining occurs and whether these levels may be relevant
toxic mechanism. for systemic uptake.
Paraquat, one of the most used herbicides Paraquat poisoning is characterized by mul-
worldwide, is a controversial compound. tiple organ failure, most frequently kidney,
Paraquat is promoted by the manufacturers as liver and lung (adult respiratory deficiency syn-
a safe herbicide provided it is used in accord- drome), and occasionally also the central nerv-
ance with label instructions, but recent stud- ous system, heart, and suprarenal glands. Severe
ies on exposure assessment and health effects gastrointestinal burns occur in case of ingestion.
demonstrate that determinants of exposure that Death is primarily a consequence of respira-
were identified thirty years ago, still prevail in tory failure from either pulmonary edema in the
developing countries, for example defective and first few days or extensive alveolar damage and
leaking spray equipment, absence of or deficient fibrotic changes in later stages. No antidote or
personal protective equipment, and inadequate effective treatment has been identified. Fatalities
spraying techniques such as spraying against after suicidal ingestions of very small amounts
the wind. Global campaigns to ban or severely run in the thousands. Mild systemic occupa-
restrict paraquat have been ongoing since the tional poisonings are common; severe and fatal
1980s. In 2003, the European Commission’s occupational poisonings are not frequent but
Standing Committee on the Food Chain & do occur. Fatal suicidal and accidental paraquat
Animal Health voted to include paraquat in the poisonings are more frequent among those
list of pesticides permitted in EU countries, working in agriculture than among the general
but in 2007 this decision was reversed after the population.
334
Pesticides
Skin and eye injuries Chlorophenoxy herbicides

Paraquat is also a severe skin and eye irritant. The systemic herbicides 2,4,5-T, MCPA and
The irritative and corrosive properties of 2,4-D belong to this group. Globally 2,4-D is
paraquat cause skin injuries in a very high pro- one of the most used herbicides, used on many
portion of paraquat users (as high as 50% in ex- crops. In Central America it is aerially sprayed
posed workers in both early and recent surveys) on rice and sorghum. Since the early and mid
ranging from red, swollen and blistered skin up 1980s, 2,4,5-T is not marketed in most coun-
to third degree burns needing skin grafts. Inju- tries due to its dioxin contamination (see below).
ries in the eye can equally range from mild con- Agent Orange, a mixture of 2,4,5-T and 2,4-D,
junctivitis up to permanent loss of vision due to with high dioxin contamination, was used as a
burning and scarring of the cornea. Nosebleeds defoliant during the Vietnam War.
occur from irritation of the upper respiratory
mucous membranes. Nail damage is frequent Acute poisonings
and can be permanent with long term exposure. The main exposure route is oral, absorption by
inhalation is moderate and skin absorption is
Chronic and delayed health effects poor. Acute toxicity is low to moderate. Cases
In Nicaragua, a dose-response gradient between of acute poisonings occur with some frequency,
intensity of exposure and the prevalence of but occupational fatalities are unknown. Symp-
respiratory symptoms was reported. In South toms include nausea, vomiting, abdominal pain,
Africa, in one study clinical and histological lung diarrhea, headache, fatigue, weakness and, in
lesions were observed among exposed workers severe cases, muscle pain and contractions, elec-
who had skin injuries, and another study associ- trocardiographic changes, and kidney failure.
ated arterial oxygen desaturation during exercise
with long-term paraquat exposure, which was Chronic and delayed effects
also observed in a Costa Rican study. Skin can- Few cases of chronic toxicity of the peripheral
cer has been observed among industrial paraquat nervous system and muscles have been reported.
workers in Taiwan. Paraquat has been linked Chlorophenoxy herbicides have been associated
with Parkinson’s disease in several epidemiologi- with soft tissue sarcoma and lymphohematopoi-
cal studies. The causality of paraquat in Parkin- etic cancers among Swedish forest workers and
son’s disease is supported by recent experimental US farmers.
studies that have shown that paraquat affects the In earlier times, these herbicides, in particular
dopaminergic system of the brain. In addition, 2,4,5-T, contained 2,3,7,8-tetrachlorodibenzo-p-
synergism with maneb, a manganese containing dioxin (TCDD) as a contaminant. TCDD is an
dithiocarbamate fungicide, has been observed. established animal carcinogen, an endocrine dis-
From an occupational health point of view, this rupter, a teratogen, an immunotoxin, and causes
is of great concern considering that both types chloracne, a severe skin disease. There is con-
of pesticides are widely used, often by the same troversy whether TCDD may be responsible for
farmers. the cancer excesses observed in worker’s popula-
tions exposed to chlorophenoxy herbicides. The
question of effects from TCDD on the offspring
335
Chapter 5.2
of Vietnam veterans and the Vietnamese popula- in fruit and flower production in developing
tion remains unresolved. countries. Systemic poisonings are characterized
by neurological symptoms and irritation of the
Dithiocarbamates respiratory tract. Methyl bromide can also cause
This category concerns a group of widely used severe skin burns. Other widely used fumigants
fungicides mancozeb, maneb, zineb, ziram, and include chloropicrin and 1,3-dichloropropene
ferbam (all with a metal atom: manganese, zinc with irritative respiratory symptoms that can
or iron). For over 30 years, mancozeb has been lead to vomiting and bronchospasm. Dibromo-
the pesticide with the highest import volume in chloropropane (DBCP), a nematocide used on
Costa Rica, where it is aerially sprayed on ba- banana and pineapples in the 1970s, is a sperma-
nana plantations. totoxin and left many thousands of male workers
The acute toxicity of dithiocarbamates is low in Latin American, Africa and Asia, hypo- or
and systemic poisonings are rare. These fungi- azospermic and childless. Other health effects
cides irritate the skin, eyes and respiratory tract. from DBCP, a multiple site animal carcinogen
The metabolite ethylene thiourea (ETU) of the and an endocrine disruptor, have not been evalu-
ethylenebisdithiocarbamates (EBDC) fungicides ated.
mancozeb, maneb and zineb is a well-recognized
animal carcinogen. Dithiocarbamates can cause Other compounds
irritant or allergic contact dermatitis and eye There are many other chemical categories and
irritation, ETU being the possible sensitizer. specific pesticides of concern for developing
ETU has also been associated with adverse countries, in particular herbicides and fungi-
effects on the thyroid. Manganese is a known cides. In general, they have a low acute toxicity
dopamine neurotoxicant and maneb has been but may pose considerable allergenic, carci-
associated with a Parkinson like syndrome in nogenic, and reproductive risks for long-term
exposed workers in Brazil. In animal experi- exposed workers. Persistent triazine herbicides
ments, interaction of maneb with paraquat has have been linked to ovary cancer in exposed
been observed in the destruction of dopaminer- female workers. Benomyl and chlorothalonil are
gic neurons, suggesting a synergistic role in the both skin irritants and sensitizers, and animal
etiology of Parkinson’s disease. data on carcinogenicity are sufficient. Glypho-
sate is the main chemical substitute for paraquat.
Fumigants This herbicide, and in particular the most
Fumigants are not a class of chemicals but a het- important commercial brand Roundup, is an
erogeneous group of broad-spectrum biocides irritant for skin, eyes and respiratory tract and
in gas form with different chemical structures may affect foetal development. Copper based
and toxicities. Being gases, the main exposure fungicides are often contaminated with arsenic;
route is respiratory, but they can also be easily inorganic and organic arsenic pesticides are
absorbed by dermal and gastrointestinal routes. recognized human carcinogens.
WHO-IPCS does not classify the toxicity of
fumigants but many are highly toxic. Methyl “Inert ingredients”
bromide, a fumigant currently being phased out The inert ingredients in a pesticide formulation
in industrialized countries, is increasingly used are often not specified. They include solvents,
336
Pesticides
adsorbents, emulsifiers, stickers, penetrants, and users are in general aware that pesticides are
synergists. Solvents and adjuvants may be more dangerous and cause health and environmental
toxic than the pesticide itself or they may in- effects. However, these same studies also show
crease dermal absorption enhancing the toxicity that hazardous work practices continue as shown
of the pesticide. In addition, many of these in Figure 5.2.3. This table contains data from a
compounds are skin irritants and sensitizers. recent Nicaraguan national survey, which found
Such products include alcohols, ethers, aliphatic high prevalences of risk factors for pesticide ill-
and aromatic hydrocarbons, and chlorinated ness and an incidence of 6.4 poisonings, mostly
hydrocarbons. A widely used synergist is pipero- occupational, per 100 rural inhabitants in one
nyl butoxide, which has a low acute toxicity but year. A burning question is why are pesticides
could possibly inhibit pesticide-metabolizing still a problem despite more awareness about the
enzymes. risks?
knowledge, attitudes and Practice %

Purchase of pesticides 97
practices in developing countries
No use of personal protective equip-
Despite listing a considerable number of pesti- 90
ment
cides and their health effects, the occurrence of Leaving containers in the field 41
many potential health effects from pesticide Pesticide spills during the previous
39
exposures in human populations still remains year
uncertain or unknown. Reasons for these uncer- Entering recently sprayed areas 38
Decanting of pesticides 27
tainties include lack of registration of diseases,
Blowing on blocked spray nozzles 25
incorrect diagnoses of the etiologies, difficulties
Disposal of toxic waste in rivers 19
of linking a health effect to a specific pesticide in Washing equipment in rivers 18
the presence of multiple exposures, and gaps in Eating after application without wash-
scientific knowledge on specific pesticides, for- 10
ing hands
mulations of pesticides, multiple exposures, as Letting their children work with pesti-
3
well as host and external factors modifying cides
toxicities and exposures. Figure 5.2.3 Pesticide practices by Nicaraguan
During the 1980s, studies on knowledge, at- farmers, 1999-2000. Source: Corriols M, Silva
titude and practice (KAP-studies) in relation to D, Marín J, et al. “Incidencia de intoxicaciones
pesticides were carried out and show, without agudas porplaguicidas y estimación del subreg-
exception, the lack of knowledge and inadequate istro en Nicaragua” (Incidence of acutepesticide
intoxications and underregistration estimates in
risk perceptions and practices of pesticide users. Nicaragua). Managua: OPS/OMS, 2002.
It has been widely presumed that pesticide prob-
lems are mainly due to the ignorance of pesticide research on exposure and health
users and lack of regulation. For over twenty effects from pesticides use in
years, training efforts, some of them huge and developing countries
very expensive, have been undertaken to increase Pesticide research in developing countries is
knowledge in developing countries. Indeed, insufficient when the overall presence of this oc-
recent studies in East Africa, Central America cupational and environmental hazard and sub-
and South East Asia show that today, pesticide
337
Chapter 5.2
sequent potential health risks are considered. In among paraquat exposed workers have been
general, developing countries have few good ex- followed by studies showing an excess of respira-
posure data. Some countries keep import statis- tory symptoms in Nicaragua and arterial oxygen
tics, but these are not systematically scrutinized desaturation during exercise in South Africa and
for trends on the import of hazardous pesticides. Costa Rica. Many thousands of DBCP applica-
Studies quantifying exposures are scarce and tors working on banana and pineapple planta-
usually difficult to interpret. Exposure or hazard tions suffered sterility in Africa, South-East
surveillance is generally absent. Asia, and Central America and the Caribbean.
Surveillance systems of pesticide illness are Cancer studies have been carried out in various
also uncommon. The WHO has estimated the countries of Latin America and Asia, showing a
annual number of acute poisonings at 3 million variety of excesses among workers, children of
severe poisonings with only 700,000 of these be- pesticide exposed parents and the general popu-
ing occupational poisonings. When milder cases lation.
are included, the estimate increases to 25 million
agricultural workers or 3% of the active labour risk reduction strategies
force. Surveys in different continents have re-
‘Safe use’ approach
ported between 1 - 7% of workers suffer a poi-
soning each year. In Central America, a recent For decades, international bodies, in collabora-
estimate yielded 400,000 acute poisonings in one tion with local governments, have used ‘safe use’
year with an overall incidence of almost 1.9 per approaches to reduce the risks associated with
100 inhabitants. Most surveillance systems do pesticide use in developing countries. The ‘safe
not record dermal and eye lesions, but studies use’ focus emphasises the prevention of acute
in Costa Rica show that they may be even more health effects among agricultural workers and
frequent than acute poisonings. farmers.
Studies evaluating chronic effects of massive The WHO-IPCS “Classification of
overexposures or long-term exposures are even Pesticides by Acute Hazard” contains impor-
scarcer, but nonetheless there is increasing evi- tant regulatory guidelines for those governments
dence on the deleterious effects of pesticides on that don’t carry out independent risk assess-
populations in developing countries. In Latin ments. IPCS limits its toxicity evaluation only to
America, genotoxicity studies among pesticide acute toxicity. Pesticides classified as “non haz-
exposed populations have been carried out on ardous under normal use conditions” are often
workers of a number of countries. In Central widely used in developing countries without
America, a number of studies have been carried further evaluation of topical and chronic toxicity,
out on the neurological consequences of organo- as is the case with the fungicides mancozeb,
phosphate and organochlorinated compounds. maneb, and chlorothalonil, which are irritants or
In Mexico, Ecuador and Costa Rica deficits in allergens and possible human carcinogens.
neurological developmental have been observed The most important ‘safe use’ initiative is the
in children of agricultural communities. In International Code of Conduct of the United
Egypt, chronic effects among industrial pesti- Nation’s Food and Agriculture Organization
cide workers have been studied. Early negative (FAO) that aims to strengthen registration and
studies in South-East Asia on respiratory effects regulation on pesticides by national govern-
338
Pesticides
ments. The code was first issued in 1985 and How realistic is the ‘safe use’ approach?
revised in 2002. The “Prior Informed Consent” Pesticide use is increasing in developing coun-
(PIC) procedure of the Code, passed as an in- tries. Governments preoccupied with food
ternational agreement through the Rotterdam security are the target of industry lobbists who
Convention of 1999, aims at controlling inter- claim that pesticides are indispensable and safe if
national commerce of particularly dangerous used according to label instructions. Traditional
or obsolete pesticides. However, adherence to alliances between pesticide manufacturers and
the code is voluntary and only 24 pesticides ministries of agriculture are now extending to
are included as a Persistent Organic Pollutants ministries of health. Factors that induce farmers
(POPs); criteria for inclusion of new products to continue or increase their use of pesticides
are difficult to meet but endosulfan is proposed include: heavy marketing, fear of losing their
to be listed. Debates on inclusion of WHO- harvests, the psychological assurance of literally
IPCS Ia and Ib pesticides have been ongoing observing a pest die, the relative simplicity of a
for about a decade but have not resulted in a pesticide application, and the loss of knowledge
formalised agreement. Industrialised countries of sustainable non chemical pest control meth-
continue to allow the manufacturing or formula- ods.
tion of prohibited pesticides for export, mostly The assumption that pesticides are safe if
to developing countries. used according to label instructions places the
Another important initiative is the ‘Safe Use full responsibility and consequences of inad-
Initiative’ of the Global Crop Protection equate use with the pesticide user. The reasons
Federation (GCPF) [formerly the International why there are little or no changes towards safer
Group of National Associations of Agrochemical behaviour even though there is a higher aware-
Manufacturers (GIFAP) and currently Croplife ness of safety issues have not been well studied.
International). The global stewardship program However, it is easy to envisage that safe practices
of the GCPF was initiated in support of the are difficult or impossible to implement in con-
FAO Code of Conduct. Three pilot Safe Use ditions of poverty and a tropical climate. For
Projects of GCPF, conducted in Kenya, Thai- safe use of pesticides, pesticide users in develop-
land, and Guatemala, are now being extended ing countries need not only knowledge, but also
to other countries in Africa, Asia, and Latin resources or access to technical advice on proper
America. GCPF aims at enhancing collaboration selection of pesticide; adequate, dry and venti-
between the private and governmental sectors lated storage facilities away from the food and
in the training of pesticide users on “safe use”: water supplies; adequate and well maintained
distributors, agricultural technicians, regulators, spray equipment; full protective equipment with
inspectors, schoolchildren, teachers, and house- continuous replacement of contaminated parts;
wives. The training materials are reassuring waste disposal facilities; continuous training
about the need, benefits, and safety of pesticides, programs; and medical care. In addition, farmers
and may actually lead to increased use of pesti- in developing countries have a high acceptance
cides. of risk because risk taking is part of daily life or
because there are often other priorities for im-
mediate survival.
339
Chapter 5.2
Risk assessment and management in is done only on the active ingredient and never
industrialised countries on pesticide formulations, despite potential
In industrialized countries, pesticide associated hazards of the ‘inert’ ingredients. In fact, WHO-
health and environmental risks are managed IPCS advises governments to lower the acute
through registration of pesticides with regula- toxicity category of the active ingredient for the
tions on their use based on extensive risk as- registration of pesticide formulations, in accord-
sessment procedures for individual pesticides. ance to the degree of dilution. Finally, following
Health risk assessment is the determination of up on exposures and health effects to evaluate
the probability of occurrence of potential health the effectiveness of risk management strategies
effects in association with different types of requires huge resources, even in rich countries.
exposures. On the one hand, different exposure
scenarios in occupational settings, residential Risk assessment and management in
exposures and consumer’s exposures through developing countries
food and water are evaluated and quantified. On Human and technical resources are so restricted
the other hand, in vitro and in vivo experimental in developing countries that risk assessment is
data are produced on acute and chronic systemic reduced to copying international guidelines of
toxicity, dermal and eye irritant potency, sensiti- FAO (Codex Alimentarius or PIC) and WHO-
zation, mutagenicity, genotoxicity, carcinogenic- IPCS (Classification of Pesticides by Acute
ity, reproductive effects (teratogenicity, fetotox- Hazard) or of regulatory decisions by the Eu-
icity, sterility, infertility) in multiple generation ropean Commission or the U.S. Environmental
tests, and for some groups of pesticides neuro- Protection Agency (US EPA). There is no con-
toxicity. After combining exposure and toxicity sideration of local or regional data on harmful
data, and assigning safety factors to allow for human health and environmental effects or local
uncertainties, pesticides are then registered for circumstances of use, e.g. hot humid climate,
use under specific conditions, which should impossibility of purchase and use of protective
guarantee that exposures don’t exceed acceptable equipment; general poverty; illiteracy; under-
health risk standards. Results of monitoring of nourished populations; very young and very old
exposures and health may lead to later modifica- workers; lack of recycling facilities for pesticide
tions of such regulations. containers, and innumerable other aspects that
Despite the complexity and high costs of differentiate developing countries from devel-
these risk assessment procedures, there are im- oped countries. The interpretation of the toxi-
portant flaws in the procedure. Testing is done cological, epidemiological, and exposure assess-
in selected healthy, adult laboratory animals, not ment considerations of the risk assessments that
resembling vulnerable population groups. Tests underlie the risk management decisions in devel-
for neurotoxicity, immunotoxicity, and develop- oped countries, are frequently, clearly erroneous.
mental toxicity are not part of the typical testing For example, pesticides not registered for use
battery. In the setting of standards, it is only but with a food tolerance in the US, or pesti-
recently that steps are being taken to look into cides that are regulated as RUPs (restricted use
multiple sources of simultaneous exposure. No pesticides) by US-EPA, are routinely approved
regulatory body that has started to look into the for a large variety of purposes and sold without
effects of pesticide mixtures. In addition, testing any restrictions.
340
Pesticides
To continue the policy of safe pesticide use by studies on economic consequences, such as costs
national governments in developing countries, of residue export retentions up to the complete
the key question to be answered is whether safe bankruptcy of producers of certain crops due to
use of pesticides is at all possible. A true safe use pest resistance. Such studies are scarce and even
approach for pesticides in developing countries when local research institutions produce rel-
should first consider whether there is a real need evant data, these are seldom considered in local
for a certain pesticide, by examining local pest policy making. In fact, we need to go beyond
patterns and the accessibility of less dangerous local risk assessment and apply the precautionary
alternatives (non-chemical or chemical). If use approach, i.e. include common sense and intel-
of the pesticide is considered necessary, there ligence in regulatory decisions and use proactive
must be an evaluation as to whether the condi- policy making to solve pesticide problems.
tions of use can guarantee that there will be no
health and/or environmental damage. Regula- Pesticide OSH at the company and farm
tory authorities in developing countries need to level
be capable of making local risk assessments as a Management of pesticide risks at enterprise or
basis for decision-making, implying evaluation plantation level presents many difficulties in
and integration of intrinsic toxicity data, expo- developing countries. Regulations usually exist
sure data, and considerations such as host sus- only in broad legal directives which, generally
ceptibility data, together with the socioeconom- speaking, means any pesticide can be used on
ic, cultural and legal entourage. However, the any crop or with any application method. The
resources needed for such an approach exceed implementation of serious OSH pesticide pro-
the economic and technical capacity of virtually grams is therefore limited from the very start
any developing country. and often there is no systematic follow-up on
If less dangerous alternatives are not avail- the effectiveness of preventive efforts or the
able, and safety conditions are adequate, the use adverse or beneficial effects of new products or
of a hazardous substance may be temporarily technologies. Adverse effects that are observed
justified, depending on the expected benefits. may be downplayed because OSH managers feel
Once approved, the use and impact of hazard- powerless to comply with both the protection of
ous substances must be closely followed up over workers’ health and production requirements.
time. However, little or no effort is made in Workers have little or no influence on pest
developing countries to follow up the use and management decisions even though they are the
consequences of registered pesticides. Hazard or most severely affected. Integration of experts in
exposure monitoring, such as statistics on pesti- Integrated Pest Management (IPM) and organic
cide imports, exports and use or monitoring of agriculture in pest management may be the best
residues in food, ground water or the environ- OSH solutions in the longer term.
ment, is usually absent, deficient or not accessi-
ble to the public. No human, technical or finan- Alternative pest control methods
cial resources exist to carry out monitoring of Pesticide technology is typically favoured over
adverse effects, including human, domestic ani- alternative pest control methods, however, al-
mal and wildlife poisoning surveillance systems; ternative approaches are needed and successful
human health and ecotoxicological studies; and examples exist. The FAO Code of Conduct,
341
Chapter 5.2
despite its primary focus on safe use, has also recommended strategies for
promoted IPM programs, especially in South- pesticide illness prevention
east Asia, which achieved important reductions It is necessary to understand the full implications
in pesticide use. IPM programs have also been of pesticide use in order to reach acceptable
carried out by public and private agronomic and viable solutions. The safe use approach has
research institutes in Central America, on im- proven to be an inefficient method to prevent
portant crops like sugar cane, coffee, citrus and pesticide-related illness in developing countries
potatoes. These programs have included pest and in reality actually prevents countries from
monitoring, biological control, and the use of investing in sustainable methods of pest control.
pheromone traps and natural pesticides. IPM Other actions aimed at a progressive reduction
programs have proven to be more profitable and elimination of pesticide use and the preven-
than conventional pesticide-based pest control, tion of occupational hazards from pesticides
although farmers sometimes have to bear the must be undertaken at international, national,
costs of a transition period. The disadvantage of local, and enterprise levels. The following sug-
IPM programs is that they still recommend the gestions would be some possible steps in the
use of some chemical pesticides. Any use of pes- right direction:
ticide is inherently not safe by itself, no matter • To measure the health, environmental and
if it is used under IPM or any other sustainable economic impact of pesticide use. If viable so-
production system. Above all, there is a real risk lutions are to be found and implemented, we
that the strategy turns into an attenuated safe need to create strong alliances between policy
pesticide use approach. GCPF, on the one hand planners (agricultural, health, and economic
commits itself to IPM strategy and on the other development) and researchers of various
hand, contradicts itself by advocating high-input disciplines. The full involvement and commit-
and large-scale agriculture. ment of agricultural workers and producers is
Organic agriculture does not use any syn- required to reduce pesticide use, starting with
thetic pesticides and integrates other principles the most hazardous pesticides.
of sustainable land use. Industry has pointed out • Local data on the health and environmental
that organic agriculture is too much of a radical impact of pesticides must be produced and
strategy and is unsustainable due to lower yields, taken into account in choosing strategies
which would force farmers to extend agricultural towards sound production systems and a de-
land use and cut forests to feed growing urban crease of pesticide dependence.
populations. However, studies show that organic • Governmental agencies must be assisted by
agriculture can produce similar yields to tradi- academics for systematic data collection and
tional pesticide-dependent cropping and may be analysis, performance of ad hoc studies for the
more profitable over the longer term because it evaluation of emerging problems, and local
uses more sustainable methods. Failures, such risk assessments.
as the lack of technical assistance and research • Studies on health promoting and economi-
services on the implementation of this type of cally sustainable agricultural technologies
agriculture are avoidable. that are not based on chemical pest control
342
Pesticides
are needed at enterprise, local, national, and

international levels.
• Creative technical assistance projects are ur-
gently needed to promote the use of alterna-
tive and safer technologies by producers. Such
technologies should be assessed for effective-
ness.
• The implementation of OSH programs, clean
technologies, integrated pest management
or organic agriculture needs to consider how
cultural factors and risk perception affect their
usefulness.
• Workers’ rights to know and workers’ em-
powerment need to be strengthened.
• The academic sector should assist workers,
high-risk communities and the general public
with sound information and provide them
with tools for meaningful participation in
decision-making.
• Industry should redefine its role toward de-
velopment of less toxic and safer products,
accompanied by responsible marketing and
reliable information.
• The precautionary approach should become a
commonly used and accepted regulatory tool,
i.e. common sense and intelligence should be
employed in regulatory decisions and proac-
tive policy making used to solve pesticide
problems.
343
5.3
Solvents and gases

Gun Nise
organic solvents from an unpleasant odour to death from uptake

Organic solvents are widely used in industry and of high concentrations.
in many consumer products. They constitute a Solvents can be divided into a number of
chemically diverse group of liquids characterised categories based on their chemical structure
by their ability to dissolve, suspend or extract however, they are all hydrocarbons. A common
other material such as oils, fats, resins, rubber, classification system is presented in Figure 5.3.1.
and plastics, without chemical change to the
Chemical class of Solvent
material or solvent. Solvents are used within a hydrocarbons
broad range of sectors. Industry uses solvents for Aliphatic n-Hexane, heptane
degreasing, paint and varnish removal and for
Aromatic Benzene, toluene, xylenes,
cleaning. They are also used to thin paints, var- styrene
nishes, adhesives, rubber and glues, in the manu- Halogenated Methylene chloride, chloro-
facture of such products in addition to chemicals form, carbon tetrachloride,
and pesticides. Organic solvents are also used for trichloroethylene,
manufacturing of plastics and pharmaceuticals as Esters Ethyl acetate, butyl acetate
used for dry-cleaning. Large quantities are used Ketones Acetone, methyl ethyl ketone,
methyl-isobutyl ketone
in printing and chemical industries, construc-
tion, engineering and wood processing. Alcohols Methanol, ethanol, isopropa-
nol, n-butanol, ethylene glycol
Exposures to solvents occur throughout life,
Glycol ethers 2-Ethoxyethanol, 2-ethoxyethyl
from conception to death. For example, organic acetate
solvent vapours inhaled by a mother can reach Miscellaneous Carbon disulphide, dimethyl-
a foetus. Daily exposures can occur through formamide, tetrahydrofuran,
all routes of exposure (inhalation, dermal, and limonene, ethylene oxide
ingestion) in both the home and/or at work, e.g. Petroleum distillates Naphtas, white spirit
from the inhalation of vapours from a “fresh Figure 5.3.1. A commonly used classification sys-
newspaper” to the uptake of a cleaning solvent. tem of hydrocarbons according to their chemical
The effects from exposure to solvents can range structure.
345
Chapter 5.3
The different chemical structures of solvents Other properties that can be useful when evalu-
give them different properties that make them ating the risk of adverse exposure from a solvent
more or less usable for specific tasks. There are a are the “partition coefficient between oil and
number of technical properties that can be use- water” (Pow) and odour threshold, see Figure
ful for consideration when evaluating exposure 5.3.2. The octanol-water partition coefficient is
risks. the ratio of the concentration of a chemical in
Ability to dissolve fat. Solvents can be used to octanol and in water at equilibrium. The higher
dissolve dirt, fat etc. on the surface of a working the Pow of an organic solvent, the greater affin-
material. If the solvent comes in contact with the ity it has to fat, so the greater the ease that the
skin, it will dissolve the fat on the skin and result body fat absorbs the solvent.
in an irritation or possibly eczema from pro-
longed contact. Examples of solvents that easily uptake, biotransformation and
dissolve fat are styrene, acetone, and white spirit. elimination
Flash point. All solvents are more or less in- Uptake through inhalation
flammable. The flash point is a measure of the During occupational exposure, solvents may
risk of fire, i.e. the lower flash point, the higher be taken up via inhalation or the skin; uptake
risk of fire. The potential for fire is extremely through the gastrointestinal tract is negligible
high if the flash point is less than 21 οC, e.g. ac- under normal working conditions. The lungs
etone and toluene. A solvent is considered flam- generally provide the most important absorp-
mable with a flash point up to 55 οC, e.g. styrene tion route. The most important determinant of
and white spirit. Organic solvents with a flash pulmonary uptake is the solubility of the solvent
point above 55 οC are combustible, e.g. ethylene in the blood. Even for solvents that are readily
glycol. Chlorinated solvents like chloroform and absorbed through the lungs, the uptake cannot
tetrachloroethylene are not combustible. exceed about 80 %. The uptake at rest for meth-
Limit of explosion. This is the concentration of ylene chloride, trichloroethylene, toluene, xy-
a solvent (in air) that may result in an explosion. lene, and styrene varies between 50 % and 70 %
There is a lower and upper limit of explosion of the amount inhaled. Physical activity is the
(LLE and ULE, respectively). The concentra- most important modifying factor on the toxi-
tion interval between LLE and ULE is the one cokinetics of organic solvents. The amount of
to avoid. Below the LEL there is not enough solvents taken up per time unit increases during
solvent to continue an explosion; at concentra- exercise. Figure 5.3.3 divides solvent into two
tions above the UEL the fuel has displaced so groups. Those in the first group, (styrene, xy-
much air that there is not enough oxygen to lene, acetone, and butanol) are more soluble in
begin a reaction. In order to avoid explosion it blood and tissues than those listed in the second
is important to consider the presence of static group, (methylene chloride, trichloroethylene,
electricity while handling organic solvents. and toluene). The uptake of the solvents in the
Vapour pressure. There are great differences first group increases linearly with increasing
in the rate of evaporation of different solvents. work–load. In the second group, the uptake in-
High volatility decreases the drying time but creases at 50 W, but remains fairly constant with
also increases the concentration of the solvent in further increasing workload. Studies on occupa-
the air and hence increases the risk of exposure. tionally exposed workers have shown that body
346
Solvents and gases
Solvent Boiling Melting Solubility Vapour Flash Explosive Octanol/water Odour

(CAS No) point point ºC in water pressure point limits partition threshold
ºC g/100ml at 20ºC ºC vol% in air coeffient as (ppm)
at 20 ºC (kPa) log Pow
Acetone 56 -95 Miscible 24 -18 2.2-13 -0.24 200-450
(67-64-1)
Benzene 80 6 0.18 10 -11 1.2-8.0 2.13
(71-43-2)
n-Butanol 117 -90 7.7 0.6 29 1.4-11.3 0.9 15-25
(71-36-3)
Carbon disulphide 46 -111 0.2 48 -30 1-50 1.84
(75-15-0)
Chloroform 62 -64 0.8 21.2 not combustible 1.97 200
(67-66-3)
Dichloromethane 40 -95 1.3 47.4 combustible under 1.25 50-80
(75-09-2) special conditions
Dimethylformamide 153 -61 Miscible 2.5 58 2.2-15.2 0.87 1
(68-12-2)
Ethanol 79 -117 Miscible 5.8 13 3.3-19 0.32 350
(64-17-5)
2-ethoxyethanol 135 -70 Miscible 0.5 44 1.7-15.6 -0.54
(110-80-5)
2-ethoxyethyl acetate 156 -62 23 0.27 51 1.7-14 0.24
(111-15-9)
Ethyl acetate 77 -84 Very good 10 -4 2.2-11.5 0.73 50-200
(141-78-6)
Ethylene glycol 198 -13 Miscible 7 111 3.2-15.3 -1.93
(107-21-1)
Ethylene oxide 11 -111 Miscible 146 <-18 3-100 -0.3
(75-21-8)
n-Hexane 69 -95 0.0013 17 -22 1.1-7.5 3.9
(110-54-3)
Isopropyl alcohol 83 -90 Miscible 4.4 12 2-12 0.05 200
(67-63-0)
Limonene 178 -74 Very poor 0.2 48 4.2 30
(5989-27-5)
Methanol 65 -98 Miscible 12.3 12 5.5-44 -0.82/-0.66 400-
(67-56-1 2000
Methyl ethyl ketone 80 -86 29 10.5 -9 1.8-11.5 0.29 <25
(78-93-3)
Methyl isobutyl 117 -85 1.9 2.1 14 1.4-7.5 1.38 <100
ketone
(108-10-1)
Naphthas, alkylate 172- <-30 None 0.1-0.2 ≥ 44 0.6-8 260
(64741-65-7) 215
Naphthas, hydrot- 155- <0 None 0.1-0.3 40- 0.7-6 260
reated 217 62
(64742-48-9)
347
Chapter 5.3
Solvent Boiling Melting Solubility Vapour Flash Explosive Octanol/water Odour

(CAS No) point point ºC in water pressure point limits partition threshold
ºC g/100ml at 20ºC ºC vol% in air coeffient as (ppm)
at 20 ºC (kPa) log Pow
Styrene 145 -31 0.03 0.7 31 0.9-6.8 3.0 0.05-25
(100-42-5)
Tetrachlororethylene 121 -22 0.015 1.9 not combustible 2.9 50-70
(127-18-14)
Tetrahydrofuran 66 -108 Miscible 19.3 -14.5 2-11.8
(109-99-9)
Toluene 111 -95 none 3.8 4 1.1-7.1 2.69 0.03-3
(108-88-3)
Trichloroethylene 87 -73 0.1 7.8 combustible under 2.42 20-100
(79-01-6) special conditions
White spirit 130- None 0.1-1.4 21- 0.6-8 3.16-7.06
(8052-41-3) 230 60
Xylenes None 20-40
o- (95-47-6) 144 -25 0.7 32 0.9-6.7 3.12
m- (108-38-3) 139 -48 0.8 27 1.1-7.0 3.20
p- (106-42-3) 138 13 0.9 27 1.1-7.0 3.15
Figure 5.3.2 Useful properties for some commonly used organic solvents. Source: International chemi-
cal safety cards (ICSC) that summarize essential information on chemical substances; developed coop-
eratively by the IPCS and the Commission of the European Union (EC) and Health and Safety Guide
(HSG) series published by the WHO. The HSG provide concise information on risks from exposure to
chemicals, with practical advice on medical and administrative issues. Both are available from the IPCS
INCHEM website (www.inchem.org).
fat accumulates a significant amount of some Glycolethers and dimethylformamide are sol-
solvents, implying an endogenous low-dose solvents that are both lipophilic and hydrophilic
vent exposure even during work-free periods. and they are easily absorbed through the skin.
Skin absorption from vapours may also be sig-
Uptake through the skin
nificant. The high boiling point and relatively
Considerable amounts of a number of solvents low volatility of glycolethers make them stay on
may be absorbed through the skin contribut- the skin surface for long periods and enhance
ing to the total body burden of solvents. Skin the possibility for skin absorption.
absorption can occur during direct handling of Most commonly used solvents require a very
the solvent as well as through products contain- extreme exposure on the skin before the skin
ing solvents, e.g. cleansing and defatting agents. uptake reaches the level of lung uptake. For
Uptake varies widely between different solvents example, if both hands are kept in xylene for 15
a number of factors, principally water solubil- minutes, the uptake will be equal to the respira-
ity, lipid solubility and volatility of the solvent, tory uptake from air exposure to 100 ppm dur-
influence uptake. Solvents that are soluble in ing the same period.
both water and lipophilic compounds are easily
absorbed.
348
Solvents and gases
600
500
400 rest
50 W
300
100 W
200 150 W
100
0
Xylene
Toluene
Trichloro-
Styrene
Butanol
Acetone
Methylene
ethylene
chloride
Figure 5.3.3 Effect of physical exercise on uptake (mg) of seven different organic solvents during four con-
secutive periods of exposure. (From Åstrand I. in: Modeling of inhalation exposure to vapours: uptake,
distribution, and elimination. Vol II. Fiserova-Bergerova V. (ed). CRC Press INC. 1983, pp 107-130).
Biotransformation and elimination metabolites that are more toxic than the mother
Absorbed solvents are usually biotransformed, compound. The hepatotoxicity of chloroform
principally by the liver, to more water-soluble and dimethylformamide depends on reactive
metabolites that are excreted in the urine. Up metabolites.
to 95% of absorbed xylene and styrene, and up
to 80% of the total amount of absorbed tolu- health effects
ene and trichloroethylene, are biotransformed. The principal effects of solvents are irritation to
However, some common solvents like methyl the skin, eyes and lungs; headache, dizziness and
chloroform and tetrachloroethylene, are only light-headedness. Solvent exposure can impair
metabolised to a small extent and are largely a worker’s co-ordination that can lead to poor
excreted unchanged by exhalation. Excretion of performance and accidents; susceptibility varies
unchanged solvent by exhalation increases dur- from person to person. Very high solvent expo-
ing physical activity. Biotransformation has im- sure can lead to unconsciousness and even death.
portant implications for the evaluation of solvent If workers are exposed to more than one solvent
toxicity and in assessment of solvent exposure. at the same time it is very important to consider
Some solvents are biotransformed into reactive the overall effect. This may be additative or in
349
Chapter 5.3
some cases, greater than the sum of the effects of Effects on other organs
the individual solvents. Liver
Irritating effects Even though the liver is involved in the bi-
otransformation of many organic solvents, oc-
Though the chemical properties of different
cupational exposure seem to cause little hepatic
solvents vary considerably there are some gen-
damage. However, some halogenated solvents
eral health effects. Most solvents are irritating
are classic hepatotoxins e.g. carbon tetrachloride
to the mucous membranes of the eyes, nose and
and chloroform.
throat with the eyes often being the most sensi-
tive. Heavy exposures are often associated with
Kidney
cough, chest tightness, and breathlessness. At
very high exposures, some common solvents Certain solvents like carbon tetrachloride and
such as toluene, xylene and methylene chloride ethylene glycol may induce renal failure in hu-
can induce pulmonary ooedema or chemical mans after extensive acute exposure but most
pneumonitis. solvents have no adverse effects on the kidney.
Effects on the central nervous system Carcinogenicity and mutagenicity

Some solvents, (e.g. benzene, styrene, formal-
Acute effects
dehyde, methylenechloride, trichloroethylene,
Short-term high exposure to organic solvents perchloroethylene, carbon tetrachloride and
gives narcotic effects and several solvents have chloroform), are established or presumed car-
been used as general anaesthetics, e.g. trichlo- cinogens according to evaluation by the Interna-
roethylene and chloroform. Acute symptoms tional Agency for Research on Cancer (IARC).
are headache, dizziness, confusion, a feeling Further information is available at the IARC
of drunkenness, and if the exposure continues, website (www.iarc.fr).
unconsciousness and death. While acute symp-
toms are reversible after an exposure ends it may Reproductive effects
increase the sensitivity to future exposures.
Several studies have suggested that occupational
exposure to organic solvents during pregnancy
Sub acute and chronic effects
may damage the foetus. Current hygienic stand-
Most workers are exposed to mixtures of ards are usually not based on the possibilities of
aliphatic and aromatic solvents. Such long term reproductive effects and it is important to keep
exposures are associated with symptoms such the solvent exposure of pregnant women well
as impaired neuropsychological performance. below these standards.
Symptoms include memory problems, concen- The observation that glycol ethers with short
tration difficulties, aggressiveness, depression, alkyl groups, (2-metoxy- and 2-ethoxyethanol),
fatigue and sleeping problems. Several years are teratogenic and testicular toxins at rather
of high solvent exposure are required for these low doses, has seen most branches of industry
symptoms to become chronic. shift to the use of glycol ethers with longer alkyl
chains.
350
Solvents and gases
Name Characteristics Main uses Health effects Recommendations for

safe use
Acetone Colourless liquid with Solvent for resins, Inhalation may give Adequate ventilation, lo-
sweet or pungent smell. fats, lacquers, headache, dizziness, and cal exhaust, or breathing
Very volatile. oils, cotton, cel- fatigue. Very high expo- protection, use protective
Absorbed through inhala- lulose acetate, sure may cause uncon- gloves. If risk of splashes
tion and through the skin. and acetylene. sciousness. Degreasing use safety goggles. No
Employed in paint, the skin. Prolonged skin open flames, no sparks.
varnish, lacquer, exposure may cause Do not eat drink or smoke
rubber plastics, dermatitis. Irritating for during work.
and chemical the eyes.
manufacturing
industries.
Benzene Colourless liquid with In chemical syn- Irritates the eyes, skin, Avoid contact. Important
characteristic odour. theses of nitroben- and respiratory tract. Pro- with adequate ventilation,
Can be absorbed through zenes, halogen- longed exposure defats local exhaust, or breathing
inhalation and through the ated derivatives, the skin, may have effects protection, use protective
skin and by ingestion. aromatic amines, on the bone marrow and gloves and clothing, face
styrene etc. for an- immune system. Is carci- shield or eye protection in
tiknock properties nogenic to humans. combination with breath-
in unleaded gaso- ing protection. No open
line. Solvents for flames, no sparks.
paints, inks, rubber Do not eat drink or smoke
and plastics. during work.
n-Butanol Colourless liquid with Solvent in paints The vapours irritate eyes Adequate ventilation, lo-
pungent smell. and lacquers and and lungs. Inhalation and cal exhaust, or breathing
Absorbed through inhala- for synthetic and skin contact may cause protection, use protective
tion and by ingestion. natural polymers. headache, dizziness, gloves. If risk of splashes
Can easily penetrate the Used for extraction and fatigues. Prolonged use safety goggles.
skin. and dehydration skin exposure may cause No open flames, no
in pharmaceutical dermatitis. sparks.
industry. Do not eat drink or smoke
during work.
Ethyl acetate Colourless liquid with Solvent in paints, The vapours irritate eyes Avoid generation of mists.
fruity smell. Very volatile. varnishes, lac- and lungs. Inhalation may Adequate ventilation, lo-
Can be absorbed through quers, inks, and cause headache, feeling cal exhaust, or breathing
inhalation. synthetic rubbers. of sickness, and dizzi- protection, use protective
Used in manufac- ness. Very high exposure gloves and clothing. If risk
turing photograph- may cause unconscious- of splashes use safety
ic films, linoleum, ness. Prolonged exposure goggles.
plastic wood, may cause kidney and No open flames, no
artificial silk, and liver damage. sparks.
leather. Do not eat drink or smoke
during work.
Figure 5.3.4. Examples of some organic solvents frequently used at workplaces, their main uses, and
health effects.
351
Chapter 5.3
Name Characteristics Main uses Health effects Recommendations for

safe use
Ethylene Odourless, colourless, Used as antifreeze The substance irritates Avoid generation of
glycol viscous hydroscopic formulation in the eyes and the respira- mists. Adequate general
liquid. heating and cool- tory tract. May cause ventilation, use protective
Uptake through inhalation ing systems, a effects on the kidney and gloves. If risk of splashes
and through the skin. component in the central nervous sys- use safety goggles.
hydraulic liquid. tem. Long-term repeated No open flames.
As a solvent in exposure may result in Do not eat drink or smoke
lacquers, inks, abnormal eye movements during work.
adhesives, and (nystagmus)
resins.
n-Hexane Volatile colourless liquid Component in The substance irritates Adequate ventilation, lo-
with characteristic odour. gasoline and the skin. Repeated skin cal exhaust, or breathing
Can be absorbed through solvent used in contact may cause protection, use protective
inhalation and by inges- production of dermatitis. The substance gloves. If risk of splashes
tion. plastic and rubber, may affect the central use safety goggles.
in printing of lami- nervous system and espe- No open flames, no
nated products, cially the peripheral nerv- sparks.
in extraction of ous system. Animal tests Do not eat drink or smoke
vegetable oil. show that the substance during work.
possibly affects the hu- Avoid exposure during
man reproduction. pregnancy.
Toluene Colourless liquid with Solvent in paints, Irritates the eyes and the Use strict hygiene, avoid
characteristic odour. coatings, inks, ad- respiratory tract. Expo- exposure of (pregnant)
Can be absorbed through hesives, in leather sure to high levels may women! Adequate ven-
inhalation and by inges- and pharmaceuti- cause cardiac dysrhyth- tilation, local exhaust, or
tion. Can easily penetrate cal industries. mia. Long-term exposure breathing protection, use
the skin. For production may have effect on the protective gloves. If risk
of benzene and central nervous system, of splashes use safety
toluene diisocy- enhance noise induced goggles.
anate. In gasoline hearing loss. Animal tests No open flames, no
to improve octane show that the substance sparks.
rating. possibly affects the Do not eat drink or smoke
human reproduction or during work.
development.
Figure 5.3.4. Continued.
352
Solvents and gases
Effects from specific solvents cleaning can be performed automatically which

Exposure to some typical industrial solvents is reduces workers contact with solvents and de-
associated with specific adverse effects, see Fig- creases the risk of high exposure. However, even
ure 5.3.4. if there is equipment for automatic cleaning,
there are still many needs for manual cleaning.
risk assessment and risk Dry cleaning can result in high exposure to
management e.g. tetrachloroethylene, when washing ma-
chines are placed in badly ventilated premises.
Solvents in the workplace
When assessing the possibilities to reduce
Workers may be exposed to liquid solvent, sol- solvent exposure the first question to ask is
vent vapour or mist. Vapour is the gaseous state “Is cleaning necessary?” It may be that small
of a liquid that is formed when molecules evapo- changes in the work process can reduce dirt on
rate from the surface of the liquid. The rate at components making subsequent cleaning easier.
which a solvent evaporates depends very much In many cases, such changes reduce costs. For
on the boiling point of the solvent, the lower instance, by using the minimal amount of glue
the boiling point, the faster evaporation occurs. to assemble pieces of work, there is less need
Increasing the temperature of a solvent, the to remove excess glue from components. This
surface area of the liquid and the airflow over its reduces the amount of glue and cleaning solvent
surface will increase its evaporation rate. Va- used. Enclosure of the cleaning process often
pours follow the air movement in a working area reduces the amount solvent needed as well as
and can spread throughout the workplace. reducing the amount of solvent emitted into the
Solvent mists are small droplets of the liquid working environment. A well design ventilation
and can be formed during spraying and high system also reduces the emission of solvents into
speed mixing. the workers’ breathing zone.
Work tasks related to high risk of solvent
Working with paints
exposure
Workers who manufacturing and use solvent-
Cleaning and degreasing procedures based paints are both at high risk of solvent
Cleaning and degreasing of material and equip- exposure. In enterprises manufacturing paints,
ment occurs frequently in all forms of manufac- manual cleaning is associated with high exposure
turing. In many cases organic solvents are used, to organic solvents. Work tasks during batch
even if there are solvent-free alternatives, e.g. preparation and container filling will give high
alkaline products, available. There are not only exposure if there is inadequate or faulty ventila-
health risks posed by solvents in cleaning prod- tion.
ucts but also the presence of other chemicals. Painters are exposed when they are using sol-
Methods used during cleaning and degreasing vent based paints and may also be exposed when
affect exposure, e.g. the use of brushes, clothes they are working in close proximity to newly
or spraying changes the solvent vapour concen- painted areas or products. Painting large areas
tration in the air. When spraying there will be or working in badly ventilated spaces will easily
an aerosol of the solvent in the workers’ envi- give high solvent concentrations. Spray painting
ronment that increases exposure. In some cases,
353
Chapter 5.3
also increases the risks of high concentrations of Managing solvent risks can improve workers’
solvents in the air. health, reduce the amount of solvents used and
decrease costs. Controlling exposure to solvents
Printing operations is often straightforward. The following steps
Rotogravure and screen printing techniques may be useful.
frequently still use solvent-based printing ink.
In order to increase printing velocity the sol- Define the problem
vents used have to evaporate rapidly so if there It is essential to find out what solvents are being
is insufficient ventilation around the printing used. In many cases, e.g. in paints, more than
press, workers will suffer considerable solvent one solvent is present. Safety Data Sheets (SDS)
exposure. Even when other printing techniques should be received together with the product
are used, organic solvents are still used for clean- containing solvents. It is important not to buy
ing the printing plates and the press even though any chemical product without getting a SDS
there are water-based alternatives available. with complete information about all the product
contents. It is important to look for information
Other work tasks about vapour pressure and boiling point that
Production of glass fibre-reinforced polyester helps understand how easily the solvent evapo-
plastics, particularly lamination of large areas as rates into the working environment. The higher
in the production of boats and cisterns, are as- the vapour pressure, or the lower the boiling
sociated with high exposure to styrene. Further- point, the more easily the solvent will evaporate.
more, the use of solvent containing glues during As a rule of thumb, highly volatile solvents have
e.g. floor laying, is associated with high solvent a vapour pressure greater than 25 kPa or a boil-
concentrations in the air. The production of ing point less than 50°C, and they easily evapo-
sport shoes includes the heavy use of glues con- rate to the working environment increasing the
taining organic solvents. Glue is often stored exposure level.
in small open containers and brushed onto the Observation of a process will help to find out
sole and the shoe in work areas lacking adequate how solvents are being used. It is important to
ventilation so the solvent evaporates easily to the include maintenance, working in confined spaces
worker’s breathing zone. and cleaning tasks. The highest exposure often
occurs out of regular routines or at the end of a
solvent health risk management shift. It is useful to find out how solvent vapour
It is important to have good work practices in or mist is generated, how workers handle it and
order to minimise solvent exposure. Unneces- the frequency, duration and amount of solvent
sary evaporation of solvents can be prevented by used. This information will help to assess the
using the minimum amount for the job, keeping level of exposure and potential control methods.
lids on containers and by sealing containers for It may be necessary to measure the concentra-
solvent contaminated waste. Where appropriate, tion of solvents in the air. If a solvent is absorbed
natural ventilation can be optimised by open- through the skin biological monitoring can
ing doors and windows, and organising work so provide information about the total uptake.
that the air flow moves vapours away from the It may be possible to modify the process e.g.
breathing zone of workers. by substituting a solvent with a less harmful one,
354
Solvents and gases
lowering the temperature or reducing the quan- Control the result

tity that is used. Enclosure of the whole or part It is important to regularly review the working
of a process usually makes a major impact on environment to confirm that preventive meas-
the exposure level. If it isn’t possible to enclose a ures remain effective. Control measures must be
process, well designed local exhaust ventilation accepted by the workers and evaluated to ensure
that removes vapour at source may be an alter- their effectiveness.
native. When possible, vessels and baths should
be closed in order to reduce solvent evaporation. irritating and asphyxious gases
Ventilation by opening doors and windows can Gases do not usually exist as liquids or solids at
reduce background levels of solvents, however, normal room temperature and pressure. Irritant
it is important to be aware that uncontrolled gases are an important example of respiratory
draughts can also increase exposure levels and toxins. The site of injury is related to the solubil-
disperse solvent vapours to normally non-expo- ity of the gas. For example, gases that are highly
sure areas. water soluble, such as hydrogen fluoride and
Good housekeeping is important to reduce ammonia, dissolve in the moist lining of the up-
unnecessary solvent vapour emission to the per respiratory tract, and often produce immedi-
workers environment. Open container and ate irritation. Less soluble irritant gases, such
solvent soaked rags on work surfaces or in open as nitrogen dioxide, ozone and phosgene, reach
bins allow solvent evaporation into the work- the bronchioles and alveoli, where they dissolve
place. slowly and may cause pneumonitis and pulmo-
nary oedema hours later. Gases may also act as
Take action asphyxiants by interrupting the supply of oxy-
Problems found during a risk assessment need gen (simple asphyxiants) or by inhibiting tissue
to be prioritised. There may be some very bad oxygenation (chemical asphyxiants). Examples of
situations that need immediate solutions but simple asphyxiants are carbon dioxide, methane
financial factors cannot be ignored so joint and nitrogen, which may cause sudden death,
discussions between employers, supervisors and and therefore may present a problem for those
workers representatives may be helpful. working in confined spaces. Chemical asphyxi-
Workers should have enough training to be ants block the delivery or use of oxygen at the
aware of the possible health effects of solvent cellular level. They include carbon monoxide (a
exposure, and to recognise the symptoms of ex- product of incomplete combustion), cyanide (in
posure and the measures that have been taken to electroplating and fires), and hydrogen sulphide,
reduce risks to their health. A well trained work- which can be find in sewers, coal mines, petro-
er may be able to reduce the amount solvent chemical refineries and rubber manufacturing
used, decreasing exposure and saving on costs. plants.
There could be a need for respiratory protective All gases can easily reach the breezing zone
equipment (RPE) until more efficient preven- when they are used at the workplace. It is impor-
tive measures are implemented. It is important tant to perform work in well ventilated area and
to remember that RPEs only protect to a limited to use exhaust ventilation properly.
degree and their effectiveness depends on careful Employees who are, or who may be, exposed
selection, use and maintenance. to irritating and asphyxiating gases should have
355
Chapter 5.3
sufficient information, instruction and training be used for sampling and other operations where
to understand the potential problems and pre- there is open exposure. Particular care should be
cautions they need to take. It is especially im- taken to the thorough washing out of pumps and
portant that they recognise symptoms that may other equipment that has contained or been used
occur several hours after end of exposure from for transferring ammonia prior to disassembly or
irritating gases. maintenance.
Ammonia Carbon monoxide

Most of the ammonia produced is used for pro- Many people using gasoline-powered tools
duction of fertilisers, fibres, plastics, and explo- such as high-pressure washers, concrete cutting
sives. It is also used in the production of animal saws (walk-behind/hand-held), power trowels,
feed, pulp and paper, rubber and in a variety of floor buffers, welders, pumps, compressors, and
other chemical production processes. Ammonia generators in buildings or semi enclosed spaces
and ammonium compounds are also used as have been poisoned by carbon monoxide (CO).
cleaning fluids, and in food as leavening agents, CO can rapidly accumulate, (even in areas that
stabilizers, and for flavouring purposes. appear to be well ventilated), and build up to
Ammonia is a colourless gas with pungent dangerous or fatal concentrations within min-
odour. The substance is a strong base and reacts utes. Studies of human exposure have shown
violently with acid, strong oxidants and halo- that motor vehicle exhaust and environmental
gens. It is also corrosive and attacks copper, tobacco smoke are the most important sources
aluminium, zinc and their alloys. Heat evolves of CO exposure. The workplace is another
when ammonia is dissolved in water. important setting for carbon monoxide expo-
Ammonia can be absorbed into the body by sures. In general, apart from transportation to
inhalation and is corrosive to the eyes, skin, and and from work, exposures at work exceed carbon
respiratory tract. Inhalation of high concentra- monoxide exposures during non-work periods.
tions may cause lung oedema. The symptoms Occupational groups exposed to carbon monox-
of lung oedema often do not become manifest ide from vehicle exhaust include auto mechan-
until a few hours after exposure and they are ics; parking garage and gas station attendants;
aggravated by physical effort. Rest and medical bus, truck or taxi drivers; police; and warehouse
observation is therefore essential. workers. Certain industrial processes can expose
Exposure to ammonia or ammonium com- workers to carbon monoxide produced directly
pounds can occur in occupations involving their or as a by-product including steel production,
production, transportation, and use in agricul- coke ovens, carbon black production and petro-
tural and farm settings, during fertilizer applica- leum refining. Fire-fighters, cooks and construc-
tion, or as a result of animal waste decomposi- tion workers may also be exposed to high carbon
tion. Ammonia is generated as a by-product in a monoxide levels at work. Occupational and non-
wide variety of industrial activities. occupational exposures may overlay one another
As far as possible, ammonia, in the form of a and result in a higher concentration of carbon
liquid, gas, or concentrated solution, should be monoxide in the blood.
handled in closed systems. Impervious clothing Carbon monoxide (CO) is a colourless,
and gloves, and eye and face protection, should odourless gas that can be poisonous to humans.
356
Solvents and gases
Carbon monoxide is absorbed through the lungs Prolonged exposure may have effects on the
and is readily absorbed from the lungs into the lungs, resulting in chronic bronchitis, and it can
bloodstream. The health effects of carbon mon- also have effects on the teeth, resulting in ero-
oxide are largely the result of the formation of sion.
carboxyhaemoglobin (COHb), which impairs It is not sufficient to rely on the odour warn-
the oxygen carrying capacity of the blood. CO is ing to indicate when the exposure limit value has
produced from incomplete combustion of car- been exceeded. Chlorine should not be used in
bon-containing fuels. With external exposure to the vicinity of a fire or a hot surface, or during
carbon monoxide, subtle effects can occur, and welding.
exposure to higher levels can result in death.
To prevent from CO exposure it is important Hydrogen cyanide
to reduce carbon monoxide emissions from Hydrogen cyanide is liberated during the use
combustion engines, improve ventilation at the of cyanide salts or solutions in metal treatment
source and if that impossible recommend use of operations, blast furnace and coke oven opera-
personal protective equipment. tions, metal ore processing, and photoengraving
operations. It is also used in production of inter-
Chlorine mediates in synthesis of resin monomers, acrylic
Most chlorine is used in industry to produce plastics, cyanide salts, nitrates, chelating agents,
chlorinated chemicals. The pulp and paper dyes, and pharmaceuticals. Hydrogen cyanide is
industry is a major user of chlorine for bleach- released during petroleum refining and electro-
ing pulp to produce white paper. Chlorine is also plating. Furthermore, it is used in the manufac-
used for disinfecting drinking-water supplies. ture of silver and metal polishes, and electroplat-
Chlorine is a greenish-yellow gas, with a ing solutions, and as a chemical reagent.
pungent odour. Chlorine solution in water is a Hydrogen cyanide is a colourless gas or liquid
strong acid that reacts violently with bases and is with a characteristic odour. The gas mixes well
corrosive. Furthermore, it reacts violently with with air easily forming explosive mixtures. The
many organic compounds, such as ammonia, substance may polymerize due to heating under
hydrogen and metal powder, causing fire and the influence of base(s), over 2% water, or if not
explosion hazard. Chlorine attacks many metals chemically stabilized, with fire or explosion haz-
in the presence of water, as well as plastic, rub- ard. On combustion, it forms toxic and corrosive
ber and coatings. gases including nitrogen oxides. The solution in
Chlorine can be absorbed into the body by in- water is a weak acid. Hydrogen cyanide reacts
halation and exposure to chlorine may result in violently with oxidants, hydrogen chloride in
watering eyes. It is corrosive to the eyes, the skin alcoholic mixtures, causing fire and explosion
and the respiratory tract. Inhalation of gas may hazard.
cause pneumonitis and lung oedema, resulting in The substance can be absorbed into the body
reactive airways dysfunction syndrome (RADS). by inhalation, through the skin and by ingestion
Rapid evaporation of the liquid may cause frost- and is irritating to the eyes and respiratory tract.
bite. Exposure far above the OEL may result in The substance may cause effects on the cellular
death. The effects from chlorine exposure may respiration, resulting in convulsions and uncon-
be delayed so medical observation is indicated. sciousness. Exposure to high concentrations may
357
Chapter 5.3
result in death so medical observation is indicat- by ingestion. The substance is corrosive to

ed. Repeated exposure may affect the thyroid. the eyes, skin and respiratory tract. Inhalation
The occupational exposure limit value should of this gas or vapour may cause lung oedema.
not be exceeded during any part of a workplace The symptoms of lung oedema may be delayed
exposure. Specific treatment is necessary in case and are aggravated by physical effort. Rest and
of poisoning with this substance; the appropri- medical observation are therefore essential. The
ate treatment means and instructions must be substance may cause hypocalcaemia. Exposure
available. The odour warning is insufficient to above the OEL may result in death. Prolonged
indicate when the exposure limit value has been exposure may cause fluorosis.
exceeded. Workers should never work alone in
an area if there is a potential risk of hydrogen Hydrogen sulfide
cyanide exposure. Depending on the degree of Hydrogen sulphide is one of the principal com-
exposure, periodic medical examination is sug- pounds involved in the natural cycle of sulfur
gested. in the environment. It occurs in volcanic gases
and is produced by bacterial action during the
Hydrogen fluoride decay of both plant and animal protein. In in-
Hydrogen fluoride (hydrofluoric acid) is an dustry, it is usually produced as an undesirable
important industrial compound. It is manufac- by-product, though it is an important reagent
tured from calcium fluoride and is used mainly or intermediate in some processes. Hydrogen
in the production of synthetic cryolite, alu- sulfide occurs as a by-product in: the production
minium fluoride, motor gasoline alkylates and of coke from sulfur-containing coal, the refining
chlorofluorocarbons. However, the demand for of sulfur-containing crude oils, the production
chlorofluorocarbons is decreasing as a result of of carbon disulfide, the manufacture of viscose
efforts to restrict their use. Hydrogen fluoride is rayon, and for producing wood pulp.
also used in the synthesis of uranium tetrafluo- Hydrogen sulfide is a colourless gas with a
ride and uranium hexafluoride, both of which characteristic odour of rotten eggs. Heating
are used in the nuclear industry. It is also used may cause violent combustion or explosion. The
in etching semiconductor devices, cleaning and substance decomposes on burning and produces
etching glass, cleaning brick and aluminium toxic gas (sulfur oxides). Hydrogen sulfide reacts
and tanning leather, as well as in petrochemical violently with strong oxidants, causing fire and
manufacturing processes. Hydrogen fluoride explosion hazard, and also attacks many metals
may also be found in commercial rust removers. and some plastics.
Hydrogen fluoride is a colourless gas or fum- Hydrogen sulfide is heavier than air and can
ing liquid with a pungent odour. The substance accumulate in lethal concentrations in low-lying
is a strong acid that reacts violently with bases or enclosed areas.
and is corrosive. It reacts violently with many The substance can be absorbed into the body
compounds causing fire and explosion hazard by inhalation. The substance irritates the eyes
and attacks metals, glass, some forms of plastic, and the respiratory tract. The substance may
rubber, and coatings. cause effects on the central nervous system.
Hydrogen fluoride can be absorbed into Exposure may result in unconsciousness and
the body by inhalation, through the skin and even in death. Inhalation of gas may cause lung
358
Solvents and gases
oedema. The symptoms of lung oedema often and nitric oxide. It also attacks many metals in
do not become manifest until a few hours after the presence of water.
exposure so medical observation is indicated. The substance can be absorbed into the body
Specific treatment is necessary in case of by inhalation and is corrosive to the skin, eyes,
poisoning with this substance; the appropriate and respiratory tract. Inhalation of the gas or
treatment means with instructions must be avail- the vapour may cause lung oedema. Exposure
able. The odour threshold is very low, below 1 far above the OEL may result in death. The
parts per million (ppm). However, at concentra- effects may be delayed so medical observation is
tions above 100 ppm, a person’s ability to detect indicated. Prolonged and repeated exposure may
the gas is affected by rapid temporary loss of have effects on the immune system and lungs,
the sense of smell. Prolonged exposure at lower resulting in decreased resistance to infection.
concentration can result in similar effects. The Animal tests show that this substance possibly
odour warning is insufficient to indicate when causes toxic effects on human reproduction.
the exposure limit value has been exceeded.
Ozone
Nitrogen dioxide Ozone exposure can occur when ozone is pro-
Nitrogen dioxide is formed in combustion proc- duced and as an intermediate in chemical pro-
esses e.g. from motor vehicles using petrol and duction. Ozone is used for bleaching of textiles,
diesel fuels. Nitrogen dioxide is used in the cellulose and sugar, sterilization of medical
manufacture of nitric acid and ammonium ni- instruments and for water purification. It is also
trate fertilisers and as a chemical intermediate in formed in gas arc welding and photocopying.
nitration reactions and the oxidation of metallic Furthermore, there is potential exposure from
compounds. It is produced in processes involv- the use of UV curing inks in the printing indus-
ing high temperatures e.g. welding, due to the try.
oxidation of atmospheric nitrogen. It is pro- Ozone is a colourless or bluish gas with char-
duced in the combustion of fossil fuels so there acteristic odour. It decomposes on warming pro-
could be exposure in coal-fired power stations. ducing oxygen which increases fire hazard. The
Exposure to nitrogen dioxide occurs during met- substance is a strong oxidant and reacts violently
al cleaning using nitric acid. Nitrogen dioxide is with combustible and reducing materials. Ozone
also produced on farms following the breakdown reacts with alkenes, aromatics e.g. aniline, and
of silage, and following explosions in mines and ethers, bromine, nitrogen compounds and rub-
quarries. Hospital personnel can also be exposed ber. Ozone attacks metals except gold and plati-
to nitrogen dioxide when nitrogen monoxide is num.
used in intensive care treatment. The oxidation Ozone can be absorbed into the body by
of any released nitrogen monoxide can lead to inhalation and it irritates the eyes and respira-
the formation of nitrogen dioxide. tory tract. Inhalation of the gas may cause lung
Nitrogen dioxide is a reddish-brown gas or oedema and asthmatic reactions. The substance
brown or yellow liquid with a pungent odour. may cause effects on the central nervous system,
The substance is a strong oxidant that reacts resulting in headache and impaired vigilance and
violently with combustible and reducing materi- performance. Repeated or prolonged exposure
als. It reacts with water to produce nitric acid may affect the lungs.
359
Chapter 5.3
The symptoms of lung oedema and asthma often odour warning is insufficient to indicate when
do not become manifest until a few hours have the exposure limit value has been exceeded.
passed and are aggravated by physical effort so
rest and medical observation are essential. Any- Sulfur dioxide
one who has shown symptoms of asthma due to Sulfur dioxide is produced from the combustion
ozone exposure should avoid all further contact of fossil fuels and the incineration of refuse. It is
with this substance. also produced during ore and metal refining, and
in the manufacture of sulfuric acid and elemental
Phosgene sulfur. Sulfur dioxide is produced in the conver-
Phosgene is used as an intermediate in the man- sion of wood pulp to paper, during casting and
ufacturing of many organic chemicals. The larg- knock-out in some foundries, and is used as a
est amount is used to produce toluene diisocy- preservative in beer, wines and foods.
anate and other isocyanates used in polyurethane Sulfur dioxide is a colourless gas with an
foam production, preparation of plastics, and irritating odour that dissolves in water to pro-
pesticides. duce acidic conditions. The substance can be
Fire-fighters and workers engaged in welding absorbed into the body by inhalation and it
and the building trade are at risk from exposure strongly irritates the eyes and respiratory tract.
of phosgene formed by the thermal degradation Inhalation of the gas may cause lung oedema.
of chlorinated solvents and polymers. Removers Rapid evaporation of the liquid (compressed gas)
and non-flammable dry cleaning solvents (e.g. may cause frostbite. Sulfur dioxide may affect
carbon tetrachloride, chloroform, tri- and tetra- the respiratory tract, resulting in asthma-like
chloroethylene and methylene chloride) should reactions, reflex spasm of the larynx and respira-
never be used in closed areas where fire or heat- tory arrest. High exposure may result in death.
ers of any kind are since these chemicals can de- The effects may be delayed. Medical observation
compose to phosgene. Welding or heat-treating is indicated. Repeated or prolonged inhalation
vessels or equipment that may have contained exposure may cause asthma.
such materials should be avoided until they have Where preventing exposure to sulfur diox-
been purged of all remaining chemical. ide is not reasonably practicable (e.g. by using
Phosgene is a colourless gas with characteris- a different substance), then it is important to
tic odour. The substance decomposes on contact adequately control exposure by a combination
with water and moisture, producing toxic and of engineering and process control measures.
corrosive gases (carbon monoxide and hydrogen If possible, attempts should be made to reduce
chloride). Phosgene reacts with aluminium, and the number of people exposed and the length
isopropyl alcohol. of time of exposure in line with good hygiene
Phosgene can be absorbed into the body by practice.
inhalation. The substance is irritating to the
eyes, the skin and respiratory tract. Inhalation of isocyanates
this gas may cause lung oedema. The effects may Several isocyanates are used in industry to make
be delayed. Exposure to high levels may result urethane paints and resins. The compounds
in death. Medical observation is indicated. The most commonly used are toluene di-isocyanate
360
Solvents and gases
(TDI), methylene bisphenyl di-isocyanate

(MDI), and naphtalene di-isocyanate (NDI).
The isocyanates can be absorbed into the body
by inhalation and irritate the eyes, skin and
respiratory tract. Isocyanates may cause effects
on the lungs, resulting in impaired function.
Asthma is the main adverse effect caused by the
inhalation of isocyanates.
Completely cured polyurethanes are harmless
but isocyanates can be liberated when products
containing cured isocyanates are heated. Iso-
cyanates are set free during welding, cutting,
and grinding of products painted with urethane
paints. Spraying of urethane foam is especially
hazardous and workers must be supplied with
fresh air in their breathing zone. The symptoms
of asthma often do not become manifest until a
few hours have passed and they are aggravated
by physical effort so rest and medical observa-
tion are essential. Anyone who has shown symp-
toms of asthma due to this substance or from
other causes should avoid all further contact
with this substance.
361
5.4
Dusts and metals

Linnéa Lillienberg & Bengt Sjögren
introduction
Workers may be exposed to dust (inorganic and Depending on the size of the particles, dust will
organic) and metals through inhalation, skin be deposited in different parts of the respiratory
contact or ingestion. Inhalation is the most system. Small particles (< 5 µm) will primarily
important route. Skin absorption can vary from be deposited in the alveoli in the lung. Particles
negligible to very high depending on the chemi- of 5-10 µm will predominantly deposit in the
cal composition of the compound. Ingestion tracheobronchial tract, while larger particles will
can occur in dirty workplaces where workers are deposit in the nose and upper airways. Depend-
allowed to eat, drink or smoke in the workplace. ing on the reactivity or solubility of the particle,
Health hazards associated with occupational small particles might deposit higher up in the
exposures are very dependent on the dose and respiratory system.
type of exposure. Long-term exposure to dusts
or irritant gases may lead to the development inorganic dusts
of cough and sputum. This condition is termed Most inorganic dusts will be generated in me-
chronic bronchitis when the productive cough chanical processes like grinding, sawing, cutting,
occurs daily for at least three months a year over crushing, screening or sieving. Handling dry
the last two years. A highly irritating or cor- materials or powder by weighing, filling, charg-
rosive dust (e.g. from strong acidic or alkaline ing, transporting and packing will also generate
dust) may result in serious damage after only a dust, as will activities like insulation and cleaning
single peak exposure if the concentration is high. work. Fumes are vaporised and condensed small
Such an exposure may cause an irritant-induced particles generated during welding, plasma cut-
asthma and be associated with non-specific ting or other cutting operations in metals at high
bronchial hyperreactivity that lasts for many temperatures. These particles contain oxides of
years. Flour dust may cause allergic asthma iron, chromium, nickel, manganese and other
within a year of exposure. Some type of dusts metals.
will result in diseases after many years of expo-
sure e.g. lung cancer from asbestos or silicosis
from quartz.
363
Chapter 5.4
Asbestos advances. Pulmonary fibrosis may progress and

Asbestos is a general term to describe a group death from this disease is not uncommon.
of minerals of crystalline hydrated silicates with
a fibrous structure. Asbestos minerals are char- Cancer
acterized by their strength, flexibility, durability Asbestos exposure causes lung cancer. There is a
and resistance to acid and heat. There are two synergistic effect between asbestos and smoking.
main types of asbestos, amphiboles (straight This means that the incidence of lung cancer
fibres) and serpentines (curly fibres). Crocido- associated with smoking and the incidence of
lite (blue asbestos), amosite (brown asbestos), lung cancer associated with asbestos exposure
antophyllite, tremolite, and actinolite belong to does not increase in an additive way when both
the amphibole family. Chrysotile belongs to the exposures coincide but multiplies, resulting
serpentine family. in a much higher risk. Pleural and peritoneal
Asbestos is principally mined in Canada, mesothelioma are also associated with asbestos
Russia, Zimbabwe and South Africa. Asbestos exposure, however the risk of mesothelioma is
has been used for many different purposes and not related to tobacco use. Currently mesothe-
in a wide range of products such as insulation of lioma causes the death of more workers (around
pipes, furnaces, and electrical wires. It has also 100) per year, in Sweden, than the total number
been used in the construction industry in asbes- of work–related fatal accidents. Most of those
tos cement, shingles, tiles, and in textiles, brake now suffering from mesothelioma were exposed
and clutch linings and in plastics. to asbestos 30 years ago. In the UK, the annual
Inhalation of asbestos fibres causes several number of people diagnosed with mesothelioma
lung diseases. in 2020 is calculated to be about 3,000. Some
researchers have concluded that amphibole
Pleural plaques asbestos gives a higher risk of mesotheliomas
Pleural plaques contain connective tissue rich in than exposure to chrysotile, but both have been
collagen and are most often located under the implicated in asbestos related diseases.
parietal (the outer) pleura. Changes to pleural The European Union has banned the use of
plaques are the most common abnormalities asbestos in new products. WHO recommends
observed among asbestos-exposed workers and health screening, comprising chest radiography,
they appear decades after exposure. This disor- spirometry, and symptom questionnaires, for
der is usually not associated with any symptoms. workers exposed to asbestos.
Asbestosis Prevention
Asbestosis is a fibrotic disease of the pulmonary If possible, asbestos, especially the amphiboles,
tissue. This is a much more severe disorder than should be substituted by other less dangerous
pleural plaques as it impairs lung function. The materials. Various types of mineral wool are a
most common initial symptom is dyspnea (la- better alternative for insulation and other types
boured or difficult breathing). A non-productive of fibres can be used in brake linings. If it is not
cough becomes more common as the disease possible to use a substitute, work must be made
as safe as possible through the use of good ven-
tilation, personal protection (respirators with
364
Dusts and metals
fresh air supply or half mask with P3 filter), wet Machines for cleaning roads and pavements
cleaning methods and minimized manual han- should be closed with well fitted filters on fresh
dling of the dry material. In dusty environments air intake vents. Quartz powder with a high
using asbestos there may be a need to use dis- moisture content, (produced by a wet method),
posable clothes (single use), fitted together with is preferable for the manufacturing of quartz
personal protective equipment like respirators or glass. The installation of spinning disc sprayers
half masks. Such protective clothes must be used in storage houses increases the moisture content
in a proper way and taken off before the respira- in the air. Effective exhaust hoods should be
tors are removed to avoid inhalation asbestos- installed above crushers or mills and processes
containing dust. should be enclosed whenever possible.
Quartz or silica
Crystalline silica occurs in different forms of WHO recommends health screening for
crystals. Quartz is one natural form found in workers exposed to silica.
rocks that can cause fibrosis in the lungs, silicosis,
after inhalation. Workers are exposed in mines,
quarries and during stone cutting, glass manu- Coal
facturing and sandblasting. After heating quartz, Coal mining is associated with several occupa-
crystals may reorganise into cristobalite and tional risks. Many accidents occur due to unsta-
tridymite, crystals that are even more fibrogenic ble support structures in underground mining.
than quartz. Workers can be exposed in steel Pockets of methane can cause fires and explo-
industries, foundries, and during manual and sions. Coal mining is either on the earth’s sur-
machine cleaning of roads and pavements made face or underground. Coal dust may also contain
of stone and sand containing quartz. a low percentage of quartz and thus increase the
Silicosis is a chronic disease and symptoms risk of silicosis. Other important exposures in
(shortness of breath) may not develop for many underground coal mining are diesel particulates
years. It frequently requires 15 to 20 years of and nitrogen oxides.
exposure before chest X-ray shows abnormali- Inhalation of coal dust may cause coal work-
ties. Silicosis increases the risk of developing ers´ pneumoconiosis (CWP), sometimes called
pulmonary tuberculosis. Inhalation of crystalline “black lung”. This disease exists in both a simple
silica can cause lung cancer. and complex form. The more complex form,
progressive massive fibrosis, can lead to disabil-
Prevention ity and death. The disease develops after 10-15
Quartz should be substituted with other material years of exposure to coal dust.
wherever possible. For example olivine, stauro-
lite, steel grit or aluminium oxide can be used Prevention
instead of using silica sand as blasting abrasives. Precautions against accidents due to construc-
If silica sand is used in sand blasting, respiration collapses are strictly regulated and of ut-
tory protection is necessary to avoid the risk of most importance. Methane must be monitored
silicosis. Adding water to rock drilling is one way in order to avoid dangerous levels of the gas.
of reducing silica dust in the work environment. It is essential that there is a good housekeep-
365
Chapter 5.4
ing policy and that workers are educated about glasses, and ceramics; in special alloys and in
health risks. There should be an efficient venti- nickel-cadmium batteries.
lation system and workers should not be exposed Inhalation of high levels can result in a chemi-
to contaminants during blasting operations. One cal pneumonitis and pulmonary oedema. Long-
potential source of coal dust exposure is at tips. term exposure can cause tubular kidney damage
The amount of dust can be reduced by making as the metal is stored in the kidneys. Cadmium
tip openings as small as possible, reducing the and its compounds are regarded as carcinogenic
drop distance or most efficiently, by filtering air to humans. Some early studies pointed to a rela-
from the bottom and around the tip through a tion with prostatic cancer but more recent stud-
ventilation system. Diesel exhaust particulates ies have failed to confirm these results. There
can be decreased by using diesel fuel with low is stronger evidence of a relationship between
sulphur content, disposable exhaust filters, de- cadmium exposure and lung cancer.
coking engines (removing gum etc from cylin-
ders giving better combustion) and by the use of Chromium
adequate ventilation. Chromium is a hard, corrosion-resistant, grey
metal that exists in several oxidative states. The
metals hexavalent compounds are much more chemi-
Aluminium cally aggressive than the trivalent compounds.
Hexavalent chromium (chromate) is used in
Aluminium is a grey metal widely used due to its
pigments and for chromium plating. Stain-
light weight. The highest exposed occupational
less steel contains nickel and chromium and in
groups are welders and powder production
manual metal arc welding chromium is oxidised
workers. Stamped aluminium powder is used in
to hexavalent chromium. Some types of cement
pyrotechnical products. Inhalation of this pow-
and treated wood products contain hexavalent
der may cause a fibrotic lung disease, aluminosis.
chromium.
An obstructive pulmonary disease, “pot room
As hexavalent chromium compounds are
asthma”, is well known among workers in the
more chemically aggressive, they also cause
primary electrolytic production of aluminium,
more irritative symptoms when inhaled. Inhala-
however, fluorides might be more likely to cause
tion of hexavalent chromium particles may cause
this disease. Aluminium also affects the cen-
sneezing, rhinorrhoea, lesion of the nasal sep-
tral nervous system and is the cause of dialysis
tum, which may result in perforation of the nasal
dementia, which previously killed hundreds of
septum, and asthma.
patients around the world. Minor effects on
In general, hexavalent compounds pass bio-
the nervous system have been observed among
logical membranes while trivalent chromium
welders.
compounds do not. Exposures to hexavalent
Cadmium chromium compounds are associated with an
increased risk of lung cancer.
Cadmium is a silver-white metal that is highly
resistant to corrosion and therefore used for
Lead
electroplating of other metals. Cadmium com-
Lead is a heavy, soft, bluish-grey metal. The
pounds are also used as pigments in paints,
largest amounts of lead are used in the manufac-
366
Dusts and metals
ture of electric storage batteries. The cable in- Manganese

dustry uses lead alloys for the covering of cables. Manganese is reddish-grey hard metal and is a
Sheet lead is used in storage tanks. Lead is also very common alloy in different steels.
used for soldering. Lead salts form the basis for The primary target organs of manganese
many paints and pigments. Gas cutting of lead- toxicity are the brain and the lungs. The toxic-
painted outdoor iron constructions can generate ity of the nervous system is presented by various
very high exposure levels. manifestations. The early stage is characterized
Lead causes several different effects on the by emotional instability and irritability. A severe
human body. The most sensitive target of lead form of aggressiveness and mental excitement is
poisoning is the nervous system. Lead affects the sometimes called “manganese psychosis”. The
central nervous system as well as the peripheral advanced stage is characterized by neurological
nervous system. Lead can cause anaemia as it disturbances similar to Parkinson’s disease.
inhibits the body’s ability to make haemoglobin In addition to the neurological effects, man-
by interfering with several enzymatic steps in the ganese is known to cause respiratory effects
production of the heme part of the protein. including chronic bronchitis and pneumonia.
Symptoms from the alimentary tract occur
often in acute lead poisoning. The first symp- Mercury
toms are loss of appetite, digestive disturbances Mercury is a liquid at normal temperature and
and gastric discomfort. Lead colic is character- pressure. Metallic mercury is used in many sci-
ized by sharp onset and recurrent spasms in entific instruments such as barometers. It is also
the abdomen. This condition is associated with used in the silent light switch, fluorescent lamps
high blood concentrations of lead, above about and in powerful street lamps. Some 500,000
7 µmol/L. Heavy and prolonged lead exposure gold miners are working in the Amazonas using
may cause progressive and irreversible renal liquid mercury to separate gold from sediments.
disease. They use the old method of heating the gold-
Lead can decrease the sperm quality in ex- mercury complex (amalgam), where mercury
posed male workers and cross the placenta in vaporizes and leaves the gold. Organic mercury
pregnant women, which can increase the risk compounds have been used as external antisep-
of spontaneous abortions and retardation of tics and pesticides.
neurobehavioural development and growth in Acute poisoning can occur after inhalation of
the infants. The limits for exposure of men and high concentrations of mercury vapour or dust.
women to lead are different in Sweden due to Acute interstitial pneumonitis, bronchitis, and
this fact. A woman, below 50 years of age, with bronchiolitis will present symptoms of tightness
a blood lead concentration above 1.2 µmol/L, and pain in the chest, coughing, and difficulty
should be removed from exposure. The corre- in breathing. In three or four days the salivary
sponding limit for men and women older than glands swell, gingivitis appears, symptoms of
50 years is 2.0 µmol/L. Many countries have gastroenteritis and signs of nephritis develop. In
established biological exposure limits for lead. more severe cases psychopathological symptoms
will appear.
In chronic mercury poisoning digestive and
nervous symptoms predominate.
367
Chapter 5.4
Poisoning by alkyl mercury may occur after

inhalation of vapours or dusts. Symptoms and
signs of acute and chronic exposure result from
the accumulation of mercury in the central nerv-
ous system. The signs are characterized by sen-
sory disturbances with paresthaesia (numbness)
in the distal extremities. A more severe intoxica-
tion may cause ataxia and concentric constric-
tion of the visual field.
Pregnant workers exposed to mercury may
have reproductive effects like stillbirth, low birth
weight and birth defects of their offspring.
Figure 5.4.2. Solder fume extractor with HEPA

filter.
chitis seem to be quite common. Occupational

asthma may be caused by hexavalent chromium
in stainless steel welding or by diisocyanates
inhaled when welding polyurethane-coated steel.
Irritative symptoms are common in soldering
activities. Fumes from rosin (colophony) cored
solder in the electronics industry are recognized
as a cause of occupational asthma.
Figure 5.4.1. Gas-shielded welding with mobile
local exhaust ventilation. Prevention
Fumes containing metal oxides and nitrogen
Zinc oxides are generated in welding operations.
Zinc is highly resistant to corrosion and conse- Some of the most hazardous being chromium-
quently is used for galvanising iron. Inhalation and nickel oxides are generated when stainless
of zinc fume causes “zinc fume fever”. Malaise, steel is welded. Movable exhaust hoods, Figure
chills, and fever may occur 4 to 6 hours after 5.4.1, can be efficient in small shops when work-
exposure. The condition is not fatal and affected ers move the hood close to the emission source.
subjects usually recover completely within 2 These types of exhaust hoods can also be used
days. Inhalation of other metal fumes may also for other non-repetitive tasks like casting, chip-
be associated with fever, “metal fume fever”. ping, grinding or sanding with a motorised hand
tool. If the exhaust system is not very efficient,
Exposures to metal fumes and dusts personal protective equipment, like respirators
Welding is an occupation associated with res- with fresh air supply, should be used when weld-
piratory symptoms and bronchial obstruction. ing painted steel and high-alloyed steel such as
Metal fume fever (zinc oxides) and acute bron- stainless steel.
368
Dusts and metals
Efficient local exhaust hoods should be used in organic dust

soldering work. A push-pull ventilation system Organic dusts are airborne particles of vegeta-
and simple blowers, with a filter or low-volume ble, animal or microbial origin. These dusts are
high velocity ventilation, Figure 5.4.2, can also generated in farming, zoos, pet shops, vegetable
be used. fibre processing (cotton, flax, hemp, jute, sisal),
Workers demolishing tanks and ships, or textile industries, timber and wood processing,
other large lead-painted steel constructions, bakeries, flourmills, greenhouses, in fermenta-
with gas cutting equipment should use personal tion and biotechnology processing.
protective equipment like half masks with gas
and dust filters. The manufacture of electric Farming
storage batteries involves potential lead exposure In farms producing plant crops there are expo-
and should be performed in a well ventilated or sures to organic dusts from handling grain, hay
enclosed system. or other crops, processing sugarcane, working
Whenever there is hazardous dust, an air in greenhouses and with storage silos. Working
cleaner should be used to remove airborne con- with plant crops exposes workers to grain dust,
taminants from the exhaust air stream before pollen, mites and fungal spores in hay or other
discharge to the atmosphere, see Figure 5.4.3. crops. Spraying pesticides and other chemicals
The air cleaner (filter or other cleaning device), in greenhouses will give exposures to organic
should be located immediately upstream of the aerosols.
fan to protect the fan from corrosion and ero- In animal farms (cattle, pig, poultry) there
sion. are exposures to dust containing dander, dried
fecal material, animal feed (e.g. grain, soy bean,
fish), bedding, endotoxins and ammonia. Dusts
inside animal confinement buildings are mainly
respirable and ammonia may be absorbed on the
particles.
The major health problems in farming are
asthma, asthma-like syndrome (wheeze and
breathlessness), chronic bronchitis, non-allergic
rhinitis, organic dust toxic syndrome (OTDS)
and hypersensitivity pneumonitis. Asthmatic
symptoms are related to exposure to sensitising
agents like storage mites, dander, pollen and soy
beans. Grain workers and workers in swine and
poultry houses have a risk of getting asthma-
like symptoms. Exposure to endotoxins may
lead to non-allergic rhinitis and induce chronic
bronchitis or asthma. Causative agents leading
to hypersensitivity pneumonitis are different
microbial agents in mouldy hay, grain and other
vegetable matter.
Figure 5.4.3. Air cleaner in the exhaust air stream.
369
Chapter 5.4
Prevention tive skin-prick tests to common allergens. This

One way to prevent or decrease respiratory condition in bakery workers increases the risk of
diseases among farmers is to improve the char- sensitisation to flour allergens.
acteristics and the management of confinement
buildings, e.g. with good cleaning routines. Ad- Prevention
equate ventilation is the most effective measure Prevention measures should be focused on ac-
to reduce dust and the health risks. The use of tivities that produce peak exposures. Automa-
silage instead of hay will reduce microbial activ- tion is the most efficient prevention method.
ity. During cleaning of a confinement building, Another important measure is to install local
e.g. after selling one stock of animals (pigs) and exhaust ventilation above dough machines and
prior to the introduction of new ones, personal at manual weighing stations. Flour dust consists
protective equipment should be used, e.g. half- of particle sizes ranging from respirable to 15-30
face respirators with an ammonia cartridge and a µm, which complicates ventilation measures. It
dust filter (P2). is difficult to install efficient ventilation exhausts
at manual handling tables so it may be better to
Bakery and flour mills use maize flour instead of wheat flour to avoid
Bakery flour mill workers are exposed to flour dough sticking to work surfaces. Good working
dust. Dough makers are the task group most practices should be used, e.g. not using pres-
exposed to flour dust and dust from dry ingre- surised air in cleaning activities, not throwing
dients in the dough. Most of the dust exposure flour onto dough and by emptying and handling
occurs during relatively short work tasks like empty bags carefully. Ingredients containing
manual weighing, tipping and mixing, giving rise fungal-amylase or other enzymes should be
to peak exposures of short duration. Cleaning handled in a safe way so that the workers are not
activities with compressed air will also give high exposed to any dust containing enzymes.
peak exposures. The manual handling of dough,
using flour to prevent the dough sticking to the Forestry and woodworking
work surface, is another activity that can give Exposure to wood dust is common in those
peak exposure to flour dust. Flour dust consists working in forests and sawmills and to carpen-
mostly of cereals from wheat, rye, barley, oats, ters, joiners and other wood workers. Sawmills
rice or maize. It is well known that flour dust can often produce dust of relatively large and non-
cause allergies such as asthma, rhinitis and der- respirable particle size. Wood contaminated
matitis. Specific sensitisation is more frequent with moulds and spore forming bacteria produce
than allergic diseases and the proteins in wheat small respirable particles. Wood dust contains
flour are strong sensitisers. Other ingredients terpenes, especially the dust from pine trees.
or flours that pose a health risk are soy bean There will also be respirable aerosols of saps,
flour, and enzymes like fungal α-amylase, stor- gums and wood tars.
age mites and moulds. The higher the exposure Occupational asthma has been shown to be
to flour dust, the higher the risk of rhinitis and the most common respiratory disorder within
respiratory disorders. Atopy is often defined by forestry and wood working industries. In for-
the presence of elevated levels of total and al- estry where western red cedar is common, e.g.
lergen-specific IgE-antibodies leading to posi- in British Columbia in Canada, wood dust is the
370
Dusts and metals
cause of asthma in many sawmill workers. Dusts pounds have a higher risk of malignant lympho-
from African maple, oak and mahogany are also mas.
known to cause occupational asthma. Wood
dust is associated with several other respiratory Prevention
disorders including mucosal irritation, rhinitis, The use of chlorine or chlorine compounds as
chronic bronchitis, chronic obstructive pulmo- bleaching agents should be avoided and exposure
nary disease (COPD), inhalation fever, toxic to paper dust should be reduced. Maintenance
pneumonitis and organic dust toxic syndrome workers should use proper protective equipment
(ODTS). Dusts from certain hard woods have during repair and maintenance work.
been recognized to cause nasal cancer and wood
dust has been classified as a human carcinogen. Textiles
There are some wood dusts that can be toxic if There are many types of textiles, including
inhaled or ingested, e.g. East Indian satinwood, cotton, wool, sisal, synthetic textiles, nylon,
ipe and South African boxwood. Wood toxins etc. Textile dust often consists of fibres of low
are usually alkaloids. weight so exposure measurements in apparently
dusty environments may show surprisingly low
Prevention dust levels in mg/m3. Many textiles are treated
Wood dust exposure can be reduced by using with chemicals. For example, formaldehyde
efficient exhaust ventilation, working at fully resins may be used in crease-resistant finishes;
automated or semi-automatic machines, daily polymers (like polyacrylates and polyurethanes)
cleaning of rooms, cleaning of work pieces with that may contain monomers, are used as resist-
a brush and vacuum cleaning of machines in- ant agents; pyrethrin and other pesticides and
stead of using compressed air. fire protecting agents are also used. New textile
products include synthetic polyaramid products
Paper dust used in a range of products like plastic pipes,
Workers in the pulp and paper industry are bullet resistant vests and for fire and heat pro-
exposed to different substances such as sulphur tection. Sewing these products generates dust
compounds, paper dust, bleaching agents like containing synthetic fibres.
chlorine, chlorine dioxide or ozone. High lev- Exposure to cotton dust involves a risk of
els of paper dust seem to impair lung function. chronic bronchitis and an occupational disease
Workers exposed to high peak exposures of the (specific to cotton dust), byssinosis. Byssinosis
bleaching agent ozone (gassings) have a risk of is caused by very high exposure to cotton dusts
getting asthma and attacks of wheeze. Exposure in operations such as ginning, carding and spin-
to high peaks of chlorine-containing bleaching ning. Dust exposure in both wool and synthetic
agents increases the risk of wheeze and chronic textile production has been shown to cause
bronchitis but not asthma. Maintenance workers chronic respiratory symptoms and impaired lung
in the paper and pulp industry have an increased function. Reported symptoms include cough,
risk for lung cancer indicating that this group throat dryness, and nose and eye irritation. Use
had been exposed to asbestos. Epidemiological of reactive dyes in textile plants may induce a
studies in the paper and pulp industry have often production of IgE-antibodies which is assumed
found that workers exposed to chlorine com- to be the mechanism behind the respiratory and
371
Chapter 5.4
Type of dust or metal Main health effect Target organ

Asbestos Pleural plaques, asbestosis, lung cancer, mesothe- Lungs
lioma
Crystalline silica Silicosis, lung cancer Lungs
Coal dust Coal workers’ pneumoconiosis, restrictive lung Lungs
disease
Lead Effects on the central nervous system Central nervous system
Anaemia
Decreased sperm quality, spontaneous abortions, Blood-forming organs
retardation of neurobehavioural development Reproduction
Manganese Chronic bronchitis, pneumonia, Tremor, psychosis, Lungs
Parkinson-like disease Central nervous system
Mercury Pneumonitis, bronchitis Lungs
Gingivitis, gastroenteritis Gastro-intestinal system
Effects on central nervous system Central nervous system
Flour dust Rhinitis, allergic asthma Respiratory system
Wood dust Asthma and other respiratory disorders, nasal Lungs
cancer Nose
Cotton dust Byssinosis, obstructive lung disease Lungs
Figure 5.4.4. Exemples of some dusts and metals at workplaces, main health effects and target organ.
nasal allergic symptoms in workers handling urban air pollutants

these dyes.
Recently it has been found that exposure to en-
vironmental particulate air pollutants is associat-
Prevention
ed with coronary heart disease. The short-term
Textile dust can be lowered by decreasing the effects of air pollutants have been studied among
number of machines in a workplace and by the 38 million persons in eight European cities. An
installation of adequate ventilation. Good work- increase of 10 µg/m3 in PM10 (particulate mat-
ing practices, daily vacuum cleaning and the ter < 10 µm) was associated with 0.5% (95%CI
avoidance of compressed air for cleaning activi- 0.2-0.8%) increase in hospital admissions for
ties are also useful prevention measures. Expo- cardiovascular disease. A cohort of approxi-
sure to synthetic fibers should be decreased by mately 500,000 persons was formed in 1982 and
the use of exhaust ventilation. followed for 16 years. Each 10 µg/m3 elevation
of fine particulate (PM2.5) was associated with a
Other dusts
6% increase of cardiopulmonary deaths. In an
Vegetable dusts such as tea and rice may cause intervention study the cardiovascular death rate
chronic airway obstruction and bronchitis. Dust decreased by 10% in Dublin after the ban of
from dried sugar cane can cause bagassosis (ex- coal sales in 1990, which decreased the average
trinsic allergic alveolitis). black smoke by 36 µg/m3 in the city. One theory
links inhalation of air pollutants to a low-grade
372
Dusts and metals
inflammatory process in the lungs, which causes

an increase in blood coagulation and, as a conse-
quence, coronary heart disease.
Inhalation of several occupational air pollut-
ants causes chronic bronchitis and lung function
impairment. Chronic bronchitis as well as de-
creased FEV1 are associated with coronary heart
disease, and future studies will focus on various
occupational air pollutants as causative agents
for these conditions. Future knowledge may
increase the scope of potential preventive activi-
ties regarding coronary heart disease through
the reduction of air pollutants.
373
5.5
Skin disorders
Carola Lidén & Anders Boman
skin diseases caused by chemical tact dermatitis (hand eczema), but the face, arms
exposure and whole body surface may be affected. The
Many chemical substances are hazardous when clinical picture includes redness, papules, blis-
they come into contact with the skin. Some ters, dryness, scaling, fissures and itching, Figure
toxic chemicals such as pesticides are absorbed 5.5.1. Hand eczema often becomes chronic, has
through the skin. Skin contact with many chem- a poor prognosis that results in sick leave, job
ical and consumer products also cause irritation loss or unemployment and negatively affects a
or allergies. victim’s quality of life.
Contact dermatitis caused by occupational In Europe, 10% of adults are affected by hand
and non-occupational exposure to skin sensi- eczema. More women than men suffer from it.
tizers and irritants is a common problem that The prevalence of hand eczema in developing
affects a large number of the population in both countries is unknown but it is likely to be more
developing and industrialized countries. Contact prevalent due to higher exposure levels, limited
dermatitis is the most common effect caused by access to preventive measures and lack of health
skin exposure to chemicals. The hands are the care for diagnosis and treatment.
most common part of the body affected by con-
Figure 5.5.1. Allergic contact dermatitis.
375
Chapter 5.5
Allergen A substance which may cause an immunologically mediated hyper-sensitivity reac-

tion. Low-molecular substances (contact allergens, skin sensitizers) (e.g. nickel ions,
preservatives, epoxy monomer) may induce contact allergy and allergic contact der-
matitis in exposed individuals. Proteins (e.g. pollens, or from fur animals) may cause
respiratory allergy, asthma and rhinitis.
Atopy Genetically determined ability to develop IgE anti-bodies to allergens such as pollens
and fur animals, to develop allergic asthma, allergic rhinitis and atopic dermatitis. At-
opic individuals often have sensitive skin and thus increased ability to develop irritant
contact dermatitis.
Dermatitis Inflammation of the skin (used here as synonym to eczema) characterized by redness,
blisters, scaling, fissures and itching. Contact dermatitis and atopic dermatitis are the
most frequent types.
Contact dermatitis Dermatitis (eczema) due to skin exposure to irritants (irritant contact dermatitis) or
contact allergens (allergic contact dermatitis).
Allergic contact dermatitis Contact dermatitis due to skin exposure to an allergen to which the individual previ-
ously has been sensitized. Allergic contact dermatitis develops several hours or days
after exposure to the allergen. The risk of skin sensitization and dermatitis is related to
exposure and is not genetically determined.
Irritant contact dermatitis Contact dermatitis due to skin exposure to skin irritants. Water, many chemical prod-
ucts such as detergents, organic solvents, alkaline substances, foods (e.g. fresh fish,
meat, vegetables) and friction etc. are the most frequent causes.
Eczema See dermatitis
Figure 5.5.2. Definitions on skin and allergy reactions.
While contact allergy occurs equally in atopic the majority of cases. The most important causes
and non-atopic persons, irritant hand eczema of contact allergy are metals, rubber and plastic
is more common in persons with atopy, Figure chemicals, preservatives and fragrance chemicals
5.5.1. Colour of the skin does not appear to play (perfumes).
a role in contact allergy, and heredity plays a mi- Contact allergens have a potential to induce
nor role. The exposure pattern varies, however, cell-mediated allergy (delayed hypersensitivity)
between socio-economic groups, occupations, and allergic contact dermatitis after skin contact
geographical, cultural and national regions. The (another mechanism than in allergic asthma and
overall risk factor for sensitization and dermati- rhinitis). Most contact allergens causing derma-
tis in already sensitized persons is skin exposure titis are present in man-made products but some
to skin sensitizers. are found in plants and in other natural sources.
It is estimated that 15-20% of the adult popula-
contact allergens and dermatitis tion in Europe is sensitized to one or more con-
More than 3,700 chemical substances are de- tact allergens. The level of sensitization in other
scribed as contact allergens but a limited number parts of the world, particularly in developing
of substances are responsible for sensitization in countries, is little known due to limited access to
376
Skin disorders
dermatologists, to diagnostic procedures such as prevention

patch testing and the lack of clinical and epide- Low exposure to chemicals has to be maintained
miological data. if workers are to perform their jobs with mini-
Once a person has developed an allergy to a mal risk of acquiring a skin disease. A low expo-
contact allergen (sensitization), further exposure sure environment can be sustained by a number
may cause allergic contact dermatitis (elicita- of administrative and practical processes, Figure
tion). Sensitization generally requires more in- 5.5.3.
tense exposure to the allergen, while lower doses Limitations on the use of dangerous chemi-
are required for elicitation of dermatitis in those cals and products can be enforced by national
already sensitized. Contact allergy is regarded to and international legislation and regulations.
be a lifelong allergy, while dermatitis may disap- Such measures include occupational exposure
pear if skin exposure to the allergen is avoided. limits (of concentration or time), regulations
The avoidance of skin exposure is essential for that limit the content of dangerous chemicals in
prevention of sensitization as well as elicitation products or conspicuous marking of containers.
of allergic contact dermatitis. European and national authorities use regula-
Some occupations represent increased risk for tions that limit use and labelling of chemicals.
sensitization to specific occupational allergens (Some specific examples concerning nickel,
and some common allergens. chromium in cement, preservatives, fragrances
and latex are mentioned below).
irritants and dermatitis
Irritant reactions are frequently caused by differ- 1. Regulations on chemicals, products, work environ-
ment: limitations, labelling of chemical products,
ent type of exposure, single or repeated. Some of exposure limits, use limits
the most prominent skin irritants are defatting
2. Substitution of dangerous substances and
agents such as detergents, solvents (including products
water), and corrosive substances that may cause
3. Technical solutions including automation, encapsu-
irritant contact dermatitis. Some substances may lation of hazardous processes
act as both an irritant as well as a skin sensitizer. 4. Hygiene routines by workplace and workers to
In general the clinical appearance is the same minimize hazardous skin exposure
for irritant and allergic contact dermatitis, and 5. Information about risks and preventive measures
they are often combined. Correct diagnosis, and 6. Preventive skin care programmes including suitable
effective treatment requires knowledge about soap and moisturiser without potent skin sensitizers
exposure to irritants and allergens, and patch 7. Personal protective equipment such as protective
testing for detection of contact allergy. gloves, aprons, sleeves, boots, goggles, visors
A limited number of substances affect both
Figure 5.5.3. Examples of measures at internation-
the skin and the respiratory tract, but by differ- al, national, work place and individual levels for
ent mechanisms. Typical examples are fragrances prevention of occupational skin disease.
and formaldehyde that are contact allergens that
may cause allergic contact dermatitis after skin Practical reduction of workplace exposure can
contact, as well as causing hyper-reactivity due include substitution of hazardous chemicals
to irritation of the respiratory tract. or products with less hazardous ones, techni-
377
Chapter 5.5
cal devices or reorganization of work. Enclos- Protective gloves

ing machinery, changing routines for handling When other methods of preventing skin contact
chemicals or contaminated goods or using tools with toxic, irritant, or sensitizing chemicals are
to handle containers and goods are also ways to exhausted, the use of protective gloves may be
minimize exposure. the only means left. Protective gloves are manu-
As a last resort, personal protective equip- factured from various materials, Figure 5.5.4,
ment must be introduced as a barrier between a but effective skin protection requires gloves to
worker and a chemical. Impermeable gloves and be made of impermeable polymeric materials.
sleeves may be used for hand and arm protection Gloves made of leather, cotton or other tex-
and boots and aprons can protect the feet and tiles do not usually give sufficient protection.
abdomen. Visors or ventilated hoods protect the (Permeability data on various protective gloves/
face from splashes and fumes. chemical combinations is available).
The cost of implementing a new routine or Gloves should be personal, free of holes and
practical device to protect workers from expo- clean on the inside otherwise a toxic, irritant or
sure to chemicals is always balanced by lower sensitizing substance can come into contact with
costs for sick leave and ill-health. the skin and is more easily absorbed due the
Material Monomer Trade-name, examples

Natural materials
Natural rubber (NRL) cis-Isoprene Canners and Handlers, AirFlex, FL100/FL200,
Natural Blue, Tan Rubber, Natural Rubber Latex
HD, Best Master, Tuff Guard, Belmain Plus
Synthetic materials
Butyl rubber Isobutene/isopropene ChemTek, Best Butyl, Butoject,
NORTH Butyl
Chloroprene Neoprene, Redmont, Chemi-Pro, Scorpio, Best
Neoprene, Chloroflex II, Camapren
Fluoro rubber Vinylidene fluoride/hexafluor- Viton, Best® Viton®, NORTH Viton
propene
Nitrile rubber Acrylic nitrile/butadiene Sol-Vex, Sol-Knit, Nitri-Solve, Blue Nitrile G25B.
Camatril, Chemsoft
Polyvinyl-chloride (PVC) Vinyl chloride Snorkel, Ever-Flex Monkey Grip, Black Knight,
Cannonball, Hustler, P56B & P57B, Supasoft
Polyethylene (PE) Ethylene P-glove
Polyvinyl-alcohol (PVA) Vinylalcohol PVA
PE/EVOH/PE PE and EVOH laminate 4H/Silver Shield, Barrier
Polyurethane (PU) Isocyanate
Neoprene/Natural Rubber Technicians, Omni, Comaprene, Lapren
Latex Blend
Figure 5.5.4. Examples of commonly used materials in protective gloves made by major manufacturers.
378
Skin disorders
occlusion caused by the glove. The use of gloves should not contain perfumes, odour masking
may also cause skin irritation particularly if they agents or preservatives that are potent sensitiz-
are worn for long periods. Gloves should be ers. Many “barrier creams” contain such hazard-
taken off frequently to let the hands and gloves ous substances.
dry. Cotton gloves can be worn underneath pro-
tective gloves in order to increase comfort. hazardous substances
The choice of glove should be based on con- Metals
siderations concerning the period of work, toxic- Nickel is the most common cause of contact
ity and adverse effects of a chemical, exposure allergy. Nickel allergy is much more common
possibilities, comfort and functionality. A well amongst women than men due to differences in
fitting, comfortable glove is essential when good exposure. In Europe, 10-15% of women and 2-
manual manipulation is needed, but a cheaper 5% of men are allergic to nickel. Chromium and
less well fitting glove may be used for a short cobalt cause skin sensitization less frequently
exposure. than nickel but they are still some of the most
The cheapest and generally least protective common causes of contact allergy, Figure 5.5.5.
gloves are disposable gloves made of natural
rubber latex. Thicker gloves and those made Substance Exposure and use
of synthetic materials are more expensive but
Nickel Items in prolonged contact with the
give better protection. The purchase of larger skin are the most frequent sensitizers.
quantities of gloves may be economically advan- Occupational exposure of the hands
tageous as lower prices can be negotiated.This to items with high nickel release (tools,
coins, equipment etc.) may cause hand
is mandatory for public, government agencies
eczema. Exposure to nickel-containing
within EU, communities, counties, regions and solutions may also cause dermatitis.
federal governments and their companies, how- Chromium Chromium (VI) in cement is the most
ever not for private companies. important cause of contact allergy to
chromium. Chromium (III)-tanned leather
Preventive skin care programmes may cause allergic contact dermatitis.
Maintaining a healthy and functional skin bar- Cobalt Which types of exposure that cause con-
rier is important to prevent skin disease and the tact allergy to cobalt are not fully under-
stood. Cobalt is a potent skin sensitizer.
absorption of noxious chemicals. One important
preventive measure is a good skin care pro- Figure 5.5.5. Sensitizing metals, examples of expo-
gramme for workers where at least a mild soap sure and use.
and a skin care cream (moisturiser) are provided.
The use of pre-work “barrier creams” is gener- Nickel
ally not necessary. “Barrier creams” are not real Currently nickel allergy predominantly affects
barriers against absorption, but they may reduce girls and women who become sensitized by
soiling of the skin which can also be achieved by jewellery and other personal items, however, a
the use of an ordinary skin cream. Sometimes century ago nickel dermatitis was an occupation-
“barrier creams” can enhance skin absorption of al disease that principally affected men. Occupa-
hazardous substances. tional exposure to nickel is still a major factor in
The products used for skin care programmes eliciting and maintaining hand eczema and may
379
Chapter 5.5
also cause sensitization to nickel. Groups with in 2001. Experience from Denmark and Sweden
high skin exposure to nickel at risk for occupa- indicate that nickel dermatitis is becoming less
tional nickel dermatitis include electroplaters, frequent and severe and that exposure has de-
electronics workers, metal workers, construction creased due to the limitation on nickel release.
workers, car mechanics, hairdressers, cashiers, Similar regulation has recently been introduced
and employees doing wet work in hospitals and in China.
cleaning.
The essential factor in relation to nickel der- Chromium
matitis is the release of nickel ions (rather than Direct skin contact with uncured cement and
nickel content) from solid items. Various alloys cement-containing products is the main cause
and platings containing nickel have different of sensitization to chromium in men. Soluble
properties when in contact with skin. Some hexavalent chromium, Cr (VI), is present in ce-
alloys, such as nickel-silver and copper-nickel, ment in large parts of the world, and is an im-
release much nickel while others, such as many portant cause of occupational dermatitis among
stainless steels, release little nickel, (so most constructions workers. It should be noted that
stainless steels don’t cause contact dermatitis). uncured cement is very corrosive and may cause
High exposure to soluble nickel compounds irritant dermatitis and chemical burns that facili-
occurs in nickel refining, electroplating, nickel- tate sensitization to chromium.
cadmium battery production, chemical produc- Cr (III) is used to tan leather products. Der-
tion, and nickel catalyst production. matitis can occur in already sensitized persons
through direct skin contact with leather. Such
Prevention persons may be consumers, workers using pro-
The dimethylglyoxime (DMG) test is a simple tective equipment made of leather, and workers
screening test for nickel release, available com- producing leather and leather products. Leather
mercially in many countries. It is very useful may also cause sensitization. During recent
for identification of sources of skin exposure to years, chromium in tanned leather has been
nickel in order to prevent nickel dermatitis by discussed as an important source of sensitization
reducing exposure. The test is based on DMG in women.
(0.8% in alcohol) and ammonia (10%). A cotton Anti-corrosion and electroplating agents,
tipped stick with 1-2 drops of each solution is catalysts, chromated products and magnetic
rubbed for up to 30 seconds on the surface to be tapes are examples of other causes of occupa-
tested. A pink-red colour indicates presence of tional contact dermatitis due to chromium.
nickel ions. A person who has become sensitized to either
In Europe the “Nickel Directive” limits nickel Cr (III) or Cr (VI) may react if exposed to the
release from certain items intended for direct other form of chromium. Elemental chromium,
and prolonged contact with the skin (jewellery, Cr (0), is regarded as stable and is not allergenic
watches, buttons, spectacle frames etc.). Items at skin contact.
such as tools, coins and handles are not covered
by the “Nickel Directive”, although they also Prevention
contribute to nickel exposure and dermatitis. In some countries (Denmark, Finland, Sweden,
The “Nickel Directive” entered into full force Germany) exposure to soluble chromium has
380
Skin disorders
since decades been reduced by regulation lim- Prevention

iting the Cr (VI) level in cement and cement Dermatologists often recommend patients al-
products to <2ppm. Reduction of the Cr (VI) lergic to cobalt to avoid contact with nickel as
content is achieved by adding iron sulfate to cobalt and nickel allergy are often seen together.
the cement. Contact allergy to chromium has A screening test for cobalt, similar to the test
decreased, largely due to the limitation. Similar already available for nickel, may be available in
regulation was implemented also by the EU in the future.
2005.
rubber and plastics
Cobalt
Contact allergy to rubber chemicals is common,
Contact allergy to cobalt is often seen in patients mainly caused by occupational and non-occu-
who are allergic to nickel or chromium. Uses of pational exposure to finished rubber products.
cobalt include binders for hard metals, organo- Contact allergy to plastic chemicals is also com-
cobalt compounds, coloured glasses, enamels, mon, most often caused by occupational expo-
ceramics, magnets, paint pigments, catalysts and sure to unfinished plastics, Figure 5.5.6.
metallic alloys such as Co-Cr used in spectacle
frames and prostheses. Occupational skin expo- Rubber chemicals
sure occurs by contact with hard metal products, Thiurams, carbamates and mercaptobenzothia-
alloys, paints, magnetic tapes, and in hard metal zoles are used in the production of rubber prod-
production. There is limited knowledge about ucts, and in many other products and processes.
the sources of skin exposure and sensitization to Many of the substances are skin sensitizers.
cobalt in the general population. Rubber gloves (household and surgical), boots,
Substance Exposure and use

Rubber chemicals: Used as additives in rubber production, in articles such as gloves, watch straps,
Mercaptobenzothiazoles, diving equipment, gas masks, elastic bands, elasticated garments and shoes. Used
dithiocarbamates and thiurams as pesticides.
Diisocyanates Industrial uses of isocyanates include manufacture of rigid or flexible polyurethane
foam, surface coatings, adhesives, elastomers and textiles. Occupational exposure
in rubber workers, spray painters, plastic factory workers, foam manufacturers, print-
ers, laminators etc. Polyurethane can break down into isocyanate monomers upon
heating, exposure may occur in e.g. welders.
Epoxy resins Used in a wide range products and materials - adhesives, paints, electric insulation,
cement and glass fibres etc. Occupational and non-occupational exposure.
Methacrylates Used as, or in production of binders for glues, paints, inks, coatings, in dentistry
etc. Occupational exposure to uncured acrylic resins. Non-occupational exposure
to anaerobic sealants, contact with cured products which still contain non-reacted
monomer.
p-tert-Butylphenol- Binder, used mainly in glues, paints, adhesive tapes and labels, inks and sur-
formaldehyde resin face coatings. Used in glued leather products such as shoes and watchstraps.
(PTBP-F-R) Occupational and non-occupational exposure.
Figure 5.5.6. Examples of skin sensitizing rubber and plastic chemicals, their exposure and use.
381
Chapter 5.5
shoes, watchstraps, diving equipment, gas masks, route for sensitization. Acrylates are used in
tyres, tubes etc. are examples of rubber products a wide range of applications and occupations.
in frequent contact with the skin. Ironically, Dental acrylates cause hand eczema in dentists,
protective gloves are the most important cause dental technicians and dental nurses, but seldom
of contact allergy to rubber chemicals. Sensitiz- affect dental patients.
ing rubber chemicals may be used also in paints, Isocyanates, particularly some of the diisocy-
glue removers, anti-corrosives and pesticides. anates, are potent skin sensitizers. This has not
Natural rubber latex proteins may cause IgE- received as much attention as the respiratory
mediated allergy which is another type of allergy effects, which are more common and may be
with different symptoms (see below). severe.
Phenol formaldehyde resins is a group of
Prevention resins with varying properties, composition and
The use of protective gloves made of plastic applications. p-tert-Butylphenolformaldehyde
rather than rubber materials should be consid- resin (PTBP-F-R) is a frequent skin sensitizer,
ered (see below). used mainly in adhesives, where flexibility and
water resistance is needed. It is often used in
Plastics shoes and watch straps and may cause severe
Many plastic chemicals are known skin sensitiz- dermatitis.
ers. The following are some of the most fre-
quent sensitizers. Prevention
Epoxy resins are used in epoxy-resin systems All skin exposure to uncured plastic resins
that consist of resin, a hardener, and other com- should be avoided. It is essential for workers
ponents such as diluents, fillers and pigments. and consumers to know that the monomers pass
There are many different epoxy resins. Mono- through the common protective glove materials
mers and dimers of epoxy resins are extremely within minutes.
potent skin sensitizers and may cause sensitiza-
tion after a single exposure to the uncured resin. preservatives
Some of the hardeners and other components Contact allergy to preservatives is a frequent
may also cause sensitization. problem. All preservatives are potential skin sen-
Epoxy resins are used in a wide range of prod- sitizers, and some of them are extremely potent.
ucts and applications such as two component Due to the continuous introduction of new pre-
paints, glues and adhesives, corrosion inhibitors, servatives, the situation is dynamic, Figure 5.5.7.
metal coatings and printing inks. They are used The presence of preservatives in products is
to insulate electric assembly and electronic de- often unknown since there is no requirement to
vices, as an additive to cement for quick bonding declare ingredients on the labels of chemical or
and strengthening, in glass fibres and flooring household products. There are inadequate safety
materials etc. data sheets. To add to the confusion, preserva-
Many acrylates, and particularly methacr- tives often have many different trade names
ylates, are potent skin sensitizers. Like epoxy and products frequently contain more than one
resins, skin exposure to monomers, oligomers preservative.
or uncured acrylic resins is the most important Formaldehyde is a common preservative in
382
Skin disorders
Substance Exposure and use
Benzisothiazolinone Preservative in chemical products, mainly for occupational use, such as in paints. Not
(BIT) allowed in cosmetic products in the EU.
Formaldehyde and Preservatives in a wide range of products including cosmetics, chemical products for
formaldehyde releasers consumers and occupational use.
Formaldehyde used also in textiles and leather in contact with skin.
Methylchloriso- Preservative in a wide range of products including cosmetics, chemical products for con-
thiazolinone/methyl- sumers and occupational use. Kathon CG is the most well-known of many trade names.
isothiazolinone
MCI/MI is an extremely potent skin sensitizer. Severe restrictions of use in cosmetics have
(MCI/MI)
been introduced in the EU and in North America. The use of MI only, often together with
other preservatives, is increasing.
Methyldibromo Preservative in a wide range of products including cosmetics, chemical products for
glutaronitrile consumers and occupational use.
(MDBGN)
Alarming increase in sensitivity to MDBGN recorded in Europe. From June 2008 not
allowed in cosmetics in the EU.
Figure 5.5.7. Examples of skin sensitizing preservatives, their exposure and use.
paints/lacquers, binding agents, cleaning agents, sensitization rate in dermatitis patients in Europe
printing inks, adhesives/glues, filling agents, principally attributed to the use of MDBGN in
hardeners, cutting fluids, cosmetics, toiletries cosmetic products. Strict limitations on the use
etc. Formaldehyde resins are used in textiles to of MDBGN were adopted in the EU as from
avoid shrinkage and in the production of leather. June 2008 it cannot be used in cosmetics (includ-
Formaldehyde is also used in many chemical ing products for personal hygiene). However, the
processes. use of MDGDN is still allowed in chemical or
Occupational exposure to formaldehyde oc- other type of products.
curs among health care workers, photographers, Methylchlorisothiazolinone/methylisothia-
textile workers, metal workers, painters, car- zolinone (MCI/MI) is an extremely potent skin
penters, joiners etc. Non-occupational exposure sensitizer widely used in cosmetics and chemical
occurs among the general population through products. However, its use has been limited in
contact with detergents, glues, cosmetics, toilet- cosmetics because of the rapid increase in skin
ries etc. sensitization.
Formaldehyde releasers act as preservatives by Benzisothiazolinone (BIT) is a chemically re-
releasing formaldehyde into a variety of prod- lated substance but it is not allowed in cosmetic
ucts including cosmetics and hygiene products. products in Europe.
Some of the formaldehyde releasers are common
skin sensitizers. dyes
The preservative that causes the most prob- Many dyes are skin sensitizers and may cause
lems is methyldibromo glutaronitrile (MDBGN). allergic contact dermatitis. The chemistry is very
There has been an alarming increase in the complex due to the reactivity of the substances.
383
Chapter 5.5
Hair dyes and dyes used in textiles are common Group Important skin sensitizers
causes of dermatitis. Some examples are given in
Figure 5.5.8. Hair dyes The most potent and frequent skin sen-
sitizers are p-phenylenediamine and its
derivatives 3-aminophenol and toluene-
Hair dyes 2,5-diaminesulfate. Hairdressers and
Contact allergy to hair dyes is a frequent prob- consumers are exposed.
lem among hairdressers and consumers in in- Disperse Dyes in a wide range of products and
dustrialized countries and developing countries. dyes materials for consumers and occupational
Hairdressers may develop severe hand eczema use. Used in textiles, leather, plastics,
printing inks etc. Examples of some of the
and consumers may develop dermatitis on the
most frequent skin sensitizers: Disperse
face, neck and scalp. There are several types of blue 106, Disperse blue 124, Disperse
hair dyes including vegetable dyes based on hen- yellow 3, Disperse red 1, Disperse
na, temporary dyes that are washed away quickly, orange 3.
semi-permanent, permanent or oxidation hair Figure 5.5.8. The most important skin sensitiz-
dyes. Permanent hair dyes generally consist of ing dyes in consumer products and occupational
a cream base with a mixture of aromatic amines exposure, examples.
and couplers. The most important skin sensitiz-
ers are p-phenylenediamine and related sub- fragrances and colophony
stances that may be used in both permanent and
Contact allergy to perfumes (fragrance sub-
temporary hair dyes.
stances) is an increasing problem. Fragrances
Many other substances used in hairdressing,
are used in a wide range of products. Several
not only hair dyes, are skin sensitizers. Examples
hundreds of different fragrances are in use,
are bleaching agents, permanent wave agents,
and a small number are not allowed in cosmet-
preservatives, fragrances, and nickel and cobalt
ics due to severe health effects. Fragrances are
in cutting equipment. Hairdressers are often
used in cosmetics, household products, chemical
affected by hand eczema due to the combination
products etc. They are used to give an attractive
of intense wet work and exposure to potent skin
and/or specific smell, and to mask bad odours, in
sensitizers.
products as cutting fluids, Figure 5.5.9.
Contact allergy to colophony (rosin) is com-
Disperse dyes
mon. Colophony is derived from pine trees by a
Many disperse dyes are contact allergens. The
variety of processes. It may be used unmodified
magnitude of the problem is not known due to
or modified and has a wide range of applications.
limited experience from patch testing with dyes.
All modified colophony products contain com-
Disperse dyes are often used in textiles. Occupa-
ponents from unmodified colophony, and may
tional dermatitis may be caused by exposure in
cause contact dermatitis, Figure 5.5.9.
production of textiles and fabrics. Dermatitis is
also caused by wearing dyed clothes.
384
Skin disorders
Substance Exposure and use Pesticide Skin effect

Fragrances Frequently used in cosmetics, hygiene
Chlorothalonil Extremely potent skin sensitizer.
products and chemical product etc.
Allergic contact dermatitis has
Respiratory symptoms caused by
been described in workers
fragrances are due to irritation, not
exposed in floriculture, banana
allergy.
fields, wood preservation and to
Colophony Used in a wide range of products and paint. Skin pigmentation (ashy
(rosin) materials for occupational and non-oc- dermatosis) has been described
cupational use. Solder flux, emulsifiers, in banana field workers.
glues for different purpose, cosmetics,
waxes are some examples. 2,4-D and 2,4,5-T May contain TCDD (dioxin) which
Asthma has been related to exposure is often formed during production.
to fumes from solder flux. The mecha- This is the explanation of several
nism is not settled. outbreaks of chloracne and por-
phyria cutanea tarda.
Figure 5.5.9. Fragrances and colophony, examples
of exposure and use. Paraquat Irritant contact dermatitis, oc-
cupational keratoses, nail lesions,
necrotic ulcers, deaths have been
reported after skin exposure.
pesticides Considerable amounts may be
The most important fatal effects of skin expo- absorbed through damaged skin
sure to pesticides are acute toxic reactions due and under occlusion.
to skin absorption of organophosphorus com- Carbamates, Allergic contact dermatitis has
pounds. Irritant contact dermatitis due to pes- thiurams, benomyl, frequently been reported. Car-
ticide exposure is believed to be more frequent fluaxinam and other bamates and thiurams are used
fungicides also in the production of rubber.
than allergic contact dermatitis. Allergic contact
dermatitis caused by pesticides has often been Figure 5.5.10. Examples of severe or frequently
related to fungicides and insecticides. It must be occurring skin effects caused by skin exposure to
stressed, however, that there is limited experi- pesticides.
ence and data from patch testing with pesticides
for diagnosis of contact allergy. A broad range damage concentration, contact time, area, hu-
of skin effects of pesticides has been described. midity and temperature are all important factors
Some examples are given in Figure 5.5.10. affecting skin absorption.
There is a broad variation in the degree Prevention of skin exposure to pesticides is
of skin exposure to pesticides experienced by extremely important.
workers. Sprayers, mixers, loaders, packers, and
mechanics perform work with high risk of di- organic solvents
rect skin contact with pesticides. Aerosols and Considerable amounts of several solvents may
residues on treated plants and surfaces may also be absorbed through the skin from exposure to
contribute to exposure. Percutaneous absorption neat solvents, products containing solvents (e.g.
of pesticides varies considerably from compound cleansing and defatting agents), and in some
to compound. Absorption is highest through cases, to vapours. The uptake varies widely be-
scrotal skin, the head and neck. Occlusion, skin tween different solvents. Water solubility, lipid
385
Chapter 5.5
solubility and volatility are of importance. Other Protective gloves should be used to prevent skin
factors influencing the rate of skin absorption exposure to organic solvents. There are different
are environmental factors such as humidity, models of gloves made from different materials
temperature, air velocity, vehicle, occlusion, and of differing strength, so their resistance to or-
exposure time. ganic solvents is variable. When selecting pro-
Skin exposure to organic solvents has been tective gloves, it is essential to consider these
estimated to be responsible for up to 20% of aspects as well as the risk of side effects from the
occupationally induced dermatitis. The main gloves themselves. Barrier creams are less effi-
effects of organic solvents on the skin are irrita- cient than protective gloves in reducing skin ex-
tion, irritant contact dermatitis and acute burns. posure and percutaneous absorption of organic
Skin sensitization occurs rarely. Other effects solvents and their use may lull users into a false
are subjective irritation, whitening, contact belief that their skin is protected.
urticaria, generalised dermatitis, and systemic
toxicity due to percutaneous absorption. Skin corrosives
may be exposed to organic solvents when hands A wide variety of products and chemicals are
are cleaned with solvents or cleaners containing corrosive to the skin causing chemical burns on
solvents, through accidents, lack of proper pro- contact. Usually, they have an extreme pH or are
tective equipment, or poor workplace routines toxic to the keratinocytes of the skin. Examples
and facilities. of corrosive products are cement, hydrofluoric
Skin exposure to glycolethers and dimethyl- acid, concentrated acids and alkalis, phenol.
formamide is hazardous because they are easily Some concentrated chemicals such as the pre-
absorbed. Aromatic solvents are more potent servative MCI/MI may be both corrosive and
irritants than aliphatic solvents. Contact with sensitizing.
perchloroethylene and several other halogen-
ated solvents may cause severe burns. This can skin irritants and wet-work
result from clothes that have not been properly Many chemicals and chemical products are skin
dried after dry cleaning with perchloroethylene irritants because they remove lipids from the
or trichloroethylene. Alcohols are less irritating skin. Commonly used products such as deter-
than the aldehydes or ketones. Carbon disulfide gents, organic solvents, cleansers, soaps, mild al-
is one of the most irritating solvents. While kali, defatting agents and even excess water may
dimethyl sulfoxide (DMSO) is readily absorbed cause irritant contact dermatitis. Use of protec-
through the skin, its systemic toxicity is low. The tive and medical gloves may also contribute to
use of turpentine has declined but previously the development of dermatitis. Handling fresh
it was a common cause of contact dermatitis foodstuffs is considered as wet-work and derma-
among painters. D-Limonene, (a citrus solvent), titis among cooks and other kitchen staff is often
is an organic solvent increasingly used in metal attributed to contact with fresh vegetables, raw
cleaning, and many other uses. Allergenic oxida- fish and meat and frequent hand washing.
tion products are created when exposed to air. Exposure to wet-work is very frequent in
Several organic solvents are known to induce a wide range of jobs and in non-occupational
scleroderma-like eruptions with localized sclero- settings. Clinically, irritant contact dermatitis
sis of skin on hands and feet. caused by wet-work and exposure to chemicals is
386
Skin disorders
a major problem. Physical factors such as fric- in contact with food and the general population
tion from tools and handles, exposure to dust may be affected.
and man-made fibres may cause and aggravate The Anacardiaceae family (cashew family) in-
dermatitis. cludes some 600 species of trees and shrubs, dis-
tributed throughout the tropics and temperate
natural products regions of Europe, eastern Asia, and the Ameri-
Wood cas. They are considered to cause more derma-
titis than all other plant families combined. The
A number of types of wood cause contact der-
most important genus is Toxicodendron which
matitis due to skin irritation and contact allergy.
includes poison ivy, poison oak and poison su-
Some tropical woods are extremely potent skin
mac, frequent allergens except in Europe where
sensitizers, particularly palisander, rosewood,
these plants are not widespread.
pao ferro, sandalwood, jacaranda, teak, African
Peels and juice from citrus fruits such as lime,
ebony and African mahogany. Important skin
lemon, orange and grape fruit may cause derma-
sensitizers in tropical woods are quinines. In Eu-
titis by irritation, sensitization and photoallergy.
rope, pine trees are the most frequent sensitizers
Citrus peels contain essential oils and d-limone
as they contain colophony (rosin), a common
(citrus solvent) used as fragrance substances and
sensitizer.
solvents.
Handling of fresh wood and exposure to saw
dust may cause severe and widespread dermatitis
Natural rubber latex
on hands, forearms, face and neck mainly affect-
The protein in natural rubber latex may cause
ing wood workers such as carpenters, joiners,
contact urticaria, asthma, rhinitis and even life
cabinet-makers and trades persons. Standard
threatening anaphylaxia, due to IgE-mediated
clothing is not good protection and airborne
allergy. In Europe and Northern America, this
sawdust may drift inside clothing, and adhere
type of allergy has become more frequent during
to sweaty areas of skin like armpits, waist, groin
the 1990s, largely attributed to the increasing
and ankles. Finished wood products may also
use of natural rubber latex gloves in health care.
cause dermatitis. Dermatitis in forest workers is
In some European countries, 10% of health care
generally caused by liverwort and lichens grow-
workers who frequently use gloves are affected
ing on trees, not by the wood itself. Inhaling saw
by latex allergy. Increased awareness of the
dust may also cause asthma, cancer and higher
problem in Europe and the USA has resulted in
risk of Hodgkin’s disease.
regulations and standardisation for prevention
Plants and lichens by improvement in the quality of the products.
The situation on latex allergy in developing
Plants may cause allergic and irritant contact
countries in unknown.
dermatitis, photosensitivity and contact urti-
caria. Some fruits and vegetables cause derma-
titis. Dermatitis caused by plants often appears
as streaks on the arms and face, or as dermatitis
on the fingertips and palms. Agricultural work-
ers, florists, gardeners, forestry workers, workers
387
5.6
Epidemiology
Gun Nise & Bengt Sjögren
The discipline of Epidemiology has developed ronmental exposures and diseases. The design
tremendously over the last half century. The of a study is based on the character of the expo-
content of occupational epidemiology is studies sure of concern, the expected health outcome,
of the occurrence of diseases and occupational and the feasibility of conducting the study. The
exposures. This short presentation gives a touch probability of finding an increased risk very
of some features of occupational epidemiology. much depends on the intensity and duration
Comprehensive presentations of this topic are of exposure, the number included in the study
available in textbooks, some examples are given group and the occurrence of disease.
under “Suggestions for further reading” at the Epidemiology continues to play an important
end of this Section. Most of the epidemiological role in identification of major causes of occu-
studies can be divided into the following groups: pational diseases which is the key element for
prevention and controlling hazardous exposures.
• Descriptive studies present the occurrence
Some basic definitions will be presented
of a symptom or disease in a defined popula-
which are used in epidemiology describing
tion, e.g. a particular effect/disease amongst a
associations between exposure and disease.
specific group of workers.
• Analytical studies compare the occurrence
of a symptom or disease among workers ex- basic concepts
posed to a defined agent with the occurrence
of symptom or disease among non-exposed Risk
workers. Risk refers to the probability that an event will
occur, e.g. that an individual will become ill or
Epidemiology has been a crucial tool in research
die within a stated period of time or by a certain
to elucidate and establish the association be-
age. The time at risk refers to the period when it
tween occupational exposures and adverse health
is possible for an individual to get a disease. For
effects, e.g. asbestos and lung cancer, benzene
example, during pregnancy a woman is at risk of
and leukaemia, heavy workload and muscu-
having miscarriage. The time at risk is usually
loskeletal disorders.
given as person-time, a measurement combining
Various approaches can be used to investigate
persons and time at risk of developing symptom
the relationship between occupational or envi-
389
Chapter 5.6
or disease. The most commonly used person- period of time. In order to calculate the inci-
time is person-years. dence, individuals have to be followed over time.
The “I” can be 0 but has no upper limit.
Prevalence (P)
I= Number of people who get a disease during a
The prevalence of a disease is defined as the
specified period / sum of the length of time each
proportion of sick persons in a population at a
person in the study population is at risk.
specified time. P lies always between 0 and 1,
since the lowest number of sick persons are zero Example: Following the earlier mentioned 25
and the maximum is 1 if the total population students over 3 years, we might find 26 events of
is sick. P is often expressed as per cent. Several sore throat. The time at risk is 3x25 years. The
factors can influence the prevalence, see Figure incidence of sore throat will be 26/(3x25) = 0.35
5.6.1. cases/person-year.
P = number of sick people at a specified time Cumulative incidence (CI)

divided by total number of people in the popula-
The cumulative incidence (incidence propor-
tion at the same time
tion) is the proportion of persons in the study
Example: Today, in a group of 25 students, 8 population getting ill during a specified time
have a sore throat i.e. the prevalence of sore period. In general the CI increases with obser-
throat among the students is 32 % (8/25). vation time, which is why the observed period
must be given.
P increases if: P decreases if:
CI= Number of people getting a disease during
Long duration of disease Short duration of disease a specified time period / number of people free
Patients with incurable Fatality rate is high from disease in the population at the beginning
disease live longer of the period.
Number of new cases Number of new cases CI lies between 0 to 1.
increase decrease
Migration of cases into Migration of cases from Risk measures

the group the group The commonly used risk measures are described
Migration of healthy per- Migration of healthy per- below.
sons from the group sons into the group The risk difference is the difference between
Migration of susceptible Improved recovery rate the risk of disease in two populations. Risk dif-
persons into the group ference is the occurrence of disease in an ex-
Improved diagnostic posed group minus the occurrence of disease in
and/or reporting facilities an unexposed group.
The relative risk or risk ratio (RR) is the oc-
Figure 5.6.1. Factors that can influence prevalence. currence of disease in an exposed group divided
with the occurrence of disease in an unexposed
Incidence (I) group.
Incidence describes the number of new cases of a The odds ratio (OR) is a basic measure of risks
disease in a defined population within a specific used in case-control studies (see below). OR is
390
Epidemiology
the ratio between two odds: the odds of exposure sible to collect reliable exposure data, however,
among the cases divided with the odds of expo- it will take several years or even decades before
sure among the controls. The odds of exposure sufficient numbers on manifest or indicators
means the probability of being exposed divided of disease will develop. Sometimes the terms
with the probability of not being exposed. prospective and retrospective are employed to
When comparing groups it is necessary to describe the timing of disease occurrence with
consider possible age differences between the respect to the assessment of exposure.
groups, since age affect the occurrence of most
diseases. The number of observed cases in the Case-control studies, case-referent studies
population can be compared with the expected A case-control study starts with a number of cas-
number of cases. This expected number can be es with symptoms or disease. Then a number of
calculated from the incidence in a standard pop- controls are selected from the same population
ulation after adjustment of age differences. The from which the cases are recruited. Sometimes
ratio between observed and expected number of both the cases and the controls are matched on
cases can be written as the Standardized Mortality relevant confounders (see below). The exposures
Ratio (SMR) or Standardized Incidence Ratio (SIR). among cases and controls are compared. This is
a suitable method to study rare diseases.
time perspective
Cohort study Case-control study
A cross sectional study investigates the occurrence
Start with exposure and look Start with disease and
of disease at a given point in time. The outcome at disease look at exposure
of the study is the prevalence.
Several diseases but only one Several exposures, but
In a longitudinal study the conditions are fol- exposure at the same time only one disease
lowed over time. Such studies can be prospective Both prospective and retro- Retrospective (and
(starting before any cases have occurred), ret- spective prospective)
rospective (performed after the cases have hap- Efficient for common disease Efficient for common ex-
pened) or ambispective (a combination of both). and rare exposure posure and rare disease
Relative risk often expressed Relative risk expressed
study design as SMR or SIR as OR
Cohort studies, follow-up studies
A cohort is a population with some common
potential errors
characteristic, e.g. the same workplace or oc-
cupational exposure. A cohort study can be both Occupational epidemiological studies aim to
prospective and retrospective. In a retrospec- accurately measure the exposure of workers, the
tive cohort study old personnel records from an occurrence and risk of disease. Errors can be
industry can be used to give information about either random or systematic.
individual exposures and work tasks. It may be
simple to collect data on diseases in this type of Precision and random errors
cohort, but it can be difficult to find reliable in- The precision of a test is expressed as the varia-
formation about previous levels and duration of tion between repeated measurements. Perfect
exposure. In prospective cohort studies it is pos- precision is defined as the absence of random
391
Chapter 5.6
errors. Precision in epidemiological studies can in either direction (underestimating or overesti-

be improved in two ways. The primary means mating effects). Recall bias is present if cases in a
is to increase the size of the study. Precision can case-control study have better and more detailed
also be improved by modifying the design of the memories of their exposures than controls do.
study to increase the efficiency with which infor- The exposure classification will not be equiva-
mation is obtained from a given number of study lent for the two groups. For example, in a study
subjects. Poor precision of individual exposure of solvent related symptoms, there is a more
results in misclassification and leads to less reli- accurate exposure classification by workers’ with
able results. symptoms than among those without symptoms.
This can distort the result to an overestimation
Validity and systematic errors of the effect of exposure.
Systematic error (bias) occurs when the measure- Interview bias can be a problem if different in-
ments have a systemic tendency to differ from terview methods (e.g. personal interview versus
the true value. A study has high validity when it questionnaire) are used for cases and controls.
measures what it purports to measure.
Selection bias occurs when there is a systematic Confounding
deviation between the characteristics of those The occurrence of disease among exposed and
people selected for the study and those who are non-exposed can differ because of another factor
not. There is a risk of selection bias when: causing the disease. If this factor is not account-
ed for in a study, the result will be a systematic
• only voluntary subjects are included in a study
error, a confounding factor. A confounder is:
• comparisons are made between employed and
unemployed persons • associated with the exposure
• a cross-sectional study of employed is un- • an independent risk factor of a disease
dertaken in an unhealthy work environment • not part of the causality chain from exposure
where workers are transferred from the envi- to effect.
ronment. For example, smoking causes lung cancer. If an
The main information bias is misclassification of investigation of the occurrence of lung cancer
either exposure or health status. Misclassifica- is carried out in a group of workers exposed to
tion can be differential or non-differential. For Chemical A, a comparison can be made with a
example, exposure misclassification is regarded group of workers not exposed to Chemical A. If
as non-differential if the exposure classification smoking habits differ between the exposed and
error is similar for persons with and without non-exposed workers, this factor will be a con-
disease. Misclassification of disease or symp- founder that distorts the results. Confounding
tom is non-differential when the sensitivity and can be controlled either in study design (match-
specificity of the diagnoses are the same over ing or restriction) or through stratification or
exposure categories. The effect of non-differen- adjustment in the analysis. If matching is used
tial misclassification of either exposure or health to control confounding, the cases and controls
status usually gives an underestimation of the as- are selected in such a way that the potential
sociations between exposure and outcome. Dif- confounding factor is evenly distributed among
ferential misclassification can affect the results cases and controls. Restriction can be used to
392
Epidemiology
limit the study to people with particular charac-

teristics, e.g. smokers or non-smokers.
Control by stratification requires separate
analysis for different strata (homogenous catego-
ries), e.g. calculation of separate risk estimates
for smokers and non-smokers.
393
Suggestions for further reading
section 5 as a whole www.inchem.org
The International Programme on Chemical
Encyclopaedia of Occupational Health and
Safety (IPCS) allows rapid access to interna-
Safety, 4th edition ILO J. M: Stellman 1998. Free
tionally peer reviewed information on chemi-
on www.ilo.org/encyclopaedia/.
cals commonly used throughout the world
that may also occur as contaminants in the
Patty’s Toxicology. Editors Eula Bingham,
environment and food. It consolidates infor-
Barbara Cohrssen and Charles H Powell. 5th
mation from a number of intergovernmental
edition. Volumes 1-8. John Wiley & Sons, Inc.
organizations whose goal is to assist in the
New York 2001.
sound management of chemicals.
Webpages
www.cdc.gov/niosh
www.pubmed.gov
The National Institute for Occupational
Pubmed is a service of the U.S. National Li-
Safety & Health (NIOSH) in the USA of-
brary of Medicine that includes over 18 mil-
fers the NIOSH Pocket Guide to Chemical
lion citations from MEDLINE and other life
Hazards and Manual of Analytical Methods as
science journals for biomedical articles back
well as other free information.
to the 1950s. PubMed includes links to full
text articles and other related resources.
www.osha.gov
This website of the U.S. Department of La-
www.ilo.org/public/english/protection/safework/
bor, Occupational Safety & Health Adminis-
ILO:s Programme on Safety and Health at
tration has information in both English and
Work and the Environment (SafeWork).
Spanish largely related to legal, compliance
and cooperation issues.
www.who.org
www.osha.europa.eu/en
www.hse.gov.uk
European Agency for Safety and Health at
Health and Safety Executive (HSE ) has free
Work. This is a tripartite organisation that
leaflets on many different topics related to
produces some information in English.
safety at work. They also have guidelines on
Methods for the Determination of Hazardous
www.av.se
Substances (MDHS).
Swedish Work Environment Authority.
www.ioha.com
www.iarc.fr
The webpage of the International Occupa-
International Agency for Research on Cancer.
tional Hygiene Association contains informa-
The World Health Organization’s leading
tion on occupational hygiene topics.
source for information about cancer.
394
chapter 5.1 veillance; auditing; compliance; pesticides,
Major hazard control: A practical manual. Inter- chemicals, carcinogens, biological agents, and
national Program on Chemical Safety. Geneva, radiation; equipment screening; manual han-
1994, 296 pp ISBN 92-2-106432-8. dling; stress; and workplace violence.
An overview of major hazards, presented in
chapter 5.2
a readable format. Appendices contain some
practical tools and interesting examples of a Hayes W, Laws ER (eds). Handbook of Pesti-
variety of applications. Translated into French cide Toxicology. Vol. 2. San Diego, California:
and Spanish. The manual is also published in Academic Press��
, 1991.
local languages throughout the world.
Jacobs M, Dinham B (eds). Silent
��
Invaders: pes-
A Strategy for Assessing and Managing Oc- ticides, livelihoods and women’s health. London,
cupational Exposures, Third Edition, Edited ZED Books, 2003.
by Joselito S. Ignacio and William H. Bullock.
E-mail infonet@aiha.org. Keifer M (ed). Human health effects of pesti-
OSH professionals will find this resource cides. Occup Med: State Art Rev 1997;12:203-
beneficial when allocating resources for as- 411.
sessing and managing occupational exposures
to chemical, physical, and biological agents. Reigart JR, Roberts JR. Recognition and man-
The topics addressed include basic characteri- agement of pesticide poisonings Fifth Edition.
zation; qualitative and quantitative risk assess- Washington D.C.: EPA, 1999.
ment and priority setting; monitoring, inter- http://epa.gov/pesticides/safety/healthcare/
pretation, and decision making; recommenda- handbook/handbook.pdf
tions; reporting; and evaluations. A CD-ROM
with supplementary materials is included. Wesseling C, Aragon A, Castillo L, Corriols M,
Chaverri F, de la Cruz E, Keifer M, Monge P,
Occupational Health. Risk Assessment and Partanen TJ, Ruepert C, van Wendel de Joode
Management. Eds. Steven S Sadhra, Krishna B. Hazardous pesticides in Central America. Int
G. Rampal, Blackwell Science Ltd, 1999, ISBN J Occup Environ Health 2001;7:287-94.
9780 632 04199 2.
Integrates all aspects of workplace risk as- EPA:http://www.epa.gov/pesticides/
sessment and management, now the overrid-
ing emphasis in occupational health. Topics Pesticide Action Network: Pesticide database:
include: basic concepts and developments; http://www.pesticideinfo.org
toxic hazards; hazard characteristics and iden-
tification; standards setting; requirements for
chapter 5.3
monitoring workplace exposure; contami- Industrial Solvents Handbook (2nd Edition),
nants; exposure modeling; risk perception Cherimisinoff NP. Marcel Dekker 2003.
and management; prevention and control; This book covers safe handling practices,
economics; emergency response; health sur- health effects, physical properties, and chemi-
cal synthesis routes for some of the most
395
important organic solvents used in the chemi- drome following exposure to high levels of
cal and allied process industries. This handy irritant dusts.
reference features a glossary of solvent ter-
minology and an easy-to-reference index of Wagner GR. Screening and surveillance of
synonyms for chemicals and solvents. It fea- workers exposed to mineral dusts. Geneva:
tures chapters on the major classes of organic WHO, 1996.
solvents, descriptions for general use, and the
chemical formulation, thermodynamic prop- Hazard Prevention and Control in the Work
erties, health and toxicity, and combustible Environment (PACE), WHO Sustainable De-
characteristics of solvents. velopment and Health Environments, Geneva
1999.
Löf A, Johanson G. Toxicokinetics of organic Gives basic information about prevention and
solvents. A review of modifying factors. Crit control of dust in the workplace including
Rev. Toxicol 1998; 28:571-650. control approaches and strategies and practi-
cal examples of dust control. 170 pages, avail-
Johanson G, Rauma M. Basis for skin notation. able free at: http://www.who.int/occupation-
Part 1. Dermal penetration data for substances al_health/publications/en/oehairbornedust.
on the Swedish OEL list. Arbete & Hälsa 2008; pdf.
42: 2.
Free available www.medicine.gu.se/avdelnin- Brunekreef B, Holgate ST. Air pollution and
gar/samhallsmedicin_folkhalsa/amm/aoh health. Lancet 2002; 360: 1233-1242.
This review discusses the evidence for ad-
chapter 5.4 verse effects on health from air pollutants like
Nordberg GF, Fowler BA, Nordberg M and airborne particulate matter and ozone.
Friberg LT, eds. Handbook on the Toxicology
of Metals, 3rd edition. Elsevier Academic Press chapter 5.5
Inc., 2007, 975 pages. Condensed Handbook of Occupational Derma-
A valuable one volume handbook that gives tology. Kanerva L, Elsner P, Wahlberg JE, Mai-
in-depth coverage. The first part covers the bach HI (eds.) Springer 2004.
fundamentals of metals toxicology including Gives concise information needed to deal
good coverage of factors important in health with occupational dermatology patients. It
risk assessment. The other part gives detailed combines a practical approach to occupational
information on individual metals. dermatology with research experience in clini-
cal and experimental dermatology. 528 pages.
Brooks SM, Bernstein IL. Reactive
��
airways dys-
Contact Dermatitis, 4th ed. Frosch P J, Menné
function syndrome or irritant-induced asthma.
T, Lepoittevin J-P (eds). Springer 2006.
In Asthma in the workplace. Eds��
Bernstein IL,
The comprehensive textbook covers irritant
Chan-Yeung M, Malo J-L, Bernstein DI. Marcel��
and allergic contact dermatitis, including
Dekker Inc, New York, 1993.
epidemiology, methods of skin-testing, skin
This article discusses persistent asthma syn-
penetration, and principles of prevention and
396
protection and legislative regulations. 1,150 www.lni.wa.gov/Safety/Research/Dermatitis/
pages in 52 chapters, and a CD-ROM. Washington State Department of Labor and
Industries. Information concerning research
Protective Gloves for Occupational Use, 2nd on safe work and educational material on skin
edn. Boman A, Estlander T, Wahlberg JE, Mai- disorders and prevention.
bach HI (eds). CRC Press 2004.
Provides state-of-the-art information on www.cdc.gov/niosh/98-113.html
glove materials, protective effects, and adverse National Institute for Occupational Safety &
medical effects. It provides guidance on how Health. A guide on prevention of latex allergy.
to select gloves to prevent skin contamination.
368 pages. www.jobbafrisk.se
A website on occupational guidance, asthma
Chemical Protective Clothing. Performance In- and dermatitis; originally in Swedish, but will
dex. Forsberg K, Keith LH. Wiley-Interscience, be available in English from 2009.
New York, 1999.
A compilation of performance data of chemi- www.cdc.gov/niosh/ncpc/ncpc1.html
cal protective clothing useful for industrial The National Institute for Occupational
hygienists and workplace safety professionals. Safety & Health in the USA has a database
639 pages. on recommendations for Chemical Protective
Clothing
Pesticide Dermatosis. Penagos H, O’Malley M,
Maibach HI (eds). CRC Press LLC, 2001. Websites on glove permeation data by glove
Provides experience in the clinical, experi- anufacturers
m
mental, and regulatory evaluation of the effect www.bestglove.com/site/chemrest/
of pesticides on the skin. 344 pages. www.ansellpro.com/download/Ansell_7thEdi-
tionChemicalResistanceGuide.pdf
Lidén C. Legislative and preventive measures www.northsafety.com/
related to contact dermatitis (review article). www.comasec.com/home.aspx?Langue_ID=2
Contact Dermatitis 2001:44:65-69.
chapter 5.6
A review over European legislation for the
prevention of contact dermatitis. Last JM. A dictionary of epidemiology. 3rd ed.
Oxford University Press, New York 1995.
Websites on prevention of skin disorders Checkoway H, Pearce N, Kriebel D. Research
www.cdc.gov/niosh/topics/skin/conference/pro- methods in occupational epidemiology. 2nd ed.
ducts.html New York, NY: Oxford University Press, 2004.
National Institute for Occupational Safety An excellent and comprehensive text and
& Health. Proceedings of the International reference book suitable for both the
Conference on Occupational & Environmen- introductory and intermediate reader.
tal Exposures of Skin to Chemicals: Science &
policy 2002.
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Rothman KJ, Greenland S. Modern epidemiol-
ogy. 3rd ed. Lipppincott-Raven Publishers, Phila-
delphia, 2008.
A desk reference on the methods of modern
epidemiology. It includes coverage of new
methods being currently being applied in
epidemiology including: Bayesian analysis of
tables; risk/policy analysis; the use of second-
ary data sources such as registry databases;
and statistical genetics.
Bonita R, Beaglehole R, Kjellström T. Basic

Epidemiology. 2nd ed. WHO 2008.
An introduction to the principles and meth-
ods of epidemiology. Basic epidemiology is a
standard reference for education, training and
research in the field of public health and has
been translated into more than 25 languages.
Available as textbook or PDF/Ebook version
at: www.who.int/bookorders
Nieuwenhuijsen MJ. Exposure assessment in

occupational and environmental epidemiology.
Oxford United Kingdom, Oxford University
Press, 2003.
An accurate measure of exposure is crucial for
epidemiological studies. This book describes
exposure assessment methods and their ap-
plication in occupational and environmental
epidemiology.
398
6
Prevention of biological risks

6

Mohamed Jeebhay & Eliana Alvarez
the hba panorama

This chapter will present an approach to pre- to suit the worker, to introduce intervention
venting exposure to hazardous biological agents measures to minimise exposure to hbas, to
(HBAs) in the workplace, taking into account develop education and training programs to
international standards as well as specific, lo- increase awareness and behaviour modification
cal considerations in eliminating, controlling or and to provide counseling and support programs
minimising exposure to a HBA. for workers and families when appropriate. This
The true disease burden associated with will ultimately contribute to a reduction in the
hbas in the workplace is unknown due to the overall morbidity and mortality associated with
ubiquitous nature of these agents in the general biological agents, particularly in the workplace.
environment. A number of diseases due to bio- Infections, respiratory and skin diseases are
logical agents (e.g. asthma, tuberculosis, hepati- the most common health outcomes due to
tis, bilharzia, malaria and AIDS), also occur out- hazardous biological agents. However, valid inci-
side the workplace. These diseases have a major dence and prevalence data for most occupational
impact on work and working life potentially biological diseases is lacking because biological
resulting in higher absenteeism, increased per- factors reveal a large diversity in distribution
sonnel turnover, poor worker health and lower within working environments. The distribution
productivity. When such diseases arise as a con- is affected by geographic, microclimatic and nu-
sequence of work-related exposures or activities, tritional conditions. Many developing countries
(e.g. needle-stick injuries causing hiv/aids; have tropical and sub-tropical climatic condi-
bakery work causing asthma, gold mining tions with high temperature and humidity which
causing tb), the general public are likely to may activate or enhance the harmful effects of
attribute such conditions to non-work-related biological agents, e.g. malaria in oil palm planta-
exposures. It is therefore important to define the tions, fungal infections of the hands in wet food
burden of disease from hbas in the workplace canning environments, bilharzia in fishing and
and to identify high-risk work factors. This will rice plantations.
enable workplaces to adjust working conditions
401
Chapter 6
The epidemiology of occupational diseases asso- by gram negative bacteria, mycotoxins produced
ciated with protein allergens of biological origin by fungi), cell wall constituents such as (1–>3)-
has begun to emerge in the last decade. Studies B-D-glucans produced by moulds, or enzymes
of workers in grain, bakery, laboratory animal produced by genetic modification of micro-or-
and health care show the prevalence of allergic ganisms.
sensitisation to be between 5–50 per cent. The Among plant tissue, processed plant proteins
incidence (per person-year) of work-related (e.g. grain, coffee, soya), vegetable gums or
sensitisation among apprentices in various trades resins (e.g. latex, guar gum in plants), toxins,
including dental hygienists exposed to latex or wood compounds (e.g. plicatic acid in western
pastry-makers exposed to flour, is almost 10 per red cedar wood, tannins, colophony), proteolytic
cent. Similarly, various studies indicate a 12 per (protein breakdown) enzymes and organic dust
cent annual incidence rate for occupational from processing have been shown to be biologi-
allergic disease. cally active.
A biological agent may be defined as any agent In the animal group, exposure to arthropods
which may cause an infection, allergy, inflam- such as crustaceans, arachnids (e.g. storage
mation, toxic reaction, malignancy or otherwise mites) and insects (e.g. weevil) have been com-
create a hazard to human health. Biological monly associated with adverse health effects.
agents include micro-organisms, plant/vegeta- Some species of arthropods (e.g. snakes, scor-
ble cells; animal or human cell cultures; human pions, bees) and vertebrates (e.g. rabid dogs),
endoparasites, including those that have been attack, bite or sting workers causing adverse
genetically modified. The three main sources of effects such as skin inflammation, systemic toxic
biological agents are microbes, animal and plant effects and transmission of infections. Further-
tissue, Figure 6.1. more, invertebrates other than arthropods, e.g.
The biologically active agents of microbial ori- endoparasites (such as Shistosoma, Anisakis) and
gin may include the organism itself (e.g. viruses, proteins present in urine, hair, dander, feathers,
bacteria, fungi), toxins (e.g. endotoxins produced saliva and faeces of vertebrate animals, are also a
Category Examples
Micro-organisms
Viruses Hepatitis, HIV, Influenza, Rubella, Herpes
Bacteria Legionella, Mycobacteriium TB, Leptospira, Thermophilic bacteria
Fungi Aspergillus, Alternaria
Plants
Lower plants Lichens, liverwarts, ferns
Higher plants Wood, grain, cotton, coffee, tobacco, spices
Animals
Invertebrates Amoebae, Shistosoma, Plasmodium, Anisakis, Sponges, Sea-squirts
Arthropods Crustaceans, Arachnids (spiders, storage mites, ticks), Insects (cockroaches,
weevils, moths, bees)
Vertebrates Fish, Amphibians, Reptiles, Birds, Mammals
Figure 6.1. Major categories of biological agents of natural origin.
402
common source of infectious agents or protein These settings include health care and laboratory
allergens. workers threatened by human pathogens causing
The term “organic dust” usually refers to a infection. Agricultural workers are at risk from
dust of plant, animal or microbial origin, that organic dust-borne biological allergens, toxins
may also contain a wide range of biological con- and parasitic worm infestations, especially in
taminants mentioned above (e.g. endotoxin, my- warm climates. Mining activities are a high risk
cotoxin, allergens, volatile organic compounds). setting associated with tuberculosis infection.
Biological agents are ubiquitous in ambient
air, contaminated water supplies and diseased health effects of biological
animals. They enter the body by inhalation (air- agents
borne, droplet spread), ingestion or through the hbas mediate their adverse health effects
faecal-oral route, skin innoculation and by direct through four main pathological mechanisms,
contact with plants or animals (zoonosis). The infection, allergic, toxic/inflammatory and carci-
extent to which they become hazardous to human nogenic, Figure 6.3. The most common non-in-
health will depend on the occupational context, fectious diseases affect the lungs and skin, with a
the circumstances surrounding exposure and the large proportion of these diseases or syndromes
health status of the host (worker). causing a general inflammation or affecting
the immune system, Figure 6.4. One biological
high risk occupational settings agent may be frequently associated with more
Although biological agents are commonly found than one adverse health outcome and it may be
in most domestic and workplace environments, difficult to differentiate between the two disease
there are certain high risk occupational settings entities, e.g. asthma and organic dust toxic syn-
that constitute hazardous exposure because they drome or Hepatitis B infection and liver cancer
result in adverse health outcomes, Figure 6.2. in the same individual.
Sector Examples

Agriculture Cultivating, harvesting, forestry, flower production
Breeding and tending animals, fishing
Agricultural products Abattoirs
Food processing plants (e.g. grain, sugar, coffee, tea, seafood)
Storage facilities: grain silos, tobacco
Processing animal hair, leather, silk
Textile plants, sawmills, paper-mills
Animal care Veterinary facilities, pet shops
Biotechnology/research labs Production of enzymes; microbiology; animal units
Mining Gold and coal mining
Health care Patient care in hospitals, clinics, nursing homes
Pharmaceutical Production of drugs, herbal products
Sewage and waste disposal Waste removal, treatment plants
Figure 6.2. Common occupational settings with exposure to hazardous biological agents.
403
Chapter 6
risk assessment
An adequate risk assessment requires extensive • a detailed observation of the workplace
knowledge of the work processes, health hazards • the collection of information on hazards from
and occupational hygiene practices. It is impor- surveys already conducted from similar work
tant to begin with: places or from the literature.
Pathological mechanisms Examples of causative agents
Microbial infection
Infectious material Hepatitis (A/B/C), Leptospira, Mycobacterium TB
Opportunist pathogens Legionella Pneumophilia
Zoonoses B. Anthracis, C.Psittaci
Allergic response
Micro-organisms Actinomycetes, Aspergillus
Proteinaceous material Pollen, dust, animal secretions
Chemical compounds Plicatic acid, gums, resins
Toxic/inflammatory response
Endotoxins (gram neg. bacteria) Stored grain, hay, cotton, swine and poultry confinement units
Mycotoxins (fungi) and Stored fodder, grain, nuts
(1->3)-B-D-glucans
Carcinogenic
Wood dust Hardwood (Beech, oak), Softwood
Mycotoxins (aflatoxin) Stored nuts
Figure 6.3. Major pathological mechanisms for health effects associated with hazardous biological agents.
Pathological mechanisms Examples of occupational syndromes or disease entities
General constitutional symptoms Inhalation fever (fever, myalgia, fatigue)

Infection of any body organ/system Infections (including zoonosis) e.g. TB, Brucellosis, Hepatitis B
Allergic/Toxic inflammatory Toxic pneumonitis
lung reactions Organic dust toxic syndrome
(fever, myalgia, headache, respiratory symptoms)
Rhinitis, conjuctivitis, urticaria
Asthma
Asthma-like syndrome (acute functional response)
Hypersensitivity pneumonitis (extrinsic allergic alveolitis)
Chronic bronchitis
Chronic obstructive lung disease
Allergic/Toxic inflammatory Contact irritant dermatitis
skin reactions Contact allergic dermatitis
Protein contact dermatitis
Cancer Carcinoma (e.g. nasopharynx, liver, lung)
Figure 6.4. Occupational syndromes or disease entities associated with hazardous biological agents.
404
An analysis of observations made at the work to deal with the source of the hazard directly
place may indicate the need for safer operations by taking immediate remedial measures without
or control measures. Where obvious and serious any prior measurement. But there are occasions
hazards are observed, immediate implementation when measurement can be justifiable, for exam-
of adequate intervention measures should be ple:
undertaken. For example, if an inspection re- • when investigating an illness believed to have
veals very dusty areas in a grain/flour mill, local been caused by micro-organisms and/or bio-
exhaust ventilation may be required. logical contaminants
There are many questions that need to be • to verify the effect of an intervention intended
addressed before workplace measurements of to reduce microbiological air contaminants
micro-organisms and biological contaminants • e.g. after installing a new process and tech-
(e.g. endotoxin, mycotoxin, allergens, volatile nique suspected to decrease micro-organism
organic compounds) are undertaken, e.g. clarify- concentrations in the workplace.
ing reasons why measurements are being under-
taken, how the results are to be used and what
managing risks
the readings are to be compared with.
Measurements of micro-organism concentra- Policies, procedures and exposure standards
tions in the workplace are often taken because a Although the traditional emphasis of health and
worker or workers have been affected by health safety regulations and occupational health activi-
problems suspected to be due to micro-organisms. ties has been on microbes causing infection in
One problem connected with measurements is occupational settings, the toxic/inflammatory,
that it may be hard to find “normal” or “back- allergic and carcinogenic potential of hbas
ground” reference values with which to compare have become increasingly important. Some of
the concentrations found. Presently there are the well known regulatory initiatives include the
no recommended occupational exposure limit comprehensive European Union directive No.
values for airborne micro-organisms in the work 2000/54/ec on the protection of workers from
place and, accordingly, no recommended values. risks related to exposure to biological agents at
One reason for the absence of limit values is the work. This directive covers high risk activities
lack of standardised methods of measurement. in food production, plants, agriculture, contact
Comparison with concentrations in asympto- with animals and/or their products, health care,
matic individuals or outdoor conditions is gen- isolation and post mortem units, laboratories
erally not possible. Instead the comparison has (clinical, diagnostic, veterinary), refuse disposal
to be linked to an agent, a method and an envi- plants and sewerage purification installations.
ronment. In order to compare the result with a hbas are grouped into four categories for the
general “normal concentration”, one needs to purposes of controlling exposure, Figure 6.5.
know how the investigations were conducted Any material containing an hba needs to be
and conditions should be comparable, e.g. in properly labelled, Figure 6.6.
terms of measuring method and analysis. Other well-cited standards include the
Another point to be considered is what gain acgih guidelines, us osha Regulations
is expected from the measurement and what the (Hepatitis B vaccination, blood-borne patho-
result is going to be used for. Very often it pays gens, tb) and the niosh criteria documents
405
Chapter 6
for animal handlers and health care workers ex-

posed to latex. The lack of emphasis on protein
allergens causing allergic diseases in the absence
of microbial infections, may point to the need
for the development of specific guidelines in the
future that deal adequately and effectively with
allergens of biological (protein) origin.
In more recent years industrial hygiene and
analytical capabilities have been refined for eval-
uation of bioaerosols and their protein allergens Figure 6.6. Biohazard sign (orange-red with blue
which has made surveillance technically feasible. pictogram).
Clear evidence is also emerging for exposure
intensity response relationships for occupational lergens and wood dust. The stipulation of legally
allergens of plant, animal or microbial origin, binding occupational exposure limits is therefore
illustrating the renewed emphasis on this group an essential strategy in preventing exposure to
of agents. Allergen exposure levels below deter- allergens, endotoxins and (1–3)Beta, D-glucans.
mined exposure limit values have been associ- There may also be statutory duty for medical
ated with a decreased risk of sensitisation and practitioners to notify cases of suspected oc-
allergic health outcomes such as asthma. Some cupational and/or communicable disease to the
examples include wheat flour, fungal a-amylase, appropriate enforcement agencies, e.g. in the
natural rubber latex, western red cedar, rat al- Ministry of Labour and/or Health.
Category Definition Examples
Group 1 unlikely to cause human disease E Coli K10, yeast

Group 2 can cause severe human disease Legionella pneumoniae, Leptospira,
might be a hazard to workers Neisseria meningitidis (V), Rubella,
unlikely to spread to community Influenza A/B (V), Hepatitis A (V), Herpes simplex,
effective prophylaxis/treatment Ascaris (A)
Group 3 can cause severe human disease Mycobacterium TB (V), Bacillus anthracis (V),
serious hazard to workers Shigella dysenteriae Type I (T),
may spread to community Plasmodium falciparum, Rabies (V),
effective prophylaxis/treatment Hepatitis B (V), Human immunodeficiency virus
Group 4 causes severe human disease Congo haemorrhagic Fever, Ebola pox
serious hazard to workers
high risk of spread to community
no effective prophylaxis/treatment
Figure 6.5. Risk group categories according to the European directive No. 2000/54/EC on the protection
of workers from risks related to exposure to biological agents at work. Symbols: A-allergenic, T-toxic
effects, V-vaccine available.
406
Workplace control measures air have been found in some agricultural envi-
The diagnosis of an occupational disease in a ronments. In agricultural work where discom-
worker implies that measures at the workplace fort has occurred, total concentrations of up to
are inadequate and pose a potential health risk 10x109 mould spores/m3 air have been recorded
to co-workers similarly exposed so prompt in- in the inhalation zone. On farms with asympto-
vestigation and action is required. The exposure matic agricultural workers, the concentrations
should be evaluated by an industrial hygienist. are usually 106 mould spores/m3 or less.
This evaluation will identify sources of high-risk High concentrations of airborne bacteria oc-
exposure and provide recommendations for con cur in connection with animal husbandry, from
trolling the hazards either through substitution, dried dung. Prolonged storage of manure in
body substance isolation, engineering controls livestock pens can cause high concentrations of
(e.g. exhaust ventilation) and/or administra- bacteria in the indoor air. In hot and temperate
tive controls (e.g. universal infection control climates natural hazards arising from snakebites
precautions). Special care should be taken when and scorpion stings can be a common occur-
instituting preventive measures that one hazard rence in wood cutters, fishermen, builders,
is not replaced by another hazard. For example, oil plantation workers, sugar cane cultivators,
using natural rubber latex powdered gloves, mushroom gatherers and other agricultural
instead of non-powdered or latex free gloves to workers.
prevent skin transmission of blood-borne patho-
gens in health care settings. Pig-farming
Below are some examples of preventive meas- Changing pig litter, feeding and weighing pigs
ures used to minimize exposure to biological can generate large quantities of organic dust.
agents in the work environment. The dust in pigpens usually contains bacteria
and endotoxins as well as epithelium from pigs.
Agricultural work Therefore, work that has to be done among live-
Aside from animal farming, there are a number stock entails a serious exposure risk to organic
of major occupational settings in developing dust. The concentration of organic dust in live-
countries such as sugarcane cultivation and sugar stock pens increases with the level of activity and
production, oil palm plantations, tea and coffee congestion of the animals. For example, heavy
plantations, flower production, vineyards, fruit concentration of organic dust occurs in con-
plantations, fishing and forestry. nection with the transfer of pigs between pens,
Agriculture involves the handling of many culling, weighing, changing litter and manual
different materials such as grain, hay and straw, feeding. Manual feeding generates heavy con-
livestock feed, excrement from livestock, skin centrations of organic dust, due to the activity of
particles, hair and feathers, all of which are the pigs and the friability of the feed itself.
potential habitats for the growth of micro-or-
Preventive measures:
ganisms and a source of potential allergens. For
• Add water or vegetable oil (1 per cent) to the
example, fungi occur in livestock feed, grass
feed to bind the dust. Feed containing a large
and cereals which have been damaged in stor-
proportion of water should be consumed
age. Airborne mould concentrations more than
within a few days to prevent mould growth.
a million times higher than normal for outdoor
407
Chapter 6
• Vacuum cleaning of feed troughs and fittings Cattle-farming

at least once every week reduces the amount Personnel working with beef cattle are exposed
of organic dust. Vacuum cleaning is more to organic dust, e.g. when working with hay,
suited to smaller pens where the feed troughs straw, silage and concentrated feed. The risk of
and inspection paths are located at floor level. dust exposure is increased by manual feeding,
• Daily oil showering of livestock at feeding manual mucking out and the movement of live-
time reduces the concentration of organic stock.
dust in the pens. This showering can be done
using a mixture of rapeseed and linseed oil Preventive measures:
with water and an emulsifier. Oil showering • Handling of mouldy feed, straw and litter
is more effective than flushing with water. must be avoided.
No work should be done in the pens while oil • Manual mucking out must be done using a
showering is in progress. technique whereby litter is not blown out.
Poultry farming Handling of hay and straw

Organic dust components in poultry houses Dust is released into the air when hay and straw
include epithelium, feather fragments, manure are worked in connection with gathering, stor-
particles and micro-organisms. Caging and age, mucking out and feeding, etc. A great deal
culling of birds are tasks entailing very high of dust is generated when straw is chopped for
concentrations of dust. In pens for laying birds, litter.
the deep litter on the floor helps to augment the
concentration of organic dust on the premises. A
• Mouldy hay must not be used.
large proportion of the manure enters the litter.
• Dust separators fitted to straw choppers effec-
Free-range systems add to the risk of dust expo-
tively reduce the concentration of dust. When
sure, e.g. because of the requirement for stray
making silage from hay/straw it is important
eggs to be collected manually several times daily.
to remove the air as effectively as possible,
Personnel are also exposed to organic dust in the
because air seeping into the silage can give
course of daily supervision, cleaning and pro-
rise to microbial growth. The plastic covering
duction, between production rounds and when
should not be damaged when baling silage.
mucking out.
• Loft drying of hay must be conducted rapidly
Preventive measures: to avoid mould growth. Hay that is not dried
• Mechanised regulation of feed, water, light- in a loft must be dried when compacted to
ing, temperature, etc. reduces the time per- prevent mould growing.
sonnel need to spend in poultry houses. • Hay and straw must have a low moisture con-
• Mechanical egg and feed handling. tent when stored.
• Manure should be stored for the shortest pos-
Grain handling
sible time inside a poultry house.
Very heavy concentrations of dust are likely to
• Water mist treatment of the pens reduces dust
occur during the threshing, harvesting and stor-
content.
age of grain. Damaged corn can easily be attacked
by micro-organisms. Tasks that are associated
408
with a high-risk of exposure to grain dust include • Chip stores, chip dryers and fuel plants should
the cleaning of silos, driers and grain hoppers, as be positioned where dust cannot spread to
well as the threshing and milling of feed grains. other spaces.
Excessive dust is formed in chutes, elevators, • Chip stores should be completely emptied and
open conveyors, hoppers, silos, dryers and scales. cleaned (preferably vacuum-cleaned) before
replenishment, because micro-organisms can
Preventive measures: grow in old residues.
• Chutes, elevators, conveyors and grain dryers • Respiratory protective equipment should be
should be fitted with local exhaust extraction used for operations generating large quanti-
devices. ties of dust and where it is suspected microbes
• When crushing or grinding grain, moistening may be growing in the chips.
can be used to reduce exposure to dust. Mois-
tening can take place in transit to the buffer Sugar cane cultivation and sugar production
hopper above the mill or crusher. Water can Sugar cane is cultivated in tropical and sub-
be applied in batches, using ordinary batch tropical regions for its sucrose content (for
mixers, or continuously with helical screws. making sugar) and by-products such as molas-
• The grain kernel must be kept free of damage ses and bagasse (waste fibrous residue), used to
by setting the harvester correctly and provid- make paper or as a fuel source. Aside from the
ing gentle transport, to prevent the growth of common chemical pesticide hazards, the major
micro-organisms. biological hazards encountered in the cultivation
• Dust exposure will be reduced if the har- process include inhalation of droppings (from
vester is fitted with a cab and ventilator. An insects, rodents and other pests contaminating
airstream helmet should be used by the driver the crops), snakebites or secondary infection
when threshing with a combine. of wounds due to machete tool-related injuries
• For storage purposes, the temperature and sustained during manual harvesting. Bagasso-
water content of the grain should not be too sis (extrinsic allergic alveolitis/hypersensitivity
high. The temperature should be continu- pneumonitis), caused by breathing dusts con-
ously monitored at several points during the taining spores of thermophilic actinomycetes
storage time. A rise in temperature indicates which grow in stored and ‘mouldy’ bagasse in
mould formation, which may then spread. sugar cane mills/processing plants, is also unique
In this eventuality, cold air-drying should be to this workplace setting.
used.
Chip firing • Burn fields prior to harvest to destroy snakes,
Organic dust containing micro-organisms can dangerous insects and other pests that live in
be released when wood chips are conveyed from cane fields.
storage facilities to a boiler, e.g. by shovelling. • Identify sources of excessive dust, gas and va-
pours and introduce local exhaust ventilation
Preventive measures: where possible in mills. Dust control can be
• Wood for chipping should be as dry as pos- used effectively for controlling bagasse dust
sible, because fragmented fresh timber is very and appropriate respirators can be used for
prone to mould. short-term tasks.
409
Chapter 6
• Wear gloves, long sleeved shirts and pants and snakes, spiders, bees, mosquitoes and mites,
boots to prevent insect/snakebites and trauma some of which are important disease vectors.
when working in foliage. In addition to these natural biological hazards,
• Special antidotes should be available for poi- allergic reactions from contact with certain
sonous snake bites and scorpion stings. species of caterpillars have been reported in tea
• Cuts should be washed and cleaned and anti- plantation workers. Among workers involved in
bacterial agent applied. processing of coffee beans in processing plants,
• All field workers should be provided with up- green bean handlers have been reported to de-
to-date tetanus immunisation. velop occupational allergic rhino-conjunctivitis,
urticaria and asthma. Similar reports of occu-
Oil palm and tropical plantations pational allergies and asthma due to “tea fluff”
Oil palms are grown in tropical climates where have been reported in tea processing/blending
natural biological hazards are an important workers. Tropical diseases such as malaria, yel-
consideration. These hazards include snakes low fever, filariasis, trypnasomiasis, leishmaniasis
encountered during forest clearance, insects like and onchocercosis are endemic in certain culti-
mosquitoes that spread malaria, parasites like vating areas and tetanus is still a common occur-
hookworms that cause anaemia and gastro-in- rence in certain rural areas.
testinal disease. The retting operation in which
the husk of the coconut is soaked in waist-deep Preventive measures:
water before it is sent for decortication, bleach- • Wear gloves, long sleeved shirts and pants to
ing and processing, exposes workers to increased prevent insect bites/stings, trauma and allergic
risk of parasitic and other infections. Workers skin symptoms when working in foliage.
employed in date palm plantations are at in- • Cuts should be washed and cleaned and anti-
creased risk of developing occupational asthma bacterial agent applied.
from pollen exposure as well as chronic dry • All field workers should be provided with up-
eczema and onychia (nail disease). to-date tetanus immunisation.
• Local exhaust ventilation should be employed
Preventive measures: and appropriate respirators should be used
• Mosquito control and malaria prophylaxis is during processing of coffee beans and tea
crucial (see Table VI malaria). (“tea fluff” extractors).
• Sanitation and safe drinking water are key in • Regular surveillance of workers for allergic
the prevention of waterborne parasitic dis- symptoms and sensitisation using question-
eases. naires and allergy tests (skin prick tests, aller-
• Appropriate respirators should be used during gen specific IgE levels).
the pollination process. Workers should wear • Sanitation and safe drinking water are key in
gloves and wash their hands when working the prevention of waterborne parasitic diseases.
with trees and dates. • Mosquito control and malaria prophylaxis is
crucial.
Coffee and tea plantations
Biological agents of importance for coffee
plantation workers include bites or stings from
410
Flower production (vegetable or micro-organisms and their con-

Flower production can be divided into three taminants such as mycotoxins/endotoxins; fer-
main processes, i.e. germination (planting par- tilisers such as cottonseed meal, fishmeal, blood
ent plants), cultivation (done in greenhouses meal, sterilised sewage sludge; insects such as
and nurseries) and post-harvest (selection and the honey bee). The handling of certain types
packaging). Increased health risks from biologi- of fruit, especially citrus fruit, are known to
cal exposures originate from exposure to out- cause occupational allergies, asthma and contact
door mites (spider mites, predator mites), mould dermatitis among fruit farm workers. Biologi-
spores, pollen from plants (e.g. chrysanthemum, cal agents implicated are micro-organisms such
sunflower), dust from dried plants and from Botrytis cinerea, a mould commonly found on
insects such as bees and locusts, all of which are grapes; plant allergens such as the Wall Rocket
known to cause allergic rhino-conjunctivitis, oc- (Diplotaxis erucoides), Crucifera plant or vine pol-
cupational asthma and urticaria. Contact der- len, Vitis vinifera; as well as arthropods such as
matitis is commonly caused by irritants (60 per insects (e.g. fruit moths) and mites (e.g. storage
cent) or allergens (40 per cent), some of which mites). Farm workers, particularly those on fruit
may be biological in origin, for e.g. organic farms, can become sensitised to spider mites
fertiliser, plant matter. Flower workers are also (e.g. Tetranychus and Panonychus species), which
at increased risk of acquiring infections such as live on the leaves of fruit trees. Excessive use
tetanus and rabies as well as stings by bees/wasps of pesticides has been associated with increas-
while working in the fields. ing spider mite populations and increased risk
of sensitisation. Studies in South Africa indicate
Preventive measures: that this mite may be more important than the
• Positive pressure ventilation of greenhouses; common house dust mite in causing asthma
Improved work practices which will reduce symptoms among workers on grape farms. Al-
the exposure time to potential allergens. though farmers, like other inhabitants of rural
• Use of specific respirators and gloves to pre- areas, are exposed to enhanced levels of pollens
vent contact with primary irritants or aller- from grasses, weeds and trees, the prevalence of
genic substances. pollen-related allergy is certainly not higher, and
• Provide a source of potable water, good sani- possibly lower, than that in urban populations,
tary facilities, first aid and medical care for as has been found in studies investigating atopy
cuts and abrasions. prevalence in these populations. Endotoxin ex-
• Regular surveillance of workers for allergic posures on contaminated seed and dry fertiliser
symptoms and sensitisation using question- can cause irritation affecting eyes, nose, chest
naires and allergy tests (skin prick tests, aller- (organic dust toxic syndrome) and skin. Pro-
gen specific IgE levels). longed and frequent contact with plant products
can also result in sensitisation and contact der-
Fruit plantations and vineyards matitis. Infections complicating cut or puncture
Hazardous exposures among fruit farm workers wounds from tree thorns or tools are a common
are a result of concomitant exposures to agri- among fruit farm workers. Mycotoxins contami-
chemicals (fertilisers, herbicides, fungicides, nating nuts are known to be associated with an
insecticides, sulphur) and biological agents increased risk of liver cancer.
411
Chapter 6
Preventive measures: associated with elevated endotoxin levels from

• Avoid excessive pesticide use in spraying of contaminated fish.
crops.
• Introduce natural biological control mecha- Preventive measures:
nisms into crops. • Wear cotton-lined gloves to prevent skin
• Wear appropriate respirators when picking trauma and allergic skin symptoms when han-
fruit to prevent inhalation of mites when dling fish.
disturbing leaves on fruit trees and when han- • Cuts should be washed and cleaned and anti-
dling fertiliser. bacterial agent applied.
• Wear gloves, long sleeved shirts and pants to • Use local exhaust ventilation to remove
prevent insect bites/stings, trauma and allergic seafood aerosols produced during seafood
skin symptoms when working in foliage; processing.
• Cuts should be washed and cleaned and anti- • Use respirators and/or air-supplied hoods
bacterial agent applied. when entering unventilated holds containing
• All field workers should be provided with up- fish and fish products.
to-date tetanus immunisation.
• Regular surveillance of workers for allergic Forestry
symptoms and sensitisation using question- While physical safety hazards are a major con-
naires and allergy tests (skin prick tests, aller- cern in the harvesting and transport of wood
gen specific IgE levels). products, biological agents are a key concern
in the harvesting of non-wood forest products
Fishing such as food products (e.g. berries, mushrooms),
While the main task of fishermen is fishing at chemical products (e.g. aromatics, gums and
sea, fish processing is also done aboard vessels at resins, latex, toxins), decorative materials (e.g.
sea (see section on food processing plants). The bark, flowers, grasses) and non-wood fibres
biological agents commonly encountered dur- (e.g. bamboo, palm leaves, reeds). Exposure to
ing fishing include microorganisms (e.g. Vibrio, biological agents includes direct contact with
Hepatitis A, Anisakis, Hoya – sea squirt, fungal plants, wood products like sawdust and pollen
spores) and bioaerosols containing seafood al- from trees. Direct skin contact could be a source
lergens (e.g. muscle, blood, enzymes) and toxins of topical poisons causing contact urticaria and
(e.g. endotoxin, histamine). Exposure to these dermatitis. Inhalation of pollen causes allergic
agents commonly results in skin infection and rhinitis and asthma, while inhalation of spores
sepsis of puncture wounds, allergic respiratory on mouldy damp bark causes a hypersensitivity
diseases (rhino-conjunctivitis, asthma, extrinsic pneumonitis. Working with large mammals such
allergic alveolitis) and skin conditions (urticaria, as oxen, buffalo and elephants may result in zoo-
contact dermatitis/eczema) from direct skin nosis (transmission of infections from animals to
contact with seafood. Fatal poisoning and as- humans). Snake and insect bites/stings (e.g. bees,
phyxia can also result from exposure toxic gases wasps, hornets, scorpions) can be poisonous and
in confined spaces (e.g. hydrogen sulphide) due life threatening for workers allergic to insect
to anaerobic decay of organic material in un- poisons. In addition, infections and certain dis-
ventilated holds. Toxic reactions have also been eases (e.g. Lyme disease, malaria, yellow fever,
412
tick bite fever, onchocerciasis), are transmit- sol is formed, endotoxins can be diffused in air
ted by mites, mosquitoes, ticks and flies. Other as a result of violent agitation or when water is
diseases (e.g. leptospirosis, rabies), are transmit- sprayed. Recycled process water is often used in
ted by wild or house animals and constitute a pulp and paper manufacturing to moisten wood,
significant biological hazard, with the nature sludge, etc. While recycling allows economic
and incidence varying between different geo- gains, it also means water with high organic ma-
graphical regions. Micro-organisms can cause terial content remains in the process for a great-
gangrene and tetanus by infecting bruises or cuts er length of time, which facilitates the growth of
sustained from direct contact with thorns/spines micro-organisms such as bacteria. Moistening is
and incorrect handling of tools during harvest- sometimes done with spray nozzles that can cause
ing. Inhalation of hard wood and soft wood dust endotoxins to enter the workplace. In addition, a
in sawmills is known to be associated with naso- liquid aerosol can be spread from moist material
pharyngeal cancer. in transit.
The concentration of airborne endotoxins
Preventive measures: varies from one stage of production to another.
• Provide direct training for work tasks and Elevated concentrations can be found in most
training in work organisation for those in- processing parts of the cleaning department,
volved with cutting operations. especially at sludge watering presses and bark-
• Wear gloves, long sleeved shirts and pants, ing drums. Elevated concentrations also occur
boots to prevent insect bites/stings, trauma at water purification plants, especially aerated
and allergic skin symptoms. pools, and at papermaking machinery. It should
• Use appropriate respirators and dust control be noted that personnel are not continuously
procedures (e.g. local exhaust ventilation) for stationed in the different production depart-
dusty operations. ments but spend a large part of their time in the
• Provide a source of good sanitary facilities, control room, so that their exposure is probably
first aid and medical care for cuts and abra- lower than concentrations recorded. However,
sions. maintenance personnel can be exposed to rela-
• Special antidote should be available for poi- tively heavy concentrations and therefore likely
sonous snake bites and scorpion stings. to experience discomfort. Low concentrations
• All field workers should be provided with up- can be expected in bleaching plants and in out-
to-date tetanus immunisation. door sedimentation tanks.
• Mosquito control and malaria prophylaxis is
crucial (see special section on malaria). Preventive measures:
There are two alternative methods of reduc-
Work in the paper and pulp industry ing the spread of endotoxins from the different
Bacteria and endotoxins are identified as impor- sources:
tant cause of safety and health problems in the a. To reduce the bacterial content of the proc-
pulp and paper industry. Endotoxins are bound ess water. (It can be assumed that endotoxin
to particles and cannot be released from a stag- diffusion is due to the use of recycled process
nant water surface. In cases where a liquid aero- water containing living and dead bacteria and
413
Chapter 6
endotoxins). Bacterial growth can be partly domestic refuse they develop less rapidly than
controlled by adding biocides and by adjust- the bacteria.
ing pH and temperature.
b. To reduce the spread of endotoxins from the Preventive measures, refuse separation:
individual sources by means of encapsula- • Where domestic refuse such as food scraps
tion and local ventilation. During service is sorted mechanically, it must not be left
and maintenance, personnel intervene in the undisturbed for weeks during summertime,
process, working inside or very close to vari- otherwise it may dry out and start to emit
ous processing parts, however, conventional dust. The dust may contain a high proportion
remediation techniques like encapsulation and of micro-organisms and endotoxins and may
local extraction do not afford protection for constitute a health hazard when inhaled. The
maintenance personnel. The concentrations facility must be emptied daily and all spillage
of endotoxins can be reduced by closure of the collected continuously. Refuse that cannot be
processing equipment, including the recycled processed within the next 24 hours must be
water, for at least 30 minutes. The duration removed so that none is left lying about.
of the closure will depend on the nature of • Maintain a high standard of cleanliness.
the premises housing the process emitting the Among other things, this means cleaning all
endotoxins – the larger and better ventilated processing parts daily, collecting all spillage
the premises, the shorter the period of closure continuously and cleaning the floor and walls
needed. of the refuse reception room every day. Con-
veyors, walls and floors of the sorting premis-
es must be vacuum-cleaned daily and the floor
Refuse disposal
flushed once every day. Compressed air must
Manual and mechanical sorting of pre-separated
not be used for cleaning. All equipment must
refuse takes place at recycling plants and refuse
be cleaned before any repair work or servic-
disposal sites. The final, manual sorting of refuse
ing.
most often takes place at a conveyor belt which
• Manual refuse handling should be mechanised
also carries wrongly sorted refuse, such as dead
as far as possible so that personnel will not
birds, dog’s mess, disposable nappies, etc., expos-
come into direct contact with refuse.
ing workers to micro-organisms.
• Pre-separated refuse that is to be sorted man-
Organic material and contaminants in refuse
ually, should not be mixed with wet
are a breeding ground for the growth of micro-
domestic refuse (food scraps or suchlike).
organisms which, when handled, can be diffused
Correctly pre-separated refuse is a sine qua
with dust into the atmosphere, especially if the
non of a work environment free from micro-
refuse is wet or has become wet in the course
organisms.
of handling. Moisture, temperature and the
• An effective local extraction device should be
presence of organic waste are important factors
installed where sorting is done manually.
determining the growth of micro-organisms in
• Routine checks should be made of the purity
refuse. Fungi live mainly on organic material
of refuse arriving at the plant. Incorrect refuse
such as bread, wood, paper and fruit, for exam-
must be turned away.
ple. Mould flourish in damp newspapers, but in
• Where possible, encapsulated conveyors
414
should be used for moving refuse inside the sensitisation by high molecular weight proteins
plant. through inhalation. These processes include
degutting, heading and cooking/boiling of fish,
Work in food processing plants mincing of seafood, fish meal milling/bagging
Common constituents of food products that and cleaning of the processing line and storage
cause occupational allergies, asthma and infec- tanks with high-pressured water, Figures 6.7 and
tion include proteinaceous material (e.g. pollen, 6.8. Occupational asthma is commonly related to
spices, grain cereal flour and coffee dust, sugar crustaceans (e.g. crabs and prawns) and fishmeal
cane, animal hair and secretions, storage mites, production. Dermatologically-related allergic
insect pests), micro-organisms (e.g. Aspergillus), symptoms may be due to direct contact with the
parasites (e.g. Anisakis sp., Hoya sp.), toxins (e.g. actual vegetable additives e.g. spices, in seafood.
histamine, endotoxin, mycotoxin) and synthetic There may also be a systemic response to ex-
enzymes such as papain and (1->3)-B-D-glucans posure through inhalation. Occupational skin
(e.g. fungal a-amylase). exposure occurs mainly as a result of unprotect-
The adverse health effects experienced in the ed handling of various fish and their products
poorly regulated seafood processing industry are at various stages in the production process. Fish
the result of exposure to the seafood itself, includ- juice contains high molecular weight proteins
ing muscle and connective tissue, exoskeleton, (meat, skin, skin slime/mucin, gut); biogenic
blood, endolymph fish juice, skin, skin slime/mu- amines; histamine and cadaverine; degradation
cin, gut, or to various non-seafood components compounds in old fish; digestive enzymes (pep-
present in the product. The production of sea- sin and trypsin).
food aerosols during processing has been identi-
fied as a potentially high-risk activity for allergic
Figure 6.7. The fish degutting

process produces bioaerosols
containing allergenic proteins,
bacteria and endotoxins causing
allergies, asthma and irritant
reactions.
415
Chapter 6
Figure 6.8. The shovelling and

loading operation in a fishmeal
procuction plant is a source of
bioaerosol production caus-
ing allergic sensitisation and
asthma to fish (e.g. anchovy)
allergens.
Exposure to flour dust in traditional baker- wheat, rye and fungal alpha-amylase allergens
ies and supermarket bakeries has been shown present in flour. Studies in supermarket baker-
to increase the risk of allergic sensitization, ies indicate that bakers have the highest wheat
asthma (also called baker’s asthma) and derma- allergen exposures, followed by confectioners,
titis among exposed workers. Studies conducted whilst counterhands are the least exposed. High
among bakery workers have reported the preva- risk work processes identified in bakeries include
lence of baker’s asthma to be between 5–17%. shaking bags after loading flour and additives
Asthma is commonly due to sensitization to into mixers, high speed mixers using powdered
Figure 6.9. Bioaerosol emis-

sions from the fish degutting
machine can be reduced by
enclosing the machine with
a simple shroud of clear
polythene.
416
Figure 6.10. The introduction

of a bagging operation in a
fishmeal production plant
operating with a chute and
local exhaust ventilation can
reduce dry bioareosol emis-
sions.
ingredients, dusting of surfaces to prevent dough • An appropriate combination of emollients

adherence to working surfaces and sweeping and moisturisers can be used as prophylactic
during daily cleaning of the bakery floors. measure to protect skin barrier function and
prevent the development of irritant contact
dermatitis.
• Control measures to reduce the emission of
bio aerosols in fish processing plants include Work in sawmills/trimming plants
process separation or enclosure as well as the
Most often, the occurrence of wood mould in
use of local extraction ventilation systems to
sawmills is first noticed when cleared off plants
certain processes or equipment (gutting ma-
are trimmed or when packages are removed
chine, fish meal bagging) , Figures 6.9 and
from the drying kiln. Wood mould attacks
6.10.
mostly occur in connection with disruptions in
• Where there is skin contact with the hazard-
the drying process, especially when there is a
ous agent (fish sorting, spice mixing), appro-
long period of high humidity before the drying
priate cotton lined gloves and plastic sleeves
process. Mechanical and biological damage to
can be worn.
the bark layer on timber can occur anywhere in
• In small scale bakeries where mixers are used,
the handling sequence from felling to saw mill-
enclosure of bakery mixers with lids; start-
ing and can result in heavier attacks from micro-
ing mixers at slow speeds until wet and dry
organisms. While various kinds of bacteria and
ingredients form a mixture; using dredgers
fungi in timber have different water, tempera-
or sprinklers for “dusting” the work surface;
ture, nutrition and acidity (pH) requirements
substituting divider oils for “dusting” surfaces
for survival, favourable conditions allow mould
to prevent dough adhesion; and using vacuum
fungi to grow superficially and rapidly.
cleaners instead of pressurised air hoses or
At the sawmill, timber is usually moistened
brooms; and use appropriate respirators for
during the dry season of the year and the water
short-term dusty tasks.
417
Chapter 6
is often recycled so as to limit consumption. If spreading. Sticks must not be made from blue
so, the water derives a high content of organic timber. Badly discoloured sticks must always
material from the timber, which favours bacte- be removed from production because, when
rial growth. Generally speaking, the concentra- attacked, they are liable to contaminate un-
tion of airborne micro-organisms in sawmills damaged timber in the course of re-moisten-
depends on: ing.
• the prevailing growth conditions, (tempera- • In the event of a stoppage inside the saw, the
ture, humidity), while the timber was in stor- facility should be emptied of sawn timber,
age otherwise there will be a risk of micro-organ-
• the level of micro-organisms present in the isms growing in the raw timber.
timber and any liquid (e.g. recycled water) on • Limit the use of recycled water.
the timber. Long delays between storage and • To limit the diffusion of dust, stick discharge
drying posing a high risk of exposure to mi- should be separated from other activities.
cro-organisms • Sawmill machinery generating wood dust
• the growth conditions prevailing within the should, where feasible, be encapsulated or fit-
process, especially in the dryer ted with extraction devices.
• aerosol (dust) diffusion into the premises, e.g. • Dried and trimmed timber in storage must be
from sawing. protected from re-moistening by warehouse
storage or by wrapping in impermeable mate-
Endotoxins can spread in sawmills from the rial.
handling of timber that has been stored in water.
Symptoms related to inhalation of endotoxins Work in health care institutions
have been reported in sawmills processing wa- For health care workers, the main risk of acquir-
tered timber. The commonest complaints are ing workplace infections comes from inadvert-
cough, phlegm and hoarseness of voice, mainly ent exposure to unsuspected infectious material,
experienced by personnel working in places (e.g. blood, sputum, urine, faeces). Tuberculosis,
where the timber is first received and processed. hepatitis B and hiv pose the greatest risks to
health care workers worldwide. Among the
Preventive measures: blood borne pathogens, Hepatitis B virus ap-
• Storage times for roundwood and raw timber pears to pose a greater risk since exposure results
should be kept as short as possible, especially in higher sero-conversion and resultant death
during the warmer seasons of the year. than with hiv infection –30 per cent versus 0.5
• Timber should be dried in properly equipped per cent. The highest risk of exposure to blood
drying plants which should not be charged borne pathogens occurs through needlestick skin
beyond their intended capacity. injuries during blood collection, surgical opera-
• Wherever possible, timber with visible mould tive procedures and insertion of intravenous
should be segregated from other timber, strip- catheters in patients with advanced hiv disease
piled and yard-dried or dried separately in a (aids). In communities with a high background
timber kiln. hiv prevalence, the suppression of the immune
• Good strip-piling and stick management are system that results from hiv infection leads to
important in preventing wood mould from a greatly increased risk of tb disease. Health
418
Figure 6.11. Avoid manual recapping of

needles to prevent needlestick injuries
by using specific needle holders for
recapping of needles.
workers are at high risk of inhaling the tb my- • Avoid manual recapping of needles to prevent
cobacteria when dealing with patients with open needlestick injuries by using specific needle
cavities in the lungs. holders for recapping of needles and vacutain-
ers (for blood samples) with sleeves with a
Preventive measures: needle release device, Figure 6.11.
• Transmission of hiv and Hepatitis B virus is • Adopt procedures to sterilise or disinfect
minimised by strict adherence to standard and equipment in contact with blood, blood prod-
universal precautions that require health care ucts or other body fluids.
workers to treat the blood and body fluids of • Discard all medical waste and sharps in spe-
all patients as potential sources of infection, cially labelled containers marked for incinera-
independent of perceived risk or diagnosis. tion, Figure 6.12.
Figure 6.12. All needle sharps and infec-

tious material should be inserted into
specifically labelled containers for dis-
posal.
419
Chapter 6
• Isolation and prompt treatment of highly influencing transmission include overcrowding,

infectious tb patients in wards that maximize poor ventilation and the poor quality of housing
natural ventilation and have positive pressure provided by employers. Other hazards of note in
ventilation systems. small scale mining, common in developing coun-
• Covering skin lesions, cuts or abrasions with tries, include safety hazards as well as exposure to
occlusive dressings. chemicals such as mercury and arsenic.
• Use of personal protective equipment such as
respirators (e.g. when working with high risk Preventive measures:
tb patients), gloves, goggles and aprons. • Better dust control practices such as dust
• Immunisation of all health care workers extraction and ventilation systems and wet
against hepatitis B and passive immunisation processes such as using water in rock drills,
(immunoglobulin) for non-immune exposed will decrease the exposure to silica quartz and
workers following occupational exposure to reduce the prevalence of silicosis.
Hepatitis B virus. • Reduce workplace tb transmission by im-
• Post-exposure prophylaxis with anti-retroviral proving living conditions for migrant workers,
drugs (e.g. Zidovudine medication) following e.g. by improving hostels.
high-risk occupational exposures to hiv. • Prompt diagnosis and treatment of workers
• Where a significant proportion of tb cases is with tb.
likely to be hiv associated (communities with • Use of secondary prophylaxis (isoniazid medi-
high background prevalence of hiv), volun- cation) for workers who are hiv positive,
tary counselling and hiv testing should be have silicosis or who have been in contact
encouraged in anyone diagnosed with tb, in with tb.
addition to conventional tb treatment. • Institute a broad range of hiv preventive
activities including voluntary counselling and
Work in mines and quarries testing, health education including peer edu-
Tuberculosis is undoubtedly the most common cation, syndromic management of sexually
occupational disease caused by a hazardous bio- transmitted illnesses (treatment covering for a
logical agent (Mycobacterium tuberculosis) in gold number of causes at the same time), ensuring
mines and quarries. Factors considered to con- that the partner of the affected individual is
tribute towards the increasing incidence of tb in also notified and treated when disease is diag-
developing countries include: poor dust (contain- nosed, and broader community interventions.
ing silica quartz) control; a high prevalence of
silicosis; the general hiv epidemic; the migrant special diseases
labour system, particularly the use of single sex Major epidemics such as hiv/aids, Malaria,
hostels. Overall, tb rates are about three times Severe Acute Respiratory Syndrome (sars)
greater in silica exposed miners and in workers and Chicken-flu have been found to be major
with silicosis. The suppression of the immune public health problems affecting working popu-
system that results from hiv infection leads to lations in one of two ways, either by affecting
a greatly increased risk of tb disease following the worker’s ability to work or posing a direct
tb infection, especially in communities where occupational health risk to high-risk working
there is a high tb prevalence. Workplace factors populations. Malaria may also be classified as an
420
Industrial sectors/
Nature of the disease Prevention
populations at risk

Farmers, forestry workers, • Transmitted by malaria- • Visit a doctor for vaccinations and
fishermen, oil workers, infected(Plasmodium sp.) anti-malarial drugs (e.g. Chloro-
pesticide sprayers, migrant mosquito quine, Proguanil, Mefloquin, Doxy-
and/or contract workers cycline) 4–6 weeks before travel
• Infects the liver and red blood
in tropical countries cells • Take drugs on schedule without
missing doses
• Period between infection and
the presentation of symptoms • Prevent mosquito and other insect
is 10 days to 4 weeks bites by using insect repellent on
exposed skin (e.g. DEET – diethly-
• Affected person presents methyltoluamide, citronella based
with the following symptoms: products)
fever and flu-like illness, shaking
chills, headache, muscle aches, • Wear long pants and long-sleeved
tiredness, nausea, vomiting, di- shirts, especially from dusk to
arrhoea, anaemia and jaundice. dawn
May cause kidney failure, • Sleep under a Permethrin-treated
fits, mental confusion, coma mosquito bed net
and death • Reduce mosquito breeding by
• Diagnosis is made on blood regular insecticide spraying of
smear swamps etc.
Figure 6.13. Malaria – major features of the disease and its prevention.
occupational disease as is evident from the large per cent are infected). In addition to the broader
number of farmers, forestry workers, fishermen public health risk of developing the disease from
and oil workers in tropical countries who acquire community acquired infections as a result of un
the disease, Figur 6.13. Similarly, the outbreaks protected sex, intravenous drug abuse or mother
of sars and Chicken-flu affected not only the to child transmission, there are also certain jobs
general public but also posed an occupational associated with a high risk for transmitting hiv.
health risk to health care workers and chicken These include health care workers, sex workers,
farmers respectively, Figure 6.14. long distance truck drivers, migrant mine work-
The hiv/aids epidemic is worldwide and ers and farm workers.
it is estimated that over two-thirds of all the The impact of the hiv/aids epidemic has
people living with the human immunodeficiency been far reaching with labour intensive work-
virus (hiv) live in sub-Saharan Africa, the re- places appearing to be at higher risk of lost pro-
gion that also accounts for a large proportion duction, depletion of skills and escalating worker
of the world’s aids deaths. The prevalence of benefit and medical scheme expenses. In order
hiv infection in these countries is over 20 per to stem the tide of this epidemic, hiv/aids
cent. The most affected groups are economically should be treated as a management issue, more
active women aged 15 to 49 years (more than 50 specifically as part of a company’s strategic hu-
421
Chapter 6
Industrial sectors/
Nature of the disease Prevention
populations at risk

Travellers, health care • Transmitted by Coronavirus • Case detection to identify SARS
workers, laboratory workers (SARS-associated coronavi- • solation and management, infection
rus) control
• Affects the respiratory sys- • Effective contact tracing and fol-
tem and eventually the entire low-up
body
• Quarantine
• Period between infection
and the presentation of Health care setting:
symptoms is 10 days • Healthcare workers should wear
N95 masks, together with head
• Affected person presents
cover, goggles, gowns, and gloves
with the following symptoms:
when caring for these patients
high fever, headache, feeling
of discomfort, body aches, • Daily and terminal disinfection
occasionally diarrhoea, mild should be thorough, with careful
respiratory symptoms, dry washing and disinfection of the
cough, pneumonia, respira- bed, handrails, bedside tables, floor,
tory failure and equipment with hypochlorite
solution
• Diagnosis is made on isola-
ting the virus from sputum or • For intubated patients, use of
throat swabs or antibodies in closed system is essential to avoid
blood air leakage and enhanced disease
transmission
Figure 6.14. Severe Acute Respiratory Syndrome (SARS) – major features of the disease and its prevention.
man resources management. The International sive occupational health program. The key com-
Labour Organisation (ilo) lists four key areas ponents of an intervention strategy to prevent
of action to address hiv/aids in the work- hiv/aids in the workplace should include:
place. (ilo Code of Practice on hiv/aids and • A company hiv/aids policy, which is non-
the World of Work, Geneva, 2002): discriminatory and preventive in its orienta-
• prevention of hiv/aids tion (see checklist in ilo Code of Practice on
• management and mitigation of the impact of hiv/aids and the World of Work, Geneva,
hiv/aids on the world of work 2002).
• care and support of workers infected and af- • Promotion of awareness on hiv and other
fected by hiv/aids sexually transmitted infections (sti’s) and
• elimination of stigma and discrimination on their prevention through in-house education
the basis of real or perceived hiv status. and training activities.
• Training of peer educators (e.g. trade union
In order to achieve a reduction in hiv, a holistic shop stewards).
approach should be in place. It is essential that • Early diagnosis and treatment of sti’s using
this approach is integrated within a comprehen- the syndromic approach.
422
• Access to voluntary pre- and post-test coun- of a Recommendation that would reinforce and
selling and testing for hiv status on a confi- extend the impact of the ILO Code of Practice
dential basis. on HIV/AIDS and the world of work adopted in
• Employee assistance programs that include 2001, with its focus on the protection and pro-
ongoing counselling of hiv positive individu- motion of rights. It is envisaged that this would
als focussing on pyscho-social issues such as further support joint action on HIV/AIDS by
crisis intervention, medical aid, social security the ILO’s tripartite constituents and other part-
benefits and terminal care. Medical sup- ners, and strengthen the workplace contribution
port such as tb prophylaxis using isoniazid to achieving universal access to HIV prevention,
medication, vitamin supplementation and treatment, care and support.
treatment of opportunistic infections, is also
required. industrial hygiene and medical
• Optimal condom accessibility and distribu- surveillance
tion. Exposure monitoring, using industrial hygiene
• Provision of safe first aid support. surveillance programs, can evaluate the effective-
• Control of work organisation or environmen- ness of control measures in decreasing the risk
tal factors that increase risk of hiv transmis- of infection and/or allergic sensitisation of other
sion. workers not yet affected. Employers should also
• Health information and management system use the expertise of an occupational medical
focussing on ongoing surveillance and the practitioner to design appropriate medical sur-
development of intervention strategies. veillance programs for the workforce as an
adjunct to industrial hygiene evaluation and
A report recently published by the ILO (2008), control measures. Various early sub-clinical bi-
HIV/AIDS and the World of Work, reported omarkers (e.g. skin prick testing, serum antibod-
that more than 70 ILO Member States have, or ies, target organ tests), can be used to identify
are in the process of adopting, a general law on signs of early infection, inflammation or allergic
HIV/AIDS, while 30 countries have adopted, or sensitisation before overt symptoms and clinical
are in the process of adopting, specific workplace disease manifest. These tests can also be used to
rules. Other countries deal with HIV/AIDS assess the effectiveness of control measures.
under either equal opportunities or public health The medical management of an occupation-
legislation, and some have integrated HIV/AIDS ally acquired infection/allergy is no different to
into labour legislation. The report notes that that acquired outside the workplace, however,
the majority of the 33.2 million people world- there are additional measures that need to be
wide now living with HIV are still working and taken. After discussion with the worker, the
in their most productive years, with skills and medical practitioner should write a letter to their
experience their families, workplace and country employer requesting that the person be moved
can ill afford to lose. However, despite major ad- to a job that has zero or minimal exposure to
vances in attitudes and knowledge about AIDS, hbas. Alternatively the worker may be declared
many workers still face discrimination, stigma as temporarily unfit to work in the presence of
and fear of losing their job. The ILO is work- acute infection. It is also necessary to institute
ing towards a new labour standard in the form both appropriate treatment of an infection/al-
423
Chapter 6
lergy and preventive measures such as post-ex- Training is required whenever workers are re-
posure prophylactic treatment, counselling or quired to use personal protective equipment
vaccination for unaffected workers. Treatment (ppe) such as respirators, gloves and goggles.
should be the same for anyone who sufferers a Such training should be interactive and demon-
disease caused by exposure to an hba regard- strate the use of ppe. The following elements
less of whether the exposure was occupational or must be covered in ppe training: identification
non-occupational. of the hazard requiring respirator use; selection,
use and proper fitting of respirators; duration
education and training of usage, limitations, maintenance and stor-
There should be education and training for all age of respirators. In some circumstances more
workers, managers, health and safety representa- advanced training may be required e.g. where
tives and occupational health service providers. self contained-breathing apparatus and/or a full
Specific training on hbas should be part of body suit is required to be worn.
comprehensive workplace education and train- Training and risk communication materi-
ing programs. Employers and managers need to als such as pamphlets, posters or booklets, are
be aware of biological risks inherent in the work important tools in empowering workers and
processes so that they may institute primary pre- employers to take appropriate preventive meas-
ventive measures such as engineering controls, ures. Some examples of preventive measures to
preferably in the design phase of the production be followed for latex and animal allergens, blood
process. Each workplace needs to have an inte- borne pathogens and tuberculosis are avail-
grated occupational health and safety manage- able on the internet (niosh, osha). A useful
ment system which include procedures to elimi- pamphlet, available in a number of languages, on
nate or reduce worker exposure to hazardous educating workers and employers on biological
biological substances and addresses the correct hazards and their prevention, is on the European
disposal of hazardous biological substances and Union osha website. The ilo has produced a
other materials used on site. very useful education and training manual avail-
Education and training programs are also able in English and French “Implementing the
essential in informing and educating workers ilo Code of Practice on hiv/aids and the
about the production process; policy and proce- World of Work” (2002). This Code of Prac-
dures to be observed; their legal rights regarding tice outlines the approach to hiv/aids in the
health and safety; specific information on the workplace, the rights and responsibilities of vari-
properties and health effects of the hazardous ous stakeholders, achieving prevention through
biological agents they are exposed to; the pre- providing information and training, testing for
ventive measures to be employed when working hiv and care and support issues. Some of the
with these agents; first aid measures in case of an best practices taken by companies in Southern
emergency and general health promotion. Some Africa on hiv/aids have been published by
of this information is available in material safety the Organisation of African Trade Union Unity
data sheets (msds). Workers need to be aware (oatuu) Health, Safety and Environment
of where these msds registers are located and Program. This covers workplace case studies
trained in the use of msds. relating to hiv prevention, managing ill health,
424
human resource development, employee benefits ton (usa) for permission to use some of the pic-
and survivor support, as well as monitoring and tures. The contribution of Ms Roslynn Baatjies
planning issues. See reference list for above web and Dr Sophia Kisting of the Occupational
site addresses. Health Research Unit, University of Cape Town
(South Africa) is also hereby acknowledged.
acknowledgements
The authors would like to thank Ms Mary Miller,
Department of Labour and Industries, Washing-
Basic texts
The following texts give a more detailed insight • Aresery M, Lehrer SB. Occupational reactions to
into aspects of risk assessment, exposure assess- foods. Curr Allergy Asthma Rep 2002;2(1):78-86
ment and workplace control measures for hazard- • Bernstein IL, Chan-Yeung M, Malo JL and
ous biological agents: Bernstein DI, ed. Asthma in the Workplace, 3rd
• American Conference of Governmental Indus- edition. New York, U.S.A.: Marcel Decker Inc.,
trial Hygienists: Bioaerosols: Assessment and 2006
Control. ACGIH, Cincinnati, OH (1998) The following texts give more detailed insight into
• Fakhiri ZI. Workplace biohazards. In Encyclope- the policy and legal framework for the preven-
dia of Occupational Health and Safety Eds Stell- tion and control of risks associated with hazardous
man et al. ILO (4th ed) 1998;38:2-12 biological agents:
• Myers ML. Industries based on biological re- • European directive No. 2000/54/EC on the pro-
sources. In Encyclopedia of Occupational Health tection of workers from risks related to exposure
and Safety Eds Stellman et al. ILO (4th ed) to biological agents at work (http://www.allrisk-
1998;64:2-59 mgmt.co.uk/directives/00-054.htm)
The following texts give more detailed insight into • Biologically derived airborne contaminants. In
the various adverse health effects and diseases as- American Conference of Governmental Indus-
sociated with occupational exposure to hazardous trial Hygienists: TLVs and BEIs, 2008; 230-235
biological agents, their identification, diagnosis, • ILO: HIV/AIDS and the world of work, Geneva,
management and prognosis: 2002 (http://www.ilo.org/public/english/support/
• Rylander R, Schilling RSF. Diseases caused by publ/pdf/hiv.pdf)
organic dusts. In Encyclopedia of Occupational • ILO: Report IV(1) - HIV/AIDS and the world
Health and Safety. Eds Stellman et al. ILO (4th of work, Geneva, 2008 (www.ilo.org/wcmsp5/
ed) 1998;10:24-27 groups/public/---ed_norm/---relconf/docu-
• Takahasi K. Occupational Infections. In Ladou ments/meetingdocument/wcms_090177.pdf)
J ed. Current Occupational and Environmental
Medicine. 4th edition. Mc Graw Hill. USA,
2007; 262-279
425
Chapter 6
Best practice materials • OSHA: www.osha.gov/SLTC/biologicalagents/

index.html
The following texts give more detailed insight into
practical examples and case studies of successful • Baatjies R, Jeebhay MF. Dust control in the Bak-
policies and programmes in dealing with HIV and ery - Manual. Occupational and Environmental
AIDS in Southern Africa: Health Research Unit, University of Cape Town,
South Africa, May 2007
• Jeebhay M F, London L. Food and Allied Work-
ers Union (FAWU) AIDS policy. SA Labour
Bulletin 1993;17:13-14
• Loewenson R et al. Best Practices – Company
action on HIV/AIDS in Southern Africa. OAT-
UU, Benaby Printing and Publishing, 1999
• The Global Busincess Coalition (GBC) awards
for Business in Action – Workplace programmes,
Case studies, 2008 (http://www.gbcimpact.org/
live/events/awards/2008.php)
Training materials, examples of some

websites
The following websites provide very well illustrat-
ed training material and pamphlets for prevention
of exposure to hazardous biological agents in gen-
eral and specific occupational diseases in particular:
• European Agency for Safety and Health at Work.
Biological Agents fact sheet. Issue 41. OSHA,
Belgium, 2003 (www.osha.eu.int/ew2003/publi-
cations/factsheets/index_en.htm)
• ILO: Implementing the ILO Code of Practice
on HIV/AIDS and the World of Work. An edu-
cation and training manual, Geneva, 2002
(www.ilo.org/public/english/protection/trav/
aids/code/manualen/index.htm)
• NIOSH: www.cdc.gov/niosh/alerts2.html
(needlestick injuries, animal handlers, latex al-
lergy, organic dust toxic syndrome)
• NIOSH: www.cdc.gov/niosh/hazcomm-hazid.
html (wood dust, organic dust in diary barns)
• OSHA: www.osha.gov/SLTC/bloodbornepatho-
gens/index.html
• OSHA: www.osha.gov/SLTC/tuberculosis/index.
html
426
7
Prevention of psychosocial risks

7.1 Psychosocial risks and work 429
7.2 Improvement of psychosocial conditions 439
7.1
Psychosocial risks and work

Staffan Marklund
introduction
In industrial countries, great interest has been the specific workplace and at the organisational
shown to the psychosocial aspects of work for a level. However, similar preventive measures
long time, but physical and ergonomic risks have often have positive effects in a variety of dif-
been the priority for preventive actions. ferent settings. There is good reason to believe
There are three common reasons given for that organisational learning is an important
this lack of emphasis on prevention of psychoso- method to prevent psychosocial problems. The
cial risks. One claim is that such risks are ‘soft’, assertion that prevention of psychosocial risks
lacking scientifically established measurements, at the workplace is a luxury that imposes higher
and evidence on exposure and consequences. production costs is rarely based on experience
Another is the claim that prevention of these or evidence. Several research studies from in-
risks cannot usually be achieved through legisla- dustrial countries have shown that an improved
tion or the establishment of exposure limits. A psychosocial working environment directly
third claim is that prevention of psychosocial increases productivity and limits costs for absen-
risks is closely related to production, manage- teeism and sickness.
ment, productivity and the economic perform- While the prevention of occupational health
ance of companies. The consequence is that problems usually covers four areas of risk,
psychosocial conditions are seen to be part of (accidents; chemical, biological and physical;
how management is dealing with its tasks and ergonomic; psychosocial), it should be noted
that suggestions for prevention may often be that all aspects of the work environment are
seen as negative for the managers. closely interrelated. Prevention in one area
The first claim is not valid, given that there is frequently affects other areas. In the early stages
very strong research evidence on several aspects of industrialisation, the priority is accident
of the relationship between psychosocial condi- prevention in places with frequent injuries or
tions and health. Some of these research findings fatalities. As fatalities and accidents incur high
are presented later. The second claim is partially political costs, they are often the initial focus for
valid as effective prevention of psychosocial risks legislation and social security. While there are
is only possible if activities are conducted at large differences between countries, in general
429
Chapter 7.1
these measures have resulted in considerable ingly important as the intensity of work has
reductions in accidents. Accidents have also been increased along with demands for higher quality
reduced as workers shift from farming, mining and increased specialisation at work. The fact
and heavy industry towards high technology that work has in some respects become more
industries such as communications and pharma- individualised also means that psychosocial risks
ceuticals. have become increasingly individualised and that
Historically the prevention of specific chemi- the reaction to individual risks may vary between
cal and physical risks has been closely related individual workers. However, there are similari-
to accident prevention; however, new risks and ties in the models used to prevent psychosocial
scientific knowledge about the damaging effects risks and ergonomic risks as they both include
of specific substances or conditions are always workplace and organisational factors as well as
being discovered. The prevention of chemical factors related to individual workers and their
and physical risks requires detailed knowledge capacities.
of exposure and effects. Prevention can also be Psychosocial risks at work are clearly related
influenced by trade unions and national political to the degree of autonomy experienced by work-
developments. ers. In the early phases of industrialisation,
The prevention of ergonomic risks includes workers were craftsmen with a high degree of
a wide variety of factors but focuses on different control over all aspects of their work. Devel-
physical loads and musculoskeletal disorders. opments then led to a division of labour and a
“Physical loads” not only refer to heavy work high degree of specialisation that has resulted in
but to other demands on the body related to reduced worker control and lower qualification
awkward postures, movements that may cause requirements. This process can be seen most
disorders or pain, monotonous work and lack clearly in industrialised countries but is also
of movement during work. Prevention of er- increasing in developing nations.
gonomic risks has developed through a com- A specific characteristic relating to psychoso-
bination of improved technical arrangements cial factors at the workplace is the role of inter-
to lower demands on the body, organisational personal relationships between workers. Social
measures that increase work rotation, and pro- support and possibilities for cooperation are
motion of increased muscle strength and physi- essential not only for the psychological well be-
cal fitness. In modern organisations, efficient ing of individual workers, but also for improved
prevention of ergonomic risks is often closely quality of products and services, and increased
related to an improved psychosocial work envi- organisational creativity and learning in organi-
ronment, based on the experience that mental sations. Awareness of the contribution made by
stress and psychosocial demands affect the way individual workers to productivity and creativity
in which an individual copes with high physical may primarily emerge in wealthy countries first
strain and monotonous work. but is then exported to poorer countries via mul-
Awareness and prevention of psychosocial tinational companies, students educated abroad
work risks may be seen as the most recent de- and international networks and organisation.
velopment in the work environment history. Structures that support individuals to use their
Demanding psychosocial conditions have existed productive and creative resources may provide
throughout history, but have become increas- scientific and technical prestige to those who
430
deal with ‘modern’ questions in wealthy nations to a job and how a job is organised. Psychosocial
as well as in wealthy sectors in poor nations. risks at work may be defined as follows:
stress and psychosocial risks Psychosocial work risks are any organisational con-
ditions at work that disrupt the balance between
There is a close relationship between psychoso- demands from work and control over work, for an
cial conditions at the workplace and stress. Tra- individual worker, that limit her/his ability to perform
ditionally the concept of stress was closely linked a good job.
to biological reactions to all kinds of strains both The concept of psychosocial conditions is often
at work and outside work, e.g. as defined in the confused with the psychological, psychosomatic
following example from Selye in 1974: or psychiatric reactions of individuals. While
psychosocial conditions are often measured
“Stress is the general reaction of the body to external
or internal strain factors” through individual cases, they do not only reflect
the psychological status of the individual but also
However, modern stress research not only deals how the job is organised in general. Although
with measurements of biomedical stress markers psychological reactions to negative psychoso-
such as adrenalin or cortisol, but generally re- cial conditions are common, it is well known
gards stress as the psychological balance between that a range of ‘physical ‘reactions also occur.
demands and individual abilities. A common Musculoskeletal and cardio-vascular disorders
definition originates from the work of Lazarus: have been shown to have a high correlation with
“Stress occurs when the relationship between the negative psychosocial work conditions.
individual and her environment is seen as exhausting One reason why psychosocial conditions are
the resources of the individual and is threatening to so important in modern working life is that they
her well being”
encompass various aspects of consciousness,
This kind of definition results in confusion motivation and identity for both individual and
between the concept of stress and stressors. groups of workers. Work plays an important role
Stressors are defined as the external factors in in the formation of personal identity, the fulfil-
the work environment or other areas of an indi- ment of personal goals and personal satisfaction.
vidual’s life that affect health or well-being. The Aside from work providing economic support,
term stress is generally concerned with individu- it also affects workers’ self esteem and sense of
als and individual reactions rather than with achievement. Work plays an important role in
collective conditions at the workplace. terms of social relations and workers’ pride in
Psychosocial risks in the workplace include the group or company that they belong to. The
all non-physical hazards that negatively affect social value of work is not only relevant for peo-
any individual. It is important to consider how ple with intellectual jobs but has been shown to
work is organised and managed and to identify be essential for all types of manual workers.
the mental demands required for specific tasks. While there are differences between occu-
Psychosocial conditions also include relation- pations and work situations, most people take
ships between individual workers, workers with some pride in their jobs. Work is a highly social
their supervisors and workers and customers or activity in that people work together and have
clients. It should be noted that these conditions relationships with supervisors, customers and
are, at least formally, defined as external factors work mates. The development of theories and
431
Chapter 7.1
measurement of psychosocial risks at the work- increase in productivity and a decline in

place involve important social factors such as rejected products.
collective behaviour, individual motivation and The next step involved changes to some
creativity. of the physical conditions, made without
the knowledge of the workers. The lighting
an influential experiment and temperature were decreased, and the
One of the first studies which used the concept noise level was increased. The result was
of ‘psychosocial’ working conditions was the no decline at all in productivity related to
”Western Electric” experiments conducted in these negative changes to the physical work
the Hawthorne Plant of the Western Electric environment.
Company in the USA during the Great Depres- 2. The only change made for the control
sion between 1924-1932. The study was headed group was improvements to lighting; that
by Professor Elton Mayo under the auspices of single change resulted in improved produc-
the American Academy of Science. tivity. When the lighting was decreased,
The company had identified high levels of productivity declined in contrast to the
fatigue among workers, inefficient movements experiment group.
between and during each moment of work,
bad physical conditions due to poor lighting, 3. The same experiments were later replicated
cold rooms and noise, all conditions suspected using a group of male workers. The results
of negatively affecting productivity and prod- were less positive in terms of increased
uct quality. A pseudo-experimental design was productivity, but still significant. The male
adopted in order to study and solve these prob- workers were generally suspicious of both
lems. Different interventions were studied and, the supervisors and the company and con-
where possible, control groups were used, (at tinued to engage in individual competition
least partially), to guarantee reliable testing of for wages, and were less willing to share
the effects of the interventions. knowledge with workmates and supervisors.
Two groups were primarily used in the so
called lighting study: The interpretation of these experiments has
greatly influenced the understanding of psycho-
1. A study group of about 120 women workers logical and social conditions at work and their
was set up. They were assigned a new su- effect on productivity – the notion of psychosocial
pervisor and asked to try to work together. working conditions was invented. Relationships
They were given special, friendly atten- between co-workers and supervisors are ex-
tion by the supervisor, served better food, tremely important for productivity, however, as
and offered special clothing. The lighting in the case with the suspicious male workers, it
was improved and the heating was raised. may take time to convince workers that a new
The workers were also encouraged to solve supervisor is not trying to manipulate them. In
problems themselves whenever possible. In some industrial settings there is a strongly nega-
other words, these workers were asked to tive culture among workers and supervisors that
use their informal knowledge and ability to affects productivity and well-being, e.g. one
cooperate. The results showed a significant worker shouldn’t work harder than another or
432
workers shouldn’t befriend a supervisor. Infor- an individual can use his/her breadth of skills,
mal rules between workers and supervisors are interact with others and be a productive, healthy
extremely important for productivity as they person in working life. Maslow’s ordering of the
affect behaviour and attitudes and are often very needs into a hierarchy means that the first step,
hard to change. If a group of workers has never physiological needs, must be met before an indi-
been allowed to influence their own work, they vidual moves up to the new level. Maslow’s view
will need considerable time before being con- has been criticised and the common view today
vinced of the benefits of change. The develop- is that needs are not hierarchically ordered.
ment of good psychosocial conditions requires However, Maslow’s theory on human needs is
a supervision and control system that is friendly similar to how OSH has developed over time
and takes workers’ views into account. with the physical work environment and safety
The Western Electric experiments also issues emphasised for a long time before the
showed that physical work conditions are related more recent focus on the psychosocial aspects of
to workers’ perception of the psychosocial situa- work.
tion. Productivity is improved if workers are able Fredrik Hertzberg’s theory of motivation
and allowed to talk to each other while working divides workplace environmental factors into
and during breaks. Even small issues such as the motivational factors and hygiene factors. Moti-
quality of food, may be an important sign of that vational factors are based on work content and
management takes the well-being of workers are the most important for a positive develop-
seriously. The provision of special clothing for ment of skills and job satisfaction. Hygiene
the female workers in the experiment group was factors refer to conditions such as salary, psy-
intended to create a sense of group identity. chosocial climate, safety at work and the physi-
Each worker is a complex human being. Even cal environment. While they are important to
though she or he may be doing a manual job counteract the negative effects of work, accord-
there is a need to be seen, to be supported by ing to Herzberg, they have very little effect on
others, to be accepted, to belong to a group, to job satisfaction. Hygiene factors are based on the
feel secure and reassured. The Western Electric need for a business to avoid unpleasantness at
experiments showed that improved psychosocial work. If these factors are considered inadequate
conditions will increase productivity and qual- by employees, then they can cause dissatisfaction
ity of production in a more permanent way than with work. According to Herzberg, management
some alterations to the physical work environ- should focus on rearranging work so that moti-
ment. vating factors can take effect.
Theories on motivation and human needs are The social needs of the individual have impli-
another research field that has contributed to the cations for supervision and leadership in organi-
way in which psychosocial factors are defined zations. The emphasis on management of “hu-
and dealt with. In the 1950s, the personality man relations” can be regarded as an attempt to
theorist Abraham Maslow classified needs into promote self regulation in addition to the execu-
a hierarchy: physiological needs, safety needs, tion of power based on rewards and punishment.
social needs (belonging and love), esteem needs
and self-actualisation. According to this theory,
if all these needs are met in a satisfactory way,
433
Chapter 7.1
the demand and control model of Karasek and Theorell combined the two con-
psychosocial conditions cepts of demands and control:
An influential approach to psychosocial work Low demands High demands
conditions can be found in the demand-control High control Low strain jobs Active jobs
model developed by Robert Karasek and Töres Low control Passive jobs High strain jobs
Theorell in the early 1980s. The model origi-
nates from and combines two different theoreti- Figure 7.1.1. The Demand/Control model develo-
ped by Karasek & Theorell.
cal and empirical traditions – stress theory and
classical alienation theory.
The model defines passive jobs as those with low
In general stress theorists studies the way in
demands in terms of pace and complexity and
which people are affected by demands at work,
where workers have very little possibility to
particularly how excessive work affects health
decide when and how their job should be done.
through the release of stress hormones in the
Stress theory is likely to define such jobs as
body. However, research also shows that there
“under-stimulating”. Passive jobs often include a
are negative health effects from excessively low
high degree of monotony and repetition.
work demands, particularly for individuals who
Low strain jobs are those where workers have
have to be alert while performing monotonous
a higher degree of freedom, even though their
tasks. For example, workers in control positions,
jobs have low demands and low levels of in-
such as those in the control rooms of power
tensity and complexity. Jobs combining high
stations, often have very little to do but, if any-
demands and freedom for workers are called
thing goes wrong, large economic or other costs
active jobs. A number of professional occupations
are involved. Other demand factors are related
belong to this category. Jobs where the demands
to the intensity, speed and complexity of work
for speed or complexity are high but where
tasks and workers’ specific or general experi-
workers have little influence over how and when
ence. Some jobs present conflicting demands so
the job should be performed are called high
worker may have to decide on priorities, quality
strain jobs.
and/or quantity.
The two most problematic conditions in the
The second element in the demand/con-
model were passive jobs and high strain jobs. These
trol model originates from classical alienation
were jobs where there was either too little to do
theory. Robert Blauner’s 1964 book, ‘Alienation
and no control over the work process/product
and Freedom’, showed that most workers, even
or, too much to do and no control. However, the
those involved in seemingly meaningless rou-
aim of the model is not only to define these cat-
tine work, were striving to do their jobs as well
egories. Combining the two dimensions of high
as they could. Most workers wanted to develop
demands, (active and high strains jobs), may not
their skills and to make an individual impression
be problematic if it results in increased freedom
on their work but if they were denied this pos-
for workers. The demand/control model implies
sibility, they performed less well and were more
that the increased intensity of work that occurs
likely to develop negative attitudes towards
in many countries and industries should be bal-
work. An ability to affect work and control tasks
anced with increased control for workers. This
was important.
process is happening partly because of increased
434
complexity of work tasks, increased profession- get support from work mates and/or supervisors,
alisation and educational levels, which generally affects the way in which demands are handled
results in a growth of occupations and profes- and the possibility of an individual worker to
sions with a high degree of autonomy. On the control their job.
other hand, increasing demands in traditional
production or services may not automatically measurements of psychosocial
increase control by workers. working conditions
Karasek & Theorell used this model to study Psychosocial working conditions are measured
the risks for cardio-vascular diseases. The model in a number of ways. Ideally any measurement
has also been used to explain other medical of psychosocial conditions should focus on job
conditions such as musculoskeletal disorders, characteristics rather than on individuals and it
psychiatric disorders and more general outcomes should encompass factors that are not heavily
like sickness absenteeism and work related dis- affected by attitudes and personality differences
abilities. An epidemiological study of long term among workers. On the other hand, measure-
sickness absenteeism showed a very good fit with ments may be more useful if they can be used
the theoretical and explanatory expectations. generally for different occupations and/or work
Figure 7.1.2 shows that the relative risk for long tasks rather than being very specific. The follow-
term sickness was more than three times higher ing options may be used. The first option is to
among workers in high strain jobs compared to ask employees to assess their own psychosocial
those in passive jobs. conditions through the use of questionnaires.
R e la tive ris k fo r lo n g te rm s ic k n e s s a b s e n te e is m in re la tio n s h ip to le ve l o f d e m a n d s
a n d c o n tro l (M a rk lu n d 1 9 9 5 )
A second strategy is to use experts or other
4
informants to assess a particular job or occupa-
tion through a developed task analysis. A third
3
alternative is a combination of both the above
2 options. All three have been used, but the most
1
popular strategy today is to use employees as
L o w co n tro l the main informants as validation studies show
0 H ig h c o n tro l a high correlation between questionnaire results
H ig h
dem ands
Low and expert assessments. Based on repeated ques-
dem ands
tions and tests of different wording, question-
Figure 7.1.2. Demand/control for relative risk of
naires have proved to be a reasonably reliable
long term sickness absenteeism, (60 days or
methodology.
more) among women. In the regression model
the category ‘passive job’ (low control/low de- One of the most influential scales is based
mands) is used as the reference category. The on a set of questions developed by Karasek and
model controls for age and social support. Theorell, for the measurement of demands and
control at work. The questions are directed to-
In addition, the demand/control model has been wards individual employees and can be used for
developed in various ways including the impor- most types of work tasks and occupations.
tant step of including ‘social support’ as a di-
mension of the psychosocial work environment.
The degree to which an individual worker can
435
Chapter 7.1
Control over work/control at work Never Rarely Some times Mostly Always
My work demands that I work very hard
My work contains too high a work-load
I have enough time to perform my work tasks
In my work I need to consider large amounts of information
My work involves conflicting demands
Demands at work
I have the freedom to decide how my work should be done
I have the freedom to decide what should be done
I can decide when different tasks should be done
I can decide my own pace at work
Figure 7.1.3. The Demand – Control Questionnaire from Karasek & Theorell ‘Healthy Work’ 1990.
This scale has been used in a number of stud- areas. Data on self reported health in different
ies in several countries. Individual items, as well occupations was used to test the prognostic value
as the total measurement, have been validated of the matrix.
through external measures, mainly using experts It is obvious that there are distinct and expect-
to define demands and control. Differences in ed differences in psychosocial risks between oc-
psychosocial conditions between sectors and occupations and between women and men. How-
cupations have also been tested in several stud- ever, it may seem surprising to learn that female
ies. The degree of sensitivity in relationship to medical doctors report lower demands than fe-
various health outcomes has also been tested. male cleaners do or, that male electricians report
the same degree of control as medical staff and
Psychosocial job exposure matrix farmers. There seems to be no reason to assume
A specific use for measurements of psychoso- that demands at work are generally higher for
cial conditions is the comparison of different intellectual work than for manual work. On the
occupations and differences between men and other hand, most traditional professions (such
women within these occupations with respect to as lawyers, accountants and physicians) report a
demands and control. This is done in a psycho- distinctly higher degree of control compared to
social job exposure matrix. Such a matrix can be blue-collar workers.
constructed if there is reliable information about
large groups of individuals in a range of occupa-
tions. This type of matrix was developed in Swe-
den in 2000, based on a series of surveys with
data on psychosocial conditions for the 1990’s
for men and women in different occupational
436
Occupation Demands Demands Control Control
Women Men Women Men
Engineer 6.1 6.4 7.9 8.3
University teacher 5.5 5.7 8.3 8.7
Pre-school teacher 6.4 6.6 7.6 8.0
Medical doctors 4.8 5.3 6.9 7.5
Registered nurse 5.8 6.1 7.1 7.5
Shop assistant 7.0 7.2 7.0 6.7
Farmer 6.8 6.8 7.4 7.5
Mineworker - 6.8 - 6.0
Bus and lorry driver 6.3 6.5 3.8 4.3
Mail delivery staff 7.1 7.0 4.9 4.5
Mechanic 7.4 7.1 4.4 6.8
Electrician 7.3 6.9 5.5 7.6
Carpenter 7.5 7.1 5.6 6.9
Baker 7.3 7.0 5.1 6.2
Process operator 6.9 6.9 4.8 5.0
Ware house worker 7.2 7.1 5.6 6.5
Cook 6.9 6.1 6.8 6.5
Cleaner 8.3 7.6 5.6 6.3
Figure 7.1.4. Average values on demands and control for selected occupations in Sweden in 2000. Demands
and control are both measured on a ten digit scale. High demands can be said to occur for values over 6
and low demands for values below 6. High levels of control can be defined as representing values over 6
and low control can be said to occur for values below 6.
There are also some interesting differences but it may also be related to the specific tasks
between men and women within the same oc- assigned to men and women within the profes-
cupation. Male professionals such as engineers, sions. The fact that female blue-collar workers
university teachers and medical doctors, report a report higher levels of demands than males in
higher level of control than women in the same the same occupation, may indicate that females
profession. The same is true for some of the and males are unequally distributed within that
blue collar workers such as mechanics, electri- occupation or it may be that women working in
cians and carpenters. This may reflect the fact typical male jobs have more problems in meet-
that more men are in supervisory positions, ing job demands.
437
Chapter 7.1
To conclude, consideration of psychosocial

working conditions is important for all kinds of
jobs and for all kinds of economies. The de-
mand/control model for assessment of psycho-
social working conditions shows that increased
demands on workers should be balanced by in-
creased control. Enhanced productivity through
increasing quantitative or qualitative demands
on employees is only possible if they are given
more freedom to decide how and when tasks
should be done. This is equally true for manual
and intellectual jobs and for both wealthy and
poor countries.
438
7.2
Improvement of psychosocial conditions

Annika Härenstam
This chapter presents a number of organisa- and problems in the work environment, Figure
tional conditions, vital for a healthy workplace, 7.2.1. The transfer of low paid, hazardous jobs
focused on the premise that psychosocial condi- from industrial countries to developing countries
tions are an integral part of workplace organisa- is a problem. Differences between metropoli-
tion. However, there are numerous differences tan and rural regions in both industrialised and
between various occupations, enterprises and developing countries are also increasing. There
industries within the labor market. Successful in- is a transfer of OSH risks and problems from
terventions to improve psychosocial conditions corporations to subcontractors as core indus-
require comprehensive measures specifically tries increasingly outsource work and downsize.
adapted to each workplace. Psychosocial work- Responsibility has been shifted downwards from
ing conditions are also dependent on both na- stock-holders to strategic senior management
tional and international conditions and changes. and on to operational managers and individual
While the conditions described in this chapter employees. Differences in working conditions
refer mainly to the labour markets in industri- and OSH risks are also found between those
alized countries and Swedish studies are used, with regular employment and those with pre-
increased globalization means that even if the carious employment.
labor market conditions in developing countries Changes in workplace organisation have also
are very different, there are very similar condi- been described as a process of “individualisation
tions within the industries described. of responsibility” while Human Resource Man-
agement (HRM) often uses enthusiastic rhetoric
changes in psychosocial risks to stress the positive aspects of individualisation,
Work organisation continually changes due to it can have different consequences depending
economic, political, ideological and technologi- whether increased responsibility is accompanied
cal circumstances. It has been suggested that by increased control and improved learning pos-
since the early 1990’s, there have been more sibilities. The ideologically driven, “hard” ver-
frequent and extensive changes than ever be- sion of HRM, (such as quantitative result moni-
fore. Several studies have drawn attention to the toring and measurement), is said to be directed
recent, significant transfer of occupational risks towards relatively poorly educated, replaceable
439
Chapter 7.2
groups of workers. The soft” version of HRM, authority over resources has been centralised,
(such as dialogue with management on the com- responsibility for jobs and production has been
panies’ values and goals), is directed toward a decentralised and survey results point to a nega-
core group of employees whose competence is tive development since the 1990s with respect
desirable for a company’s principal activities. An to psychosocial working conditions when work
important question is whether the process of in- demands were increased and decision-making
dividualisation has been internalised by employ- latitude was reduced.
ees to the extent that they drive themselves to Centralisation of power can be described as
work too intensely. Workers themselves, rather “remote control”, where strategic operational
than managers or supervisors, increasingly leave decisions are more and more made at a greater
their jobs feeling dissatisfied or uncertain about distance from the place where work is done.
their work performance. Increasing globalisation and the growth of mul-
tinational corporations and networks,
combined with deregulation of financial
Permanently employed
Employed on projects
Corporatation
Company
Substitutes
Temporary employed
markets, have contributed to this devel-
Local workplace
Contractor
On call workers opment. In the 1990’s, new information
Unemployed
Sub-contractor technology systems made it possible to
monitor and manage workplace activities
Growing trades
Down sizing trades
from a distance, even from other parts of
the world.
Stock holder
Top level management
Core activities
Increased work intensity, combined
Managers
Foremen, supervisors
Service activities with result orientated management
Staff Industrialized countries Metropolitan areas systems, has also resulted in less reflec-
Developing countries Rural areas
tion and exchange of experiences be-
Figure 7.2.1 Changes in working life since 1990. Transfer of tween colleagues and supervisors, and
OSH risks and problems from centre to periphery. The production workers and strategic deci-
text and the arrows indicate the direction of transfer of sion makers. This is often exacerbated
risks from actors and arenas with a strong position to those by large disparities in the professional
with a weaker position. backgrounds, knowledge, experience
and status of high level strategic decision
In many developed countries, changes in work- makers and those who work for them.
ing life have resulted in many groups being At the same time, various types of collective
given greater responsibility for their own work, support structures such as trade unions have
For some groups e.g. in knowledge intensive been weakened. Safety officers find it more
services and high-technological industries, this difficult to carry out their work as workplaces
change has has meant a decrease in monoto- become less socially integrated when operations
nous, low skill jobs as well as increased demands. are fragmented through outsourcing and sub-
Thus, increased authority and learning pos- contracting. As the link between management
sibilities must also be implemented in order to and operational level is weakened, the employ-
maintain positive effects when work demands er’s responsibility also becomes attenuated. Any
are raised. While strategic management and remedial process, e.g. on OSH, becomes com-
440
plicated if individuals who work together have Inadequate knowledge of work environment and
different employers and supervisors, belong to health among those with supervisory and coor-
different trade unions, have different safety of- dinating responsibilities
ficers and unequal access to occupational health Weakened responsibility for employers because
services. Collective action is less influential of a multi-tiered decision making and manage-
when those affected need to use different means ment structure which makes it difficult to moni-
and resources for problem solving. In general, tor and report on work environment problems
there are reduced opportunities for many actors
Lack of qualifications, inadequate job training
including OSH experts, labour inspectors, man-
and lack of experience among employees
agers, and workers, to address the problems of
working life. Difficulties for employees to organise and pro-
It is reasonable to assume that private compa- tect themselves.
nies and public organisations, whose operations 3) Legislation and supervision
are based on outside contracts and competitive
Work environment legislation and supervision
tendering, are in a weaker position with respect
is directed and adapted to cover permanent
to the promotion of a good work environment.
employees of large corporations so it functions
An overview of 29 international research studies
poorly in many small companies
on occupational health risks in businesses using
contracting out, found an association between Problems to identify the responsible employer in
this form of operation and occupational illness establishments where many subcontractors work
in almost all the studies. The authors’ review of Weakened supervision systems that are poorly
these studies identified three groups of problems adapted to contracting businesses
which could explain this association: economic, Lack of knowledge and monitoring of minimum
organisational, and those related to legislation requirements with respect to employment con-
and supervision. ditions and work environment.
1) Economic factors Structural changes in working life have also had

Competition and undercutting a personal impact on workers. Entry require-
Performance-based wage systems ments for jobs have increased but “on the job”
Long, inconvenient and irregular working hours training has actually decreased for large numbers
of workers e.g. in manufacturing and service
Understaffing and excessive work intensity
industries. The emphasis on individual respon-
Lack of resources sibility has blurred the line between work and
High-risk activities which a company does not leisure, and flexible working hours have made it
wish to carry out itself harder for people to combine work and family
life. For many employees, flexibility from the
2) Organisational factors
personal perspective has diminished as corpora-
Unclear and complex responsibilities and job tions implement strategies that are flexible from
descriptions their point of view. Rapid change also makes it
more difficult for people to plan their leisure
time and more vulnerable groups in the labour
441
Chapter 7.2
market find it increasingly difficult to use their ergonomic aspects. The freedom to create a
occupational life to achieve their personal ambi- system of work organisation that will provide
tions. Workers in relational occupations such as healthy working conditions varies greatly de-
healthcare, education and social care, face par- pending on the type of operation.
ticular challenges when trying to balance their Different types of operations (using the above
work and private life because their clients needs classifications), are found all over the world but
cannot be predicted even if the organisational their distribution in the total labour market dif-
prerequisites are adequate. fers between countries and regions. The gender
Structural changes in the labor market also composition within various occupations also dif-
affect the extent and type of health problems fers from country to country but gender segre-
experienced by women and men respectively. gation in both occupations and industrial sec-
As the labor market is segregated by gender, tors is a feature of any labour market. Another
women and men are exposed to different risks. characteristic observed in most countries is that
Along with a general increase in the intensity of workers in female dominated sectors generally
work, it has also been demonstrated that there have lower salaries and less influence over their
are increased differences in working conditions work than sectors dominated by men or with a
based on gender, age, ethnicity and social class. mixed workforce.
In Sweden there has been an upsurge in the rates According to Giertz, there are similar charac-
of work-related stress and sick leave in female teristics within each of the operations across all
dominated areas, particularly in the public sec- countries, although the problems may be accen-
tor. A number of studies have linked this in- tuated in countries with generally poor working
crease to negative stress and high workload. conditions. Figure 7.2.2 shows the female and
male labour force in Sweden in 2003, by type of
Changes in different sectors of the labour operation.
market High-tech and knowledge based industries
In addition to general development trends in include production of both goods and services.
working life, there are major differences be- While 25% of the Swedish labour force works
tween industries and sectors. Possibilities to bal- in this sector, the sector employs more men
ance business requirements and employees’ need than women. In Sweden, human services such
for security and good working conditions vary as education, health care, social care, policing,
because of factors such as business organisation social services, and judicial services employ one
and management, position in the labour market, third of the total labour force but more than half
and requirements for employee competence. of the female labour force is employed in this
Companies have traditionally been classified by sector. In contrast, labour intensive services such
what they produce, e.g. construction, or cars. as cleaning, maintenance, trades, transportation,
The industrial economist Eric Giertz has pro- retail and customer support, also accounts for
posed a classification system, based on market one third of the workforce but employs a larger
conditions, production process characteristics proportion of men. In the past, most of these
and management requirements, which has been operations were an integral part of corpora-
useful for studies of the distribution of “good” tions or government agencies, but increasingly
and “bad” jobs, with regard to psychosocial and they are outsourced and organised by specialist
442
Distribution of the female work force Distribution of the male work force
1% 6% Raw material production 3%

15%
Labour intensive goods 22%

production
22%
Hightech and knowledge
based production of goods
and services
51% Labour intensive services
33%
Human services
27%
20%
Data source: Work environment survey, Statistics Sweden, 2003
Figure 7.2.2. The Swedish labour force divided by gender and type of operation.
companies, often linked to multinationals. In hierarchical structures, span of control, and the
Sweden, the production/manufacture of “labour integration/fragmentation of work processes as
intensive” goods and raw material harvesting the most important links. Recent research sug-
(agriculture, mining, and fishing), now employs gests that issues such as staffing policies, man-
a small and diminishing part of the labour force agement technologies, organisational change,
but these are still the largest industrial sectors in production resources, downsizing and “lean
many developing countries. management” have the greatest impact on work-
While management strategies have become ing conditions.
increasingly homogeneous among companies
with similar types of operations (i.e. clusters of a comparative study on the
companies in specific industries), they are in- relationship between work
creasingly dissimilar between different types of organisation and psychosocial
businesses, resulting in striking differences in conditions
work and business organisation. This trend ap- In the late 1990’s, an investigation of organi-
pears to result from the growing use of standard- sational and working conditions was carried
ised management principles, (e.g. benchmarking, out in a broad selection of strategically chosen
key numbers, TQM (Total Quality Manage- private and public sector establishments in Swe-
ment), which may accentuate the differences in den. Data concerning both organisational and
working and employment conditions. individual working conditions were collected
At the workplace a number of dimensions link by means of interviews, questionnaires, observa-
psychosocial conditions and organisational char- tions and measurements. The 72 establishments
acteristics. Traditional research has identified in the study were classified by: 1) the type of
443
Chapter 7.2
operation and, 2) position in relation to other ness”, a management strategy associated with
companies in a production chain. Their position a healthy work environment, stimulating job
was ascertained by comparing establishments tasks, and good control and learning possi-
where production is purchased or ordered by bilities. In addition, these establishments had
another company/authority with those that invested resources in information technology,
have control of the production themselves. Both increased employee competence and extended
these classifications were used for comparative external contacts for product development. In
analyses with respect to the use of various man- contrast, the bottom bar, “increased centralised
agement strategies. Data on working conditions control”, representing increased remote control
were also compared at an individual level. Multi- and measurements of results, was associated with
level analyses showed that a large proportion of poorer working conditions, repetitive/monoto-
the variance (16-65%) in psychosocial and ergo- nous tasks, and reduced control and learning
nomic working conditions at the individual level possibilities for employees. The same applied
could be explained by conditions at the organi- to numeral flexibility, i.e. more casual informal
sational level, e.g. organisational structures and forms of employment and frequent changes in
changes, employer and gender segregation. The the number of employees. In between the two
results also showed that low status employees, management strategies outlined above is “indi-
(e.g. women, those from ethnic minority groups, vidualisation”, associated with relatively good
or the poorly educated), were more vulnerable learning possibilities, control and motivation,
to organisational changes than other workers, low physical loads but higher mental demands.
which indicates that organisational changes The same associations applied to “dialogue with
contribute to increased polarisation of the work management” or “soft management systems”,
force with regard to psychosocial and ergonom- which were also associated with better career
ic/physical working conditions. opportunities.
In this study, functional flexibility showed no
Management strategies in different types association with psychosocial working condi-
of operations tions. However, negative effects were observed
Six different management strategies were com- when functional flexibility and greater individual
pared, based on the researchers’ assessment of responsibility was accompanied by downsizing
information from managers, documents and and increased measurement of results (“lean
workplace visits. Variables from organisational management”), particularly in the public sector.
descriptions have been summarised as indices
that have been converted to a 0-100 scale. Fig- Organisational change and working
ure 7.2.3 illustrates the differences between conditions in high-tech and knowledge
labour intensive services, human services and based operations
high-tech/IT companies in their use of particu- High-tech and knowledge based companies,
lar management strategies. (including process industries, consulting and
The figure shows that labour intensive service data companies), concentrated on core activities
companies were the most problematic and had while transferring more simple tasks such as data
implemented the smallest number of positive entry, customer support and cleaning to con-
changes. The top bar represents “innovative- tracting businesses and sub-contractors. Chang-
444
Innovativeness
Service Increased individualisation
Funktional flexibility
Numeral flexibility
Welfare Increased centralizing*
Hightech
0 100
Figure 7.2.3. Management strategies at establishments in three types of operations. Average values in
five indices (0-100).
es were often motivated by new technology and competent and capable. It was very important
changing market demands and were accompa- that employees were self-confident and had
nied by streamlining of production processes access to support in order to successfully meet
and a flattening of hierarchical management new demands. Workers with lower status were
structures. Employees had increased customer not always allowed to assume a prominent role,
contacts, buffers in the production process were a situation that was particularly applicable to
minimised and work was organised according to women working in male dominated environ-
“just-in-time” principles which increased em- ments. In traditional industries, new manage-
ployee competence. Employees viewed this as a ment ideals, such as the importance of showing
positive change as they were given more training personal initiative, were sometimes perceived as
and responsibility and their jobs became more disloyalty to the group or as wanting to promote
stimulating. one’s own career at the expense of others. Wom-
Difficulties were often related to increased en also faced problems when asserting their
demands for collaboration and changed rela- development and career opportunities on equal
tionships with managers and co-workers. Con- terms with men but the positive consequences
flicts within working groups were more easily of the changes predominated in most of these
triggered as employees were expected to show operations.
initiative, face challenges and to appear to be
445
Chapter 7.2
Organisational change and working new staff quickly so they become productive as
conditions in labour intensive service soon as possible. Personnel costs are directly
production. linked to customer requirements in order to
The production of services has been greatly af- increase profitability which results in standard-
fected by restructuring and downsizing in recent ised, low skilled jobs, often with inconvenient
years. Included in the research were companies working hours and lack of job security. In many
within retail trade, transportation, postal and countries, service employees (e.g. bus drivers
banking services, hotels, restaurants, janitorial or shop assistants), are increasingly exposed to
services, temporary staff agencies, call centres, violence and threats from customers, particularly
operating, maintenance and construction com- if they are working alone, or outside normal
panies. While much of this kind of work, (e.g. working hours.
driving a bus, cleaning floors, making hotel Overall, changes in the organisation of work
beds), cannot be rationalised by new technology in labour intensive services seem to have in-
in the same way as high-tech and knowledge creased work intensity and imposed less conven-
based operations, there is still strong competi- ient working hours for workers. Job expansion
tion and demands for efficiency. In labour inten- rarely required more qualifications or made jobs
sive service production, companies are increas- more stimulating.
ingly linked together into supply chains and
standardise their production in order to address Working conditions in human services
this challenge. The use of various forms of staff A different pattern of change was found in
monitoring systems, (such as video-monitoring, healthcare, teaching, social work, child and
drug-tests, recording of telephone calls with cus- elder care, police and court services and similar
tomers), are increasing used as means to control operations. The picture in human services was
employees. dominated by job expansion and restructuring,
There is a growing tendency to measure work motivated by the need to cut costs in line with
performance because contractors are increas- a new management system, labelled New Pub-
ingly carrying out this type of work. Companies lic Management (NPM), that has already been
compete fiercely for contracts and frequently implemented in many countries. Human services
undercut to procure contracts. If price is the de- employ many highly trained professionals, most-
cisive factor, there is a risk that companies with ly women. The numbers of less highly trained
poor work environments will win contracts. It is workers such as nurse aids, clerical staff and
rational from an economic perspective because cleaners have been reduced and their tasks reas-
service operations can save on personnel costs, a signed to more highly trained professionals. For
major part of their total costs, so changes often example, physicians and nurses now do more
focus on reducing the payroll and increasing paperwork, administration, service and social
flexibility through less formal forms of employ- care tasks; nursery school teachers are required
ment and shorter training periods. to do more cleaning, tasks that were previously
Production services such as selling, cleaning, outside core professional work.
serving and bus driving, are characterised by the In an effort to prevent third parties (e.g.
immediate consumption of their products so patients, students, clients) from the affects of
service providers are very keen to hire and train downsizing, employees often made unreasonable
446
efforts to perform their jobs better, but many cifically designed for the situation. The follow-
still felt inadequate and guilty about their work ing sections summarise a number of strategies
performance. As opportunities to nurture their adapted to specific operations and industries.
professional interests and competence dimin-
ished, employees found their jobs less meaning- Human Services
ful. Experience, professional knowledge, and In this sector, it is important to protect profes-
cultural and social competence were valued sional competence for operational requirements
less than “theoretical” competence. Constant and to revive the confidence and satisfaction of
restructuring destroyed functioning teams and employees. The fragmentation of operations
networks, which in turn led to more frequent through outsourcing and restructuring should be
misunderstandings and conflicts. Work objec- avoided because complex social systems become
tives were unclear and ambiguous while man- disrupted. It is also important that there is a con-
agement was seen as overloaded and lacking in nection between political promises to the com-
authority and resources to address problems. munity and the management of resources to re-
Violence and threats from clients and patients alise such promises, largely through empowering
constituted an additional risk for many employ- managers with the necessary authority to control
ees in services. and allocate resources. Local operational man-
agers within the human service sector face an
Gender segregation almost impossible challenge when they are asked
Few gender differences were found in compari- to reduce costs while increasing services for
sons of work and employment conditions for clients or patients. Such leadership conditions
women and men employed in the same types of lead to paralysis. Decisions must be made at the
occupations and operations. However, changes highest level in the organisational hierarchy if
in work life increase the differences between meaningful changes to the principles of resource
women and men at the group level as a conse- allocation, the creation of employee confidence
quence of the gender segregated labour market. and the prevention of occupational illness are to
In conclusion, women are mainly found in the be achieved. If the following problems are to be
sectors and in the types of operations where resolved at individual establishments, operation-
work redesign deteriorated working conditions. al managers must have the power and resources
The opposite situation characterised many male to properly manage the operation.
dominated parts of the labour market. The
discrepancy between working women and men
appears to be increasing in Sweden in spite of
the wide range of policy and actions in place to
foster gender equality.
remedial strategies
This chapter has shown that many aspects of the
psychosocial work environment vary between
different operations and occupations so strate-
gies to prevent psychosocial risks must be spe-
447
Chapter 7.2
Target groups: Politicians and decision-makers at the strategic administrative level in municipalities, county councils
and government.
Attention/measures/improvement:
– Creation of peace of mind and confidence for managers and employees
– Careful and thorough consideration of all the outcomes of restructuring
– Analyses of planned and implemented changes on operations and working conditions
– Adaptation of targets and means of achieving them, identification of connections between political objectives and
resources
– Establishment of priorities within operations and limit the workload on groups and individuals
– Set up functioning information flow logistics, reduce unnecessary paperwork
– Support for additional resources for basic operations
– Set up decision making structures and administrative support that will allow operational managers to take respon-
sibility, i.e. to control resources and to exert authority
– Ensure that employees are appropriately qualified and competent for the required work tasks
– Development of competence and professional autonomy
– Quality assurance in moderation limited to relevant aspects of the basic operation
– Evaluate by linking ”customer evaluation” to evaluation of the work environment
– Train procurement officers/purchasers in work environment issues
– Financial incentives for good work and to reduce long-term sick leave.
Labour-intensive production of goods and and contracting as they decide on laws and regu-
services lations. Consumers are another important group
In view of the extensive outsourcing of labour- that could be engaged in improvements of con-
intensive production of goods and services, it ditions for workers. However, consumers need
is essential to have functioning rules for pro- to know more about the conditions under which
curement and contracting. Work environment services are carried out. Customers/consumers
conditions are conditioned at the procurement are often unaware of the way in which services
stage when costs are specified so working condi- are delivered (e.g. how workplaces are cleaned,
tions have to be taken into consideration when or telephone services are provided). There is
contracts are drawn up. Because of the vast scale a significant moral aspect to problems within
of public procurement of services and politi- these operations as consumers interests can be in
cal measures made to support the labour mar- opposition to workers interests.
ket, there is a risk that tax revenue may favour
companies with the poorest work environment High-tech and knowledge-based production
because these companies offer the lowest prices of goods and services
in order to secure contracts. Even responsible The reduction of problems and risks for conflict
and serious employers are forced to compromise and gender and ethnic inequality in high-tech
work environment conditions in order to obtain and knowledge-based operations encompasses a
contracts. Politicians, trade organisations and range of issues, not only for individual workers
supervisory agencies are important players in the but, for the working environment in companies,
implementation of measures on procurement the “culture” within the industry, and for gender
448
Strategies at the structural level in labour intensive production
Target groups: The political level, players at the structural administrative level including global, contracting parties,
the EU and trade organisations, as well as customer and consumer groups.
Areas requiring attention/measures/improvement:

– Financial incentives for good working conditions
– Strengthen social responsibility also in companies that procure from suppliers and contractors in other countries
– Clear rules of employer responsibility, especially within chains of contractors and subcontractors, to prevent pro-
motion of a poor work environment
– The issue of responsibility for work environment and occupational safety when many players are involved (purcha-
sers, executors, contractors, subcontractors)
– The procurement process and wording of contracts so that minimum work environment requirements are taken
into account
– Train procurement officers/purchasers in issues of work environment and occupational health
– The role of legislation and supervisory authorities
– Labour law and labour legislation
– New approaches to management of the work environment, distribution of knowledge and rehabilitation, e.g. em-
ployer circles, trade organisations, regional networks of authorities, companies and experts.
– Customer and consumer groups stipulating requirements also for social and work environment-related aspects of
goods and services.
– Ethical standards for production comparable to those for environmental aspects.
Strategies at the establishment level in labour intensive production
Target groups: Business leaders, supervisors, safety officers, occupational health services and supervisory authori-
ties
Areas requiring attention, measurements or improvement in labour intensive production:

– Work distribution principles that achieve alternative jobs, variety and learning possibilities
– Job security
– Freedom to discuss viewpoints, including negative, concerning working conditions
– Assignation of working hours in time and space, including predictability
– Breaks and opportunities for recuperation
– Social contact with co-workers and managers, not only customers
– The physical environment, noise, passive smoking, wet work, chemicals, accident risks
– Violence and threats
– Ergonomics and physical load
– Physical training in jobs with excessive, inadequate or one-sided physical load
449
Chapter 7.2
and ethnic equality in society. The problems are rights. The worst aspects of employment flex-
unlikely to be solved by increased regulation or ibility, e.g. temporary job contracts, atypical
structural administrative measures as the prob- working hours, affect the most vulnerable work-
lems are mainly cultural and social in character. ers, namely women and minority workers.
While this industry offers many incentives in While there are general changes in working
order to hire and retain competent staff and to life, other changes are specific to parts of the
develop their long term business operations, labour market. A general trend of deterioration
there are not similar strategies to achieve a good in psychosocial working conditions over the
work environment, gender equality or to create last decade has been identified by occupational
possibilities to balance work and family life. health researchers. Several studies indicate a dif-
ferentiation and polarisation of working condi-
differentiation and polarisation of tions and occupational health between countries,
psychosocial risks sectors, companies and employees with a strong
Although increased intensity, complexity and position and those with a vulnerable position.
insecurity of work seems to be a problem in all This type of research relies mainly on categori-
sectors, there are large differences in the conse- sation by occupation or class to identify differ-
quences for individuals and in the possibilities to ences between groups.
prevent negative effects. This variation in effect On the other hand, work organisation and
is partly dependant on the composition of the management research has primarily described
workforce, e.g. whether they are professionals general management trends. There are many
or come from less well educated groups, but is examples of studies about learning organisations,
even more closely linked to the way in which non-hierarchical (flat) organisations, “lean”
production is organised in terms of time and the production, Time Quality Management (TQM)
ability of the organisation to maximise control, and other management models but this field of
autonomy and social support for individuals and research rarely links management actions and
the work group. From a cross-cultural perspec- policies with the conditions actually experienced
tive, there are still large differences in political by employees.
and financial power between developing and There is a general outcome that emerges
industrialised countries. It is not unreasonable to from the research described above. The choice
believe that these differences will increase as low of management level and the explanatory mod-
skill jobs with high health and safety risks are els selected for this research, tends to describe
transferred to countries with weak legislation, working life in general terms and suggests that
high unemployment, low levels of union mem- solutions to problems can be found ”down-
bership, and low pay rates. There is, however, a stream”. In other words, responsibility for action
possibility that the opposite trend might occur is assigned “downstream” to local managers or
as multinational companies organise work in a employees on the premise that the workplace
similar, standardised way throughout the world. is both the source of problems and the optimal
The increased trend towards “employment setting for intervention. For example, there is
flexibility” may be introduced in order to meet a large volume of literature on stress manage-
market demands but it may also be a method ment aiming at teaching the worker to adapt to
of avoiding legislation that protects employee working conditions instead of improving them.
450
Understanding the source of problems and the working conditions experienced by women
identifying adequate solutions, requires knowl- and men. Women are mainly found in female
edge about research on occupational health, dominated sectors and the types of operations
organisations and management, labour markets where work redesign resulted in deteriorated
and health promotion. If knowledge from these working conditions whereas, many male domi-
four research areas is integrated, it is easier to nated sectors of the labour market experienced
discriminate between general trends and trends improvements from work redesign. Similarly,
that are specific to only certain sectors of the differences between ethnic groups continue to
labour market. increase because immigrants are over repre-
This chapter argues that changes in work sented in labour-intensive services that are char-
organisation and psychosocial conditions dif- acterised by a number of psychosocial problems
fer depending on the type of operation, partly such as low control and learning possibilities.
depending on the company’s position as a core Similar differences might be observed between
or peripheral organisation. There are significant the rich and poor world as companies move
distinctions in how work is managed and or- hazardous production to poor countries. It is im-
ganised, as well as in working and employment portant to discuss the ethical and moral issues in
conditions. Employees in high-tech and knowl- order to counteract dumping of hazardous jobs
edge-based businesses have experienced the to countries and workers with very little power
most favourable developments in terms of the to demand a decent quality of working life.
above conditions. In Sweden the worst psycho- It is not surprising that the best working and
social working conditions exist in the produc- employment conditions are found in establish-
tion of labour-intensive services. Human service ments performing their own “core activities” as
employees have experienced the most the most primarily it is low skilled work that is outsourced
serious negative developments with respect to and procured from contracting businesses. In-
psychosocial working conditions. creasingly, low skilled manufacturing jobs are
Polarisation within the workforce must also outsourced to low wage countries. Contracting
be considered. In Sweden, high-tech and knowl- companies range from large companies and mul-
edge-based operations mostly employ men, very tinationals to small contractors, some of which
few of whom are immigrants. In human services, only survive for a short time. The workforce in
about 80% of the workforce is women. Labour- contracting companies largely consists of those
intensive service production employs the highest with a weak position in the labour market, i.e.
proportion of workers with an immigrant back- those who are young, poorly educated, with a
ground while the gender distribution is fairly foreign background and not organised in trade
equal. However, women and men work in differ- unions. Short contract periods also make it dif-
ent operations and workplaces within this sector ficult for workers to organise and join forces in
- men mostly work in construction and transport order to improve their employment conditions
companies while women work predominantly and work environment. Particularly difficult
in service functions such as cleaning, retail, and problems arise when unemployment is high,
restaurants. when workers are competing for the same jobs
Consequently, changes within various opera- and are low skilled.
tions have distinctly different implications for
451
Chapter 7.2
targets for prevention of Participation and control mechanisms should allow

psychosocial risks workers to take part in decisions or actions af-
Work-related psychosocial risks can be ap- fecting their jobs.
proached on several levels: individual, establish-
ment, industrial sector, regional, national and Workload should be compatible with the capabili-
global levels. In order to identify psychosocial ties and resources of workers and allow time for
risks, systems for monitoring job content, work- recovery from especially demanding physical or
ing conditions, terms of employment, social mental tasks.
relations at work, health, well-being and pro-
ductivity are needed as a basis for action at the Job content should contain tasks that provide
“appropriate” level. meaning, stimulation, a sense of completeness,
All three parties in the labour market (work- and opportunities to use skills.
ers, employers and government), are responsible
for organisational improvements at the work Work Roles and responsibilities should be clearly
place level. Professor Lennart Levi suggests the defined.
following matters are of particular importance
in the promotion of healthy psychosocial condi- Social Environment should provide opportunities
tions: for social interaction, emotional and social sup-
port and cooperation between fellow workers.
Work schedules should be designed to avoid con-
flict with non-job related demands and respon- Future plans for job security and career develop-
sibilities such as family duties. Shift schedules ment should avoid ambiguity. Life-long learning
should be constant and predictable. and employment skills should be promoted.
According to the European Commission’s Guidance (2000) on work-related stress, improvement of stress-indu-
cing conditions in workplaces can be accomplished by:
– Allowing adequate time for the worker to perform the job satisfactorily.
– Providing the worker with a clear job description.
– Rewarding the worker for good job performance.
– Providing ways for the worker to voice complaints and have them considered seriously and swiftly.
– Harmonising the worker’s responsibility and authority.
– Clarifying the work organisation’s goals and values and adapting them to worker’s own goals and values, whene-
ver possible.
– Promoting the worker’s control, and pride, over the end product of his or her work.
– Promoting tolerance, security and justice at the workplace.
– Eliminating harmful physical exposures.
– Identifying failures, successes, and their causes and consequences in previous and future health action at the
workplace; learning how to avoid the failures and how to promote the successes, for a step-by-step improvement
of occupational environment and health (Systematic work environment management).
452
As a consequence of globalisation, there is also a important for organisational and psychosocial

need for international action. Unions, politicians factors. There is also a need for new forms of
and managers in multinational corporations have cooperation between regions where companies,
a particular role to play in order to strengthen authorities and people work and interact. Even
the social responsibility of employers, to estab- competing companies can collaborate on mini-
lish agreements on minimum standards for the mum requirements for the work environment so
work environment and to monitor the imple- that a poor work environment does not become
mentation of ILO conventions. a competitive advantage. A good example of this
Actions to reduce work-related stress don’t kind of collaboration was implemented by local
need to be complicated or prohibitively expen- authorities and distribution companies in Stock-
sive. One of the most common sense and low- holm. Agreement was reached on requirements
cost approaches is “Systematic Work Environ- for approved docks used to receive goods which
ment Management”, a self-regulatory process, reduced work environment hazards for distribu-
carried out in close co-operation with stake- tion drivers. Operations purchasing goods, e.g.
holders. The above approach is an example of restaurants and bars, had to construct facilities
a general system of strategic work environment which met the new standards as they had noth-
measures that have been recommended by po- ing to gain by choosing another distributor if
litical, scientific and union-employer assemblies. questions were raised about their docking facili-
However, there is a need to develop a variety of ties.
strategies on the work environment in order to A renewal of trade union activities and
achieve a balance between production condi- strengthening of collective influence would help
tions, economic factors and working conditions to prevent social dumping of inferior work-
within different operations. ing and employment conditions to those in the
Strategies must include the identification and weakest position in the labour market. New
linkage of problems and causes, possible actions forms of cooperation could be established, e.g.
and obstacles, and objectives and specific results. collaboration between unions and regional
Someone must have the responsibility, author- networks of companies and authorities. Fur-
ity and resources for any measures taken. It is thermore, as globalisation and new production
especially important that affected employees trends emerge, there is an increased need for co-
are involved in any change process. Three key operation between unions in different countries.
concepts for health promotion at the workplace More efficient “early warning” systems should
have been suggested: leadership, resources and be developed about changes in working life
empowerment. which can have hazardous effects for workers
There is a need for innovative multilateral health. Adequate information about the effects
cooperation on legislation, expert systems, en- of strategic decisions on operations and working
forcement and ethical standards. In addition, conditions is not available for large groups of
development of worker participation in a wider the workforce. Such information appears to have
political and economical context is an important been pushed aside by the growing volume of
challenge for the future. Worker participation standardised information about performance, re-
is a fundamental requirement for the preven- sults, costs and quality. Professional groups and
tion of all occupational risks, but particularly core operational managers have a major respon-
453
Chapter 7.2
sibility to report needs and to help to produce a supportive psychosocial climate can not only
information that reflects operational problems improve productivity but increase well-being
and opportunities. and decrease job-related accidents and diseases.
A balance between production conditions, At the industrial sector level, nationally and
economic factors and physical and psychosocial internationally, much more can be done in order
working conditions is the key to improving oc- to counteract undercutting for contracts and
cupational health and ensuring a sustainable and on work to encourage more healthy workplaces
health-promoting working life. To achieve this in specific branches of industry. Unions should
goal, action needs to be taken at many levels and continue to press for better working conditions
by many parties. The global environment move- and fair treatment of the workers. Politicians
ment has increased knowledge about environ- should contribute by formulating legislation
mental risks, and motivated changes in legisla- for minimum standards for working conditions.
tion and behaviour of customers and companies. Finally, purchasers, customers and clients have a
Work environment issues can be reinforced in moral responsibility to choose goods and serv-
a similar way. At the workplace level much can ices that are produced under reasonable condi-
be done inexpensively. Increased control by tions.
workers, fair treatment from management and
454

In the text we have referred to some classic Selye H (1974). Stress Without Distress, Phila-
books on work organization and working condi- delphia: Lippincott
tions. These are:
Blauner R (1964). Alienation and Freedom. The Other recommendations for further reading:
Factory Worker and His Industry. Chicago: At the website of European Foundation for the
University of Chicago Press. Improvement of Living and Working Condi-
tions you can find many reports, for example of
Herzberg F, Mauser B and Snyderman B (eds)
survey data on working conditions for European
(1959). The Motivation to Work, New York:
countries.
Wiley.
http://www.eurofound.europa.eu/publications/
Mayo E (1933). The Human Problem of an index.htm
Industrial Civilization, New York
Maslow, A H (1954). Motivation and Human In the text on different problems in different
Personality, New York: Harper and Row. industries, we refer to a new classification of
McGregor D (1960). The Human Side of the industries that we have found useful. This book
Enterprise, New York: Harper and Row. is intended for managers who want to develop
their business, but it is relevant also for occupa-
Summaries of these classic work as well as new tional health specialists in order to bridge the
research results and trends in this area can be gap in concepts between managers and OSH
found in a textbook that can be recommended specialists.
for those who want to read more on theories and Giertz E (2000). Measuring success – Identifying
empiricial studies on work organisation: performance indicators. Malmö, Celemilab
Thompson P & McHugh D (2002). Work Or- International AB.
ganisations, 3rd edition, Basingstoke, Hamp-
shire: Palgrave. In chapter 7.2, we refer to a Swedish study on
work organisation and working conditions. The
In chapter 7.1, we present the Job demand Con- so called MOA-study has developed a methodol-
trol Model. The theory behind that model can ogy on assessements and analyses adapted for
be found in a book by the founders of the JD-C modern working life as to facilitate for pracition-
model: ers to use research results. This study is pre-
Karasek R & Theorell T (1990) Healthy Work. sented in a report in English that can be down-
New York: Basic Books. loaded from the web: http://arbline.sub.su.se
In this book you can also find references to two Härenstam A, Rydbeck A, Karlkvist M, Walden-
classic stress theory works, such as by Lazarus ström K, Wiklund P, and the MOA Research
and Selye: Group. The significance of organisation for
healthy work. Methods, study design, analyz-
Lazarus R S (1966) Psychological stress and the
coping process, New York: McGraw-Hill
455
Chapter 7.2
ing strategies, and empirical results from the and future strategies. TUTB Newsletter No
MOA-study. Arbete och Hälsa, 2004:13;1-89. 19-20, September 2002. http://tutb.etuc.org/
uk/newsletter/files/Newsletter-20.pdf
The specific empirical study that we summarise
in the text is published in a scientific journal: Finally, we refer to an overview report on new
Härenstam A & the MOA Research Group trends in working life and the consequences for
(2005). Different development trends in workers, particularly for those in exposed posi-
working life and increasing occupational tions at the labour market:
stress require new work environment strate- Quinlan M, Mayhew C & Bohle P (2001). The
gies. Work, 24:261-277 Global Expansion of Precarious Employment,
Levi L (2002). The European Commission’s Work Disorganisation, and Consequences
Gudiance on work-related stress: from words for Occupational Health: A Review of Recent
to action. In Stress prevention in Europe: Research. International Journal of Health
review of trade union activities – Obstacles Services 31:335-414.
456
8
Development of work
and enterprise survival
Introduction 459
8.1 Enterprise survival – challenges and options 461
8.2 New principles of work organisation 465
8.3 Learning at work 475
8.4 Managing understanding – a new leadership challenge 487
8.5 Organisational development and gender integration 493
8.6 Strategies for change and team work 497
8.7 A rewarding change – an example from India 507
Introduction
Enterprise survival is about competition in encourage leaders to identify new opportunities

growing and shrinking markets. But this truism for development.
may conceal what is normally thought of as to This section is an argument for the stand-
the opposite of competition, namely collabora- point that this view goes hand in hand with and
tion. Below a competitive surface lie demands enhances enterprise development. It highlights
for a variety of forms of co-operation, since how work environment and work content is de-
ability to compete today requires collaborative veloped in relation to enterprise development..
abilities. Abilities to be dealt with and realised One point of view often expressed by employers
within the enterprise as well as in networking is that measures to improve the work environ-
between companies. ment, safety and job content are something that
This section focuses on development within managers to a certain extent have to accept, an
the enterprise. Our intention is to provide un- inevitable cost or even a luxury that only rich
derstanding and encourage action for change. companies can afford. The argument here is that
The aim is to argue for a changed view of work environment is no longer reduced to a cost
employees and introduce the potential of or a legal requirement, but rather is seen as a
employees as decisive contributors to enterprise means of providing the best possible conditions
development and survival. The idea is to move for the employees to work and taking responsi-
away from the belief that workers have to be bility in a new manner.
controlled and instructed in detail to be able to
carry out even a limited work task. The possibil- the structure and content
ities are explored of a point of departure where of the section
workers are regarded as part of the thinking and In the following seven chapters the authors ex-
development of the company, part of produc- pound arguments of importance for developing
tion in the sense that workers and teams take the human aspects of production. The general
responsibility for work tasks and quality. Our standpoint is that the improvement of working
hope is that the section as a whole will inspire conditions and work organisation is considered
various organisational actors to take action, and an important means of strengthening the enter-
459
prise in its efforts to stay competitive. A discus- environment and an organisation conducive to
sion is outlined where both employees, their learning.
unions and employers look on the development Jörgen Sandberg and Axel Targama share their
of work as a way to create safe and developing research findings on leadership. The forming
jobs as well as a way to improve the company’s of new, team based work organisations and the
efficiency and its ability to meet new challenges. need for an acceleration of change within an
The framework provided and the questions enterprise lead to a shift in the demands on lead-
raised are based on theories as well as long expe- ership. A shift from managing by using detailed
rience as practitioners and researchers. rules and instructions to managing understand-
Gunnar Broms and Marianne Döös provide ing.
a framework for the section by discussing the Martha Blomqvist sheds light on organisational
demands and threats that enterprises are facing development and the advantages of gender inte-
and their impact on the development of work gration at the workplace. She describes how the
organisation and working conditions. integration of work tasks may be used to open
Tommy Nilsson gives a background to the up some inequalities, discusses the obstacles and
development of a fruitful way of organising gives examples on how to overcome them.
work and production. This is based on the idea Gunnar Broms discusses strategies for change
of taking advantage of and involving both the and teamwork, the advantages of a learning
intellectual and the manual capabilities of the strategy based on the participation by those af-
employees. The social interaction within the en- fected by the change. The team organisation, its
terprise and the participation of those concerned applications and advantages are concretised.
in decisions and improvement work are pointed Vimal Mahendru provides an example of a
out as important. Also, this chapter briefly intro- process of change within his own company in
duces some work organisation concepts. India. The change covers both physical and
Marianne Döös provides an understanding of technical changes as well as a radical change
the mechanisms supporting experiential learning of the work organisation and leadership. The
at the workplace, on the individual level as well gender issue also plays an important role in this
as on the levels of work teams and organisations. encouraging example.
Based on this she discusses how to create an
460
8.1
Enterprise survival – challenges and options

In order to understand the challenges and options to gain by inviting workers as well as staff to find
available for developing enterprises and work it informal, practical ways of co-operating. This
is necessary to get a hold of the governing struc- way of approaching change and development is
tures, i.e. the conditions under which companies not in opposition to co-operation already existing
live and compete. The increasing globalisation of between management and the unions, and their
markets is making new demands on companies. representatives. The approach suggested is more
Companies all over the world are now exposed of an adjunct.
to competition, domestic as well as international.
In developing and more industrialised countries scope available
alike, these changes call for development where What scope is available for the development of
competence is in focus and where co-operation work and working conditions? The division of
and participation is encouraged. tasks, the distribution of decision-making pow-
Strictly hierarchical organisations are no longer ers, physical conditions and individual scope for
thought of as efficient enough, and offer an adap- development, and not least the remuneration paid
tation to changing production conditions which is for work input, vary from company to company
too slow for many companies. From the manag- and region to region. Most countries have passed
er’s point of view, breaking hierarchical structures legislation on the work environment, working
means rupturing the control perspective. For hours and child labour (see other relevant sec-
the workers and their organisations it transcends tions of this book), but the strength and efficiency
mere fighting for better remuneration. Rather it of enforcement vary a great deal. In their efforts
affords a possibility of actively participating in the to remain competitive, many enterprises trans-
development of their own working conditions in gress the limits of what is allowed or agreed upon
favour of themselves as individuals, and in favour nationally or internationally. We draw the con-
of the performance of the production system. clusion that such owners and managers are con-
So the roles of both management and workers vinced that this unsound exploitation is necessary
change when former borders are crossed. From a in order to stay competitive.
strict company perspective, management has a lot
461
Chapter 8.1
On the other hand there are companies which mies derived from standardisation and their
believe their employees to be such valuable propagation through transnational companies,
assets that they provide them with training, free trade and free flows of investment. In fact,
delegate decision-making powers and organise two processes (global standardisation in some
production in such a way that both manual and areas but increasing diversity in others) co-ex-
intellectual skills are utilised. In order to nourish ist.”
this important asset they see to it that the envi-
The above quotation from Freeman is aimed at
ronment is safe and supportive of high quality
highlighting the fact that companies are facing a
and efficient work in the long run. We assume
world which is ambiguous, where tendencies of
that they do this not only to avoid trouble from
development are not clear-cut but a question of
trade unions, labour inspectors or safety engi-
both-and, rather than either-or. Thus we have at
neers but also – or mainly – because they per-
the same time a tendency towards centralisation
ceive a competitive advantage in so doing.
and standardisation in the name of cost-efficien-
Although every enterprise is unique, and
cy, and a trend of flexibility, customer-service
not ignoring the fact that conditions vary from
and meeting local variations of demand.
country to country and region to region, we
In the following we will look further into the
believe it is possible to observe some general
globalisation, the competition enterprises are
trends which have an impact on enterprises and
facing and what this implies for the development
on the conditions of the employees within them.
of work.
One such trend affecting most enterprises is glo-
balisation. Globalisation opens up for competi- globalisation and competition
tion across borders on a scale never before seen.
The globalisation of the economy has expanded
The rapid development of information technol-
the limits of the market within which a company
ogy is a part of globalisation and facilitates it by
competes. This cuts both ways. Companies in
making information cheaply and quick acces-
the industrialised part of the world are con-
sible to larger groups than ever before. Capital
stantly trying to expand their markets, and thus
is moving more freely than ever across borders
making more and more efforts to enter markets
within transnational companies with production
within the developing countries that until now
spread around the world.
have been unexposed to outside competition.
Globalisation calls for strategies among small
The enterprises of the developing countries are
and medium-size enterprises (SME) to meet the
facing a threat within their domestic markets
challenge of the transnationals. Forming clusters
from competitors from abroad, and are at the
or networking is one way of strengthening the
same time forced to look for markets also out-
SMEs’ possibilities of competing both on the
side their own country or region.
domestic and on the international market. SMEs
Another trend is for enterprises to become
are also playing an important role in the supply
internationalised. Head office, research and
chain of the transnationals.
development (R&D), marketing and production
“In fact, the arguments for preserving and even are often separated in large companies. Produc-
encouraging diversity may sometimes outweigh tion is not seldom located to countries where the
the shorter-term advantages of the scale econo- economical conditions are considered favoura-
462
Enterprise survival – challenges and options
ble, salaries are low or the regulatory framework production must not be dependent on a skilled
is weak. and experienced work force. Easily replaceable
This is so much the case that countries are workers are the ideal.
competing with offers of e.g. limited or no taxa- There is today no homogeneity among
tion in order to attract start-ups by foreign en- companies concerning how to value and treat
terprises. This is a dangerous trend whereby low competence issues. Apart from the production
salaries and room for unhealthy exploitation also concept of the replaceable worker we see a wide-
may be seen as ways of attracting enterprises. spread trend whereby competence is regarded
The development of the Internet and ef- as the competitive factor of real importance.
ficient and cheap international transport are The aspect that we emphasise in this section is
also playing an important role in the growth of the contemporary situation, where knowledge
competition. Technological solutions and in- management and competence development are
ventions quickly become available world-wide. seen as crucial to competitiveness and company
This has accelerated the pace of change. The success on the market. The significance of an
lifetime of product generations is getting shorter organisation’s ability to learn and renew com-
and shorter. In the mobile phone sector this is petence is here recognised as a crucial issue for
easy to observe, with new products and product competition, and in such companies manage-
generations appearing all the time. This in turn ment is constantly struggling to organise for
leads to a demand for constant change and ad- competence development. Cost has long been
aptation of production. Not only do managers regarded as the main aspect of importance for
and technicians have to search for and introduce competition on the market. To reduce the cost
new ways of production, the workers also have of the end product, manufacturing companies
to be involved and trained to cope with the new have focused their efforts on improving pro-
demands. ductivity. Productivity is traditionally defined
Yet another trend is the growing importance as output in relation to input in terms of man-
of specialised, contract manufacturers. These power and other resources. This has in many
companies are transnationals with production cases led to automation, long production runs
sites spread around the world. Production can and manpower reductions. But cost is no longer
quickly be moved from one site to another. the only factor taken into consideration by cus-
When one market is weak production can be tomers when choosing between different offers.
closed down and moved to other, growing mar- Time of delivery, quality, design, after-sales
kets. These contract manufacturers try to facili- services and many other factors are equally
tate the mobility of their production by using important.
the same production technology and work or- Customers today are also susceptible to con-
ganisation no matter where in the world they are sumers’ apprehension of company behaviour in
operating. Work is strictly controlled by instruc- terms of polluting the environment, using child
tions and there is little room for forming local labour or overexploiting their employees etc.
ways of working or involving the workers in the So competition is forcing enterprises to look for
development of their own work organisation. sounder and more ethical ways of developing
The mobility of production also implies that their activities.
463
Chapter 8.1
development of work as a way “It means achieving success by working with

to compete and survive people, not by replacing them or limiting the
scope of their activities. It entails seeing the
Companies together with their suppliers are
work force as a source of strategic advantage,
continuously improving production and supply
not just as a cost to be minimized or avoided.
systems and their performance. The technology
Firms that take this different perspective are
is accessible to all, depending only on financial
often able to successfully outmaneuver and out-
resources. What, then, makes the difference be-
perform their rivals.”
tween one company and the other? Distance to
market, unique products, access to raw materials The above leads to the conclusion that invest-
and low energy costs, are of course some essen- ments in sophisticated technical systems are no
tial factors. But beyond that what finally counts longer enough. For a company to stay competi-
is cost efficiency, quality, delivery accuracy, flex- tive we would like to stress the importance of a
ibility and a high level of service and adaptability developed work organisation with a high level
to changed conditions and customer demands. of competence and motivation of all employees.
This calls for the development of innovative Advanced technology depends on skilled people
capabilities within the enterprise. in order to be competently used. By contrast, the
understanding possessed by people working in a
“The diffusion of a new techno-economic
company cannot be bought off the shelf – it takes
paradigm is a trial-and-error process involving
years to develop and will have to be constructed
great institutional variety. There are evolu
and reconstructed on an ongoing, everyday basis.
tionary advantages in this variety and con
With this as a vision there is hope for a posi-
siderable dangers in being locked in too early
tive development of work, with safe and healthy
to a standardised technology. A technological
workplaces where the employees are seen as
monoculture may be more dangerous than an
valuable and competent contributors to the con-
ecological monoculture. Even when a technol-
tinuous development of the enterprise.
ogy matures and shows clear-cut advantages and
During the process of change every workplace
scale economies it is important to retain flexibil-
and enterprise should be seen as unique and will
ity and to nourish alternative sources of radically
thrive through taking advantage of its unique
new technology and work organisation.” (Free-
qualities. Many of those qualities are formed by
man)
the composition and social interaction of the
Jeffrey Pfeffer – Professor of Organisational workforce. The competence, experience, crea-
Behaviour – stresses that successful firms are tivity, co-operation and decision structure of the
achieving competitive success because of their enterprise are then all to be seen as important
way of thinking and treating workers in a non- competitive aspects.
traditional way:
464
8.3
Learning at work
Marianne Döös
One struggle that many managers and occupa- ment prevention. The following points will be
tional safety and health (OSH) experts engage treated:
in, all over the world, concerns ways of getting
• We are all learners all the time.
employees to behave according to instructions,
rules and in line with what they are told by supe- • The quality and usefulness of what is learnt.
riors and experts. This chapter aims at shifting • Some basic learning principles.
the focus of attention, from a teacher instructing
or a boss commanding to the individuals, groups • Collective and organisational learning.
and organisations that are learning.
The fact is that all knowledge construction The text is written in a reasoning style and of-
is an active process on the part of the learner, fers understanding rather than hard facts. It is
and thus needs to be understood according not a manual or concrete advice. Some
to this logic. Learning does not take place examples are aimed at enhancing the readers’
at somebody’s command, rather it needs to possibility to draw conclusions and connect to
be enhanced and facilitated. Ongoing com- their own experiences and to local practices and
petence development and learning within the conditions.
enterprise has turned out to be of competitive In brief, to learn means to change and develop
advantage. This adds another decisive reason one’s conception and understanding of some-
for managers and leaders, for OSH-experts as thing, and is in this chapter thought of as a proc-
well as for workers, to develop an understanding ess. Competence is related to the performance
of the processes and conditions of experiential of specific tasks and is regarded as a capability to
learning. make use of knowledge in acting.
This chapter is about learning in working. It
we are all learners all the time
is meant to be of practical use and to contribute
to company development, and to healthy work- No matter what we do, we always learn into the
places as the result of competent work environ- bargain. Learning is intrinsic to activity. Ac-
475
Chapter 8.3
tions have learning as their (unintended) conse- the quality and usefulness
quence, while the intention of the action comes of what is learnt
out as the result, i.e. the intended outcome. This The important remaining questions at each
can be simply summarised: we are all learners workplace concern what is learnt, with what
all the time, learning is for everyone an activ- quality and especially to what benefit and ad-
ity that is always going on. It makes no sense vantage for the activity of the enterprise. On the
to label a person a learner or non-learner, since whole, qualifying experiences and skill enhance-
everyone in an organisation is learning. There ment among shop floor employees will add value
is no such person as a non-learner. This means to the company, whereas refraining from com-
that everyone in a workplace engages in learn- petence development will reduce a company’s
ing activities as he or she carries out normal prospects of coping with future challenges and
work tasks. Learning, then, goes with the job. It demands.
takes place when we normally do not even think In industrialised countries, competence develop-
about it, while the learner’s attention is focused ment is today considered highly important in most
on the task and not on learning. organisations, but – at the same time – learning
On the other hand, there is a definite risk of conditions frequently deteriorate due to staff
negative learning when workers are assigned to reductions, the ideal of having slim organisations
jobs of a constrictive nature, i.e. when their expe- and the resultant work intensity and overload (see
riences lower their interest and self-reliance and “Psychosocial risks and their prevention”, this
cramp their personalities, which in turn reduces book; on the pursuit of sustainable development,
the potential for constructive participation in see Docherty, Forslin, & Shani 2002). In develop-
corporate development. Another risk concerns ing countries the crucial importance of skilled
illusory learning, where employees refrain criti- workers is not yet common knowledge.
cising, even when invited to do so. If employees Transformational capacity is needed in order
are afraid of raising critical questions and issues, to attain sustainable development in a chang-
this can result in illusory learning on the part of ing environment. The American psychologist
the manager. S/he may falsely overestimate the and organisational consultant Nancy Dixon has
advantages and legitimacy of his/her own propos- found that organisations capable of handling
als and skill. change have undergone three major shifts in
Learning is clearly an integral aspect of relation to knowledge:
everyday work tasks. The importance of expe-
riential learning is from now on used as a pre- “The first is a shift in thinking about who in the
sumption. Managers ought to make use of this organisation has credible and valuable knowl-
knowledge and organise the business for learn- edge that the organisation can use to solve its
ing. It is also up to OSH-experts to understand difficult problems.
and act according to learning principles if they The second is a shift from thinking of knowl-
want to rely on participative methods in order, edge as an individual phenomenon to thinking
for example, to e.g. reduce accident risks or of knowledge as embedded within a group or
improve the work environment. community.
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Learning at work
The third is a shift from thinking of knowledge some basic learning principles
as a stable commodity to thinking of knowledge
David Kolb stated that “learning is the process
as dynamic and ever changing.”
whereby knowledge is created through the trans-
Workplace learning, or more specifically, work formation of experience” and to change one’s
task learning, has implications for individual way of doing, thinking or understanding means
development over the life span and in every learning. To learn implies changing one’s ways of
walk of life. Both lifelong and life-wide learning thinking and/or acting in relation to the task one
are dependent on the learning that takes place intends to perform. Learning can be briefly de-
when work tasks are performed and talked about scribed as a situated process of knowledge-con-
with others. Work tasks and work situations struction based on action, with the learner as an
represent ongoing opportunities for knowledge active constructor of knowledge and know-how.
construction and re-construction. In fact, tasks Piaget described learning in terms of processes
and their surrounding conditions provide the of adaptation. Qualitative shifts in an individual’s
main opportunities for learning and competence understanding are seen as accommodations that
development in adult life. If learning condi- alter cognitive structures, whereas experiences in
tions in a workplace are not favourable – either tune with already existing structures are thought
because of work tasks which are too limited and of as assimilations. The need for accommodation
confined or else because of staff reduction and stems from an unpleasant feeling of imbalance
high work intensity – the potential for individual that calls for a change in one’s thinking.
development is not used, and the organisation as
a whole will suffer from having less capability to Learning requires a learner
deal with change. Engaging the workers in car- One basic principle of organising for workplace-
rying out an organisational change and revised based learning concerns moving away from
layout may be a starting point for development. the thinking where courses and transmitting
Thus, work task quality makes a difference. information are in focus. It means acknowledg-
Limited work tasks and unfavourable condi- ing the learner and his/her everyday work tasks,
tions for qualifying experiences at the workplace environment and meaning context as crucial for
help to create stagnation and non-development learning. Thoughts on this point are elaborated
among the employees. When talks, quality is- in the “from arrow to flower” metaphor, Figure
sues, meeting attendance, customer demands, 8.3.1. Departing from traditional ideas of trans-
problem solving and so on are integrated in the mission, illustrated by the arrow from a teacher
work tasks of the workers, this is in line with or instructor to a learning object, the learner
contemporary ideas in companies where indi- is instead placed as the actor in the centre of a
vidual and enterprise development support and flower in an environment of “affordances” (Gib-
strengthen one another. The relation of learning son). As a consequence of task-related inten-
quality to participation in everyday work as well tions, the individual learns as s/he makes use of
as in change processes is also strong. the specific environment and meaning context
through action. Action that implies the captur-
ing of possible opportunities which enable the
individual to carry out and understand work
tasks, e.g. seeing how others do things, identify-
477
Chapter 8.3
ing a problem, observing a deviation, talking to ing takes place. This is illustrated with the aid
workmates. of turning arrows, sent out and brought back
The figure exemplifies what is afforded in by the actor, and thus forming the petals of the
the environment of a machine operator dealing metaphorical flower. There are also a number of
with a production disturbance. In solving the Xs, illustrating possible opportunities that the
situation he will, for example, look to see how environment affords, i.e. opportunities that in
others have solved similar problems, observe a principle are at hand in a given situation, but not
helpful deviation from what is normal running (yet) observed as useful by the operator.
production, ask questions and have a look in the Individual experiential learning can be under-
manual. stood as an ongoing interchange between action
Figure 8.3.1 illustrates the move away from and reflection, where past experiences provide
the transmission idea represented by the one- the basis for future ones. Action forges the link
way arrow, i.e. away from the idea of knowledge between the human being and the environment,
being transferred from an active person to a where active participation and personal action
presumed passive receiver. The learner is instead are prerequisites for the learning process to take
thought of as active and in the middle of car- place. Through action people enter into both
rying out a work task. This work task demands concrete experiences and the reflection that
actions, and it is during these actions that learn- build up their know-how over time; through
Figure 8.3.1. From arrow to flower – shifting focus to the activity and intentions of the working learner.
478
Learning at work
action people take part in and change circum- operator hears a bad sound from his machine) or
stances, conditions and situations. through abstract comprehending and thinking
The quality of the experiential learning proc- (realising that the parts the machine just pro-
ess can vary in terms of what is learnt. High- duced fall short of the quality required). Once
quality learning requires all four learning ingre- prehended the individual can either transform
dients to be active, Figure 8.3.2. Kolb describes the experience through acting, testing, trying
the learning process as made up of two dimen- out ideas in action (the operator enacts a pos-
sions, where the ingredients or steps constitute sible solution to the quality problem, e.g. adjusts
the end poles, with a prehending (i.e. seizing, a machine setting) or with the help of his/her
grabbing, catching) dimension and a transform- understanding observe, reflect and create an un-
ing one. derstanding (the operator creating the basis for
In order to be able to learn from an experi- a richer understanding of the production prob-
ence the individual must somehow grab or get lem). These are both transformation processes
hold of it, and this comes from prehending: whereby one turns an experience into one’s own
either through concrete apprehending, feeling know-how. The transformation means that the
and using one’s senses (for example when an experience is grounded in and to some extent
Figure 8.3.2. Experiential learning – its two dimensions and four ingredients or steps (after Kolb).
479
Chapter 8.3
also changes the individuals’ thought networks.

Kolb describes this as a process moving between
Example
the steps of concrete experience – reflective
observation – abstract conceptualisation – active A glimpse of the operator’s learning proc-
experimentation. It is useful to look upon them ess can thus be found in a situation of
as four ingredients that all have to be put to use disturbance handling. He stands besides his
in order for learning to be qualifying in the long milling machine. The machine runs automati-
run. To concretise the theoretical concepts, here cally and the metal parts produced are lifted
is a work-related example from the shop floor. away by a robot. Suddenly he sees that the
robot arm has stopped in an odd posi-
Small, almost insignificant steps tion. He ponders this occurrence, realising
Learning is commonly thought of as something that the same thing has happened several
quick and revolutionary, but studies have shown times lately, which makes him identify this
it to be a small-scale process in which the small as something that might require action on
incremental steps, for all their apparent insig- his part. He has an inkling of the reason: he
nificance, are of major importance. This goes for thinks that it has to do with metal shavings
concrete experiences, e.g. in production tasks, as from the milling disturbing the sensor which
well as for comprehending, e.g. in the proceed- signals to the robot. Thinking about this he
ings of workplace meetings. One experience is develops a comprehension of the problem
added to another and the normality of one’s eve- and forms an idea for action. He cleans
ryday work tasks is constructed, reconstructed the sensor, re-starts the machine and finds
and consolidated. When a person knows what
that the robot moves normally. With this
is normal and usual, it becomes possible to be
new concrete experience he continues to
surprised and ask efficient questions concerning
work. In describing this work we have also
identified differences and deviations, questions
described a piece of learning where the
that are relevant to learning and work task per-
operator has now added an experience that
formance combined.
gives him a better basis for action next time
The outcome of learning can be envisaged as
a similar problem occurs.
having two aspects. In terms of outwardly vis-
ible signs of learning, outcomes are expressed in
the form of changed ways of acting, performing
tasks, and talking. Within the individual, learn-
ing is expressed as constructing and reconstruct- Through thought networks, perceived charac-
ing one’s cognitive structures. Theses structures teristics of a situation (e.g. a situation of problem
are the understanding and know-how an individ- solving, production disturbance handling) are
ual has concerning something specific and can linked to action, and to the judgements and de-
be described as thought networks. The thought cisions needed for an individual to find an action
network concept is explicitly chosen to commu- path. The thought networks can be described as
nicate possibilities for connections and develop- situation-connected reasonings that are more or
ment – in contrast to similar concepts named as less alike in similar situations. Such likenesses
cognitive structures, schemata and patterns. give thought networks stability and durability,
480
Learning at work
although – at the same time – they are con- machine operator’s handling of disturbances to
tinuously modified and developed through the production, his habit of mind affects his way of
person’s thoughts and actions. To summarise, defining and dealing with his work task. Such
thought networks manifest themselves as ac- habits of mind are not one-dimensional. They
tion alternatives, and are tied to the situations in can be thought of as built along a number of
which they are constructed and re-constructed. dimensions, each of which can be seen as a
Experiential learning takes place as the con- continuum for possible development. In a study
structing of these networks. of operators’ disturbance handling in automated
Several authors have related learning to life production, a number of dimensions of impor-
span development. Mezirow, for example, speaks tance for the mode of performing the work task
of transformations that follow a disorienting were identified, Figure 8.3.3. For example, op-
dilemma and result in “a reintegration into one’s erators’ ways of thinking (their habits of mind)
life on the basis of conditions dictated by one’s about production disturbance handling varied
new perspective”. Our particular perspective with the extent to which their thinking was
tends to inform our actions in ways we are not dichotomised or process-like; on a scale from
fully aware of. Transformation of these habits of frozen statements and truncated explanations,
mind and points of view is a painful process: to the operator having related explanations and
insight into active use.
“Our values and sense of self are anchored in
our frames of reference. They provide us with collective and organisational
a sense of stability, coherence, community, and learning
identity. Consequently they are often emotion- Nancy Dixon states that “collective meaning is
ally charged and strongly defended.” meaning that organizational members hold in
common. These are the norms, strategies and
In giving an overview of the theory of trans- assumptions that specify how work gets done
formative learning and how it has been used and what work is important to do”. Learning as
in practice Wilhelmson states that the explicit a collective process means that individuals learn
purpose of transformation theory is together through some kind of interactive and
communicative action. This is a learning process
“to be useful for adult educators whose goal is that creates added value through synergy, where-
not only to teach a subject but also to assist the by what is learnt becomes qualitatively different
development of their adult students’ capacity for from what any individual could have arrived at
living in a complex and dynamic society.” unaided. Further, collective learning results in
shared knowledge, in a similar understanding
Over time, individual development is affected of something specific, and – grounded in this
by task execution and individual task definition. – a capacity for joint action. Knowledge that
One can say that behind the situation-related is jointly produced has a more stable character
thought networks, there are long-term indi- than knowledge produced individually.
vidual ways of understanding (habits of mind), Within all teams and organisations, indi-
that are more consistent over time and do not viduals are the ones who learn and carry their
vary according to situation. In, for example, a knowledge forward to the next situation and
481
Chapter 8.3
next task, to other specific environments and in order to enhance learning in an organisation
meaning contexts, and to meetings with other it is necessary to deal with these two aspects of
individuals. We learn together, but learning is knowledge – individual luggage, with its pros
always grounded in the understanding carried and cons, and the relational aspect.
by each one of us. However, this is just one side
of the coin. It is equally important to stress that Sharing and expanding knowledge
knowledge resides in the relations between expe- The sociology of knowledge concerns common-
rienced people. The latter implies that compe- sense knowledge, i.e. “what people ‘know’ as
tence is not entirely individual. A person’s know- ‘reality’ in their everyday lives”. When Berger
how is often richer, easier to use and expand, and and Luckmann describe the reality of common
better maintained and developed when s/he has sense they refer to the actor’s, the individual’s,
access to other equally competent persons. Thus interpretations of a reality that s/he takes for
Non-reflective, routine way of thinking Reflective, problem-solving way of thinking

• Dichotomised thinking, either/or, • Think in terms of variables, processes and
see no alternative alternatives
• Pose oneself no questions, no pondering; • Ponder, reflect, ask oneself “How?”
thought processes rapidly come to an end and ”Why?”
• Frozen/petrified statements, truncated • Have related explanations and insights into
explanations active use
• Do not think ahead • Future is present in ideas and thoughts,
plans of one’s own
• Controlled by external demands; • Controlled by internal demands of one’s own
wait for external changes and by goals; not dependent on external
changes
• Take things as they come, no anticipation • Quality assurance, influencing stages of
operations both before and after one’s own
• Wish to achieve approved production • Aim to produce quality in excess of formal
standards requirements
• Perceive faults as interruptions to routines, • Perceive faults as interesting problems to
as a change/as breaks solve
• Few stories related to disturbances • Masses of stories related to disturbances
Figure 8.3.3. Development makes a difference – machine operators’ ways of thinking (habits of mind)
concerning disturbance handling. Selection of a number of dimensions characterised through their
end positions.
482
Learning at work
granted. No two people have the same personal open, and thus more useful connection between
histories or experiences of life. The idea that the individual and the organisation when new
knowledge comes with experience will thus by ideas are to be introduced and changed ways of
definition imply that one person’s knowledge working are needed.
differs from everyone else’s, to a lesser or greater In a changing world, collective meaning can
extent. These are valuable differences. Multiple have a negative impact on an organisation in
perspectives and shifting nuances are often fruit- that the organisation may not realize that the
ful. collective meaning it holds is dysfunctional. For
However, the differences also quite often re- example, collective meaning that was advanta-
sult in that what one person holds to be true and geous for a company during a certain period can
valid seeming questionable to another. There is become obsolete in a rapidly changing world.
a problem related to individual knowledge in the In such situations there is a need for making the
sense that people easily believe and act as if one’s collective accessible. It is also not uncommon
own knowledge and know-how were the truth for people who want to implement change on
– instead of realising that it is rather one’s own others to try to communicate with those other
perspective. Thus the development of shared people’s non-existent meaning structures, i.e.
and joint knowledge requires an openness and with thought networks that, for one reason or
an ability to reflect and when necessary accom- another, people have not (yet) developed. Such
modate, change one’s own world views and hab- communication is doomed to failure.
its of mind. In an organisation, then, individual Transformative collective learning is a process
experience is very useful and all the same has where participating individuals get access to oth-
to be overcome to a certain extent in order for ers’ ways of understanding. According to Wil-
knowledge to become shared and collective. helmson, collective learning is seen when group
The term “collective” does not imply that participants broaden, shift and exceed their in-
everyone in an organisation entertains exactly dividual perspectives. Transformative collective
the same meaning; rather, it refers to an under- learning entails the transcending of the individu-
standing that is close enough in order for mem- al perspective in that the group forms a new and,
bers of the organisation to function as if they at least for the moment, common understand-
were in complete agreement. However, as Dixon ing. In Piaget’s terms, this could be understood
points out, significant differences between per- as a kind of collective accommodation.
sons are commonly found when collective mean- There is reason to stress the importance of
ing structures are examined closely. “Meaning conversations and group dialogues for the ac-
structure”, the term Dixon uses, comes close to cessibility and development of knowledge and
what in this chapter have been called cognitive understanding in an organisation. When work
structures and thought networks. She also stress- demands that people take part in and make sense
es that many collective meaning structures are of changes, the development of dialogue com-
tacit, and that they are changing slowly as a con- petence is of special value. In learning dialogues
sequence of day-to-day activities. By contrast, it is possible to access understandings through
accessible meaning refers to the structures that people making their different perspectives vis-
an individual is willing to make available to oth- ible. Dialogue competence is thus not a personal
ers in the organisation. Accordingly, here lies the trait, but a capability that comes with practice.
483
Chapter 8.3
Dialogue is different from discussion and also

something more than and distinct from ordinary How to arrange dialogue meetings
talking. Dialogue meetings are not the same
thing as ordinary workplace meetings. Dialogue When people meet, dialogue develops
can be characterised as a conversational ideal spontaneously. Listening and talking about
to strive towards, an ideal implying that the our own experience is how we learn from
people taking part consider each other of equal each other and develop shared conceptions.
value and each aim at developing their own and Why are so few encounters of this kind to
a common understanding. The point of depar- be seen in the workplace?
ture for learning group dialogues is the fact that Dialogue requires time and trust. The
every participant has experiences that to some arrangement of dialogue meetings where
extent differ from those of the other partici- people can train their dialogue competence
pants. These differences are the ground for and requires planning concerning choice of
idea behind organising group dialogues (e.g. at topic and rules on how to talk. Briefly, a
a workplace), but also its difficulty. Our varying room is needed where people can sit in
experiences mean that everyone contributes a small groups of five. A leader presents the
different truth to the conversation. rules and content to the whole gathering.
The rules in brief are: Pass the word around
Cultivating competence-bearing relations in the group. It is everybody’s responsibility
Every workplace has processes that carry work- so see to it that everyone speaks. The topic
place know-how and competence. These proc- chosen must concern a question that is
esses can be seen as ongoing relations between relevant to all participants and to which
persons. Apart from individuals carrying their there are no right or wrong answers. A
knowledge between different contexts, the question concerning an issue that the group
know-how of the workplace is accessible, arises can investigate a bit deeper and develop
and remains in the interstices, i.e. in relations some common understanding around.
between people. In a competence-bearing rela- A constructive structure is to start
tion an individual is more able than he would be by letting each and everyone of the five
on his own. The presence of and actual access participants to one another express their
to one another increase and preserve the know- own point of view of the way something
how. Thus there is a lingering knowledge which ought to be (e.g. among hospital staff it
resides in having recurrent access to other sense- could be “what is good treatment of patients
making and competent actors, i.e. to the work- in our hospital?”). The second step is to
mates one has thought, worked and experienced investigate impediments to achieving this,
with and who thereby know what words, allusions and the third to look for things that enhance
and solutions stand for. Having workplace history and facilitate progress in the desired
in common means that people possess shared and direction. Finally the group can write down
lived answers to the reasons for the way in which a few points that the members agree upon,
things are carried out at the workplace. and present them in plenary session.
If management one-sidedly views knowledge
and competence as individual attributes, this
484
Learning at work
might threaten an organisational change process, ity”. The work of managers and OSH-experts
because with such a view the ability to ask the is definitely facilitated by an understanding of
useful and effective questions concerning how individual and collective learning processes, by
to organise for the knowledge that resides in knowing how changed points of view, revised
the relations may be lost. Continuous use of this stances and expanded know-how come about.
relational knowledge calls for the cultivation of Such knowledge provides a ground for believing
competent relations – in contrast to what is very in and daring to practice participation, intro-
often the case when managers and change agents ducing production teams, leading understand-
re-sort people as if they were inanimate objects. ing and sustainable organisation development.
Skilled individuals are then deprived of part of This knowledge of learning processes is clearly
their competence, since interactive processes relevant to have in mind when dealing with
and knowledge transactions are the backbone of occupational prevention and making decisions
the organisational competence. concerning e.g. safety issues.
In order to connect learning to occupational
concluding remarks safety and health issues, it can be stated that to a
One important conclusion to be drawn is that a large extent risk, and safety, is constructed when
vital connection exists between life span/width people are not at all consciously dealing with
development and the learning that occurs within it. It is in reality constructed in working, when
work-task-related everyday experiences. Further, focusing and carrying out one’s ordinary work
learning and development – in their accom- tasks. When individuals and work teams are
modative and transformative natures – are not increasingly supposed to function with respon-
to be reduced to easiness and simplicity when sibility and autonomy, this calls for knowledge
in process. Although the outcome is often posi- of learning processes and an ability to manage
tive, the processes of changing ways of thinking conflict between learning and control logics
and transforming habits of mind are at times – issues discussed in “Constructing workplace
demanding, and may be associated with shaki- safety through control and learning – conflict or
ness, crisis, pain, and even chaos, if the learning compatibility?”
challenges basic values and ways of understand- If learning in working at the collective and
ing. For example, leaving existing work tasks and organisational levels is of importance for enter-
related competence in order to take on new tasks prise development, e.g. when adjusting business
might feel like sitting in a rowing boat when a to changed external demands, then how can con-
storm is brewing, before regaining and walking ditions supporting such learning be enhanced?
on terra firma. One answer to this lies in job enlargement
To act competently and to assign meaning and enrichment, which creates opportunities for
to the world we live in, i.e. our contemporary more problems and question marks to solve and
societies, requires people not only to understand learn from. Variation in work tasks and com-
and learn in the actual physical and social set- munication around them makes it possible to
ting, the specific community of practice. Siebert identify differences and deviations. Another type
stresses the need for “a meta-cognitive capacity of answer is that such favourable conditions have
to observe how we observe, how and on the basis to be created locally through involvement and
of which leading differences we construct real- participation. To start with some small and con-
485
Chapter 8.3
crete changes to the work environment might Peoples’ habits of mind are not changed over
for example invite workers to engage in fruitful night – these kind of changes, e.g. where work-
collaboration. The other chapters in this section ers are asked to broaden their work tasks and
provide aspects on work organisation, leader- responsibilities, to be involved mentally take
ship, gender and team work strategies that are time. Thought networks and habits of mind are
all in tune with the views on learning here pre- stable, even conservative structures. Albeit ame-
sented, and can thus be used as inspiration for nable to change.
organising for a more learning organisation.
486
8.3
Learning at work
Marianne Döös
One struggle that many managers and occupa- ment prevention. The following points will be
tional safety and health (OSH) experts engage treated:
in, all over the world, concerns ways of getting
• We are all learners all the time.
employees to behave according to instructions,
rules and in line with what they are told by supe- • The quality and usefulness of what is learnt.
riors and experts. This chapter aims at shifting • Some basic learning principles.
the focus of attention, from a teacher instructing
or a boss commanding to the individuals, groups • Collective and organisational learning.
and organisations that are learning.
The fact is that all knowledge construction The text is written in a reasoning style and of-
is an active process on the part of the learner, fers understanding rather than hard facts. It is
and thus needs to be understood according not a manual or concrete advice. Some
to this logic. Learning does not take place examples are aimed at enhancing the readers’
at somebody’s command, rather it needs to possibility to draw conclusions and connect to
be enhanced and facilitated. Ongoing com- their own experiences and to local practices and
petence development and learning within the conditions.
enterprise has turned out to be of competitive In brief, to learn means to change and develop
advantage. This adds another decisive reason one’s conception and understanding of some-
for managers and leaders, for OSH-experts as thing, and is in this chapter thought of as a proc-
well as for workers, to develop an understanding ess. Competence is related to the performance
of the processes and conditions of experiential of specific tasks and is regarded as a capability to
learning. make use of knowledge in acting.
This chapter is about learning in working. It
we are all learners all the time
is meant to be of practical use and to contribute
to company development, and to healthy work- No matter what we do, we always learn into the
places as the result of competent work environ- bargain. Learning is intrinsic to activity. Ac-
475
Chapter 8.3
tions have learning as their (unintended) conse- the quality and usefulness
quence, while the intention of the action comes of what is learnt
out as the result, i.e. the intended outcome. This The important remaining questions at each
can be simply summarised: we are all learners workplace concern what is learnt, with what
all the time, learning is for everyone an activ- quality and especially to what benefit and ad-
ity that is always going on. It makes no sense vantage for the activity of the enterprise. On the
to label a person a learner or non-learner, since whole, qualifying experiences and skill enhance-
everyone in an organisation is learning. There ment among shop floor employees will add value
is no such person as a non-learner. This means to the company, whereas refraining from com-
that everyone in a workplace engages in learn- petence development will reduce a company’s
ing activities as he or she carries out normal prospects of coping with future challenges and
work tasks. Learning, then, goes with the job. It demands.
takes place when we normally do not even think In industrialised countries, competence develop-
about it, while the learner’s attention is focused ment is today considered highly important in most
on the task and not on learning. organisations, but – at the same time – learning
On the other hand, there is a definite risk of conditions frequently deteriorate due to staff
negative learning when workers are assigned to reductions, the ideal of having slim organisations
jobs of a constrictive nature, i.e. when their expe- and the resultant work intensity and overload (see
riences lower their interest and self-reliance and “Psychosocial risks and their prevention”, this
cramp their personalities, which in turn reduces book; on the pursuit of sustainable development,
the potential for constructive participation in see Docherty, Forslin, & Shani 2002). In develop-
corporate development. Another risk concerns ing countries the crucial importance of skilled
illusory learning, where employees refrain criti- workers is not yet common knowledge.
cising, even when invited to do so. If employees Transformational capacity is needed in order
are afraid of raising critical questions and issues, to attain sustainable development in a chang-
this can result in illusory learning on the part of ing environment. The American psychologist
the manager. S/he may falsely overestimate the and organisational consultant Nancy Dixon has
advantages and legitimacy of his/her own propos- found that organisations capable of handling
als and skill. change have undergone three major shifts in
Learning is clearly an integral aspect of relation to knowledge:
everyday work tasks. The importance of expe-
riential learning is from now on used as a pre- “The first is a shift in thinking about who in the
sumption. Managers ought to make use of this organisation has credible and valuable knowl-
knowledge and organise the business for learn- edge that the organisation can use to solve its
ing. It is also up to OSH-experts to understand difficult problems.
and act according to learning principles if they The second is a shift from thinking of knowl-
want to rely on participative methods in order, edge as an individual phenomenon to thinking
for example, to e.g. reduce accident risks or of knowledge as embedded within a group or
improve the work environment. community.
476
Learning at work
The third is a shift from thinking of knowledge some basic learning principles
as a stable commodity to thinking of knowledge
David Kolb stated that “learning is the process
as dynamic and ever changing.”
whereby knowledge is created through the trans-
Workplace learning, or more specifically, work formation of experience” and to change one’s
task learning, has implications for individual way of doing, thinking or understanding means
development over the life span and in every learning. To learn implies changing one’s ways of
walk of life. Both lifelong and life-wide learning thinking and/or acting in relation to the task one
are dependent on the learning that takes place intends to perform. Learning can be briefly de-
when work tasks are performed and talked about scribed as a situated process of knowledge-con-
with others. Work tasks and work situations struction based on action, with the learner as an
represent ongoing opportunities for knowledge active constructor of knowledge and know-how.
construction and re-construction. In fact, tasks Piaget described learning in terms of processes
and their surrounding conditions provide the of adaptation. Qualitative shifts in an individual’s
main opportunities for learning and competence understanding are seen as accommodations that
development in adult life. If learning condi- alter cognitive structures, whereas experiences in
tions in a workplace are not favourable – either tune with already existing structures are thought
because of work tasks which are too limited and of as assimilations. The need for accommodation
confined or else because of staff reduction and stems from an unpleasant feeling of imbalance
high work intensity – the potential for individual that calls for a change in one’s thinking.
development is not used, and the organisation as
a whole will suffer from having less capability to Learning requires a learner
deal with change. Engaging the workers in car- One basic principle of organising for workplace-
rying out an organisational change and revised based learning concerns moving away from
layout may be a starting point for development. the thinking where courses and transmitting
Thus, work task quality makes a difference. information are in focus. It means acknowledg-
Limited work tasks and unfavourable condi- ing the learner and his/her everyday work tasks,
tions for qualifying experiences at the workplace environment and meaning context as crucial for
help to create stagnation and non-development learning. Thoughts on this point are elaborated
among the employees. When talks, quality is- in the “from arrow to flower” metaphor, Figure
sues, meeting attendance, customer demands, 8.3.1. Departing from traditional ideas of trans-
problem solving and so on are integrated in the mission, illustrated by the arrow from a teacher
work tasks of the workers, this is in line with or instructor to a learning object, the learner
contemporary ideas in companies where indi- is instead placed as the actor in the centre of a
vidual and enterprise development support and flower in an environment of “affordances” (Gib-
strengthen one another. The relation of learning son). As a consequence of task-related inten-
quality to participation in everyday work as well tions, the individual learns as s/he makes use of
as in change processes is also strong. the specific environment and meaning context
through action. Action that implies the captur-
ing of possible opportunities which enable the
individual to carry out and understand work
tasks, e.g. seeing how others do things, identify-
477
Chapter 8.3
ing a problem, observing a deviation, talking to ing takes place. This is illustrated with the aid
workmates. of turning arrows, sent out and brought back
The figure exemplifies what is afforded in by the actor, and thus forming the petals of the
the environment of a machine operator dealing metaphorical flower. There are also a number of
with a production disturbance. In solving the Xs, illustrating possible opportunities that the
situation he will, for example, look to see how environment affords, i.e. opportunities that in
others have solved similar problems, observe a principle are at hand in a given situation, but not
helpful deviation from what is normal running (yet) observed as useful by the operator.
production, ask questions and have a look in the Individual experiential learning can be under-
manual. stood as an ongoing interchange between action
Figure 8.3.1 illustrates the move away from and reflection, where past experiences provide
the transmission idea represented by the one- the basis for future ones. Action forges the link
way arrow, i.e. away from the idea of knowledge between the human being and the environment,
being transferred from an active person to a where active participation and personal action
presumed passive receiver. The learner is instead are prerequisites for the learning process to take
thought of as active and in the middle of car- place. Through action people enter into both
rying out a work task. This work task demands concrete experiences and the reflection that
actions, and it is during these actions that learn- build up their know-how over time; through
Figure 8.3.1. From arrow to flower – shifting focus to the activity and intentions of the working learner.
478
Learning at work
action people take part in and change circum- operator hears a bad sound from his machine) or
stances, conditions and situations. through abstract comprehending and thinking
The quality of the experiential learning proc- (realising that the parts the machine just pro-
ess can vary in terms of what is learnt. High- duced fall short of the quality required). Once
quality learning requires all four learning ingre- prehended the individual can either transform
dients to be active, Figure 8.3.2. Kolb describes the experience through acting, testing, trying
the learning process as made up of two dimen- out ideas in action (the operator enacts a pos-
sions, where the ingredients or steps constitute sible solution to the quality problem, e.g. adjusts
the end poles, with a prehending (i.e. seizing, a machine setting) or with the help of his/her
grabbing, catching) dimension and a transform- understanding observe, reflect and create an un-
ing one. derstanding (the operator creating the basis for
In order to be able to learn from an experi- a richer understanding of the production prob-
ence the individual must somehow grab or get lem). These are both transformation processes
hold of it, and this comes from prehending: whereby one turns an experience into one’s own
either through concrete apprehending, feeling know-how. The transformation means that the
and using one’s senses (for example when an experience is grounded in and to some extent
Figure 8.3.2. Experiential learning – its two dimensions and four ingredients or steps (after Kolb).
479
Chapter 8.3
also changes the individuals’ thought networks.

Kolb describes this as a process moving between
Example
the steps of concrete experience – reflective
observation – abstract conceptualisation – active A glimpse of the operator’s learning proc-
experimentation. It is useful to look upon them ess can thus be found in a situation of
as four ingredients that all have to be put to use disturbance handling. He stands besides his
in order for learning to be qualifying in the long milling machine. The machine runs automati-
run. To concretise the theoretical concepts, here cally and the metal parts produced are lifted
is a work-related example from the shop floor. away by a robot. Suddenly he sees that the
robot arm has stopped in an odd posi-
Small, almost insignificant steps tion. He ponders this occurrence, realising
Learning is commonly thought of as something that the same thing has happened several
quick and revolutionary, but studies have shown times lately, which makes him identify this
it to be a small-scale process in which the small as something that might require action on
incremental steps, for all their apparent insig- his part. He has an inkling of the reason: he
nificance, are of major importance. This goes for thinks that it has to do with metal shavings
concrete experiences, e.g. in production tasks, as from the milling disturbing the sensor which
well as for comprehending, e.g. in the proceed- signals to the robot. Thinking about this he
ings of workplace meetings. One experience is develops a comprehension of the problem
added to another and the normality of one’s eve- and forms an idea for action. He cleans
ryday work tasks is constructed, reconstructed the sensor, re-starts the machine and finds
and consolidated. When a person knows what
that the robot moves normally. With this
is normal and usual, it becomes possible to be
new concrete experience he continues to
surprised and ask efficient questions concerning
work. In describing this work we have also
identified differences and deviations, questions
described a piece of learning where the
that are relevant to learning and work task per-
operator has now added an experience that
formance combined.
gives him a better basis for action next time
The outcome of learning can be envisaged as
a similar problem occurs.
having two aspects. In terms of outwardly vis-
ible signs of learning, outcomes are expressed in
the form of changed ways of acting, performing
tasks, and talking. Within the individual, learn-
ing is expressed as constructing and reconstruct- Through thought networks, perceived charac-
ing one’s cognitive structures. Theses structures teristics of a situation (e.g. a situation of problem
are the understanding and know-how an individ- solving, production disturbance handling) are
ual has concerning something specific and can linked to action, and to the judgements and de-
be described as thought networks. The thought cisions needed for an individual to find an action
network concept is explicitly chosen to commu- path. The thought networks can be described as
nicate possibilities for connections and develop- situation-connected reasonings that are more or
ment – in contrast to similar concepts named as less alike in similar situations. Such likenesses
cognitive structures, schemata and patterns. give thought networks stability and durability,
480
Learning at work
although – at the same time – they are con- machine operator’s handling of disturbances to
tinuously modified and developed through the production, his habit of mind affects his way of
person’s thoughts and actions. To summarise, defining and dealing with his work task. Such
thought networks manifest themselves as ac- habits of mind are not one-dimensional. They
tion alternatives, and are tied to the situations in can be thought of as built along a number of
which they are constructed and re-constructed. dimensions, each of which can be seen as a
Experiential learning takes place as the con- continuum for possible development. In a study
structing of these networks. of operators’ disturbance handling in automated
Several authors have related learning to life production, a number of dimensions of impor-
span development. Mezirow, for example, speaks tance for the mode of performing the work task
of transformations that follow a disorienting were identified, Figure 8.3.3. For example, op-
dilemma and result in “a reintegration into one’s erators’ ways of thinking (their habits of mind)
life on the basis of conditions dictated by one’s about production disturbance handling varied
new perspective”. Our particular perspective with the extent to which their thinking was
tends to inform our actions in ways we are not dichotomised or process-like; on a scale from
fully aware of. Transformation of these habits of frozen statements and truncated explanations,
mind and points of view is a painful process: to the operator having related explanations and
insight into active use.
“Our values and sense of self are anchored in
our frames of reference. They provide us with collective and organisational
a sense of stability, coherence, community, and learning
identity. Consequently they are often emotion- Nancy Dixon states that “collective meaning is
ally charged and strongly defended.” meaning that organizational members hold in
common. These are the norms, strategies and
In giving an overview of the theory of trans- assumptions that specify how work gets done
formative learning and how it has been used and what work is important to do”. Learning as
in practice Wilhelmson states that the explicit a collective process means that individuals learn
purpose of transformation theory is together through some kind of interactive and
communicative action. This is a learning process
“to be useful for adult educators whose goal is that creates added value through synergy, where-
not only to teach a subject but also to assist the by what is learnt becomes qualitatively different
development of their adult students’ capacity for from what any individual could have arrived at
living in a complex and dynamic society.” unaided. Further, collective learning results in
shared knowledge, in a similar understanding
Over time, individual development is affected of something specific, and – grounded in this
by task execution and individual task definition. – a capacity for joint action. Knowledge that
One can say that behind the situation-related is jointly produced has a more stable character
thought networks, there are long-term indi- than knowledge produced individually.
vidual ways of understanding (habits of mind), Within all teams and organisations, indi-
that are more consistent over time and do not viduals are the ones who learn and carry their
vary according to situation. In, for example, a knowledge forward to the next situation and
481
Chapter 8.3
next task, to other specific environments and in order to enhance learning in an organisation
meaning contexts, and to meetings with other it is necessary to deal with these two aspects of
individuals. We learn together, but learning is knowledge – individual luggage, with its pros
always grounded in the understanding carried and cons, and the relational aspect.
by each one of us. However, this is just one side
of the coin. It is equally important to stress that Sharing and expanding knowledge
knowledge resides in the relations between expe- The sociology of knowledge concerns common-
rienced people. The latter implies that compe- sense knowledge, i.e. “what people ‘know’ as
tence is not entirely individual. A person’s know- ‘reality’ in their everyday lives”. When Berger
how is often richer, easier to use and expand, and and Luckmann describe the reality of common
better maintained and developed when s/he has sense they refer to the actor’s, the individual’s,
access to other equally competent persons. Thus interpretations of a reality that s/he takes for
Non-reflective, routine way of thinking Reflective, problem-solving way of thinking

• Dichotomised thinking, either/or, • Think in terms of variables, processes and
see no alternative alternatives
• Pose oneself no questions, no pondering; • Ponder, reflect, ask oneself “How?”
thought processes rapidly come to an end and ”Why?”
• Frozen/petrified statements, truncated • Have related explanations and insights into
explanations active use
• Do not think ahead • Future is present in ideas and thoughts,
plans of one’s own
• Controlled by external demands; • Controlled by internal demands of one’s own
wait for external changes and by goals; not dependent on external
changes
• Take things as they come, no anticipation • Quality assurance, influencing stages of
operations both before and after one’s own
• Wish to achieve approved production • Aim to produce quality in excess of formal
standards requirements
• Perceive faults as interruptions to routines, • Perceive faults as interesting problems to
as a change/as breaks solve
• Few stories related to disturbances • Masses of stories related to disturbances
Figure 8.3.3. Development makes a difference – machine operators’ ways of thinking (habits of mind)
concerning disturbance handling. Selection of a number of dimensions characterised through their
end positions.
482
Learning at work
granted. No two people have the same personal open, and thus more useful connection between
histories or experiences of life. The idea that the individual and the organisation when new
knowledge comes with experience will thus by ideas are to be introduced and changed ways of
definition imply that one person’s knowledge working are needed.
differs from everyone else’s, to a lesser or greater In a changing world, collective meaning can
extent. These are valuable differences. Multiple have a negative impact on an organisation in
perspectives and shifting nuances are often fruit- that the organisation may not realize that the
ful. collective meaning it holds is dysfunctional. For
However, the differences also quite often re- example, collective meaning that was advanta-
sult in that what one person holds to be true and geous for a company during a certain period can
valid seeming questionable to another. There is become obsolete in a rapidly changing world.
a problem related to individual knowledge in the In such situations there is a need for making the
sense that people easily believe and act as if one’s collective accessible. It is also not uncommon
own knowledge and know-how were the truth for people who want to implement change on
– instead of realising that it is rather one’s own others to try to communicate with those other
perspective. Thus the development of shared people’s non-existent meaning structures, i.e.
and joint knowledge requires an openness and with thought networks that, for one reason or
an ability to reflect and when necessary accom- another, people have not (yet) developed. Such
modate, change one’s own world views and hab- communication is doomed to failure.
its of mind. In an organisation, then, individual Transformative collective learning is a process
experience is very useful and all the same has where participating individuals get access to oth-
to be overcome to a certain extent in order for ers’ ways of understanding. According to Wil-
knowledge to become shared and collective. helmson, collective learning is seen when group
The term “collective” does not imply that participants broaden, shift and exceed their in-
everyone in an organisation entertains exactly dividual perspectives. Transformative collective
the same meaning; rather, it refers to an under- learning entails the transcending of the individu-
standing that is close enough in order for mem- al perspective in that the group forms a new and,
bers of the organisation to function as if they at least for the moment, common understand-
were in complete agreement. However, as Dixon ing. In Piaget’s terms, this could be understood
points out, significant differences between per- as a kind of collective accommodation.
sons are commonly found when collective mean- There is reason to stress the importance of
ing structures are examined closely. “Meaning conversations and group dialogues for the ac-
structure”, the term Dixon uses, comes close to cessibility and development of knowledge and
what in this chapter have been called cognitive understanding in an organisation. When work
structures and thought networks. She also stress- demands that people take part in and make sense
es that many collective meaning structures are of changes, the development of dialogue com-
tacit, and that they are changing slowly as a con- petence is of special value. In learning dialogues
sequence of day-to-day activities. By contrast, it is possible to access understandings through
accessible meaning refers to the structures that people making their different perspectives vis-
an individual is willing to make available to oth- ible. Dialogue competence is thus not a personal
ers in the organisation. Accordingly, here lies the trait, but a capability that comes with practice.
483
Chapter 8.3
Dialogue is different from discussion and also

something more than and distinct from ordinary How to arrange dialogue meetings
talking. Dialogue meetings are not the same
thing as ordinary workplace meetings. Dialogue When people meet, dialogue develops
can be characterised as a conversational ideal spontaneously. Listening and talking about
to strive towards, an ideal implying that the our own experience is how we learn from
people taking part consider each other of equal each other and develop shared conceptions.
value and each aim at developing their own and Why are so few encounters of this kind to
a common understanding. The point of depar- be seen in the workplace?
ture for learning group dialogues is the fact that Dialogue requires time and trust. The
every participant has experiences that to some arrangement of dialogue meetings where
extent differ from those of the other partici- people can train their dialogue competence
pants. These differences are the ground for and requires planning concerning choice of
idea behind organising group dialogues (e.g. at topic and rules on how to talk. Briefly, a
a workplace), but also its difficulty. Our varying room is needed where people can sit in
experiences mean that everyone contributes a small groups of five. A leader presents the
different truth to the conversation. rules and content to the whole gathering.
The rules in brief are: Pass the word around
Cultivating competence-bearing relations in the group. It is everybody’s responsibility
Every workplace has processes that carry work- so see to it that everyone speaks. The topic
place know-how and competence. These proc- chosen must concern a question that is
esses can be seen as ongoing relations between relevant to all participants and to which
persons. Apart from individuals carrying their there are no right or wrong answers. A
knowledge between different contexts, the question concerning an issue that the group
know-how of the workplace is accessible, arises can investigate a bit deeper and develop
and remains in the interstices, i.e. in relations some common understanding around.
between people. In a competence-bearing rela- A constructive structure is to start
tion an individual is more able than he would be by letting each and everyone of the five
on his own. The presence of and actual access participants to one another express their
to one another increase and preserve the know- own point of view of the way something
how. Thus there is a lingering knowledge which ought to be (e.g. among hospital staff it
resides in having recurrent access to other sense- could be “what is good treatment of patients
making and competent actors, i.e. to the work- in our hospital?”). The second step is to
mates one has thought, worked and experienced investigate impediments to achieving this,
with and who thereby know what words, allusions and the third to look for things that enhance
and solutions stand for. Having workplace history and facilitate progress in the desired
in common means that people possess shared and direction. Finally the group can write down
lived answers to the reasons for the way in which a few points that the members agree upon,
things are carried out at the workplace. and present them in plenary session.
If management one-sidedly views knowledge
and competence as individual attributes, this
484
Learning at work
might threaten an organisational change process, ity”. The work of managers and OSH-experts
because with such a view the ability to ask the is definitely facilitated by an understanding of
useful and effective questions concerning how individual and collective learning processes, by
to organise for the knowledge that resides in knowing how changed points of view, revised
the relations may be lost. Continuous use of this stances and expanded know-how come about.
relational knowledge calls for the cultivation of Such knowledge provides a ground for believing
competent relations – in contrast to what is very in and daring to practice participation, intro-
often the case when managers and change agents ducing production teams, leading understand-
re-sort people as if they were inanimate objects. ing and sustainable organisation development.
Skilled individuals are then deprived of part of This knowledge of learning processes is clearly
their competence, since interactive processes relevant to have in mind when dealing with
and knowledge transactions are the backbone of occupational prevention and making decisions
the organisational competence. concerning e.g. safety issues.
In order to connect learning to occupational
concluding remarks safety and health issues, it can be stated that to a
One important conclusion to be drawn is that a large extent risk, and safety, is constructed when
vital connection exists between life span/width people are not at all consciously dealing with
development and the learning that occurs within it. It is in reality constructed in working, when
work-task-related everyday experiences. Further, focusing and carrying out one’s ordinary work
learning and development – in their accom- tasks. When individuals and work teams are
modative and transformative natures – are not increasingly supposed to function with respon-
to be reduced to easiness and simplicity when sibility and autonomy, this calls for knowledge
in process. Although the outcome is often posi- of learning processes and an ability to manage
tive, the processes of changing ways of thinking conflict between learning and control logics
and transforming habits of mind are at times – issues discussed in “Constructing workplace
demanding, and may be associated with shaki- safety through control and learning – conflict or
ness, crisis, pain, and even chaos, if the learning compatibility?”
challenges basic values and ways of understand- If learning in working at the collective and
ing. For example, leaving existing work tasks and organisational levels is of importance for enter-
related competence in order to take on new tasks prise development, e.g. when adjusting business
might feel like sitting in a rowing boat when a to changed external demands, then how can con-
storm is brewing, before regaining and walking ditions supporting such learning be enhanced?
on terra firma. One answer to this lies in job enlargement
To act competently and to assign meaning and enrichment, which creates opportunities for
to the world we live in, i.e. our contemporary more problems and question marks to solve and
societies, requires people not only to understand learn from. Variation in work tasks and com-
and learn in the actual physical and social set- munication around them makes it possible to
ting, the specific community of practice. Siebert identify differences and deviations. Another type
stresses the need for “a meta-cognitive capacity of answer is that such favourable conditions have
to observe how we observe, how and on the basis to be created locally through involvement and
of which leading differences we construct real- participation. To start with some small and con-
485
Chapter 8.3
crete changes to the work environment might Peoples’ habits of mind are not changed over
for example invite workers to engage in fruitful night – these kind of changes, e.g. where work-
collaboration. The other chapters in this section ers are asked to broaden their work tasks and
provide aspects on work organisation, leader- responsibilities, to be involved mentally take
ship, gender and team work strategies that are time. Thought networks and habits of mind are
all in tune with the views on learning here pre- stable, even conservative structures. Albeit ame-
sented, and can thus be used as inspiration for nable to change.
organising for a more learning organisation.
486
8.4
Managing understanding
– a new leadership challenge
Jörgen Sandberg & Axel Targama
Managing change and development in or- • Participative development

ganisations is an important part of managers’
• Understanding: The basis for action
work. Typically, managers adopt a top-down
approach in the sense that it is they who plan • The case of competence in engine optimising
what change and development should take • Managing understanding
place and how it should be implemented. More
specifically, with support from administrative participative development
specialists and consultants, managers formu-
Formal authority and positional power can be
late specific rules and instructions about work,
used to implement new systems and structural
which they impose on their staff, through a hier-
changes. Employees may resist the changes and
archy of authority and responsibility. A major
be unwilling to learn the new procedures. But if
problem associated with the top-down approach
a new accounting system has been implemented,
is the resistance frequently offered to change.
you cannot go on working with the old one. If
Despite the use of expensive and sophisticated
the office has moved to a new place you cannot
techniques to inform the employees about a
go to the old one. But when we talk about be-
change, many employees seem to resist the pro-
havioural changes – concerning customer focus,
posed change and go on working in much the
service, quality, employee relations etc. – the
same way as before.
manager is completely dependent on the delib-
This chapter is about the new leadership
erate actions taken by the employees. If they do
challenge of managing understanding . To man-
not change their everyday actions there will be
age understanding, leaders must ceases managing
no change at all.
through rules and formal instructions. Instead
During the last two decades, the top-down
leadership means leading via people’s under-
approach has also been heavily criticised by both
standing of work and work tasks. The text aims
practitioners and researchers as being inadequate
at providing insights and ways of reasoning,
for managing people effectively. The main
rather than giving hard facts and concrete ad-
reason derives from the comprehensive socio-
vice. The following will be treated:
487
Chapter 8.4
economic changes taking place in society today, ance is not based upon some form of external
such as rapid technological change, more knowl- stimuli such as instructions on how work should
edge- and service-based industry and intensi- be done. Instead, people’s work performance is
fied global competition. These changes require based on how they understand those instructions
modes of organisational management that pro- and their work in general. Hence, in order to
mote a high degree of flexibility, customer have an impact on employees’ work perform-
orientation, quality, efficiency, worker empower- ance, managers need to find ways of influencing
ment and ongoing competence development. employees’ understanding of their work.
With these new requirements, the top-down What, then, is “understanding”? The term
process has been shown to be too rigid and in- does not signify a particular kind of knowledge
flexible, and managers are searching for or skill but, rather, what something means to a
methods of managing people that will facilitate particular person. For example, the expression
competitive renewal and growth. “a person’s understanding of work” does not
This has caused organisations to try more primarily mean that person’s particular knowl-
participative management approaches strongly edge of work. Instead, it signifies what the work
focusing on competence development, and the means to the person, what the work is about.
permission of more individual freedom and local Often our understanding of reality is so much a
independence at work. Participative approaches part of ourselves that we have problems describ-
to management emphasise that the initiative ing it. It is just how things are. An outsider can
to develop and improve the business is con- of course analyse our understanding of work and
sidered to be a question not only for managers identify a range of different ways of understand-
and experts but also for operative personnel. A ing one and the same work. But the individual
participative approach requires managers at all is embedded in his understanding of his every-
levels to be able to cope with problems emanat- day work, and does not look upon it as just one
ing from leading development processes where way of understanding. Understanding of reality
many people are actively involved and where the can be described as the basis for our actions and
manager will be teaching and coaching rather judgements. It provides us with intuitive answers
than dictating. to questions such as: What is it? What’s going
on here? What is it all about? How understand-
understanding: the basis for ing operates in daily life can be illustrated with a
action few simple examples.
A more participative approach to management A professor was invited to give a series of
means that subordinates will solve problems and guest lectures at a university in the former
take actions on the basis of their own analysis Soviet Union during the early transition phase
and judgement. Their judgement will not only away from communism. He knew that the stu-
be based upon existing facts and given circum- dents were eager to find out how business was
stances, at least not the ones the manager would done in the Western world. But he was dis
consider as given. Instead, the employees will be appointed by their general attitude. To him they
judging and acting on the basis of their under- seemed uninterested and totally passive. But to
standing of the situation and the tasks. Research his surprise he received a comment from a student
such has also shown that people’s work perform- saying: “This is very interesting. You really seem
488
Managing understanding – a new leadership challenge
to mean what you say”. When analysing the technology of the future. While the above IT
above case we can see that the visiting profes- company no longer exists, the teenagers have
sor’s and the students’ different expectations and become managers in the PC and server-based IT
behaviour are related to their specific under- business of today.
standing of what academic teaching means. The The example teaches us that understanding
professor had experience from Swedish univer- is an experience-based interpretation of reality. It
sities and saw lectures as an effort by a teacher shows that understanding guides our observa-
to explain ideas and concepts, thus helping the tions, judgements and actions and controls what
students in their learning process. The students’ we notice, how we interpret our actual experi-
understanding of what a lecture is about had ences, how we explain things and make sense of
been shaped by experience of professors who them. How our understanding of work forms
were obliged to discuss all matters within the the basis for the way we perform work can be
framework of Marxist-Leninist ideology. illustrated by an empirical study of what consti-
Students knew that this was something that had tutes competence at work from the car industry.
to be said, and they knew that the teacher had the
same view. They understood a lecture as a kind the case of competence in
of ritual, where the teacher preached the engine optimising
dogmas. They had to participate, but nobody Traditionally, competence is regarded as a set
took it really seriously. of knowledge and skills possessed by a person
In the middle of the 1980s a large IT com- in relation to particular work. However, a study
pany was developing software and providing IT of technicians at the Volvo Car Corporation in
service. The personal computer (PC) was already Sweden showed that competence is not prima-
around at that time, but its capacity was still rily made up of specific knowledge and skills.
fairly restricted. The PC was a recurring topic Instead, knowledge and skills used at work are
during coffee-breaks, and it became clear that based upon understanding of that work.
the software specialists had a common understand- More specifically, the task for the group of
ing of what a PC was. They made sense of it as approximately 50 technicians (called engine op-
“a smart typewriter, a game toy, a simple tool timisers) was to develop engines for new models
for customer listing etc.” These experienced of cars. Engine qualities (e.g. emissions, fuel
software engineers never thought of producing consumption and performance) were optimised
administrative software for PCs. “Everybody by adjusting various interrelated parameters
who knows something about computers must within the engine’s electronic control system,
realise that the PC will never play any role in such as its fuel and ignition systems. Engine
administrative data processing at company lev- optimising is thus a fairly complex task.
el”. Who then started to develop administrative Despite the fact that all optimisers carried
software for PC? It turned out to be a generation out the same kind of task, it turned out that they
that had been playing with the PC as teenag- showed decisive individual variations in the way
ers. They tested the capacity of the PC to the they understood what they were doing. This in
ultimate limits and learned everything about its turn was influencing the result of the optimising.
technology. They understood the PC in a differ- Three different ways of understanding engine
ent way – as a promising and rapidly developing optimisation emerged from the study:
489
Chapter 8.4
1. optimising separate engine qualities, involves first and foremost changing one’s un-
derstanding of work. In other words, the most
2. optimising interacting engine qualities or,
fundamental form of competence development
3. optimising the engine from the customers’ would require one to be able to understand ‘the
perspective. same work’ in a qualitatively different way. For
instance, if workers with understanding 2 were
Within each way of understanding, it was pos- to develop understanding 3, they would have to
sible to distinguish a number of fundamental change their understanding of the work from
aspects constituting the competence in question. “optimising interacting qualities” to “optimising
Optimisers with type 1 understanding organise from the customers’ perspective”.
optimising into a stepwise activity, and within
each step optimise one specific engine quality managing understanding
at a time. Type 2 understanding instead means The insight that understanding of work defines
focusing the relationships and interdependen- the specific knowledge and skills that are devel-
cies between engine qualities, and thus implies oped and used in work performance does not
taking all engine qualities into consideration only have far-reaching implications for develop-
within each step. Finally, type 3 understanding ing competence. It has also fundamental impli-
includes the consideration of interdependencies, cations for how we design and conduct mana-
but focuses the relation between an optimised gerial activities with the purpose of improving
engine and how customers experience driving. work performance more generally. Instead of
Thus, the results demonstrated that particular managing people by imposing detailed instruc-
ways of understanding optimisation work meant tions and rules about how to accomplish tasks or
qualitatively distinct ways of delimiting certain by specifying details about the outcome of the
attributes as essential and organising them into work assigned to employees, managers need to
a distinctive structure of competence in engine influence people’s understanding of the business and
optimisation. Hence, the workers’ understanding their work. When managers, for example, intro-
of optimisation work could be said to determine duce the balanced score card as a tool for devel-
what knowledge and skills were used by the oping operations, the outcome of that effort will
workers in engine optimisation. depend upon what development initiatives the
As Sandberg pointed out, these results pro- employees will take in working with the score-
vide an alternative answer to the central question card. And people act according to their understand-
of why some perform better than others. The ing of the reality – in this case the essence of the
variation in work performance is not first and system and what it means to use it. This implies
foremost related to a specific set of attributes that when managing by understanding, manag-
possessed by those optimisers who are regarded ers cannot only rely on their traditional posi-
as most competent. Instead, why some perform tional power. Their role begins to resemble that
better than others is related to the variation in their of the teacher, i.e., to influence other people’s
ways of understanding the work. understanding of something. Just as in educa-
Moreover, if understanding of work defines tion, people cannot be made to rethink and re-
what competence is developed and used in work place their understanding as a result of receiving
performance, competence development then orders. Learning is an active process on behalf of
490
Managing understanding – a new leadership challenge
the learner, and thus needs to be comprehended Dialogues represent a verbal process with much
according to this logic. more strength in developing and changing un-
Probably the most common mistake in derstanding. In a dialogue people must show
development work is the one where a manager their cards and this means that you reveal essen-
has been working on an issue such as a new tial parts of your present understanding to oth-
strategy or an introduction of a new information ers, and this makes you vulnerable to influence.
system for some time, discussing with consult- But this is the case also for a manager. Using
ants, reading articles and reflecting on it now dialogues means that managers must be open to
and then. Finally, the manager has developed revise their own understanding in the process of
a set of ideas that, according to him/her, rep- trying to influence others.
resents a consistent and meaningful package of Since understanding is primarily experience-
new thoughts on an important problem. This based, it follows that the natural way of impact-
package is then presented to the employees, and ing on people’s understanding should be to
the manager expects them to make sense of it provide opportunities to make experiences that
in the same way as the manager him or herself. trigger reconsideration of present understand-
This is probably always a far too optimistic ing. One approach could then be to make
view. Every person must reflect upon the issue, employees participate in activities where they are
discuss it with others and finally develop views encouraged to discover their own understand-
that are integrated into his or her understanding, and this will normally require some help
ing of the situation. There is no easy shortcut from outside. Staff development using group
to this. On the other hand it is not impossible. dynamics can be seen as a method representing
But managers must learn that managing by this approach. For instance, team leaders are
understanding can be achieved, not by tell- invited to participate in group exercises which
ing people how to think and act, but by creat- are designed to provoke critical actions from
ing conditions and practices that stimulate people to the participants in their different roles. The
investigate, reflect upon and perhaps change their participants then join in analysing their experi-
understanding of reality. ences from the exercises, and such experiences
Managers have traditionally been used to can have a heavy impact on people’s understand-
exert influence by the use of words. They try to ing of themselves as leaders and of leadership
produce elegant rhetoric in order to persuade as such. When understandings have been made
people to think in new directions. But from the explicit and people are aware of them, it is possi-
above analysis we can see that just presenting ble to work in a more rational manner to scruti-
information – however well-prepared and ele- nise the existing views and engage employees in
gant – will not lead to a change of understanding the development of new forms of understanding
among employees. The manager is only present- work. It takes time and effort, but it works. It
ing the raw material that employees could use requires, however a climate of openness, honesty
in their reflective thinking and their discussions and confidence as a necessary background for
with each other. At best the manager will create the participation efforts. In positive cases these
curiosity and trigger a more active search and qualities also improve as a side effect of partici-
processing of information. pative change efforts.
491
8.5
Organisational development
and gender integration
Martha Blomqvist
Women’s work is of critical importance not only a social construct thus refers to what culture and
for their social, economic and political empower- society make of the biology.
ment, and for family livelihoods, but also for
economic efficiency and the sustainable devel- integration of women and men
opment of society. All over the world, jobs are at the workplace
segregated by sex. The segregation may seem Integration of work tasks is an often-described
innocent enough and actions taken to weaken element in organisational change, presumed to
it are sometimes ridiculed. Nevertheless, it is a have an impact on workplaces in most industries.
cornerstone in the uneven distribution of power The changes are part of a rationalisation strategy
and economic resources (The United Nations’ and thus motivated by corporate interests.
Beijing Declaration and Platform for Action, Nevertheless, this kind of change is also for
1995). Women’s work conditions are typically the better for many employees. Horizontal job
more unfavourable than men’s. To the extent enlargement means more varied work tasks,
that the inequalities are internal to the work making work more interesting and many-sided.
organisation they can also be taken measure Vertical job enlargement means that traditional
against at the organisational level. white collar tasks, mostly from supervisory level,
Current changes in work organisation and are led downward. Most forms of job enlarge-
technology present both threats and opportuni- ment – vertical or horizontal – also mean a
ties for an improvement of the situation. This reduction in one-sided musculo-skeletal strain.
chapter deals with a key aspect of change – in- Integration of work tasks may therefore mean
tegration of work tasks – which may be used to improved working conditions, for women as
open up some inequalities. Below the concept well as for men.
of sex refers to the biology of a person. The With the integration of work tasks the division
concept of gender is wider and covers also the of work is changed. Where both women and men
socially constructed roles, status, expectations, are involved, the sexual division of work may also
and relationships of women and men. Gender as be affected. However, in highly gender-segregated
493
Chapter 8.5
industries integration of work tasks cannot in- ing devices are problematic to handle or do not
fluence the division of labour based on gender. function anyway and that learning to manage
Men represent only a very small number of those the technology is difficult for women. They
working in people-related services; women are claim that they themselves cannot do the wom-
underrepresented in many areas of goods produc- en’s work because their hands and fingers are
tion. In these areas gender-segregation itself makes too big, because they do not have the patience
integration impossible. Sometimes, however, of women or because they find it impossible to
integration includes women’s as well as men’s tasks do monotonous work or to work in a stationary
and thus both women and men. When job rotation position. Women, however, do not typically
or job enlargement involves both women’s and object to men entering their work.
men’s work the reorganisation thus has the poten- Though there definitely are differences be-
tial also to decrease the gender segregation. tween the sexes as regards physical strength
and deft with one’s fingers, these are average
resistance differences, explaining only to some extent the
The presentation of the Indo Asian case does gendered division of work. They are certainly
not comprise information about any difficulties not related to patience or to tolerance of repeti-
related to the integration of men and women. tive work tasks. Neither can the differences in
Bringing together men and women to collabo- physical constitution explain men’s many times
rate, co-operate and interact seems not to have rigid refusal to turn their hands to women’s work
caused significant problems. Research on simi- tasks. The resistance encountered by efforts to
lar re-organisations in a Swedish context does integrate men and women becomes more under-
however show that changes including integra- standable if we analyse it in terms of the status of
tion of women and men are very likely to meet work tasks and gender identity.
with resistance. Studies report on employees The definitions of women’s work and men’s
opposing the change, on men as well as women work mostly involve differences in status, in pay
reluctant to take on the non-traditional work and in career opportunities, all to men’s advan-
tasks or to accept men doing what used to be tage. Taking over women’s tasks therefore often
women’s work and vice versa. Men’s manual means that men suffer losses in status. Women
work is traditionally on average heavier than engaging in men’s work are likewise assumed to
women’s and is understood to demand more lower the status of men’s work. Considering the
technological knowledge, whereas women’s status of the work makes men’s resistance more
work more often is repetitive and/or involves understandable and even rational. Women’s
care-work or tasks connected with housework. doubts about doing men’s work can accordingly
The resistance arises when women and men are be understood as an unwillingness to challenge
expected to cross these traditional gender lines men’s status. Gendered aspects of work further
of work tasks. Many women hesitate to take on constitute an important part of male and female
heavy work, even when labour-saving devices identity. Men’s and women’s behaviour and
are available, and they say they feel insecure activity at work reflect and affirm their gender
with the technology. Men often maintain this identities. Situations challenging traditional
understanding by claiming that only men are work tasks may therefore be very threatening to
fit to do the heavy work, that the labour-sav- women as well as men.
494
Organisational development and gender integration
avoiding resistance with women, nor is the management prepared to

Due to the resistance the integration process is totally neglect the employees’ views in the matter.
sometimes interrupted altogether, more often The gurus of management philosophy are of little
it is narrowed, i.e. including fewer employees help. Some of them acknowledge the employees
and not as many work tasks as first planned. and their behaviour as significant for a successful
When carried through as initially planned a change and underline the importance of pay-
new reorganisation sometimes follows, in fact ing attention to it. Some bring up the question
just establishing the previous order. However, of employees’ resistance to change. None of
not all attempts to integrate women and men the renowned authors of this genre, however,
end in failure. When men and women workers mention resistance caused by challenges to the
are socially integrated from the start, a further gendered division of work. Its consequences are
integration is fairly easily accepted. Stereotypi- thus altogether overlooked in these fashionable
cal understandings about women’s and men’s recipes for organisational change.
capabilities and traits do not then have much
ways of acting
strength. A male building caretaker gives an ac-
count of his thoughts about having to do stair- One way to foresee and prepare for the resistance,
case cleaning, formerly done by women only. and to make it possible to avoid some of it, is to
map the gender structure at the workplace prior
“It is not much fun. If I did not have to do it, to the launching of the change. Such mapping
I would rather not, I think … But then one has should include a detailed survey of the gender di-
to think about them too. I mean the womenfolk. vision of work, of the jobs’ informal status, of pay,
It is good for them to be let off some of the of working hours, of technological knowledge and
staircase cleaning. It is fun for them to be out- physical strength needed for different tasks and
doors and do all the things we do. It is good for also of inclusion of care work, of tasks connected
them. Yes, it will do, it will do.” to housework and of monotonous work tasks. This
Though men and women at this workplace used map can then be used to identify possible points
to work separated from each other, they have for of conflicts and thus of resistance likely to arise.
years on a daily basis had coffee and lunch to- As in all change processes, an open dialogue
gether and therefore know each other fairly well. and detailed information about what is planned
Feelings of solidarity and respect are developed, to happen is essential. Individual talks with
leaving little space for stereotypical understandings employees believed to be particularly vulner-
of gender. able and threatened by the integration of gender
Now and then the integration of men and specific work tasks may be motivated. An obvi-
women is accomplished in spite of vigorous ous step is to attend to the ergonomic conditions
protests. This presupposes that management and see to it that the design of work equipment,
acts very decisively, making it clear that no con- table heights etc do not form obstacles. Extra
cessions are to be made, leaving employees with training for some employees may be called for in
no choice but to accept the change or to quit the order to increase their self-confidence and skills.
workplace. The wage system, mostly disadvantageous to
In most cases though, neither is the climate at women, often needs adjustments to make men’s
the work place characterised by men’s solidarity and women’s work of equal worth. Women’s
495
Chapter 8.5
generally heavier family responsibilities must be “I remember once, it must have been twenty
considered when new working hours are intro- years ago, when there was one person missing
duced. In some cases it may be a good idea to and we made a joke with a guy, saying: “Listen
set an example by first launching the change on Peter, why don’t you sit down and assemble
a small scale, selecting for the work employees components.” “All right”, he answered, and sat
held in good repute, known to be open-minded, down and did it. “Ooo, Peter is assembling com-
and likely to accept the change and to under- ponents!”, everybody said. It was so incredible
stand its long-term benefits. In other cases it that a guy could do it. Yes, (since then) I have
may be better to introduce the change little by always believed that a guy can do it, as I knew
little over a longer period, making it possible Peter could. I believe that everybody can.”
for men and women to get to know each other,
What by the time seemed like a funny episode
thereby weakening possible sexual prejudices
has had significant implications for this woman’s
and stereotypical understandings.
understanding of women’s and men’s capacities.
why bother?
Finally, it is often assumed that integration
of women and men in work increases produc-
What is the point in avoiding resistance? Is it
tivity, that teams made up of both sexes are
worth the effort? Why not simply accept and
more efficient than other teams. This idea,
respect the employees’ wishes, adapt the change
following the managerial diversity argument, is,
to their points of view, and see to it that gender-
however, a matter of dispute. Available quan-
segregation is not challenged? First, adjusting
titative empirical evidence has been shown not
to the obstacles means delimiting the work tasks
to be very valid. On the other hand, no claims
included in the job enlargement and thus re-
are made that gender-integrated teams would
stricting the flexibility of the production process
be less efficient than gender -segregated teams.
as well as improvements to working conditions.
Further, the idea tends to come close to argu-
Second, integrating women and men means
ments about fundamental differences between
increases in equal opportunity.
women and men, giving rise to doubts among
Third, even modest changes are important
equal opportunity staff, feminists and gender
if they challenge the gender order, i.e. the sys-
politicians in general.
tematic division of the sexes and the subsequent
Nevertheless, even without this argument, it
subordination of women. Such changes make it
is obvious that integration of women and men at
obvious that gender is a social construct, thereby
work can be economically as well as democrati-
making other arrangements visible. A women
cally motivated.
worker recalls a gender challenging event that
took place decades ago, and which since has af-
fected her thinking:
496
8.6
Strategies for change and team work

Gunnar Broms
This chapter discusses the process of change and thus be felt to be more radical than the so called
the development of teamwork at the workplace, normal changes of production. In order to give
including strategies which encourage workers’ the process of change a new direction and to be
participation, the creation of supportive environ successful you need to create conditions where
ments for teamwork and methods of organisa by the employees of the organisation can be
tion for teamwork that can increase production convinced to become engaged and take an active
and learning. The chapter also emphasises the part in the process.
ways in which OSH can be developed during a An empirical study was made during the mid-
process of organisational change. 1990s of the effectiveness of their change strate
Before undertaking a process of change, it is gies in 69 Swedish organisations . The study
crucial to examine the culture, history and concludes that so-called Learning Change
current situation and challenges of an organisa Strategies are more successful in achieving effec
tion as the basis for all decisions. While all tiveness than Programmatic Strategies.
organisations are unique, much can be learned The learning change strategy was defined as
from the experiences of others and we can be in one driven by vision, based on communication
spired to adapt these to our specific conditions. between top management and employees. This
strategy involves different ways of sharing
participatory strategies of change experiences and problem solving both within a
Most industrial companies have realised that in function, between functions and between
order to compete both nationally and interna employees and management. Characteristic for
tionally they have to develop their production this approach is the active involvement of the
to meet the challenges of competition. Change whole organisation. A programmatic strategy
is nothing new. Production is constantly chang was defined as one driven by external examples,
ing. But what is sometimes needed in order to based on standardised concepts and methods and
meet new challenges is a break with the everyday carried out in formal projects involving experts
evolution of the production system. Change and having a demarcated focus.
might have to take another direction and will
497
Chapter 8.6
Many changes are started without putting them overall vision, and information about the activity
into the context of the company development should also be spread to those that are not
as a whole. This often leads to sub-optimisa directly involved. Such openness gives less room
tion, for example focusing on reducing the cost for speculation and misunderstanding, which
of maintenance, without looking into the con otherwise could easily impede the change process
sequences for the availability of the production or create resistance based on false premisses.
machinery. Another example is reducing cost
by reducing the number of product variations, how to go about implementing
which might lead to the loss of change
customers. Introducing new production concepts or other
A learning change strategy aiming at involv major changes is not easy. Changes are delicate
ing the personnel at all levels starts with the processes. They require mental readjustment on
development of a shared view of the needs of the the part of those involved. Many may feel uneasy
company. A shared view is achieved by involving and fearful. Experience has shown that change in
the personnel at all levels in the analysis of the industry needs to address two major aspects: the
current situation within the company regard technical or organisational aspect of the change
ing organisation, technology, efficiency, work and the acquisition of support and motivation
environment etc. The current situation then for the change within the organisation..
has to be related to the external demands on the First, what needs changing in production?
company and to a vision of the role of the com As technology changes, there is scope for sig
pany in the market. The company vision – often nificant gains through rationalisation. And not
expressed in documents such as the mission of just by making changes of a technical nature. An
the company – has to be transformed and com open-minded analysis highlights causes, effects
pleted into development targets accepted and and possibilities. How can technology, layout,
understood by the majority of the organisation. working methods and organisation support each
The targets should ideally incorporate the other in the best possible way? What does the
perspectives of customers, owner/s and employ production process and the market demand from
ees. Involving persons representing different the work force? Under what conditions can this
interests, knowledge and experiences in the work be done as efficiently as possible?
process of analysis and development is a good Secondly, how are management or project
way of ensuring that important perspectives are leaders to win the support of the workforce for
not overlooked. Furthermore, it is important the work involved in making changes? Active
to involve as many as possible in the organisa participation in the change process by those
tion during the process of change to give room concerned is important from a quality aspect.
for understanding and a more or less shared The quality of problem solving and develop
comprehension of the current situation and ment of ideas and solutions will increase when
the challenges. All this adds up to an excellent managers, technicians and workers use their
framework for change. With this platform, change know-how together. Furthermore, involvement
projects can be started focusing on relevant areas is a way to prepare the organisation for the
or aspects of corporate activities. Each project or change, which result in turn shortens the time
work of change should always be relatable to the needed for the process of change. Finally, it is
498
easy to understand that those who have been These methods have been used successfully in
given the possibility to take an active role in the Sweden and other countries. Projects carried out
change process are more disposed to accept and by participants in international training pro
support the change. Such participation also leads grammes provide evidence for this. For example,
to enhanced competence for coping with change a pharmaceutical company in Egypt reduced their
which in turn is a good foundation for increas production lead time by 10 percent; reduced the
ing the pace of future development within the number of production steps by 17 percent while
company. at the same time achieving radical improvements
So the two levels of change have to be com in the work environment such as reduction of
bined. No matter how technically sophisticated noise and dust and improvement of lighting
or clever changes in production or organisation conditions. In a steel plant in Ecuador, the man
might be, if those affected by the change do not ufacture of construction elements was increased
understand or believe in the advantages of the by 78 percent; the set-up time was reduced by 51
proposals, the results will fall short of expecta percent and material consumption was reduced
tion. by 57 percent.
The traditional one-way communication from
management to employees is not enough to Methods for change projects
win the constructive involvement and commit An illustrative model of the work shop is a practi
ment of the employees. A deeper involvement of cal tool to use when gathering a group of
workers and middle management in the process workers in order to discuss matters such as ma
calls for new, more pedagogic and creative ways terials handling, production flow, work environ
of communication and dialogue. It is therefore ment or work organisation. This type of scale
of crucial importance to look for a methodol model can easily be made from wood, plastic or
ogy that facilitates active participation by those cardboard, or a computerised three-dimensional
involved. Physical models, simulations, training illustration can be used. A model helps people to
programmes and brainstorming are some ex visualise problems and possibilities and changes
amples of tools that are efficient in visualising, can easily be illustrated or tested. The model is
clarifying and concretising matters that might a democratic tool which gives all participants an
otherwise be difficult to grasp. Such tools are equal opportunity to express their views without
also useful in order to facilitate the expression being trained to understanding flow charts or
and explanation by managers, technicians and complicated tables of information etc.
workers of their ideas and misgivings. However, Simulation is another efficient tool which can
these methods must be combined with genuine be combined with a physical model, to illustrate
commitment and a preparedness on the part of the actual production situation or ideas for im
project leaders and managers to listen, be provements, e.g. a group of workers can simulate
supportive and take action in order to see to it an event such as a production disturbance in
that ideas and solutions put forward are realised. order to get input for discussing boundaries of
The opposite is a situation where the partici responsibility or information flow.
pants feel like hostages in a process they cannot Both the above tools aim to access know-how
influence. and actively involve personnel in the process
of change. A discussion based on a model or a
499
Chapter 8.6
simulation often reveals obstacles or “hidden” team work – organising for

ideas held by participants and presents an excel efficient production and learning
lent opportunity for the project leader or man Teamwork has shown itself to be a successful
agement to take action and support such ideas. form of organisation, used in a great number of
Such action and support shows participants that applications aimed at improving production and
their involvement in the process of change is working conditions. The idea of teamwork, as
worthwhile because management is listening and defined here, is to integrate tasks such as planning
prepared to take action. and control in multi-skilled work teams, responsi
A change project constitutes an excellent ble for a defined production process. This type of
opportunity for learning. Working together to organisational model can achieve high flexibility
study problems or to create visions is a form of and an efficient, time saving decision-making
training for teamwork. If the formal and infor structure. Tasks such as maintenance, quality
mal borders of responsibility and control can control, testing, packing, delivery, material trans
be crossed during the execution of a project, ports, etc. could be assigned to the team.
they can potentially be abolished during normal This is obviously not achievable in one step.
production as well. During the project members While the formal change of the organisation
co-operate, express their opinions and ideas, can take place from one day to another, the real
present their findings to colleagues etc, all change of behaviour in the organisation takes
necessary and important skills for teamwork. place gradually over time. It is important to be
Project members become empowered as they gin with the formulation of a vision and a strat
are stimulated to take responsibility and initia egy as a basis for the teams to gradually take on
tives in order to solve problems or improve work new responsibilities or tasks as their competence
operations. A project focusing on a technical and experience grows.
change or improving the work environment or
designing a new work station, can thus, besides Advantages of team work
solving the problem, also be used as a good Flexibility – the members of the team cover dif
starting point for changing the work organisa ferent skills that enable them to manage new
tion. demands. Production bottlenecks can be solved
It must also be stressed that there are situations within the team. A team organisation is also less
where there is no room available for the in vulnerable to shortcomings of individuals.
volvement of personnel and where this learning
change strategy is not applicable. For example, Improved quality control – the team is responsible
a new production department might have to be for the output in terms of volume, timing and
planned before staff are even recruited. It is not quality. There is no need for time-consuming
always possible or efficient to involve all person and costly external quality control between each
nel operationally in the process of change, then production step. Instead, quality defects which
a model of representation could be applied. As cause problems for a subsequent production step
always there is no single methodology or strat lead to immediate feedback and corrective action.
egy to suit every problem or change process.
Continuous improvements – the solving of ob
stacles and the actions taken to reduce quality
500
problems are all part of the process of continu Resistance from middle management – middle
ous improvement that naturally emerges from management often feels threatened by the intro
the work of a effective team. duction of teams to which power of decision has
been assigned. Often the importance of involv
Efficiency – human resources and skills are used ing middle management in the change process
where they are most needed within the team. or assigning them new tasks is neglected.
That means that slack in terms of waiting time
for orders, material or maintenance at each indi Isolation – teams may grow very strong and self-
vidual step of production is used by the members sufficient, but while this is a positive effect of
of the team by taking care of any of the other team organisation, it may also cause problems.
tasks assigned to the team including administra It is essential, both during and after the change
tion, planning, maintenance or project work. process, to create contacts, facilitate interaction
and stimulate flexibility between teams as well
Potential for improved working conditions – team as between teams and support functions. If not,
work offers members the opportunity to do a teams may tend to optimise their own perform
greater variety of tasks, ranging from different ance, neglecting possible negative effects on the
manual tasks, control and supervision to admin overall performance of the organisation. The
istration and planning. Teamwork also affords a performance of the individual team must be
lot of social contact. In a team which functions subordinate to the interests of the whole organi
well there is a good balance between responsibil sation. Leadership plays a key role in this area.
ity and power of control. All the above factors
are important for good working conditions. The achievement of integration – resistance to the
formation of teams is common when employees
Difficulties and demands when from different hierarchical levels or groups that
introducing team work have not previously worked together, are re
The significance of the psychosocial work environ- quired to co-operate. Resistance to gender inte
ment – working in a team makes high demands gration is another common reaction that might
on the social skills of the members. Organisa be beneficial to deal with.
tions that move from a strictly hierarchical
organisation to a team-based structure, may ex the formation of teams
perience problems with individuals who hesitate The term “team” is used to describe many dif
to assume new responsibilities, take initiatives or ferent ways of organising work. At the shop
involve themselves in areas that were previously floor level a team is often made up of a number
beyond their responsibility or power. Individuals of workers grouped together to perform a par
within a team may feel unfairly pressured to per ticular function, e.g. to assemble a product from
form or assimilate (in the case of newcomers), various components. The team members rotate
leading to stress and heavy workloads for some between different manual tasks and can replace
individuals. These demands call for support and or help each other when necessary. This is an
regular assessment of the social functioning of improvement both from the work content as
teams. pect as well as from the aspect of flexibility and
disturbance handling at the production area.
501
Chapter 8.6
It is not, however, a significant change to the

Important prerequisites
distribution of power of decision and thus does
not fully exploit the potential that lies in an
organisational change. A more comprehensive • Balance between responsibilities and
definition of a team includes vertical integration decision-making powers delegated to
of work tasks, not only horizontal. For example, the team
a team responsible for the sub-assembly of a
product may also be delegated to do administra • Well defined assignment involving a
tive tasks such as planning, follow up, reporting, variety of inter-related tasks
ordering of supplies or maintenance. • Structure and principles for co-operation
Figure 8.6.1 summarises some important with other teams and external functions
prerequisites if team work is to succeed. The
creation of such prerequisites is in turn a process • A physical production and workplace
to reach and not a condition present at the start. layout that support team-work
Complete teams are teams to which have been • Complimentary skills within the team
delegated a complete process, a production as • Support from support functions (e.g.
signment. However, there are many names for planning, personnel, maintenance) and
such teams, including Process Teams, Complete management
Flow Teams, Cross-functional Teams or End-
to-end teams. The production assignment given • Clear and well defined targets at team
to the team is defined by describing the team’s level
expected output related to its clients, e.g. pro
ducing product x according to the demands of Figure 8.6.1.
the clients with a high service level and as cost- Checklist – covering some of the more important
efficiently as possible. aspects to be taken into account when forming
teams.
Supplier Client
Production Assign- Production Assign- Production Assign-
ment ment ment
Team 1 Team 2 Team 3
Figure 8.6.2. Serial production flow.
502
To fulfil such an assignment, a complete team upon between the team and the production
needs appropriate production equipment, hu management.
man resources and support functions. The team There is no fixed model for how to compose
needs to be sufficiently empowered to take re the teams. Each organisation and situation calls
sponsibility for the decisions and conditions that for its unique solution, reached through a
govern the process. Such responsibilities could process of discussion among all those that will
include internal co-ordination of the resources, be affected by the change. Some recommenda
the maintenance of its machinery, quality con tions, however, are to include responsibility for
trol, contact with clients and suppliers, adminis both manual and intellectual tasks within the
tration etc. For practical reasons, a team cannot assignment. The relation between what is per
control all the necessary resources they need as formed and taken care of within the team and
outside support and expertise may be needed, what is done by support functions should not
e.g. for training or technical support. However be static. On the contrary, a driving force and
this support should be engaged only when the constant challenge to the team members is to
team demands it. acquire knowledge and skills in order to take
One Production Assignment may have another responsibility for an increasing number of tasks.
Assignment as its client or supplier. The targets This gives the team members room for devel
of the team is regularly discussed and agreed opment and learning on the job. An assembly
worker may train to take care of quality assur
Management Targets
• Volume
• Lead time
• Quality
• Cost
Planning Reporting Co-ordination
Complete team
Suppliers Clients
Control Supervision Manual tasks
Personnel Technology/Maintenance Quality
Support
functions
Figure 8.6.3. Complete flow team.
503
Chapter 8.6
ance, a welder to plan the coming week in order to be met in the best way possible. Personnel
to reach the targets set up, etc. have through their participation during the
process gained experiences that improve their
What effects can then be achieved competence of change – this may well be one of
with complete teams? the most important skills in today’s ever-chang
The examples are multiple. In a Swedish truck ing production environment.
assembly plant the teams have reduced the over
all lead time considerably, the quality has im creating a supportive environment
proved and the man-hours put into the assembly for teamwork
of a truck has been drastically reduced in com If the vision of teamwork is to be stimulated and
parison to the traditional hierarchical and supported to become a reality in an organisa
horizontally divided organisation. What do the tion, the technical systems, layout and workplace
workers say? Well, no one would like to go back design, planning systems, training programmes
to the old way. On the contrary, today they are etc. must all be arranged appropriately. When
proud to be “truck-builders” and responsible for designing new plants or modernising existing
their team’s production result. plants it is vital to keep this view in mind from
In an electrical component manufactur the very beginning of the process. The tradi
ing plant in India production teams have been tional procedure is the opposite; the production
formed. This meant a radical break with the facilities are then designed solely from a techni
existing “rules” of management, based on strict cal point of view, with no thought for the organ
control through a strongly hierarchical organisa isational and work environment aspects.
tion. Teams are now responsible for a complete Teamwork cannot normally be introduced
assignment covering supply, welding, assembly without major changes to the production flow,
and quality control. The team is taking care of the shop floor layout and the workplace design.
its own planning and administration as well. Teamwork including intellectual tasks calls
The changes have been a success, resulting in for a supporting environment. For example,
significant improvements in productivity and machines might have to be grouped differ
quality. The changes implemented have instilled ently. The functional layout with machines in
a team spirit, with highly motivated team mem rows could be changed to complete production
bers eager to take part in further improvements. cells, U-shaped machine and assembly groups,
Women and men now work side by side and or similar ways of creating a layout supporting
have gained mutual respect for one another. communication and cooperation within the
This latter fact is, according to the manager, team. The team also needs an area for breaks,
perhaps the most important social effect of the meetings and administration, quality control
change. etc. It is not only the layout and production
A result no less important than the improved flow which have to be adapted: often the in
working conditions and production improve formation system has to be redesigned as well.
ment, is that the organisations mentioned in Team targets, set by the team and approved by
the examples above are now more prepared for management, have to be easy to follow, with
constantly changing demands. Changes are no key-figures that are easy to measure and evalu
longer seen as threats but as natural challenges ate. The team should themselves set the targets
504
and get them approved by management. The Inviting personnel to participate in the identifi
team should conduct its own follow up and the cation of problems and the creation of visions,
number of key factors should be limited. Com opens up the potential to discuss matters which
puterised information systems at company level concern individuals, such as health and safety.
are often unable to break down key factors to On the other hand participation is not guar
a level that can be used by a team so only data anteed to secure a good working environment.
that can be significantly controlled by the team Training, information and expert support is
should be measured and evaluated. important to assist personnel to evaluate their
work situation or to come up with solutions to
the process of change, occupational hazards, such as unhealthy ex
organisational development posure etc. A change process focused on improv
and osh ing the working environment is frequently an
A learning change strategy characterised by the excellent starting point for stimulating
active participation of broad groups of employ employees’ interest and participation in a
ees and the development of a team organisa process of change, as individual benefits are
tion has a great impact on the development of clear. Often too, the elimination of risks or the
the occupational safety and health within the improvement of ergonomics is directly linked to
company. It is not easy to combine rude ex production performance. A better place to work
ploitation, dangerous working conditions and is a paying proposition!
an unhealthy environment with participation.
505
8.7
A rewarding change – an example from India

Vimal Mahendru
Indo Asian is a medium-size electrical manufac- organisation of work prior

turing plant located in North India (a total of to the change
125 workers and 55 support personnel). While The manufacturing process was organised per
the company had been fairly progressive in its function, i.e. all power presses were located in
philosophy and policies, it continued to rely on one row, a separate spot welding section existed,
low-cost labour available in India to enable it the sub-assembly workers were sitting in one
being globally competitive. area, the manual assembly operators were in
With the opening up of the Indian economy one separate block and so on. In this functional
in 1990, the company witnessed increased com- layout of the workshop each function was far
petition in the domestic market, and embarked apart from the next one. The criterion used for
on an ambitious export program to counter the deciding shop floor layout purely concerned the
threat to its existing marketing base within In- ease of maintenance and common usage of utili-
dia. This increased the pressure on the company ties like process water, pneumatic lines, power
to improve its productivity, quality and competi- points etc.
tiveness on a global scale. Within each functional area each individual
The challenges of the new situation were met was permanently assigned to a specific machine,
with decisive changes to the work organisation doing a specific operation eight hours a day,
in a part of Indo Asian – basically a re-layout repetitively. Job rotation was neither considered
of the shop floor and flow management – and a nor thought of. Emphasis on supervision was
journey of change was embarked upon within heavy and the supervisor was expected to get
the Sub Assembly part of the company. Thanks maximum out of each individual. The supervi-
to the change work carried out, break-through sor’s role was to administer, manage and control.
gains were made. Initially, the project scope He was expected to plan for materials, man-
covered 31 of the 125 workers. Later, the scope power, job allocation, fixing of tool or machine
was increased to cover 47 workers and supervi- breakdown, managing all contacts and relations
sors. Some of the break-through gains will here with other departments, and even to authorise
be accounted for. the workers’ breaks for tea or hygienic needs.
507
Chapter 8.7
The employees were not expected to arrange breakers (one of the company’s main products).
raw materials, check quality, have any real Within each team, the location of each work sta-
administrative responsibilities or even to be tion or machine was such that its output became
concerned for their colleagues who may be on the input for the adjacent workstation. The
leave or may be absent. Employees had a low old practice of surveying and measuring each
team spirit and lacked feeling for their work individual or workstation output was replaced
and for their contribution. An employee was by a total team target as the focus and measure
only expected to utilise his/her skills (read: of productivity. Direct supervision was totally
hands) to convert input to output without ap- removed by re-designating the supervisor as
plying thought. Quality Assurance Trainer and he moved to a
separate Quality Assurance Team.
abandoning the functional layout
– introducing team work significant gains – tangible and
The functional layout was totally abandoned intangible
and work was instead organised into three teams The results of the development work have turned
producing three essential sub assemblies re- out to concern tangible economic gains as well as
quired in the manufacturing of miniature circuit intangibles. I will start with the latter.
Welding
Special Purpose Machines
Shop
Press Shop
Sub-Assembly
Area
Passage
Figure 8.7.1. The initial situation.
508
2-Bin
System
A l p ha Rack
Vacant
Press Shop
Facility
Coffee
Table
Vacant
p r a t ib ha
Passage
Figure 8.7.2. Proposed new layout.
A mini cultural revolution together to collaborate, co-operate and interact.

India is still a fairly conservative society. Women This led to a mini cultural revolution where
are increasingly becoming a part of the work women and men could sit together and discuss
force, but are sometimes only reluctantly accept issues on an equal platform. Here they received
ed by their male colleagues. One of the most recognition and respect from peers, something
significant and fundamental gains of the change which the women in particular might not have
process was men and women employees work- experienced before, even at home.
ing together. Traditionally, the social structure Gender bias, not least in the work shop-floor
promotes separate working environments for masses is fairly high. The change implemented
men and women. Under the old system of work within Indo Asian is an exception, and not too
there were no obvious problems, since men and many instances and places are visible where men
women worked independently of each other and and women are expected to work together as a
never needed to collaborate. Every individual, team in the production shop-floor. In fact, the
man or woman, was concerned only with his/her uniqueness of Indo Asian’s achievement lies in
own output with little or no need to interact the team work as well as the “gender-free” self-
with colleagues, especially of the opposite sex. governed teams that have evolved.
The changed system brought men and women
509
Chapter 8.7
Figure 8.7.3. Final layout.
Commitment and self esteem witnessed individuals actually thinking about the
Another strong impact of the change concerned work they were doing. This led to a far greater
the self-esteem of the individuals making up level of ownership, commitment and feeling of
the teams. Under the old practice, people were oneness with the organisation. Several of the
hired purely to carry out manual work tasks and team members mentioned that they were gener-
were never recognised for their ability to think, ally happier, because this reorganisation gave
plan or influence the outcome of their work. them an opportunity to express themselves and
In the new system the individuals started to manage their work roles themselves, rather than
be governed by the team’s internal rules. In being dictated to at all times.
fact, even the revised layout was a direct out-
come of their inputs and efforts, rather than an Quality, productivity and safety
external “expert” or an “engineer’s” master plan. In line with corporate objectives, we also wit-
The team members decided who would do nessed tangible gains in terms of quality, produc-
which operation, at what time and to what ex- tivity and production output. For example, in
tent. This challenged their ability to think and production rejections came down from 2.3 per
come up with solutions. For the first time, we cent to 0.7 per cent. Production output of the
510
sub-assembly team was raised from 7,000 sub- contemplating evolving end-to-end teams
assemblies to 9,000 without any increase in which may take charge, not only of the sub-as-
manpower; and with no supervisory overheads. semblies, but of entire product manufacturing.
The monetary savings were substantial. There An apparent hindrance is the current use of two
was also a significant improvement in other conveyor lines for the final assembly process.
factors like absence and work-related injuries. The conveyors very much support the func-
Absence in the teams has fallen to negligible, tional layout and thus make team work difficult.
while in other departments, where the teams The challenge for Indo Asian is to evolve teams
have not been formed, it remains at 3.5 per cent. around these conveyors, and ensure that the
One minor injury was reported in 2000, and gains achieved by these developing self-gov-
two minor injuries in 2001. Prior to the change erned teams are further multiplied. The chal-
process, there used to be about 6 minor injuries lenge is also to take the experiences from one
on average every year, with one major injury to plant on to the other three plants of our com-
an operator in 1995. pany. In total the Indo Asian Group employs
1,200 employees in its four manufacturing plants
entering the future with and sales offices.
competence for change The change process has resulted in a company
Today, the company has further evolved the with committed teams and individuals who are
teams into a flow-managed layout. The team carrying on with the good work, and are seeking
layout has in addition been made part of the out ways of further development on their own.
final assembly area, and now we are seriously
511
chapter 8.1 Nilsson, T (1996). Lean production and white-

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One of the standard books in work organiza- through transforming work methods.
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Taylor, F W (1911). The principles of scientific
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management. Engineering & Management
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Press.
years old, many of the modern organization
Taylor is regarded as the ‘father’ of the scien-
strategies have their take-offs in Deming´s
tific management, and has had an important
ideas. A useful handbook if you are going to
influence on the design of production system,
develop an organization.
and the MTM system. By his ideas the pro-
Ishikawa, K (1985). What is total quality conductivity increased remarkably. On the other
trol? Prentice-Hall, Englewood Cliffs. hand, he has been blamed for creating alien-
Ishikawa is not only the ‘father’ of the ‘fish- ating jobs, and also work methods causing
bone diagram’ to identify and analyse possible musculoskeletal disorders.
causes to problems in production and else-
where. He was also a very important person in chapter 8.3
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explains his ideas, still used all over the world social construction of reality. A treatise in the so-
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introduction and insight into concepts such
Abrahamsson, L. (2002). “Restoring the order:
as teamwork, Total Productive Maintenance,
Gender segregation as an obstacle to organisa-
Kanban, Kaizen, 5S, Manufacturing Cells and
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Fransisco.
tial of improved competitiveness hidden in
Blomqvist, M. (1999) “How Organizational most organizations. Today´s managers tend to
Change Influences Gender Segregation in the express that their personnel is their most valu-
Workplace” American Journal of Industrial able resource. However, they give very little
Medicine, Supplement 1. evidence of what this means to their way of
Date-Bah, E. (1997) “Introduction” in Date- organising work. Pfeffer´s reasoning is based
Bah, E. (ed) Promoting Gender Equality at on experiences and studies from USA but is of
Work. Turning Vision into Reality. London: Zed interest and valid to most organizations. The
Books and ILO. book is recommended for those that would
like to have some facts, evidence and insight
Hammer M. & Champy J. (1993) Re-engineer- in the theory and practice of empowerment
ing the Corporation. A Manifesto for Business and the importance of creating the relevant
Revolution. London: Brealey, London. conditions for the work force to contribute to
the overall performance of the organization.
514
9
Age, gender and migration
9.1 Child labour 517

9.2 Gender and work 533
9.3 Migrant workers 551
9.1
Child labour
Bahira Lotfy
what is child labour?

The term child and child labour has different The worst forms of child labour include children
legal and common usage meanings in different of any age below 18 years who are involved in
countries and even within a country. The ILO’s forms of slavery and forced labour. For example,
minimum age convention sets a basic minimum forced recruitment for use in armed conflicts,
age for employment of 15 years. Light work is commercial sexual exploitation (prostitution or
allowed at 13 years and hazardous work is pro- pornography), illicit activities (particularly the
hibited until 18 years. Child labour, as defined production or trafficking of drugs), and hazard-
by IPEC (the International Programme on the ous work that jeopardises their lives, health or
Elimination of Child Labour) excludes the ac- morals. With the exception of hazardous work,
tivities of children 12 years and older who are these “worst forms” are defined by other con-
working only a few hours a week in permitted ventions and are consequently referred to as
light work and those of children 15 years and “unconditional worst forms”.
older whose work is not classified as “hazardous” The ILO set out the criteria for identifying
(IPEC, 2003). hazardous work of child labour, as work that
Child labour as defined above is a narrower might expose children to:
concept than “economically active children”. It
is estimated that in 2000 there were 186 mil- • Physical, psychological or sexual abuse
lion child labourers below the age of 15 years in • Work underground, under water, at danger-
the world, with 110 million below the age of 12 ous heights or in confined spaces
years. There were 246 million child labourers in
• Work with dangerous machinery, equipment
the 5–17 year age group. On average, more boys
and tools, or which involves the manual han-
are employed than girls, both in absolute and
dling or transport of heavy loads
relative terms.
Child labour is generally speaking, work for • Work in an unhealthy environment which
children that harms them or exploits them in would expose children to hazardous substanc-
some way (physically, mentally and morally, or es, agents or processes, or to temperatures,
by blocking access to education), however, there noise levels, or vibrations which might dam-
is no universally accepted definition. age.
517
Chapter 9.1
Child trafficking is defined as children under the Children in the export economy
age of 18 years recruited in one place and then Although it was concern about children in de-
moved to another, (sometimes across borders), veloping countries producing cheap exports
to be subjected to commercial sexual exploita- for the industrialized world that fuelled public-
tion or forced labour or servitude. ity about child labour in the 1990s, the export
economy involves a relatively small proportion
where do children work? of working children under 15 years. No accurate
data is available, but about 5 per cent, some 10
Children in the rural economy
million children, are thought to be involved in
More children work on farms than in any other producing either agricultural commodities such
form of work. The ILO’s survey in 2000 indi- as cocoa, coffee, rubber, sisal, tea and tobacco or
cated that 70 per cent of the world’s working manufactured products for export.
children were engaged in agriculture, fishing,
hunting or forestry. This reflects the domi- “Invisible” child workers
nance of the rural economy in many developing Many working children are virtually invisible to
countries. Some only help out on a family farm outsiders, as they work in the privacy of people’s
at peak times when there is a need for manual homes. Most of these workers are girls. There is
labour, such as weeding and the harvest. still no accurate estimate of the number of child
domestic workers worldwide but a recent assess-
Children in the informal economy ment suggests that 700,000 girls are involved in
Most of today’s urban working children can be such work in Indonesia alone. The various terms
found working on the streets rather than in fac- used to refer to these employees reflect differ-
tories. Some children live on the streets, having ent attitudes towards them: “domestic servants”,
left or lost their families. Others earn their living “maids” or “household helps”. The organiza-
there, hawking food, drinks and a whole range of tions campaigning on their behalf generally refer
other products, carrying everything from some- to them as “child domestic workers” to avoid
one’s shopping to crippling loads, running to derogatory terms such as “skivvies”, even if some
and fro at their employer’s orders. By definition, of the children involved are treated as slaves
the informal economy is unregulated: whatever – unpaid, working long hours and not allowed to
labour laws and regulations apply in the for- leave their employer.
mal economy, such as in factories and the civil
service, are not observed and little attempt is “Home workers”
made to enforce them. This applies both to laws Some children who work in their own home are
governing a minimum age for employment and simply helping out with household chores while
those covering health and safety at work. The others are participating in a family business,
millions of children living and working on the such as helping to run a shop after school. While
streets around the world come into this category, children working in their own homes are in an
as do many apprentices sewing and hammering environment that ought to protect them against
away in small workshops. harm, some are nevertheless exposed to exploita-
tion or hazards.
518
Child labour
Routinely, laws concerning child employment population aged between 5–17 years is estimated
do not apply to children working at home in a at 352 million children. Estimates show that
family business. Consequently there is a danger there are no significant gender differences in the
that families and employers avoid the terms of global incidence of children at work. In both the
the law by claiming that children are working 5–9 and 10–14 year age brackets, boys and girls
for their own family when this is not the case. are equally likely to be engaged in economic
activity. Children at work in economic activity
Global dimensions of child labour is a broad concept that encompasses most pro-
ductive activities by children, including unpaid
Currently more than 350 million children, aged
and illegal work as well as work in the informal
from 5 to 17 years, are at work. They can be
economy.
differentiated on the basis of their age, the ef-
fect that working has on their basic rights and,
Age Total Children Work
in particular, the extent to which their work group population economi- ratio (%)
causes them harm. More than 140 million of (in millions) cally active
the total are old enough to be working under 5–9 600 73 12
international standards. However, almost half of 10 – 14 599 138 23
these children (60 million) – suffer harm because 15 – 17 332 150 42
they are involved in the abuse of the “worst Total 1531 361 23
forms” of child labour, from which they should Figure 9.1.1. Global estimates of economically
be protected. The remaining 80 million, in both active children ages 5 to 17 in 2000.
industrialized and developing countries, have
reasonable jobs. Out of the 211 million working Regional distribution
children under 15 years of age, more than half The Asian-Pacific region has the largest number
(120 million), are involved in the “worst forms”. of child workers in the 5–14 year age category,
When older adolescents are also taken into ac- 127 million in total. It is followed by Sub-Saha-
count, this means that almost 180 million young ran Africa with 48 million and Latin America &
people below 18 years, (1 in every 12 children in the Caribbean with 17 million. Developed and
the world), are currently involved in the “worst transition economies have the lowest absolute
forms”. The vast majority of these children, numbers of child workers. In relative terms,
more than 170 million, are engaged in work that Sub-Saharan Africa has the highest propor-
is hazardous, posing a health risk and, in some tion of working children estimates showing
cases, even threatening their lives. that almost one child in three below the age of
15 years is economically active. The ratio of
Children at work in economic activity working children inother regions of the world
It is estimated that in 2000 there were some 211 are all below 20 per cent. It is 19 per cent in
million children aged 5 to 14 years working in Asia-Pacific, 16 per cent in Latin America & the
economic activity. This accounts for a little less Caribbean and in the Middle East and North
than one fifth of all children in this age group. Africa, it is 15 per cent.
About 73 million working children are less than
10 years old. The total economically active child
519
Chapter 9.1
Region Number of children Work Unconditional worst form of child Global

(approximated in ratio (%) labour estimate in
millions) millions
Developed econo- 3 2 Trafficked children 1
mies Children in forced and bonded labour 6
Transition economies 2 4 Children in armed conflict < 0,5
Asia and pacific 127 19 Children in prostitution & pornography 2
Latin America and Children in illicit activities 0,5
Caribbean 17 16 Total 9
Sub-Saharan Africa 48 29
Middle East & North Figure 9.1.3. Estimated number of children in un-
Africa 13 15 conditional worst forms of child labour. Source:
Total 210 18 ILO Bureau of Statistics, 2002.
Figure 9.1.2. Regional estimates of economically
active children ages 5–14 in 2000, based on ILO
Bureau of Statistics, 2002. Industry (major division) Both Boys Girls
Sexes
Children in hazardous work Agriculture, hunting, forestry
and fishing 70.2 75.8 57.2
In 2000 an estimated 171 million children aged
Mining and quarrying 0.5 0.5 0.4
5–17 years were estimated to work in hazard- Manufacturing 4.7 4.3 5.6
ous situations or conditions. In other words, Electricity, gas and water 0.1 0.0 0.1
children in hazardous work constituted about Construction 2.9 4.1 0.3
Wholesale and retail trade,
half the total number of economically active
restaurants and hotels 13.4 8.3 25.7
children with more than two thirds of those Transport, storage and com-
in child labour. A stunning 55 per cent of very munication 2.6 3.8 negligible
young child labourers, (i.e. those below 12 years Financing, insurance real es-
tate and business services 0.0 0.0 negligible
of age), were already working in a hazardous
Community social and per-
occupation or situation. Boys outnumber girls sonal services 4.9 2.5 10.2
in hazardous work across all age groups. Seen in Unspecified industries 0.6 0.7 0.6
relative terms, among all children, about half of Figure 9.1.4. Distribution of Injuries/illnesses by
the working boys were in hazardous situations industry and sex. Source: ILO Bureau of Statis-
as compared with a little more than two in five tics, 1997.
working girls.
Children in unconditional worst forms of
main characteristics
child labour: In addition to the number of chil-
of child labour
dren in hazardous work, it is estimated that
there were about 8.4 million children involved There are wide variations in the types of child
in other worst forms of child labour as defined in labour, some harmful and some not. Indicators
ILO Convention No.182, Art. 3. This includes that should be taken into account to determine
trafficking (1.2 million); forced and bonded whether work has a negative impact on chil-
labour (5.7 million); armed conflict (0.3 million); dren’s development include working conditions
prostitution and pornography (1.8 million); and (e.g. hours of work, exposure to physical haz-
illicit activities (0.6 million). ards) and other risks and abuse to which working
520
Child labour
children may be exposed (e.g. psychological and countries do so because they and their families
social adjustment risks, prostitution, and child need the extra income. Many end up doing
slavery). unpaid work for their employers in exchange
Long working hours are often responsible for board and lodging. In contrast, children
for fatigue that can cause accidents, and impair in industrialized countries seek work for quite
intellectual development. Some studies con- different reasons, usually to establish financial
sider that 20 hours of work per week is a critical independence from their parents. The reasons
threshold beyond which education starts to be children work can be divided broadly into “sup-
significantly affected. Many children work under ply” and “demand” factors.
exploitative conditions that apart from totally
precluding schooling, have harmful effects on What pushes children into work?
their physical condition and mental health. For Poverty
example, the working conditions of child gar- The main reason why children start work in-
bage pickers clearly increase the risk of diseases stead of attending school, or leave school before
and disability through exposure to lead and mer- completing their primary education, is that their
cury, heavy lifting, and the presence of parasites. families are poor and cannot pay the basic costs
Children in agriculture are more likely to be of food and housing without their children earn-
adversely affected than adults by climatic expo- ing. But the reasons why families are poor vary
sure, heavy work, toxic chemicals, and accidents enormously; some are global, some are national
from sharp tools and motorized equipment. and some are historic. Some adult workers are
Domestic service is primarily undertaken by not paid enough to support their families; the
girls and is one of the occupations that can cause wages from both parents incomes are not suf-
serious psychological and social adjustment ficient to keep their family housed, clothed and
problems. Such child workers typically live away fed. However, it is also common to find families
from home and routinely work long hours, often in which one or both parents are not earning
in almost total isolation from family and friends. anything, maybe because a parent has died or
A 1987 WHO report found that psychological left home, or because adults are unable to get
stress, premature aging, depression, and low work. Sometimes employers prefer to employ
self-esteem were common symptoms among children, because they are more obedient and
young household helpers. cheaper than adults. Alongside families where all
Children are particularly vulnerable to acci- the children are expected to work and earn their
dents since they are often unaware of danger or living from a young age, there are others where
necessary precautions to be taken at work. Safety just one or two children work to earn money to
equipment designed for adults often does not fit enable another sibling to attend school. Around
children, and tools and equipment designed for the world, the details vary but the story is the
adults are difficult for children to handle. same. There is not enough money for families
to survive without some or all of their children
why do children work? working. Children are viewed as a beneficial
There are many reasons why children are re- economic resource by both their parents and the
quired to start work when they are too young or developing country in which they reside. Strug-
to do hazardous work. Children in developing gling parents choose to rear children because
521
Chapter 9.1
they believe that they will be able to substan- laws, which are enforced, making it compulsory
tially contribute to the household income. Some for all children to attend school until a minimum
developing countries insist on child labor be- age. In most parts of the world, gender is also a
cause of lower labor costs, and argue that devel- crucial factor: girls are discouraged from staying
oped nations’ opposition to child labor is only an at school beyond puberty (and are sometimes
attempt to eliminate economic competition. withdrawn much earlier) and are propelled into
Poverty, birth control and child labour are adulthood much younger than boys, through
interlinked. Large families have many mouths work or an early marriage. In some countries,
to feed and are often poorer. Younger children school is a threatening place for teenage girls,
from large families are more likely to work and where they are at risk of sexual harassment from
less likely to attend school. The poverty cycle is male classmates and teachers, and sidelined by
perpetuated by teenage pregnancy, and teenag- prejudice and poor curricula. Many are kept at
ers who send their own children out to work due home or drop out of school simply because they
to low household income. are girls.
Children may be forced to work to directly
increase family income for subsistence, but they Discrimination against minority groups
are also used as reserve income providers. Some children also leave school and start work
earlier than others because of their origin or
Family breakdown identity. In Latin America, indigenous children
Families break down for many reasons, leav- start work earliest. In South Asia, the caste
ing the household short of income. Sometimes system determines that children from low status
divorce leaves one parent looking after more dalit families or adivasi (tribal or indigenous)
children than she or he can afford to feed. Di- communities start work first or do not attend
vorce is sometimes brought about by domestic school at all. In southeast Europe, it is children
violence, which also directly drives children to from the Roma minority. In each case, a combi-
leave home when they are still young. The death nation of supply and demand factors are at work:
of either parent precipitates economic disaster the communities concerned feel that the school
for many households. Families also lose their system was not designed for them and consider
livelihoods as a result of natural disasters and it normal for children to abandon school early to
human crises that leave people destitute and begin working.
force children to start earning.
Inadequate laws
Attitudes to girls More than 130 countries have signed an interna-
All around the world, children belonging to tional convention saying that children may not
particular social groups leave school and start work full-time before 15 (or, in some cases, 14)
work earlier than other children in the same years of age. However, in some of the countries
country. In industrialised countries the obvious concerned, relevant laws are confusing, vague
differences are based on wealth and social class: or not enforced. There are particular difficul-
children from poor families start work several ties when laws are inconsistent, e.g. when one
years before their peers in rich households. In law dictates that children must remain in school
these countries, however, there are likely to be until they are 12 years of age, while another
522
Child labour
decrees that they may not start work until aged because there is no access to schools, e.g. be-
14. Such inconsistencies are highly likely to cause of distance or absence of a school. Schools
put children into the labour market before they in many developing countries suffer from prob-
reach the legal minimum age. lems such as overcrowding, inadequate sanita-
tion and apathetic teachers. As a result, parents
Poor infrastructure may find no use in sending their children to
Another factor is the practical difficulty of cor- school when they could be home learning a skill
rectly establishing a child’s age in countries lack- (e.g. agriculture) and supplementing the family
ing the infrastructure for systematic birth regis- income. A number of factors help explain the
tration. This can disadvantage children in many failure of formal education systems to cater for
ways. Law enforcers are hampered because they the needs of children engaged in child labour or
lack the means to establish the age of children. at risk.
Young people without appropriate documenta- Structural factors, under-development and ex-
tion may also be denied access to state services treme regional poverty make children’s school-
such as schooling. ing an impossible option for destitute families.
In some circumstances social norms or cultural
The role of education attitudes towards education may favour work
Children who receive little or no school educa- over schooling, turning the necessary into some-
tion miss out on knowledge that can create op- thing virtuous and beneficial to the child.
tions for them later in life. Without education, Education in poor regions tends to be of low
people are less able to contribute as adults and quality with inadequate support for teachers,
are more vulnerable to exploitation and abuse. lack of infrastructure, training and teaching
Non-attendance at school is consequently both a aids, and conservative attitudes among teachers
cause and effect of child labour. The importance and decision makers in the education system. In
of education for a society’s economic and social most countries, industrialised and developing
development is widely acknowledged. How- alike, there is often a complete divide between
ever, even countries that have made an explicit ministries responsible for education and those
undertaking to send every child to school still dealing with social protection, including child
have to do a great deal to turn this commit- labour.
ment into reality. The shortcomings of existing It is difficult to enrol child workers in the
school systems remain a major factor that pushes educational system without substituting the
children on to the labour market when they are lost income from their work. This can be done
too young. Sending children to school does not by payment of the indirect costs of education
come without a cost. In many countries, parents (books, shoes, etc), providing free school meals
still pay a fee for their children to attend primary linked to participation in classes, offering sti-
school, as well as buying books and providing pends, or by supporting income generation op-
school uniforms. For poor families these are sig- portunities for adult members of the family.
nificant costs in addition to lowering of house- In certain countries, there is a notion that
hold income when a child is at school. educated women will not fit into their traditional
Schooling problems also contribute to child roles by choosing not to be a wife or mother.
labour. Some children seek employment simply Because of this notion, daughters are raised to
523
Chapter 9.1
accept the traditional role of executing house- public’s acceptance of corporal punishment to
hold duties. Such ethnic practices restrict the beat their child workers as a means of control.
females’ education and promote child labor. In the country with the largest number of
Parents in developing countries often assign child labourers in the world, India, adults justify
different roles to their children (“child speciali- the involvement of children in certain jobs on
zation”), which may increase the number of the grounds that only they have the “nimble
working children. This phenomenon involves fingers” which enable them to give special atten-
certain siblings going to school while others tion to detail. Some sorts of work, they argue,
work. Rapid rural to urban migration is the cannot be performed by adults.
cause for the increasing rate of child labour in
urban areas of developing countries. Families why are children especially
leave severe poverty and terrible working condi- susceptible to environmental
tions in agriculture in order to search for eco- hazards?
nomic opportunities in cities, opportunities that Children and adolescents may be exposed to
often do not exist. Over the last 40 years, this many work-related hazards that can result in
movement has been huge. In 1950, 17 percent injury, illness, or death. About 100,000 young
of the population of the developing world lived people seek treatment in hospital emergency
in urban areas, increasing to 32 percent by 1988. departments for work-related injuries each year.
By the year 2000 it is estimated that this pro- The rate of injury per hour worked appears to
portion had increased to 40 percent and will be be almost twice as high for children and ado-
at 57 percent by the year 2025. Such increases, lescents as for adults, about 4.9 injured per 100
coupled with worsening economic trends, force full-time-equivalent workers among adolescents,
children and their families into urban poverty. compared with 2.8 per 100 full-time-equivalent
workers for all workers. The industries with the
Why do employers want child labour? highest injury rates for young workers are retail
The relatively low wages paid to children are stores and restaurants, manufacturing, and con-
often a reason why employers prefer them to struction.
adult workers. Some children work unpaid, Many of the industries that employ large
particularly as domestic workers, in conditions numbers of children and adolescents who are
that would be denounced as “slavery” if they young or inexperienced have higher than aver-
involved adults. Employers find children more age injury rates for workers of all ages because
obedient and easier to control. Unlike older young workers do not receive adequate health
workers, they are unlikely to initiate protests or and safety training at work.
form trade unions. It is also easy for adults to Health and safety hazards in the working
intimidate children. Employers can force child environment can be related to the nature of the
workers into submission when the children are work, e.g. hazardous processes, to their expo-
dependent on them for food, lodging and even sure to hazardous substances and agents or to
emotional support. In most parts of the world, it exposure to poor working conditions. Chemical,
is still considered acceptable for parents to beat physical, biological and psychological hazards
their children. Employers take advantage of the are often combined in the workplace and syner-
gic interaction can magnify adverse effects that
524
Child labour
may also be cumulative. It is not easy to isolate an environment in which they are denigrated or
one single source or cause of an occupational oppressed. Physiological differences influence
hazard. the amount of a chemical that is absorbed into
Children are susceptible to all of the dangers the body. Children have a greater surface area to
faced by adults in the same situation. Survival body weight ratio than adults, which may lead to
and physical integrity are as important to chil- increased dermal absorption.
dren as to older people, however, work hazards Children’s tissues, organs, and biological sys-
affect children even more than adults. Children tems are still developing, with several stages of
are not just “little adults.” Their biological sensi- rapid growth and development occurring from
tivity, exploratory behaviour, and diet are very infancy to adolescence. This rapid development
different from that of adults, making children and immaturity of body organs and systems
particularly vulnerable to environmental expo- predisposes children to potentially more severe
sures. consequences within certain age ranges and
Children differ biologically from adults in windows of vulnerability.
their anatomical, physiological, and psychologi- Another factor that can influence a child’s
cal characteristics. These differences make them vulnerability is that circulatory flow rates are
more susceptible to occupational hazards. Their generally higher in children, which may increase
biological sensitivity varies by population, ethnic a child’s susceptibility to toxic effects.
group, age, and genetic makeup but these vari- In addition to the physical and physiological
ations are not usually taken into account during changes, children experience profound psy-
environmental exposure assessments. The child’s chological changes as they mature. As a result,
metabolic reactions, (the body’s way of process- a young worker may be assigned to a task for
ing and excreting toxic substances) are not as de- which he or she is emotionally or cognitively
veloped as those of an adult. Children are espe- unprepared, or unable to correctly judge their
cially biologically sensitive due to differences in ability to complete an assignment safely. The
the pathways of absorption, tissue distribution, adult pattern of afternoon sleepiness is first seen
and the ability to bio-transform. in children about halfway through puberty. Yet
Health effects can be more devastating for the adult pattern of a reduced need for sleep
children, causing irreversible damage to their (8 hr per night) is not observed until sometime
physical and physiological development, result- after the age of 18. Current laboratory research
ing in permanent disabilities, with serious conse- suggests that children younger than 18, and per-
quences for their adult lives. For example, carry- haps older, require approximately 9 hr of sleep
ing heavy loads or being forced to adopt unnatu- per night. Heavy part-time work schedules may
ral positions at work can permanently distort result in inadequate sleep, fatigue, and increased
or disable growing bodies. There is evidence risk of injuries while working or commuting.
that children suffer more readily from chemi- Most child workers don’t have the opportuni-
cal hazards and radiation than do adults, and ty to go through the normal stages of childhood
that they have less resistance to disease. They development or to develop meaningful relation-
are much more vulnerable to psychological and ships with family members, friends and other
physical abuse and suffer more devastating psy- people in their community. They do not get the
chological damage from living and working in opportunity to play, to be spontaneous or to get
525
Chapter 9.1
an education. Most children who work are not international convention

allowed to express their feelings or needs. Lack on child labour
of training and supervision may increase the risk From the first international child labour con-
for work injuries and illnesses among children vention in 1919, which saw working children
and adolescents. Children are especially vulner- in terms of wage employment in formal-sector
able to accidents because they lack awareness of manufacturing, the world’s position on child
the dangers and knowledge of the precautions to labour has evolved and expanded. Non-indus-
be taken at work. Children and young workers trial work by children is now addressed. Most
tend to have more serious accidents than adults. recently, any kind of work, paid or unpaid, that
When speaking of children it is necessary is injurious to children, is prohibited and safe-
to go beyond the relatively limited concept of guards and protections for children who work
“work hazard” as applied to adults, and expand have been proposed.
it to include the developmental aspects of child-
hood. Because children are still growing, they recent developments
have special characteristics and needs that must
In the last decade, several large international
be taken into consideration when defining work-
conferences focusing on child labour have
place risks. If child workers are generally more
brought together representatives of govern-
vulnerable to work-related hazards, very young
ments, workers, employers, and Non Govern-
children and girls are even more so. Children
mantal Organisations (NGOs) from industri
who start work at an early age have a longer pe-
alised and developing countries (Stockholm
riod of exposure to cumulative hazards. In cer-
1996, Amsterdam 1997, Oslo 1997). A number
tain enterprises, children are hired because adult
of regional meetings and conferences were also
health has already been compromised.
held during this period resulting in a variety of
agendas of action to combat child labour.
legal framework
In the spring of 1998, over 1 400 NGOs
Child labour in the formal sector has been con- around the world showed their concern for the
trolled to some degree by legislation so child plight of child workers by supporting the his-
labour is most prevalent in the informal and toric “Global March Against Child Labour”.
rural sectors. A lack of enforcement of labour This march travelled for six months through
restrictions perpetuates child labour in a variety more than 60 countries across Africa, Asia, Eu-
of ways. For example, in developing countries rope, and the Americas. The goals of the Global
the number of enforcement officials is low as March were to raise awareness about child la-
survival is the most immediate priority. bour issues; to urge governments to ratify and
There are also inconsistencies in legislation enforce laws protecting children and providing
that may pose problems. In some countries, them with education; to demand the immedi-
including Costa Rica, Thailand, and Sri Lanka, ate elimination of the most exploitative forms
the minimum working age is lower than the of child labour; to promote positive actions by
required age of compulsory education, giving employers and consumers; to ensure the proper
children access to employment before they have rehabilitation of child labourers, and to mobilize
even completed the minimum years of school- greater national and international funding to
ing. support education for all children.
526
Child labour
ILO’s Conventions and Recommendations regarding child labour

Serial No. of convention Name of Convention
Minimum Age
C. 5 (1919) Minimum age (Industry)
C. 59 (1937), revised Minimum age (Industry)
C. 7 (1920) Minimum age (Sea)
C. 15 (1921) Minimum age (Trimmers and Stokers)
C. 58 (1936), revised Minimum age (Sea)
C. 10 (1921) Minimum age (Agriculture)
C. 33 (1932) Minimum age (Non-industrial employment)
C. 60 (1937), revised Minimum age (Non-industrial employment)
C. 112 (1959) Minimum age (Fisherman)
C. 123 (1965) Minimum age (Underground Work)
C. 138 (1973) Minimum age
R. 41 (1932) Minimum age (Non-industrial employment)
R. 52 (1937) Minimum age (Family undertaking)
R. 96 (1953) Minimum age (Coal mines)
R. 124 (1965) Minimum age (Underground work)
R. 146 (1973) Minimum age
Night Work
C. 6 (1919) Night Work of young persons (Industry)
C. 90 (1948), revised Night Work of young persons (Industry)
C. 79 (1946) Night Work of young persons (Non-Industrial occupation)
R. 14 (1921) Night Work of young persons (Agriculture)
R. 80 (1946) Night Work of young persons (Non-Industrial occupation)
Medical Examination
C. 16 (1921) Medical Examination of Young Persons (Sea)
C. 77 (1946) Medical Examination of Young Persons (Industry)
C. 78 (1946) Medical Examination of Young Persons (Non-industrial occupations)
C. 124 (1965) Medical Examination of Young Persons (Underground work)
R. 79 (1946) Medical Examination of Young Persons
Others
C. 182 (1999) Worst Forms of Child Labour
C. 152 (1979) Occupational safety and health
C. 138 (1973) Minimum Age
527
Chapter 9.1
action to be taken to eliminate to act. A growing popular movement against

child labour abusive labor practices in general has been ac-
A worldwide a movement has emerged to put companied by a new understanding of ways in
an end to child labour in all its manifestations. which the problem of child labor can be tackled
Child labour is at the top of the agenda of a effectively and sustainably.
number of international organizations. National The approach of the ILO’s constituents -gov-
governments in a growing number of developing ernments, employers, and workers- has been to
countries, supported by the ILO, are formulat- work on the basis of partnership and trust at the
ing action programmes to tackle child labour. community and production levels to build within
NGOs in both the South and North are active countries the commitment to sustainable action
on this front. There is a growing awareness for the elimination of child labor.
among consumers and the public that child In 1999, a key instrument in this struggle
labour is unacceptable. Child labor is a pervasive was approved, Convention 182, which commits
problem in today’s world, but it is not a hopeless countries to take immediate action to prohibit
one. and eliminate the worst forms of child labor.
The evidence is clear that when individuals Over the past six years, 153 countries have rati-
make a commitment, when communities mobi- fied it, making it a national commitment and
lize, when societies come together and decide now the most rapidly and widely ratified con-
that child labor is no longer acceptable, great vention in ILO history.
progress can be made toward the goal of ensur- During the same period, there has been an
ing that children are not denied a childhood and impressive increase in ratifications of Conven-
a better future. However, it’s tough going. tion 138, the minimum age convention that was
Building consensus -and bringing real adopted in 1973. This convention states that the
change- remains an immense challenge interna- minimum age for work should not be less than
tionally, nationally and in the families and com- the age for completing compulsory schooling
munities where child labor exists. The common and sets a number of minimum ages depending
sense objective is to provide kids the opportunity on the type of employment or work.
of a sound education and parents a fair chance A growing number of countries have sought
at a decent job. This is an economic issue for the ILO’s help to take effective action against
countries and families, but it is also an ethical child labor. The ILO’s International Program on
one. The fight against child labor is ultimately a the Elimination of Child Labor (IPEC), which
battle to expand the frontiers of human dignity was founded in 1992 with six participating coun-
and freedom. tries and major funding from Germany, has now
Since its foundation, the ILO has stood expanded to include operations in 80 countries
against the scourge of child labor. In recent funded by 30 donors including employers’ and
years, through our work and collaboration with workers’ organizations.
many committed individuals and institutions, we Around the world, people are joining a grow-
have seen a sea change in attitudes toward child ing community of conscience to act. A genuine
labor. Denial and indifference have given way worldwide movement against child labor has
to acknowledgement, outrage, and a readiness emerged. Child laborers themselves are mak-
ing their voices heard, for example, through
528
Child labour
grassroots movements such as the Global March The international community must back the ef-
against Child Labor. Young students are mobi- forts of countries willing to take comprehensive
lizing in solidarity. steps through development cooperation pro-
New alliances are emerging among employ- grams, access to markets and policy advice that
ers’ and workers’ organisations, government they receive from international organizations.
agencies, and civil society organisations. These
alliances have taken sector-specific action in eliminating child labour
several multinational industries -such as to- integral to ilo agenda
bacco and cocoa growing, and the manufacture Eradicating child labor is an integral part of the
of sporting goods- in which the strengths and ILO’s agenda for the world of work called the
advantages of ILO’s tripartite partners and civil Decent Work Agenda, which seeks to promote
society reinforce global efforts to combat child opportunities for all women and men to obtain
labor. decent and productive work, in conditions of
In addition, 19 countries are now involved in freedom, equity, security and human dignity.
programs to end child labor within a specified This development framework is centered on
period. These are foundations on which to build stimulating the investments that create the op-
but much more needs to be done across the portunities for productive work; with standards
board. and rights at work, social security, health protec-
We need to match national and international tion and safety nets and voice and representation
decisions with greater development cooperation for working people. The effective abolition of
targeting the reduction of child labor. We must child labor is one of the principles at the heart of
sustain the international and national debates our agenda. We promote decent work because
and awareness-raising efforts; identify and map when you ignore the quality of work for parents,
hazardous child labor in different sectors and you open the door to child labor.
situations; build institutional capacity to deal Every country in its own circumstances can
with child labor at all levels; and put in place ef- define a reasonable threshold below which no
fective, independent and credible inspection and family should fall. Decent work is not a universal
monitoring systems. standard, not a minimum wage. ILO conven-
The problem of child labor cannot be solved tions, which are ratified voluntarily by each
in isolation. Projects alone are not enough. country, constitute a sound social floor for work-
Where poverty breaks up families, economic and ing life.
social policies must come together to help pro- We can take heart that already there has been
tect the dignity of family life. a great deal of progress achieved in knowledge
For example, free, compulsory quality educa- and experience, as well as an impressive world-
tion up to the “minimum age” -which varies wide movement to combat child labor. The
depending on the country and nature of the global challenge remains daunting, but I believe
work- for entering into employment is a key ele- that, working together, we can meet our com-
ment in the prevention of child labor. But, with mon goals: decent work for parents, quality
budget restrictions everywhere, many countries education for children, and real opportunity for
can’t afford to do so. young people.
529
Chapter 9.1
Eradicating child labor truly is a moral cause and removed from work are helpful, but can be
a societal challenge. If we summon the will to costly and difficult to sustain. They need to
do it, we can bring hope to children all over the form part of larger development programmes.
world and affirm the inalienable right of every • Positive economic incentives are preferable
child to have a childhood. to negative ones, because the latter can have
unintended effects that are not always in the
• Any attack on child labour must be com- best interest of the child.
prehensive and advance on several fronts • Economic policies that generate equitable, la-
simultaneously. Prevention, removal and bour-absorbing and poverty-reducing growth
rehabilitation are the three cornerstones of a are as important as integrated social policies
multi-pronged strategy. and practical programmes of action. Fiscal
• Affordable and accessible primary education policies which provide adequate funding for
of good quality is the centrepiece of any strat- basic social services while maintaining a stable
egy to eliminate child labour. macro-economic environment are essential to
• Legislation which clearly sets out the mini- sustain such growth.
mum age for entering employment must
form the backbone of any strategy against The main lesson that can be derived from ex-
child labour. Legislation alone will, however, perience so far is that child labour is not an
achieve very little unless it is accompanied insoluble problem. Given the political will on
by adequate enforcement mechanisms and the part of governments and the mobilization of
by effective action to improve the availability sufficient public support, much can be done to
of relevant and affordable education and to reduce the extent of child labour and the harm
provide poor families with alternative means that it does to children. At the national level
of survival. this political commitment should be reflected in
• Social mobilization is key to the success of national legislation and plans of action for the
any strategy. Concerted action by all actors child, including strategies for the eradication of
is not only vital for finding lasting solutions, child labour and to ensure the necessary re-
but it also fulfils the precondition for success, source allocation for their implementation on a
namely that the combat against child labour is sustainable basis. International actions should be
first and foremost a matter of changing at- mainly in support of national actions.
titudes. Awareness raising can lead to remark- Even though the complete elimination of
able changes in attitude on child labour. child labour is a long-term goal, practical steps
• Integrated and multi-sectoral social policies should be taken now.
and area-based approaches, which maximise First, the world community and individual
the complementarity between health, educa- countries need to show their commitment to
tion and population policies, and minimise giving top priority to the elimination in the
the family's dependence on the child's income shortest possible time of the most intolerable
contribution, are critical to the elimination of forms of child labour – slavery-like practices
child labour. including sexual exploitation, forced and bonded
• Measures that support or compensate par- labour; labour that is particularly hazardous or
ents for the loss of income once the child is
530
Child labour
detrimental to the education, health and devel- Fourth, it should not be forgotten that to attain
opment of children. the urgent goal of removing all children from
Second, wider legal protection can play an particularly extreme forms of child labour within
important role in protecting children, both to the shortest possible time will require a massive
prevent unlawful work and to ensure that legal investment in protection and rehabilitation
safeguards are provided for those who work in schemes, for which additional resources will
conformity with international standards. Three need to be mobilised. As with any welfare-ori-
sectors – agriculture, the urban informal sector ented approach based on transfers, the sustain-
and domestic service – account for the vast ma- ability of positive economic incentives proves
jority of child labour in the world, and present a problem. Incentives will therefore have to be
serious enforcement difficulties. They are the combined with employment and income-genera-
sectors which national governments most often tion activities for the parents of child labourers,
exempt from minimum age standards. National with a goal of reducing the family's dependence
legislation needs to address the situation in these on their children's contribution to household
sectors. National governments should also har- income. Given that the costs of proper rehabili-
monise existing legislation (state and local) on tation measures can be quite high, there is scope
minimum age for access to employment with for international agencies and donors to join
that relating to the completion of compulsory hands in supporting governments in the removal
education. It is also essential that national leg- and rehabilitation process.
islation prohibits all child labour under 12 in Fifth, the design and implementation of pro-
all sectors of activity. The enforcement of na- grammes for the withdrawal of children from
tional legislation could be made more effective the most extreme forms of exploitation, and of
through improved national systems for birth plans for preventing children from entering the
registration and collection of information re- labour force will require the commitment and
garding the scale, distribution and characteristics involvement of large sections of the population,
of child labour. including the children and their parents them-
Third, the elaboration of a time-bound pro- selves. Social alliances against child labour need
gramme for the elimination of child labour and to be built, and a national authority designated
for achieving free, universal compulsory primary with the necessary power and influence to act
education should be given priority by govern- effectively.
ments. Once a developing country is committed Sixth, international cooperation will need to
and determined to eliminate child labour, donor be strengthened in one other important respect
countries can demonstrate that their concern as well - namely to combat the trafficking and
with child labour is not only motivated by pres- commercial exploitation of children in prostitu-
sures from domestic consumers and economic tion and pornography. International agreements
interests, but that they are prepared to support need to be developed to facilitate the detection,
the elimination of all forms of child labour – and prosecution and punishment of those responsi-
not only those involved in export industries. ble for these particularly repulsive acts, and co-
International development assistance for basic operation among national police forces and law
education has been very limited in the past. enforcement agencies needs to be encouraged.
531
Chapter 9.1
Much has been achieved in the past few years in nothing inevitable or irreversible about child
raising the awareness of world public opinion, labour. Great hopes and expectations have been
of governments and of powerful interest groups aroused. The challenge is now to ensure that
to the scandal of child labour, and in deepening these hopes and expectations are not disappoint-
understanding of its causes and consequences. ed and that a brighter future awaits the world's
It is now increasingly recognised that there is children.
UNICEF (1999) The State of the World’s Chil- Information on the International Programme on
dren. New York: UNICEF the Elimination of Child Labour:
UCW Workshop Report: Good Practices in www.ilo.org/ipec
Combating Child Labour, Perrin, Burt (2003) www.billingsgazette.com/index.php?tl=1&displa
www.childinfo.org y=rednews/2005/02/21/build/world/33-childla-
bor.inc
www.worldbank.org/ lsms
www.ipsnews.net/interna.asp?idnews=28491
UNICEF, Guidelines for Protection of the
Rights of Children Victims of Trafficking in
Southeastern Europe, May 2003, available at
www.seerights.org
532
9.2
Gender and work

Hanna Westberg
gender issues in a global incorporated into the structures of society. This

perspective invisible influence is manifested in fundamental
Rapid changes connected with globalisation, values that for example result from unexpressed
internationalisation, new technology, market notions that exist in our surroundings and that
orientation, political reorientation and accelerat- we carry with us, often throughout our lives.
ing transformation have ended in tremendous Thus the sexual division of labour is maintained
changes on the labour market with many dif- through socialisation but above all through
ferent types of working conditions as a conse- invisible influence processes.
quence. The point at which work-related problems
The lack of power and material resources, will be legally accepted depends on the current
traditional gender roles and norms, stand in social climate and is related to historical and cul-
the way of development, as is evident in most tural factors in society including attitudes toward
parts of the world. Unequal power structures men and women. Societal values and preconcep-
for women and men constitute an obstacle to tions are changed by new messages expressed
economic growth and democratic development. through the transmission of “know-how”. These
Equal opportunities for women and men to own transmissions contain more or less hidden mes-
land and assets, to earn money and to participate sages and processes that affect society. Knowing
in working life, are essential for sustainable and this is important for understanding working
democratic development. As a larger proportion conditions for men and women and their rela-
of women than men live in poverty, efforts to tionship to health in different countries, differ-
reduce poverty are inseparable from aspirations ent classes and social groups.
to greater equality between men and women. World Health Organisation (WHO) defines
Gender is interwoven with everything. Femi- gender as follows:
ninity and masculinity are constructed through
invisible influence to which the person is ex- “Gender refers to the socially constructed roles,
posed in the family and in institutions, influ- behaviour, activities and attributes that a par-
ence which permeates everything from school ticular society considers appropriate for men and
to organizations and the media and which is women. The distinct roles and behaviour may
533
Chapter 9.2
give rise to gender inequalities, i.e. differences and training. In workplaces with as many women
between men and women that systematically as men in the same occupations, the women
favour one group. In turn, such inequalities can often perform different tasks, which most of the
lead to inequities between men and women in time are classified differently in terms of status
both health status and access to health care.” and pay. The work women perform is almost
always valued lower.
Gender segregation in the labour market is In many situations, we stare blindly at the idea
highly complex and appears on all levels. In that if only the numbers of women within an
practice the labour market is divided – horizon- occupation, organization, company, board of di-
tally and vertically and even within an organi- rectors or in the government etc. become more
sation. Horizontal segregation is when women equal, then gender segregation will decline and
work in certain occupations and industries and society will become more equal. But the values
men in others. When women are employed at and processes that result in occupations becom-
lower levels in organizations than men, this is ing gender-marked and gender-segregated do
known as vertical segregation. Internal gender not change especially when more women enter
segregation is when women and men are em- what was previously a clearly male-dominated
ployed in the same occupation (and in some cas- area.
es by the same employers) but carry out different Gender segregation is not synonymous with
work functions. This means that an apparently gender marking – a process that renders an occu-
gender-integrated occupation may actually be pation typically female or male. If a society can
highly gender-segregated in practice. Generally deal with gender marking, gender segregation
speaking, there is a man’s world and a woman’s will fade away. Notions and ideas about what is
world, worldwide. There are several occupations feminine and masculine legitimize the placement
where women strongly predominate and others of women and men in different occupational cat-
where men predominate. Vertically, there is a egories or the same occupational categories, but
hierarchical division with men found to a greater with the content differently defined. This leads
extent in the higher managerial positions and to notions that “female” qualifications and quali-
women in lower positions. This is so regardless ties differ from “male”. The gender structure
of whether men or women are in the majority in of the workplace is underpinned by the kind of
the occupational field. generally shared perceptions of which require-
A look at the official statistics for the distribu- ments are posed by various jobs and by notions
tion of the labour force by area of work in any of which skills are possessed by women and men.
country always shows a more or less skewed dis- Such qualities do not necessarily come from the
tribution. Women are more often overqualified individual; they may also be associated with what
for their job and have less influence over their a particular job attributes to the individual, such
work organisation and content than men. Wom- as power, status and pay. Gender segregation is
en also generally have a greater degree of mo- the process in which women and men end up in
notonous, repetitive motion in their work. Oc- different types of occupation, so that two differ-
cupations where women are in the majority have ent types of labour market may be said to exist,
lower status than where men predominate, even female and male. Gender marking and gender
if the occupations require equivalent education
534
Gender and work
segregation interact, and are determined by the weighted by population when the global and
social structure of gender. regional averages are produced to analyse trends.
So gender marking takes place by a process in When the overall index scores have been
which the qualifications and characteristics of calculated the index is bound between 1 (equal-
an occupation become associated with gender. ity) and 0 (inequality). The equality and inequality
This gives us an idea of which gender a person norm remain fixed across time, allowing readers to
should have for a particular job. Gender marking track an individual country’s progress in relation
becomes apparent when you associate a certain to an ideal standard of equality. The index scores
occupation with a man and another occupation can be presented as a percentage value revealing
with a woman. In theory, gender segregation how much of the gender gap a country has closed.
may be seen as a result of gender marking of Thus when the gender gap is closed (total equal-
qualifications, characteristics, occupations and ity is reached) the index reads 100% and when the
work functions. However, there is interplay gender gap is wide opened (total inequality exist)
between the gender-segregated society in which the index reads 0%. E.g. Oceania has closed over
we live and the gender-marking process, one 70% of the gender gap, which leaves it about
result of which is that the conditions that lead to 30% short of total equality between women and
gender marking change over time. men. Western Europe and North America. Latin
America and Eastern Europe have closed 67% of
Global gender gap their Gender Gap. Sub-Saharan Africa and Asia
The World Economic Forum has constructed have closed approximately 63% of their gender
the Global Gender Gap. This is an index de- gap and the Middle East and North Africa re-
signed to measure “gender-based gaps in access gion comes last, having closed approximately
to resources and opportunities in individual 58% of its gender gap. All examples mentioned
countries rather than the actual levels of the have to do with the overall index. The different
available resources and opportunities in those subindexes are measured in the same way. Thus
countries”. It is constructed to rank countries the gaps between women and men in average
by their gender gaps, not by their development with regard to economic participation and op-
level. For example, the index reveals the size of portunity and political empowerment are wide:
the gap between male and female enrolment only 58% of the economic outcomes gap and
rates, but not for the overall levels of education only 14% of the political outcomes gap have
in the country. There are four critical areas: been closed.
According to the Global Gender Gap index
– economic participation and opportunity
the 128 countries covered, representing over
– political empowerment 90% of the world’s population, are close to
– educational attainment eliminating the gap between women and men’s
educational attainment and health and survival
– health and survival. outcomes: almost 92% of the educational attain-
ment outcomes gap and 96% of the health and
Awareness of the challenges and opportuni- survival outcomes gap. The difference between
ties may serve as a catalyst for change, in both women’s and men’s health has increased some-
high- and low-ranking countries. All scores are what in the past few years.
535
Chapter 9.2
So what kind of information do we get from the particularly at country level. Health statistics
health gap measure? The differences between for recent decades present a profoundly unequal
men’s and women’s health are measured through picture, with improved health in a large part of
two variables. One has to do with the gap be- the world, but at the same time a considerable
tween women’s and men’s healthy life expect- number of countries not improving at all and
ancy, calculated by the World Health Organiza- some even losing ground.
tion. This measure consist of “an estimate of the
number of years that women and men can expect Gender paradox
to live in good health, by taking into account the One part of the gender gap health and survival
years lost to violence, disease, malnutrition or index is, as mentioned above, “an estimate of
other relevant factors”. The other variable has to the number of years that women and men can
do with the sex ratio at birth, which is presumed expect to live in good health”. A lot has been
to capture the “missing women” a phenomenon written about the so-called globally widespread
existing in countries where sons are valued more gender paradox in health. The gender paradox
highly than daughters. means that women are considered to require
The nature of health problems is changing. more health care and report more sickness than
One problem has to do with ageing. Another men while generally living longer. One tentative
problem stems from urbanisation and globalisa- explanation of women’s lower mortality has been
tion, which are resulting in worldwide transmis- that they are biologically more robust, and men’s
sion of diseases. The health system is not isolat- higher mortality has been ascribed to lifestyle
ed from the rapid changes due to globalisation. factors, psychosocial factors and health-report-
The health statistics used in the gender gap ing behaviour.
index are thus estimates made by the World However, there are reasonable explanations
Health Organisation (WHO). In an article about for this paradox. Gender differences in life ex-
Health Statistics, the authors stress that there is pectancy, for example, are largely influenced
a rapidly growing need for better health statis- by environmental and behavioural factors. The
tics. A new international partnership, the Health health problems that women report often relate
Metrics Network, was launched in May 2005, to non-fatal conditions, such as muscular pain,
which hopefully will result in improved statistics depression, sleeping problems, chronic fatigue
and health information on all levels. The prime etc. You may as well invert the interpretation.
concern is to strengthen country HIS develop- Instead of interpreting women’s higher con-
ment in a way which may help to improve both sumption of medicines, visits to doctors and sick
the quality and quantity of health statistics. leave as indicators of health problems they could
Being the leading body in health statistics instead be interpreted as factors that protect
has its problems, due to the political pressure women from more serious disorders.
to which WHO’s figures are subject. Another It is possible to link the gender paradox in
problem is that WHO often has to base its es- health to sex marking and gender segregation.
timates on poor-quality country-level data pro- Men and women are raised to act and react dif-
vided by its Member States. To ensure accuracy ferently, so it is reasonable that this also should
and transparency of health statistics, WHO has apply to work-related health.
improved its approach to producing estimates,
536
Gender and work
Informal and formal work ing home-workers), and unregistered or unde-

The labour force participation rate is not easy to clared workers.”
estimate. It is not only that the estimated statis-
tics from different countries come from differ- The formal and the informal parts of the econo-
ent, non-comparable sources, but in addition the my are often dynamically linked. Many informal
informal sector/economy plays a major role in enterprises have production or distribution rela-
many of the developing countries. Nowadays the tions with formal enterprises and many formal
term used most of the time is informal economy, enterprises hire wageworkers under informal
as the work done within the informal economy employment relations through contracting or
includes, not just one sector but several. The in- sub-contracting arrangements. Some countries
formal economy seems to be swallowing most of exclude informal employment in agriculture
the increasing labour force in the urban areas of in their estimates of informal employment and
countries with high rates of population growth some countries include agriculture.
or urbanization. Entering employment in the When agriculture is included the proportion
informal economy is often a way to survive in of informal employment increases significantly.
countries with no unemployment insurance, no Figure 9.2.1 shows total employment and from
pensions or low wages. some of the developing parts of the world infor-
Globalization is probably another reason for mal employment with agriculture excluded.
the growth of informal employment in many Women’s share of informal economy employ-
countries. Global competition opens up oppor- ment worldwide is between 60 and 80%. Ac-
tunities for formal firms to hire workers at low cording to ILO “there is a link – although not
wages with few benefits or to subcontract the a perfect correlation – between working in the
production of goods and services. informal economy and being poor”. This stems
In a publication from ILO the definition of from the circumstances already mentioned (lack
informal economy is: of labour legislation and social protection cover-
ing the informal economy workers), and from
“In the expanded conceptual framework the in- the fact that workers in the formal economy
formal economy is seen as comprised of informal earn, on average, more.
employment (without secure contracts, worker
benefits, or social protection) both inside and
outside informal enterprises.
Informal Employment in Informal Enterpris-
es (small unregistered or un-incorporate enter-
prises), including: employers, employees, own
account operators, and unpaid family workers in
informal enterprises.
Informal Employment outside Informal En-
terprises (for formal enterprises, for households,
or with no fixed employer), including: domestic
workers, casual or day labourers, temporary or
part-time workers industrial outworkers (includ-
537
Chapter 9.2
Men Women Total Informal Men’s informal Women’s infor-

employment employment mal employment
as percentage as percentage as percentage
of non-agricul- of men’s non- of women’s
tural employ- agricultural non-agricultural
ment employment employment
WORLD 79 53
Developed Economies & 69 53
European Union
Central & South-Eastern 70 50
Europe (non-EU)
East Asia 82 67
South East Asia & the Pacific 83 59
South Asia 82 36
Asia 65 65 65
Latin America & the Caribbean 80 52
Latin America 51 48 58
North Africa 76 26 48 49 43
Sub-Saharan Africa 86 63 72 63 84
South Africa 51 44 58
Middle East 78 33
Figure 9.2.1. Labour force participation rate (%); source ILO.
India as an example unpaid helpers. The highest representation for

In India the proportion of informal employment women within formal employment is in educa-
increased from 89% to 92% of total employ- tion, scientific and research service sector.
ment between 1989 and 2005. The first macro A large section of the Indian population is
analysis investigation reveals that the female involved in informal employment and there are
work force constitute 26% of the total labour sectors which have more of informal employ-
force, almost all of them (92%) occupied in ment than others. Apart from the usual agricul-
informal employment, including helpers or ture and livestock-related work, the researchers
unpaid workers. 36% of the total female work find that work in textile production, wood and
force is casual agricultural workers and 36% is wood products, other manufacturing, manufac-
unpaid helpers. Among the male workers, 22% ture of miscellaneous metal products, construc-
are casual agricultural workers and only 12% are tion, and combined services also has a substantial
538
Gender and work
informal share in production. The proportion occupational safety and health of

of informal worker in sectors like agriculture, men and women
construction, mining, manufactured food prod-
Gender and health
ucts, wood products and leather is higher than
that of formal workers. There is also evidence of The female share of total world employment
poorer households being more numerous within was 40% in 2006, which makes women indis-
the informal than in the formal economy. pensable contributors to national economies.
National Commission for Enterprises in the Un- However the women’s proportion of the world’s
organized/Informal Sector (NCEUS) stated in poor and working poor is increasing. It is esti-
August 2007 that the majority of the informal mated that women make up at least 60 per cent
workers were economically vulnerable. There- of the world’s working poor and as long as there
fore a suggestion of great importance is to are inequalities in labour markets, women will
formalize, for example, caring work, i.e. unpaid find it harder than men to escape poverty.
care of the elderly in the home, from non-mar- Women’s visible presence in paid employ-
ket work to market work, which would lead to ment, formal as well as informal economy em-
welfare benefits. Social policy intervention such ployment, has motivated reflections on the one
as higher investment in rural infrastructure or hand as to how their health should be protected,
education or health would really increase wom- and on the other hand as to how gender affects
en’s labour participation, which probably would their health related to work. Women and men
lead to an expansion of their market participa- commonly perform different tasks, work in dif-
tion, which in turn would cause value added tax ferent sectors and in different positions. A lot of
to rise. A higher value added base would lead to women work in the informal economy in domes-
a higher source of taxing and this would suc- tic work and street vending. Many work from
cessively help raise funds for social sector, thus their homes. Globally, women suffer more from
starting a possible good cycle for the less privi- job insecurity, limited possibilities for training
leged women. and promotion, and low or no social benefits
In India informal employment is a larger (e.g. insurance, sick leave).
source of employment for women than for men. Health and ill-health in a population develops
This is true of almost the whole developing through interaction between different social,
world. Home-based workers and street vendors economical and medical conditions. Thus the
are two of the largest sub-groups of the informal reasons for gender differences in health are com-
workforce and in these two sections the majority plex and have to do with biological and cultural
are women. Taken together they represent an as well as social and structural factors. By struc-
estimated 10-25% of the non-agricultural work- tural factors is meant, on a global level, factors
force in developing countries and over 5% of the such as power, influence and access to resources.
total workforce in industrial countries. Sometimes the differences in ill-health are re-
ferred to two main categories: the biological,
emphasizing the body, and the socio-cultural,
emphasizing behaviour and living conditions.
It is important to take into account both modes
539
Chapter 9.2
of explanations simultaneously; neither mode of separately for men and women. This is to get
explanation will be sufficient in itself. knowledge about women and men separately,
It is necessary to use a holistic perspective but when using the data, e.g. when designing
when looking at gender differences in health and workplaces, you have to regard the data jointly.
ill-health and to consider the interplay between Health problems are related to workplace
the biological sex and the socio-cultural gender. variables that are different for each sex. Women
The concept of health should be understood in and men are often found in different occupa-
this wider perspective. Social structures includ- tions but also when they are supposed to have
ing legislation, and power-conditions in work- the same occupation their job-tasks often differ.
life have a crucial bearing on where the line One result of the separated labour-market is
is drawn between health and ill-health. In an that in many occupations there are significant
economic situation of shrinking resources, the differences between the tasks women and men
economical and social factors will be of critical perform, and this naturally leads to their expe-
importance for both the definition of the term riencing different problems related to the work
health and the use of it. environment.
A gender perspective should be integrated
with occupational health, so as to ensure that Are health issues gender neutral?
work is safe and healthy for both men and Biological differences between men and women
women, taking into account their social, psycho- are usually discussed from an average point of
logical and physiological characteristics. When view. The biological differences between men
consideration of women’s family roles is inte- and women are closely linked with perceptions
grated, it may also be necessary to make a differ- of what is normal. When a woman doesn’t cor-
ent definition of a risky work schedule, in order respond to the norm she is sometimes con-
to include roles making it particularly difficult to sidered abnormal for her gender. Her other
combine work and family. properties are also suspected of being more
When considering women in health and like those of the average man in terms of both
safety work questions, relevant questions to men personality and sexual characteristics. Depend-
should be considered at the same time. For ex- ing on the division of power between men and
ample, in the case of weight and size, differences women, the characteristics associated with men
between persons of one sex are much greater may be seen as more important, more valuable,
than those between men and women. Therefore or simply more normal.
if you make work and work-tools better adapted Biological differences are sometimes seen as
to women, in many cases you also make them synonymous with genetic differences. In other
better adapted to men. A discussion is ongoing words, if men and women produce different
about the way of collecting statistical data that hormones in response to stress some people
will give us the best information about both may conclude that this is necessarily an innate
women’s and men’s situations. When collecting difference. Actually many biological differences
data, adjusting statistically for gender instead of are derived from the environment. Hormone
analysing data separately for women and men, secretion can, for example be affected by stress
limit information on the entire population. Less or illness.
information loss will result if you analyse data
540
Gender and work
According to socio-biological theories female- the knee joint, the two protruding section on
ness (femininity) is of biological origin and the femur (thighbone), are closer to each other
maleness is looked upon as being the norm. in women than in men. Women, therefore, are
This type of theory makes woman a prisoner of more liable to suffer injuries to the cruciate liga-
her biology. On the other hand, socially con- ments in their knees.
structed femininities and masculinities confirm Sex hormones are different in men and wom-
the thoughts that govern our understanding of en. Both men and women have testosterone, the
morbidity, treatment strategies and individual male sex hormone. However, after puberty the
patients experiences. Biological preconditions level of testosterone remains the same in women
and differences cannot be evened out, but there but rises in men. In women oestrogen and pro-
is no rational reason to label male or female bio- gesterone vary cyclically in both quantity and
logical characteristics as either better or worse. relative proportion. This occurs throughout the
It is useful to describe the differences between day. Each sex hormone affects the way men and
men and women so as to take account of such women feel psychologically.
differences, whatever their source may be, in Women and men’s reproductive systems
the design of workplaces, the establishment of differ. Women menstruate, become pregnant
training programs and the setting of standards. and nurse children, and these processes may be
Furthermore, the biological differences play a affected by work-place exposures; for instance,
role in gender-specific patterns of ill health in prolonged standing can affect birth-weight and
the workplace. some chemicals may produce malformations.
Men are on average taller, larger and heavier Women worldwide are very aware of their pat-
than women, contributing to sex differences in a tern of menstruation and how it affects their
number of other important health-related vari- lives. For the great majority of women, men-
ables such as average blood volume and oxygen struation is a “natural” process that presents
consumption. The same physical load may exert few difficulties but perceptions of menstruation
greater strain on the average woman than on the vary in different cultures. These perceptions
average man, since lifting 20 kilos for an average may be positive or negative. Menstruation may
man is equivalent to an average woman lifting be experienced as characterizing femininity,
about 12 kilos. This is calculated from women’s fertility, youth, or purification of the body, yet
average muscle strength being 60 to 70% that of at the same time it is also linked with vulnerabil-
men. Arm muscle strength for women is esti- ity and pollution, and with attitudes of disgust
mated at 50% of men’s. However, the difference and shame. In some societies, menstruating is
for horizontal pushing and pulling is smaller, connected to religious and social traditions or
and there is considerable overlap in size, shape taboos. This is the explanation why menstrua-
and strength between the sexes. Both the differ- tion not only should be looked upon as a physi-
ences and the degree of overlap are important, ological process but also has social, cultural and
e.g. when designing tools so as to minimize psychological implications. The experience of
repetitive strain injuries in both sexes. bleeding is characterized from two different
The human skeleton is structured differently points of view; one from the woman’s actual
for men and women, e.g. the knee joints do not experience and the other from her position as
have the same structure. The epicondyles in a member of society which has attached certain
541
Chapter 9.2
meanings to menstruation, The interaction of unwise to presume that an average sex difference
these two elements determines the woman’s at- applies to all or even most individuals in a popu-
titude to menstrual bleeding. lation. The percent of fat varies in both sexes
WHO report that physical symptoms during according to age, physical fitness and training.
menstruation are reported from all parts of the Exposures at work often differ by gender. All
world but changes in temper are not reported over the world, men and women work at dif-
from all countries. Women in developing coun- ferent tasks. An example from the developing
tries who reported temper changes did not re- countries is in agriculture where women may
port them as pre-menstrual but rather as some- be exposed more often to pesticides indirectly
thing happening in the beginning of the men- during planting and harvesting and men directly
struation. Thus the conclusion was that you have during application.
to pay attention to how you produce conscious Women and men are exposed to different
or unconscious bias through how statements are physical and psychological stressors such as
valued and through assuming that a special con- repetitive work, heavy lifting and monotony.
dition exists. For example, in Zimbabwe when Women are the majority of health care-workers,
vocational and non-vocational educated women exposed to risks of infection (including needle-
were asked about their menstrual experiences, stick injuries), violence, musculoskeletal injuries
they mentioned the hush-hush and the nega- and burnout. Women usually suffer discrimina-
tive attitudes around menstruation as a problem tion, mobbing and harassment more often than
whereas women in the industrialized countries men, especially if they enter male-dominated
often refer to premenstrual problems. The men- occupations.
strual cycle or the notion of menstruation may Although not many psychological differ-
cause discomfort or concern for the employee ences between women and men have been dem-
as well as skilled and unskilled female workers onstrated scientifically, it has been suggested
have to face discrimination from employers on that men usually have higher self-esteem and
the grounds of gender and physiological factors confidence and that women are more emotion-
including menstruation and childbirth. ally expressive.
Men produce sperm, and this process is very Men’s and women’s hormone responses to
sensitive to exposure to chemicals, vibration and stress are similar, but the way stress is experi-
radiation. enced may be different. The concentration of
Absorption of solvents in blood may vary be- adrenalin, noradrenaline, cortisol and other
tween men and women. Women’s skin is thinner stress hormones can be measured after differ-
and more permeable to substances it comes in ent stress situations using urine and blood sam-
contact with. Blood levels for chemical substanc- ples. In a study by Frankenhaeuser it was found
es vary between men and women since more of that female white-collar workers had higher
the chemicals can be stored in women’s larger noradrenaline, levels while at work. The wom-
subcutaneous fat. Therefore it has been hypoth- en’s noradrenaline levels rose at the end of the
esized that the average woman is at greater risk workday when they had to rush home to another
of harm from fat-soluble chemicals because of important responsibility. For male white-col-
this higher proportion of fat tissue, thinner skin lar workers, the concentration of noradrenaline
and slower metabolism. True or not, it would be fell at the end of the workday. Other studies
542
Gender and work
have shown that when the external source of studies show that women are at particular risk.
stress has the same value for men and women The nature of the work women perform, low
the differences in their reaction patterns disap- paid, low status such as domestic work, service
pear more or less. The conclusion made was that work, helpers, and high-risk occupations such
when women and men achieve more similar oc- as nurses, teachers and social-workers expose
cupational roles and take equal responsibility for women to high risks of violent behaviour in the
the home and childcare they will react similarly. workplace. The informal economies hide a lot
Knowledge of the health effects of working of work-related accidents and violence at work.
conditions in developing countries is sparse A great deal of violence against women happens
because of the lack of systematic research. in the family and many women in the informal
However, it is well known that most women in economy work in domestic work or as helpers in
developing countries still take on very heavy the family business.
physical work in the household and outside it. In 1993 the United Nations General Assem-
Women are responsible for providing water and bly adopted the Declaration on the Elimination
fuel for domestic consumption. These activities of Violence against Women, which is defined
involve heavy loads and walking long distances. as “any act of gender-based violence that re-
Given the current image of women’s work is sults in, or is likely to result in, physical, sexual
so simple, easy and harmless, it is important to or psychological harm or suffering to women,
educate the public about the fact that women’s including threats of such acts, coercion or arbi-
work often involves health risks. In addition, the trary deprivation of liberty, whether occurring
large proportion of women in precarious jobs in in public or in private life.” In a UN fact sheet
the informal economy, and in the economic free from 2006 it was stated that:
trade zones, as well as the increasing gender gap
in wages must be made visible. ”Violence against women takes many forms
In developing countries, effective workplace – physical, sexual, psychological and economic.
health and safety regulations often do not exist, They are interrelated and affect women from
or if they do they are not enforced, especially before birth to old age. As societies change, pat-
in the informal economy where many women terns of violence alter and new forms emerge.
work. New methods and strategies are needed Some forms of violence, such as trafficking,
to encourage stakeholders to implement these cross national boundaries.
regulations on low-level jobs. Such a change Women who experience violence suffer a
in perspective needs alliance with international range of health problems and their ability to
consumer groups, free trade associations and participate in public life is diminished. Violence
international social partners. against women harms families across
generations, as well as communities and rein-
Violence forces other violence throughout societies.
It is very hard to estimate the work accident Violence against women also impoverishes
rate and even worse to estimate the extent of women, their families, communities and nations.
violence against women especially when it has It lowers economic productivity, drains re-
to do with work related violence and violence sources from public services and employers, and
at work. Men meet with violence too, but many reduces human capital formation.
543
Chapter 9.2
Violence against women is complex and diverse HIV/AIDS information and receiving treat-
in its manifestations, with far-reaching and long- ment and counselling.
lasting consequences and costs. Its elimination
• Depression is one of the most common con-
requires a comprehensive, systematic and deter-
sequences of sexual and physical violence
mined response.”
against women. Women subjected to violence
are more likely to abuse alcohol and drugs and
The fact sheets also contain some data and
to report sexual dysfunction, suicide attempts,
evidence that the Secretary-General’s in-depth
post-traumatic stress and central nervous
study on violence against women seeks to stress.
system disorders.
Some of these are work-related or consequences
inflicting on the working-life of women, for • Violence against women may prevent women
example: from fully participating economically and
hinder opportunities for employment.
• There is compelling evidence that vio-
lence against women is severe and pervasive • The costs of violence against women – both
throughout the world. Surveys on violence direct and indirect – are extremely high.
against women conducted in at least 71 coun- These costs include the direct costs of services
tries show that a significant proportion of to treat and support abused women and their
women suffer physical, sexual or psychologi- children and to bring perpetrators to justice.
cal violence. The indirect costs include lost employment
and productivity, and the costs in human pain
• The most common form of violence experi-
and suffering.
enced by women globally is physical violence
inflicted by an intimate partner. On average, Conferences on occupational safety and
at least one in three women is subjected to in- health for women
timate partner violence in the course of their
A successful initiative to highlight and document
lifetimes.
women’s occupational safety and health took
• Women experience sexual harassment place in Spain 1993. This initiative has been
throughout their lives. Between 40 and 50 per of great importance for the interchange and
cent of women in the European Union re- stimulation of research, knowledge and actions
ported some form of sexual harassment in the in the field of women, work and health. The
workplace. Centre for Analysis and Sanitary Programs in
Barcelona organized an International Workshop
• Many women face multiple forms of discrimi-
Women, Health and Work. At this workshop the
nation and an increased risk of violence.
participants decided to launch the International
• Women subjected to violence are more likely congress on Women, Health and Work with
to suffer physical, mental and reproductive the intention to gather research and knowledge
health problems. about the differences between disease in women
• Women who have experienced violence are and men.
at higher risk of contracting HIV. Fear of Up till now there have been five congresses
violence also prevents women from accessing (Barcelona Spain, Rio Brazil, Stockholm Swe-
den, Delhi India and Zacatecas Mexico). Each
544
Gender and work
congress has started from the conditions that for Latin America. Other important outcomes
each organizing country found most important. were agreements on how to put further the
The congress in Sweden was intended to bring occupational safety and health so women could
together scholars, activists, representatives of take advantage of best practices reported at the
civil society organizations and trade unions, of congresses.
government agencies and persons involved in The most important role of the Women
practical work from all parts of the world for Work and Health Congresses has been to open
critical discussions on questions related to wom- the way to an interchange of knowledge between
en’s working conditions, their living conditions industrial and developing countries and between
and gender-specific issues related to health/ill researchers, different organisations, unions,
health. The congress in India centred around persons involved in practical work focusing on
the three main themes of gender, paid and un- issues that are central above all for women and
paid work, The changing world of work and their conditions of work and health.
Scientific health practised in development. The
choice of these themes by the organizers of the how to improve women´s working
Congress was prompted by the outcomes of conditions
preparatory country-wide regional workshops in In the late 1990s a Swedish research-group
which researchers, non-governmental organisa- has developed a model for understanding fac-
tions, unions and persons involved in practi- tors interacting with gender-related ill-health,
cal work gathered to discuss gender, work and Figure 9.2.2. The three main factors believed
health issues. to cause gender-related outcomes in health
As a consequence of all five congresses, new are living conditions, biological/physiological
networks were formed. The Spanish congress characteristics and psychological characteristics.
decided to continue working as a network so as These three factors are interlinked. For exam-
to preserve the information gathered from the ple, a woman’s physical strength and body size
research done by the different groups. In Brazil probably affect her choice of occupation while
a network was formed especially from interested physical training during her time off will have an
parties within Brazil but also with some other effect on her physical capacity.
Latin Americans participants. In Sweden one Psychological characteristics, e.g. motivation
outcome was the creation of different working and cognitive capacity, are also crucial for her
networks (the most important being an African choice of career, and this in turn will influence
network) on women’s health and work. Both coping strategies.
the Indian and the Mexican congresses formed
networks. An initiative called “Woman, work
and health initiative Asia” was created for the
advancement of the research findings linked
to the reality experienced by women, so as to
have a positive impact on their lives and work
conditions. The congress in Mexico generated
an initiative for Latin America, similar to that
of Asia, Initiative on Women, Work and Health
545
Chapter 9.2
Conditions in society:
Legislation, labour market (formal and
informal), education, child care,
rehabilitation, cultural norms,
stereotypes, segregation, gender-marking
of jobs and tasks
Biological/physiologi Living conditions: Psychological

cal characteristics Occupations characteristics
inborn or aquired: Income inborn or aquired:
Anatomy, Job tasks Motivation
Anthropometry Women in menÕs jobs Risk taking
Physical capacity Men in womenÕs jobs Body consciousness
Metabolism Home-work Coping strategies
Hormones Leisure time activities Cognitive capacities
Parenthood
Gender-different outcome in health:

Incidents, natural cause, treatment
Figure 9.2.2. Factors interacting with gender-related ill-health.
The interaction of the three factors and the health problems. It is therefore important to
outcome is greatly dependent on conditions in examine occupational health research, imple-
society. Differences between countries and re- mentation, policies, programs and projects with
gions can partly be explained by the differences the above model in mind.
in social conditions. Possible explanations are The model presented was partly inspired by
differences in culture, history, religion, the share another study aimed at developing methods for
of the informal economy, etc. public health and epidemiological studies ad-
Female-male differences in education, sociali- justed to work and living conditions for women
zation and upbringing may lead to differences and men. The focus was on psychological, ergo-
in the way workers manage their illnesses, their nomical and chemical/physical exposure condi-
perception of risk, and the tendency to take sick tions. Interaction between exposures in paid
leave or to seek treatment. Thus, differences work and between work, phase of life and family
in exposure to risk factors may combine with situation was examined. Statistical methods of
biological, psychological and social differences analysis suited for identification of exposure pat-
to produce sex-specific patterns of occupational
546
Gender and work
terns were tried out and guidelines were defined minants of health producing, not just different
for modelling work and health relations. but poorer outcomes for women.
Recommendations proving important for the If the aim is to improve the quality of health
health and safety of both men and women at and safety and attain equitable health outcomes
work included: for all working members of society, it is essential
to make sure that the multiple realities of peo-
– examining the possibilities of combining paid
ple’s lives are always included.
work with the rest of life, i.e. family, unpaid
An often-heard argument is that poor coun-
work and leisure time,
tries and poor companies cannot afford health
– studying the mental and physical demands of and safety measures. There is no evidence that
work, the extent and location of work in time any country or company in the long run would
and space, have benefited from a low level of health and
– examining the possibilities for relaxation and safety. In fact, recent studies show that the most
recovery, at and away from work, competitive countries are also the safest. Select-
ing a low-safety, low-health and low-income
– viewing the connection between chemical/ survival strategy may not lead to high competi-
physical occupational health problems, physi- tiveness or sustainability. Thus all countries
cal load and the individual’s influence and stand to gain economically by working towards
attractiveness on the labour market, gender-sensitive occupational health and safety
– investigating organisational changes and programmes embodying a more humanistic and
changes of work conditions. holistic approach.
A checklist based on the model is presented on

the following pages. It may be used for investi-
gating and acting on issues related to gender at
work.
Gender-sensitive perspective may reveal how
social norms limit women’s economic partici-
pation, and how this in turn increases poverty,
decreases economic independence, compromises
social networks and supports and puts women
at risk of violence which they then find hard to
name. All of which, of course, leads to poorer
health outcomes. Without a gender-sensitive
approach, this reality of women’s lives remains
invisible. It is important to remember that a
gender-sensitive perspective means more than
different sexual and reproductive bodies. A gen-
der-sensitive perspective pays attention to the
possibilities of the most commonly used deter-
547
Chapter 9.2
Gender-sensitive safety and health checklist
Conditions in society: Yes No Comments;

Type of action needed in relevant cases
Responsible
Date to follow up
Do the national laws and/or regulations
address gender issues?
If so, are they implemented in the work-
place?
Is the labour market gender-segregated?
If so, is the segregation horizontal, verti-
cal or internal?
If so, is this due to cultural norms?
Is there any noticeable informal econo-
my?
Are men and women equally distributed
in the informal economy?
Conditions at the workplace:

Do men and women have the same op-
portunities of job advancement?
Is any job and/or job task associated
with a special gender?
If so, is it due to physiological factors?
Is there equal pay for equal work?
Is there any policy and action plan
against sexual harassment?
If so, has there been any investigation
regarding sexual harassment?
Are there different working conditions for
men and women?
If so, is this due to segregation?
If so, is this due to cultural norms?
Are there different employment condi-
tions for men and women?
548
Gender and work
If so is this due to segregation?

If so is this due to cultural norms?
Are working hours evenly distributed in
time and space for men and women?
Do men and women have the same
opportunities for development in their
work?
Is there any documented information
about gender distribution in workplaces?
Are workplaces designed/adapted so
both men and women can carry out the
work tasks?
Are there separate restrooms for men
and women?
Living conditions:
Are men and women equally responsible
for and equally active concerning unpaid
work at home?
portunities to take care of the children?
portunities of time to themselves?
Do men and women have the same and
safe opportunities of travelling to work?
Health risks:
Do measures for investigating and
controlling the ergonomic situation and
physical working conditions consider
both men and women?
Do measures for investigating and
controlling chemical exposures consider
both men and women?
Do measures for investigating and con-
trolling psychosocial exposures consider
both men and women?
549
Chapter 9.2

The Global Gender Gap Report 2007. World www.wider.unu.edu/publications
Economic Forum www.weforum.org The paper clarifies questions about gender
Global Gender Gap Index is a result of coun- and the informal sector in the economy in a
try rankings. Among other things the rank- developing country. India is taken as an exam-
ings together with detailed country profiles ple but has similarities with many other coun-
will serve as a catalyst for change by providing tries in the developing world.
policy-makers a picture of their country’s rela-
Gender Equality, work and health: A review
tive strengths and weaknesses compared to
of the evidence. Karen Messing, CINBIOSE,
that of other nations.
Université du Québec, Montréal, Canada and
Women’s Health at Work. Kilbom Åsa, Mess- Piroska Östlin, Karolinska Institute, Stockholm,
ing Karen and Bildt Torbjörnsson Carina (eds.) Sweden. World Health Organization (2006).
1998. www.who.int/occupational_health/publications/
The main focus of this book is on ill health genderwork/en/
among women and a description of gender- The main purpose of this review is to describe
related ill health in working life. The meth- the relationship between gender inequality
odological problem is also discussed regarding and health and safety problems. It reviews
the development of gender-sensitive measures gender and highlights specific issues for
of working conditions. women and the necessity to strengthen and
establish enhanced programmes and practices
Gender and Informal Sector Analysis in India
to ensure women’s health and safety at work.
by Anushree Sinha and Haider Khan Research
Paper No 2008/65, World Institute for Devel-
opment Economics Research.
550
9.3
Migrant workers
Bo Johansson
migration and migrants line, including Spain and southern Italy, leaving
a demographic and cultural imprint that still
A historical review remains.
Humans have always been on the move, colo- Apart from military invasion and forced rule,
nising the earth since our earliest ancestors left trade has been the foremost reason for migra-
their home ground on the African continent. tion. Established land routes, such as the Silk
The main driving forces for movement and set- Road connecting China and Europe, improve-
tlement have probably been the same through- ments in the art of open sea sailing that gradu-
out history – to avoid scarcity and unsafe condi- ally enabled trade, and military aggression, were
tions in search of a safe haven with sufficient all of paramount importance. The initial suc-
resources. Migration has occurred by choice or cesses of pioneers were soon followed by mi-
because unfavourable circumstances have forced grants who settled permanently on the foreign
people to move. The free movement of peoples shores. For example the Vikings’ contacts with
has become increasingly restricted as societies Britain and communities around the Black and
have become more complex and tribal territories Caspian Seas; the adventurous voyages by Co-
have developed into political nation states. lumbus, Pizarro and Cortez to Latin America;
The demography of contemporary Europe Vasco da Gama’s opening of the gates to India,
is largely the result of settlements following the and the Arabs’ arrival in South-East Asia and
European era of the Great Migration, 400-900 Indonesia in the 15th and 16th centuries.
AD as tribes of different origins challenged The colonization of the Americas was driven
the prevailing order. During the first centuries mainly by the desire of European rulers for gold
of this period, it was mainly Germanic people and wealth, and by their subjects’ need to escape
who conquered and settled in the West Roman poverty, famine and religious persecution. One
Empire in Southern and Central Europe. They result was the shift from continents inhabited by
were followed by Slavs, Hungarians and Turks an indigenous population to territories domi-
who invaded what is now Turkey and Eastern nated by colonizers. Another was the emergence
Europe. From the 8th century, the Arabs con- of Catholic Europe as a contender for global
quered most parts of the Mediterranean coast- power. The Australian aborigines gradually
551
Chapter 9.3
faced the same fate as the American Indians as ery, often based on the import of slaves, has been
colonization started in 1788 with the deporta- the backbone for many imperialist economies,
tion of British criminals. Migration to Australia such as Egypt under the Pharaohs, and later
escalated and was totally dominated by Euro- under the Mamluks, ancient Greece, the Aztec
pean migrants, whose descendants comprise empire, the USA until 1865 and Brazil until the
98% of the current population; Sydney is the 1870s. Although forced labour migration has
third largest Greek city today. Although these been formally abolished, it is still a reality in
massive migrations were voluntary, the destiny many parts of the world. In spite of international
of the indigenous populations was hardly one of conventions condemning trade in humans, the
free choice. They were almost completely wiped trafficking and smuggling of people into slavery
out by new diseases, forced labour and armed is flourishing.
brutality. The next period of increased labour migra-
There is also a number of large scale forced tion, which occurred from the middle of the 19th
migrations throughout history. One early ex- century up to the First World War 1914-1918,
ample is found in the Bible, where the deporta- can be said to have initiated the migration flows
tion of the Jews to Babylon in the 6th century of the contemporary world, depending on global
B.C. is described. In more recent time one of events. Millions of Europeans escaped poverty
the most appalling and important mass move- and religious persecution by moving to new
ments was the European slave trade, dominated settlements in the Americas and Oceania. Large
by Great Britain, Portugal and France. Some 15 numbers of Asian workers, especially Chinese
million Africans were captured and transported and Indians, sought a more prosperous future in
to forced labour in North America, once again plantations, trading and mines in Asia and Af-
changing the demography of the American rica. That migration boom ended with the Great
continent. Slavery went hand in hand with the Depression following the crash of the Western
European colonization of Africa, needed not stock markets 1929, which resulted in mass un-
only for administration of the slave trade, but employment, restricted international trade and
also inspired by the wealth of resources such as closed borders.
ivory, gold and diamonds. The search for these Since then the world has experienced two
resources also turned many Africans into slaves more peaks in international migration. The first
in their own countries. European supremacy was from the end of World War II in 1945 until
was justified by a predominant racist ideology the “oil crises” of 1973 affected the oil consum-
that gave them the right to exploit and the duty ing countries of the world. (The oil-producing
to civilize “barbarians”. The imperial ideologist countries experienced their oil crises in the early
Rudyard Kipling summarized this position as 1980s, when the world market price was too
“the white man’s burden”. If the mission failed low). That post-war period was characterized
the remedy was expressed by Mr Kurtz in Joseph by increased labour migration, (both skilled and
Conrad’s novel Heart of darkness: “Exterminate unskilled), mainly to and within Europe and
the brutes!” The combination of the slave trade the USA. The restrictions on immigration that
and colonization not only implied immense were introduced in the seventies are still applied
human suffering, but also the decline and fall of in most European countries as well as in North
many prosperous African societies. Formal slav- America and Australia. Since the legal labour
552
Migrant workers
immigration have become more restrictive in Concepts

the developed countries, more people enter as Although it is individuals who move, migration
refugees applying for asylum or as close kin to is by its very nature a social process. The follow-
a migrant already residing legally in the coun- ing definition from ILO’s “Glossary on Migra-
try. The final option is to enter a country as an tion” on contemporary migration makes this
undocumented migrant, residing and working clear:
without legal recognition and protection. Mi- This definition is the basis for this chapter. The
gration flows within and between countries are concept covers all aspects of migration, includ-
allowed or restricted because of political and/or ing internal migration, e.g. domestic move-
economical considerations.
Large scale migration has been very impor- Migration – A process of moving, either across an
tant for the development of modern societies international border, or within a State. It is a population
movement, encompassing any kind of movement of
and advanced economies since the industrial people, whatever its length, composition and causes;
revolution. In recent decades new or reformed it includes migration of refugees, displaced persons,
transnational migratory systems have emerged uprooted people, and economic migrants.
in South East Asia, the Gulf, Africa, Central and
Eastern Europe and elsewhere. Huge internal ment from rural areas to cities. The process of
migrations from rural to urban areas and within migration was defined by the sociologist Émile
regions have proliferated with the accelerated Dürkheim as a “social fact”, meaning that behav-
growth of advanced industrial and service econo- iour and expectations don’t only emanate from
mies, for example in China and India. These individual responses and preferences but mainly
migrations have repercussions on social struc- from the community which socializes each of its
tures, culture and working life. These global members. These social facts exist outside of indi-
developments have been defined as the ‘age of viduals. The totality is bigger and more complex
migration’. than the sum of its parts because the totality is a
The globalisation and transnational migratory function of those parts and their interactions.
systems are closely interrelated. The processes The most important variables in the migra-
of globalisation have promoted the temporary tion equation are the conditions in both the
character of work, increased offshore activities, country of origin and the destination country
outsourcing, sub-contracting, the formation of and the historical relationship between these
networks of private and public sector micro en- countries, the migrants’ group or family experi-
terprises, sweatshop production, and home based ence of migration, and the migrant’s own aspira-
work. These developments run parallel with the tions, knowledge and skills. The history of mi-
deregulation of established national frameworks gration could expose countless fates of individual
of labour relations and working life norms, in migrants but this is not the focus of this text that
both developing and developed economies. New examines the overarching mechanisms that en-
forms of work organisation are structured along able or force people to migrate. This perspective
intersecting lines of social class, gender and has been chosen because it is only in the light
ethnicity with the regulation of migration in ac- of such an understanding that wise policies and
cordance to labour market needs as an important efficient strategic plans for the management of
vehicle for change. issues related to migration can be established.
553
Chapter 9.3
Although this text deals mainly with unfa- The push-pull arguing provides us with neat
vourable working conditions for migrants, it explanatory theories based on human rationality.
must not be forgotten that migration also offers The problem is that they are not fully consistent
opportunities for migrants to achieve their hopes with reality. Firstly these theories are individual-
and aspirations for a better life. istic and ignore history. The emphasis on indi-
vidual choice disregards other important factors
Why do people move? such as national restrictions and requirements
There are many different causes of migration concerning migration, or historical ties between
and they vary over time, and can be interpreted countries such as political unions or colonial
from various perspectives. relationships. They also assume that Homo Eco-
nomicus has access to all relevant information,
Micro perspective which is very seldom the case. Nor is it the case,
The application of neo-classic economic theory which would follow from the theory, that we
to migration has its roots in efforts made dur- find the poorest people in developing countries
ing the 19th century to establish statistical laws migrating to the rich and developed countries in
of migration. Such laws stated that people made Europe, America or Australasia. The theory also
rational choices, based on information about fails to answer why some of the poorest coun-
the conditions at hand, e.g., people moved from tries in the world host the majority of the world’s
overcrowded areas to less densely populated refugees. It also doesn’t explain why one of the
places, or from areas with a low average income most densely populated countries in the world,
to regions with higher economic standards. The the Netherlands, attracts more immigrants than
basic assumption is that migration is driven by it produces emigrants. It also leaves us in com-
causes that an individual regards as rational. plete ignorance of the causes, when faced with
Humans are seen to be ontologically a Homo the complexity of global migration patterns, re-
Economicus, evaluating the options, and moving vealing the fact that different groups from vary-
in order to maximise utility. When sociologists ing origins systematically migrate to different
adopted this perspective push-pull-theories re- regions and countries. Finally, it doesn’t explain
sulted. Migration is explained by a combination why the economic gap between the poorest and
of push factors that incite people to leave their richest countries is constantly increasing.
present residence, and pull factors that draw If national policies are based on these theo-
them to certain countries or internal destina- retical assumptions they will either fail or create
tions. Push factors may be war, political repres- the very problems they intend to prevent. For
sion, famine, demographic growth, or unfavour- instance, very strict immigration legislation im-
able economic opportunities, while pull factors plemented in order to combat irregular migra-
may include physical safety, civil rights, im- tion has proved to increase illegal immigration,
proved economic possibilities, and demand for which is the obvious case in e.g. Italy and Spain.
labour. The potential and ideal long-term result The status of undocumented immigrants makes
was believed to be increasing economic equal- them more vulnerable, e.g. regarding housing,
ity between countries and regions of the world, education, working conditions, wages, harass-
finally resulting in global economic equilibrium. ment and sexual abuse that in turn increases
554
Migrant workers
public costs, human suffering and potentially strength of the capitalist economy’s impact on
social disharmony for the host country. migration patterns.
Given these criticisms, we could conclude that Current global economic and political rela-
this way of reasoning should have been aban- tions are increasingly dominated by both old
doned but unfortunately this is not the case. The and new actors including multinational compa-
logic of push-pull theory is definitely the soil for nies, the International Monetary Fund (IMF),
the European fear of so called “social tourism”, the World Bank, World Trade Organisation
i.e. the expectation that people will immigrate, (WTO), OPEC, the G8 countries, and inter-
legally or illegally, solely to benefit from the host national NGOs. These organisations cross over
country’s social welfare. Far from being adjusted regional and national borders, using technol-
or completely abandoned, these ideas of rational ogy that enables them to perform management
choices are the backbone of migration policies and financial operations 24 hours a day all over
and legislation in many countries. When trans- the world, regardless of national and other geo-
formed into political practice, they often in- graphical boundaries and interests. The presence
crease the problems of the country in regard to and activities of the above global actors impacts
illegal migration, human smuggling and traffick- greatly on international migration patterns,
ing, populist politics, failed integration policies adding a new complexity that so far has not been
and public xenophobia. met with refined analytical tools and methods
that will be able to manage migration on a glo-
Macro perspective bal level.
An alternative historical-structural analysis, de- While the historical-structural perspective,
rived from Marxist political economy, attempts in addition to the push-pull theory, sheds some
to explain international migration as an effect of light on international migration it is equally
the prevailing global economy. It starts by rec- incapable of explaining the complexity of it.
ognising the unequal distribution of political and Whereas push-pull theories represent a micro
economic power in the global economic system. level perspective focused on the individual, the
Migration is seen mainly as a means to mobilise macro perspective theory mainly illuminates
cheap labour for capitalism, as was clearly seen macro-economic macro-level factors. Other fac-
in many countries during the 20th century. The tors are neglected, e.g. legislation and regulation
Scandinavian countries, especially Sweden, re- that restricts migration, or individual choice.
cruited skilled workers from southern and east- The historical-structural theory is therefore
ern Europe, in order to expand the capacity of equally limited.
export industries after World War II. Germany
established a guest worker system with Turkey Towards a holistic perspective
and South-European countries in the 1960s. In A new approach to migration has been devel-
parts of the USA, agriculture largely depends on oped; “migration systems”. This concept in-
cheap migrant labour from Mexico and Central cludes both historical and current links between
America. The exodus of vast numbers of skilled the countries of origin and destination. For in-
Indian IT technicians to Silicon Valley and other stance, the German gastarbeiter system between
such centres is another recent example of the Germany and Turkey had already established
relations in the 18th century while the French
555
Chapter 9.3
immigration pattern is mainly based on colonial and global conditions and the capacities, aspira-
and contemporary relationships between France tions and difficulties of the individual migrant.
and the Maghreb countries (Morocco, Algeria, Migrant communities, which often develop their
and Tunisia). The Saudi Arabian migration sys- own economic and social infrastructure aimed
tem is very much linked to other Arab countries at sustaining their community and helping
and has been that way since the dawn of Islam newcomers, partly fulfil this need. Chinese im-
almost 1400 years ago, but also more recently migrants in the USA have established their own
includes migration from non-muslim countries banking system. New religious congregations,
such as Sri Lanka and the Philippines. Under- such as the emergence of Muslim, Buddhist and
standing of a migration system requires broad Sikh religious organisations, mosques and tem-
interdisciplinary study of the conditions at both ples in Northern and Western Europe, attempt
the migrants country of origin and in the desti- to organise health care, education and social
nation country. The migration systems theory service for community members. The existence
also implies that migration patterns are based on of such structures often results in temporary mi-
previous historical relations between countries grants becoming permanent settlers. There are
or regions, such as political unions (Egypt-Syria two principal reasons for this. Either it becomes
or Denmark-Greenland), colonisation (the possible for migrants to integrate into their
Netherlands-Surinam-Indonesia or England and new society, to improve their conditions, and to
the Indian subcontinent), military occupation establish a good life, or, migrants are able to stay
(USA-Cuba, Israel-Palestine or the Soviet Un- but they remain on the margins of the host soci-
ion-the Baltic states), trade (Sweden-Germany ety. The result mainly depends on the migration
or Italy-Argentina), or a combination of several and integration policies and practices of the host
of these historical experiences. Contemporary country. While migrants may prosper or suffer
realities such as bilateral or regional treaties, in both cases, the host society will only benefit
development programmes, and military collabo- from the first scenario. A prerequisite for that
ration are also crucial factors at the macro-level. scenario is that pluralistic and inclusive views
It is of equal importance to find what forces are form the basis for policies at national, municipal
involved at the micro-level, e.g. social networks, and enterprise levels. This will enhance the mi-
which are created or inherited by migrants. grant communities’ interest to act as mediators
These networks are immensely important for and social partners between the migrant minor-
migrants to find work, housing, orientation in a ity and the majority of citizens rather than acting
new society. These networks also explain “chain purely in their own interest.
migration” where a few migrants establish them- When migration is treated in this way it will
selves as a bridge-head in a destination country truly be a Dürkheimian “social fact”. There is no
and are then followed by others who are helped single answer to why people migrate, who will
by the experiences and social knowledge of the migrate, when or from where to where. Each
initial migrants. When the migrant numbers migration movement must be seen in its own
reaches a critical mass they will form their own context, revealing its own dynamics, currently
community. and historically.
There is still one concept missing, namely the
intermediary that connects national, regional
556
Migrant workers
general trends in contemporary of migration in human history, and pose a seri-

migration ous challenge to the national and transnational
The overall global migration pattern shows a management of migration. There are no doubts
very complex picture. Today almost two million that Castles and Miller have good reasons to
people migrate annually to settle permanently, label our era “The Age of Migration”.
and in some years as many leave their countries
Whence and where
as refugees. One third of the annual number of
international migrants moves from a develop- The UN Population Division has published
ing to a developed country and another third figures that indicate the expected annual net mi-
moves between developing countries. 65-70% gration to and from various regions of the world.
of global migration involves and affects devel- The table below shows that three regions are
oping countries. In addition there are tens of expected to be net receivers of migrants during
millions temporary migrant workers crossing coming years: North America (USA, Canada),
borders annually. Most countries both send and Europe (the EU member states) and Oceania
receive migrants, and there are flows within and (mainly Australia). The remaining regions, Asia,
between continents. The European Commission Latin America and the Caribbean, and Africa,
summarises the present situation as follows: will be net senders of migrants. Most African
“The present migration situation is marked emigrants are believed to leave North Africa,
by the rise in the absolute number of migrants, mainly for Europe, while the Asians will go to
including in the number of women, the multi- North America and Europe. Latin Americans
plication of the types of migration, the increase will mostly leave for the USA.
in trafficking in human beings, the growth of
diasporas, the integration challenges for the mi- Region Annual net migration
2005-2010
grants and the host countries, the strengthening
of ties with people who have stayed in the coun-
Africa –159,000
try of origin, the diversification of destinations
Asia –1,242,000
and origins, and the multiplication of migration
Europe 579,000
routes. The migratory pressure is increasingly
heavy on Europe and other industrialised coun- Latin America –573,000
tries, while south/south migration constitutes North America 1,310,000
an important phenomenon (…..) In some cases, Oceania 84,000
countries which until recently were only origin
and/or transit countries have also become host In addition, substantial mobility within the con-
countries,…” tinents is also foreseen. These movements are
Communication from the Commission to the Euro- expected to be greatest in Asia, especially from
pean Parliament and the Council 25.1.2006 the Philippines and the Indian subcontinent to
the Gulf States, but also from South-East Asia
When domestic mobility is added, (as implied to Japan. A considerable migration from sub-
by the definition of migration), there is probably Saharan countries to South Africa is also fore-
more than a billion persons on the move annual- seen. Latin American migration is dominated
ly. These figures surpass all previous experiences by movements from Central America, Puerto
557
Chapter 9.3
Rico and Mexico to North America, but there for security, assistance and jobs. However, in
is also expected to be considerable flows from most cases this exacerbates their exclusion from
Nicaragua and Panama to Costa Rica in Central public goods and denies them a foothold in
America. It is also expected that there will be the formal labour market. This development
flows of people into Argentina and Venezuela will be further accentuated by general popula-
from neighbouring countries in South America. tion growth. The UN estimates that the world
There is also a constant mobility within population will increase by 382 million people
countries from rural to urban areas, especially in between 2005 and 2010, and that 90% of the
developing countries. Capitals cities and other increase will be in urban areas, resulting in more
big cities, such as Mexico City, Djakarta, New than 50 cities with more than 5 million inhabit-
Delhi, Sao Paolo, Beijing, Cairo and Istanbul ants, most of them in developing countries.
have rapidly grown into mega cities with 15-20
million inhabitants. Many of the rural newcom- Features of contemporary migration
ers end up in huge slum areas, shanty towns or In 1999 there was a contest in Sweden to define
favelas, trying to make a living from insecure which single word best described the evolu-
and risky low paid jobs in the informal economy. tion of the 20th century. The winning word was
Ciudad Nezahualcóyotl, a poor suburb of Mexi- “faster”, a word that characterises international
co City, hosts three million residents, Libartador migration. “More” and “everywhere” could
in Caracas, Venezuela has 2.2 million, and Aje- also be added. Castles and Miller argue that the
gunle in Lagos, Nigeria, has 1.5 million. There following five features, all relating to increased
are more than 30 slum areas scattered round the speed, numbers and complexity, depict contem-
globe that each house more than half a million porary migration trends: globalisation, accelera-
people, most of them international or domestic tion, differentiation, feminisation and politicisa-
migrants. In China alone 160 million people tion.
are reported to have moved permanently to the The globalisation of politics, economies,
big cities in the last 10 years. The majority of communication, transport and culture has also
these Chinese citizens live as undocumented city affected migration patterns. Although recognis-
dwellers without social rights, such as education able dominant routes of migration are discern-
and health care, because the legal system doesn’t able, it has truly become a global phenomenon.
allow them to register at any other place other Even countries that historically have been
than their birthplace. almost totally closed, e.g. Japan, Tibet, Libya
Even if people are free to move and register and Albania are now contributing to the glo-
domestically, urban infrastructures can’t possibly bal migration pattern. The receiving countries
keep up with the massive increase in population. – traditionally USA, Canada, Australia, New
Everything from primary health care to work Zealand, Argentina – has multiplied as migration
place surveillance and housing lag behind, and patterns have become more complex. Today they
the gap between those who have access to pub- have been accompanied by Russia as the world’s
lic facilities and those who don’t is constantly second largest immigration country. In the past
widening. One common trait everywhere in the migration was often quite one-dimensional,
world, especially prevalent in developing coun- e.g. settlers went to North America and Aus-
tries, is the reliance of people on social networks tralia, refugees crossed into their neighbouring
558
Migrant workers
country, or students from colonies went to the ent regions. For instance 70-80% of the unau-
country of their colonial master. Today, almost thorised Mexican labour migrants in the USA
every country face different types of migration, are young men. The traditional movements of
when people both immigrate and emigrate for male migrants from southern African countries
diverse reasons. They can have a legal status as to mines and factories in South Africa exceed
refugees, migrant workers, permanent settlers, those figures. On the other hand, the migration
temporary students, or just transiting on their of Philippines to other Asian countries, espe-
way to another destination, but they may also cially the Gulf States, consists of 90-95 percent
leave or entry countries without any permits. women. Other examples of female dominated
This means that governmental instruments and migrant flows are those from Sri Lanka to the
policies have to be equally diverse, in order to Middle East, from Cap Verde to Italy, and from
cope efficiently with migration issues as well as Thailand to Japan. Attention must be paid to the
with internal tensions in regard to the relations gender related vulnerability that migrant women
between minorities and the majority. face in host countries, especially in the hous-
Migration is increasing in and between all ing and labour markets. Their position is often
major regions, and there are no signs that this weaker than those of migrant men because they
will change. Since one of the main driving forces often hold jobs with very little or no protection
of migration is unequal economic conditions under social legislation. These migrants include
between regions, the widening economic and domestic workers, manual workers in agriculture
welfare gap between north and south and rural or manufacturing, or even worse, those forced
and urban areas leads us to expect this increase into the modern slave trade in the sex-industry.
to continue. In the short and mid-term, oc- Their situation is made worse by the lack of
casional events, such as wars, famines, or catas- autonomy and the strong subordination role that
trophes such as the tsunami in South-East Asia, characterises such jobs. In addition these women
hurricanes Katrina and Gustav in New Orleans are often young, poor and alone, lacking family
and the earthquakes in Pakistan and China, may support.
speed up the increase still more. The gender aspects of migration are not given
The general idea of a migrant is of a young the active attention they deserve, although the
male of working age, sometimes accompanied by concentration of women in vulnerable sectors
women or with a woman who is planning to join has generated much debate and valid concern.
him later. This perception is no longer true as While the fact that women are migrating on
since the 1960s, women have constituted a con- their own rather than as part of family migration
siderable part of international labour migration. seems to indicate greater freedom and choice,
Today half of the world’s migrants are women this is very often not the case. Women are often
many of them migrating for jobs as they are the found in gender-segregated and unregulated
primary bread-winners of a family left behind. sectors of the economy, where they are at much
A considerable number of female migrants have higher risk of gender discrimination, violence,
never worked for wages before so migration human trafficking and sexual abuse.
stimulates new groups to join the global labour Migration has always been a political issue,
force. The relative figures of male and female but the need to regulate migration through do-
migrants can vary a lot in and between differ- mestic politics and external agreements has in-
559
Chapter 9.3
creased dramatically. Since the 1980s, migration states that”…international migration constitutes
has been on the agenda for most governments an ideal means of promoting co-development,
and important international organisations, such that is, the coordinated or concerted improve-
as ASEAN, EU, G8, ILO, AU, OECD, SISCA, ment of economic conditions in both areas of
SADC and others. origin and areas of destination based on the
In the US and Europe migration issues are complementarities between them.” It further
presently creating political tensions due to in- points out that “…countries can cooperate to
ternal conditions. The US economy and their create triple wins, for migrants, their countries
present level of agricultural self-sufficiency of origin and for the societies that receive them.”
depend on labour migrants. European demo- In spite of this, UN efforts to promote develop-
graphic developments mean that labour must be ment as expressed by the Millennium Develop-
imported if social welfare is to be kept at present ment Goals, aiming at the eradication of abso-
levels. These obvious reasons for encouraging lute poverty and hunger, say very little about
labour immigration must be delicately balanced migration, labour or employment.
to avoid widespread public scepticism towards Migration is often regarded as a problematic
immigration and immigrants. To make this issue, bringing burdens of economic constraint
political task even more difficult, the devastating and social unrest to the receiving countries,
actions in New York and Washington D.C. on and causing the loss of skills from the migrants’
11th September 2001, and other international home countries. It is correct to point out that
terrorist activities have seen the economic and the ruthless exploitation of workers to the
social incentives for labour immigration been benefit of just a few curbs the economic and
surmounted by security concerns. democratic development of a society. But, mi-
gration can also add positively to development
migration’s impact on development by providing the labour demanded in expanding
What is the impact of migration on develop- economies in both developed and developing
ment? The definition of development as “…the countries. Migrants reduce unemployment and
desired changes from a life with many suffer- underemployment in their countries of origin,
ings and few choices to a life with satisfied basic and contribute to the development of these
needs and many choices that are made available countries through remittances and transfers of
through sustainable use of natural resources” knowledge. If the management of migration
(Amartya Sen), offers no single answer. Migra- rather than migration itself was seen as the prob-
tion can hamper or contribute to development. lem, migration could turn into a powerful impe-
It can accelerate the development of one region tus for development. A statement from a World
or country at the expense of another, or it can Bank report in 2003 points in this direction:
fuel the development of both. Many internation-
al organisations now acknowledge the potential
for development embedded in international
migration. The UN International migration and
development. Report of the Secretary-General, 2006,
560
Migrant workers
“Migration is increasingly seen as a force that

India, resulting in an increasing number of new
can contribute to development. The importance categories of immigrants from developed coun-
of maximizing the development benefits of tries. The Chinese economic and competitive
migration cannot be underscored: migration can position in the global arena has become even
assist countries in forwarding their development stronger than that of India. An astonishing fact
agenda. The achievement of the Millennium is that the main part of the US’s national debt is
Development Goals (MDGs) both impacts and to China (2006). Economic growth has opened
is impacted by the effective management of mi-
possibilities for rapidly increased Chinese invest-
gration. While acknowledging the contribution
of migrants in host countries, it is important to
ment abroad. Chinese foreign investment goes
note that the flows of financial, technological, back to Deng Xiaoping’s Open Door policy. In
social and human capital back to countries of or- November 1979 the Beijing Friendship Com-
igin contribute to the development of migrants’ mercial Service Co. and a Japanese business
home countries. Indeed, empirical evidence established the first joint venture in Tokyo.
suggests that remittances sent home by migrant Since China joined the World Trade Organisa-
workers have significant impacts on poverty and tion (WTO) in 2001 the country’s direct invest-
potentially on long-term economic develop-
ment abroad has reached 35 billion USD (2003)
ment. Understanding the important relationship
between migration and environment, poverty
and more than 7 000 Chinese enterprises have
and development will enable countries to better invested in 160 countries and regions (2006).
address the challenges of international migra- The affect on migration is that there are more
tion and maximize the benefits of migration for Chinese residing outside China, and more for-
both sending and receiving countries.” eigners residing in China. One example related
to the economic upswing is that around 20 000
Striking examples of the relationship between Chinese girls have been hired as au-pairs in US
development and migration are posed by the families. These au-pairs are teaching American
expanding economies of India and China. India children the basics of the Chinese language at an
introduced reforms for economic liberalisation early age.
in the 1970s, culminating with the complete Migration thus affects the political, economi-
abolition of import licenses in the 1990s. This cal and social fabric of a society. It may create
opened the Indian market of one billion people racial tension, e.g. the tension between black
for foreign investments and trade. The growth Americans and Koreans that resulted in the
of the economy has risen from an average 3.5% Los Angeles riots in 1992. Migration can cre-
in the 1970s to the present 6.5%, which among ate social conditions such as the slums in most
other things, has resulted in a rapidly increasing mega cities, which often pave the way for in-
middle-class. The most obvious consequence creased criminality, drug abuse, homelessness,
of these economic reforms is the extraordinary street-children, prostitution and the spread of
progress of the Indian telecommunication sec- infectious diseases. Solutions must be found
tor. Technological innovations have given many in the management of the migration and the
Indian professionals the possibility to sell their integration of migrants so management of the
skills on an international market and have at- labour market and the working conditions plays
tracted a lot of international investments to a crucial role.
561
Chapter 9.3
The International Organization for Migration The following text focuses on the main stake-
has attempted to systematize the most impor- holders involved in the process of migration: the
tant advantages and disadvantages regarding country of origin, the country of destination, the
the impact of migration on development policy enterprise hiring migrant workers and the mi-
perspective. grants themselves.
Possible positive effects on development Possible negative effects on development

of migration of migration
– Increased global economic efficiency. – Loss of highly skilled workers and reduced
quality of essential services.
– Good for the individual, especially where
there are new opportunities for workers not – Reduced growth and productivity because of
available in the home country. the reduced stock of highly skilled workers.
– Inflow of remittances and foreign exchange – Lower return from public investments in
benefiting receiving individuals and countries. public education.
– Emigration may reduce unemployment in – Selective migration may cause increasing

some sectors in sending countries. income disparities in sending country.
– Technology, investments and venture capital – Sending country loses potential tax revenue.
from diasporas.
– Risk of creating a “remittance economy” and
– Leads to increased trade flows between send- dependency among receivers, a problem exac-
ing and receiving countries. erbated when remittances diminish over time.
– Possibility of emigration may stimulate invest- – Inflationary potential of remittances, espe-

ment in education an individual human capital cially on real estate.
investments.
– Reduces the size of “political classes” (citizens
– Charitable activities of diasporas can assist in endowed with the resources needed to act as
relief and local community development. agents of change).
Consequences for sending countries increased over time from 102 billion USD in
There can be both negative and positive effects 1995 to an estimated 232 billion USD in 2005.
from emigration for the sending country de- 167 billion USD went to developing countries,
pending on who is leaving and the state of the dwarfing the combined total of all kinds of in-
country. A positive effect can be that emigration ternational aid. A World Bank study from 2004
may ease the pressure on the labour market, if found that remittances were the second largest,
there is a surplus of labour that produces high in some the largest, source of external funding
unemployment or underemployment. Migrant for developing countries, after direct foreign
worker remittances represent the second largest investments. For some countries remittances
legal international monetary flow, exceeded only equal 20 percent of their total export value. For
by petroleum. Remittances have considerably small countries with large diasporas, such as
562
Migrant workers
Jordan, Lesotho and Tonga, it equals between • If the physicians from Ghana working in
25 and 40% of their GDP. On the micro-level North America would return, Ghana’s
a number of studies also demonstrate that mi- number of doctors would increase by 33%.
grant households generally have more dispos- • 20% of Jamaican specialist nurses emigrate
able income, and are able to pay off debts and annually.
save money. The bulk of remittances go to Latin • There are more trained Malawian doctors in
America and South Asia. Mexico, India and the Manchester than in Malawi.
Philippines are the largest recipients in absolute
figures. The Philippine government has become Examples of migrating health workers indicate
aware of this capital inflow and so deliberately an especially alarming development, since the
educates nurses for an entry to the international needs for their skills and services are rapidly
labour market. increasing in developing countries in general,
Apart from their financial return, emigrants and in Africa in particular (not to mention that
also contribute with intellectual capital and often a doctor trained in Nigeria or Ghana has cost
pave the way for foreign financial investments in their country approximately 200,000 USD). In
their country of origin. Successful migrants can most African countries opportunities for educa-
set an example that encourages others to invest tion and training of medical staff is far too limit-
in education that contributes to raising the level ed. The HIV/AIDS epidemic requires immense
of human capital in their home country. resources in terms of hospitals, medicines and
Although the majority of the world’s migrants staff. No country can manage that burden alone
are poorly educated and unskilled, the migra- and the drain of medical staff makes the situa-
tion of highly trained and skilled people is of tion even worse. On top of that, many remaining
great importance. The effects on development medical staff suffer from HIV/AIDS themselves.
of “brain drain” of the brightest and most highly The ratio between highly educated emigrants
educated and skilled people is a much debated and the total population of highly educated peo-
issue. Some of these migrants return to benefit ple very clearly reveals the proportionate loss of
their country but many remain abroad. The brain power. Figures from 2004 show that while
examples of this outflow can be multiplied. The only 3% of the total population of India is high-
following is just a small sample: ly educated, 80% of them emigrate. For Bang-
• Almost 10% of all people born in develop- ladesh the relation (per cent of the population
ing countries with tertiary education reside in with higher education and the per cent of highly
developed countries. educated emigrants) was 1 to 62, for Brazil 10 to
• In many African countries one third or more 55, and for Indonesia 2 to 75. This clearly shows
of their college graduates live abroad. that skilled workers and professionals are more
• 40% of all African professionals have left the eager and have greater possibilities to migrate
continent in post-colonial times. than others. They are probably attracted by the
• Up to 90% of Chinese and more than 80% prospect of higher salaries, better working con-
of Indian PhD students who graduate in the ditions and improved living conditions that also
USA remain there. offer the possibility to support their family stay-
ing behind. Developed countries are also keen
to recruit skilled workers e.g. in the IT-sector.
563
Chapter 9.3
There is also aggressive recruitment of health human capital to the receiving countries, and
workers from developing countries. The com- that there are reasons to improve their treat-
bination of offensive recruitment and personal ment. Generally, poor advantage is taken of the
aspiration resulted in the exodus of 25,000 Phil- migrants’ potential so nations, employers and
ippine nurses to the USA, Canada, Saudi Arabia workers all lose out. High education and profes-
and Great Britain in 2003 alone. Philippine sional skills are naturally an advantage for an in-
doctors even retrain as nurses in order to get a dividual migrant, but do not guarantee prosper-
job in USA, where a nurse’s salary is three times ity or even a decent standard of living in the new
that of a doctor in the Philippines. Primarily this country. Too many migrants face unemploy-
exodus is a complete waste to the country that ment, under-employment or are employed in
has invested in the education and training of jobs below their capacity. Many end up outside
their youth when most of them leave for a devel- the formal labour market and societal participa-
oped country. When doctors or IT technicians tion. Very few nations, developed or developing,
are trained and needed in South Africa or India can afford such mismanagement in the long run.
migrate to the USA, Europe or Gulf States, it Apart from the obvious human and economic
naturally damages the development of their own waste resulting from this mismatch, it also cre-
countries. The obvious way to change this situ- ates an idea that immigration is a problem and
ation is to discourage migration through im- that immigrants are intruders competing for and
provements of living and working conditions in consuming scarce resources. The result can be
developing countries, however, there is a hidden social unrest, xenophobia, and populist or racist
dilemma in this strategy. Improvements in the politics.
social, economic and educational situation give This is not to say that immigration doesn’t
people greater possibilities to find the means to cause problems for receiving countries. It can
emigrate. Another paradox is that the human be a burden on the general welfare system, put
resources needed for the above improvements pressure on the housing and labour markets, stir
are found in the same people who migrate. ethnic conflicts, increase criminality, and cause
This is not an exclusive problem for developing many other unwanted consequences. Immigra-
countries. The European Union, aims to be the tion also implies responsibility costs for the state
world’s leading knowledge based economy, in- since immigrant families require education for
vests a lot to encourage the return of European their children, and access to health care and
academics now residing in competing economies other social services. If these needs are neglected
in North America and elsewhere. or badly managed, it will invite populist political
movements to influence the national agenda, as
Consequences for receiving countries has been the case in France, the Netherlands,
“Migrant workers are an asset to every country Denmark and Austria, to mention a few recent
where they bring their labour. Let us give them European examples. Nevertheless, labour migra-
the dignity they deserve as human beings, and tion is almost always a gain for the host country
the respect they deserve as workers.” because an adult worker crossing a border has
The quotation from the Director General of cost nothing in terms of education and train-
ILO, Juan Somavía, states the basic facts that ing and can start to contribute to the economy
migrant workers represent a valuable inflow of immediately if the migration process is properly
564
Migrant workers
managed. Apart from contributing to the coun- conditions, and possible unemployment among
try as employees, migrants also may prosper as the resident population.
entrepreneurs. In 1992 Germany had 150,000 If this vicious and unproductive circle is not
enterprises owned by migrants. Of these the broken, an enterprise will not truly benefit from
33,000 businesses ran by Turks generated hiring migrant labour, since these benefits are
700,000 jobs, had recorded sales figures of 17 embedded in decent working conditions, trust
billion USD and invested another 4 billion USD and loyalty. Investments in decent working con-
in Germany. If the rights of the workers and ditions will in most cases be costly in the short-
their families were secured, immigration would term but will generate long-term profits from a
probably be even more profitable, due to the at- better trained, healthier, and more motivated,
traction of a fair society and labour market, and loyal, stable, and productive workforce. Such a
the loyalty evoked by just treatment. workforce will accumulate skills and contribute
to the development of technology, production
Consequences at enterprise level processes and administrative efficiency. The
It is at the basic enterprise level, on the factory enterprise will also gain good-will among cus-
floor or in the field, that migrant labour issues tomers and subcontractors, which will also have
become real and day to day problems are faced. a positive financial impact. Migrant workers
However, it is also at this level that the way for may also contribute in other ways, for example
mutually profitable conditions and relations can through access to foreign languages and cultural
be paved. The first step towards reaching true skills needed to compete on domestic and inter-
long-term benefits for enterprises employing national markets. Furthermore, migrant work-
migrant workers is the eradication of short-term ers contribute to increased diversity among the
exploitation such as low wages, poor training, workforce which offers a variety of perspectives
non-compliance with safety regulations, gener- and experiences for creativity and problem solv-
ally harmful working conditions. The illusion ing. This holds true for a small or medium sized
that it is profitable to employ people under local enterprise, as well as for multinationals. A
such conditions lays in the hidden costs of low number of global companies have adopted diver-
productivity that result from untrained employ- sity as a management strategy to uphold quality
ees with limited motivation to contribute to an and establish a recognisable worldwide profile.
enterprise. Unnecessary risky and unhealthy Toyota has production plants in 52 countries and
working conditions result in a high turnover of sales organisations in 170 countries, states in one
employees, creating a need to recruit more new of their policy documents that each employee
untrained workers to work under the same un- should come to work each day, determined to
favourable conditions, resulting in low produc- become a little better at whatever they are doing
tivity. This is a vicious circle for employers and than they were the day before. One way to en-
employees and can go on until the enterprise courage continuous improvement is to delegate
fails. Another effect of this type of management responsibility to diverse work groups. Toyota
is that an employer will create social conflict says “…if two people always agree, one of them
at the workplace and in wider society since the is superfluous” but this statement also implies
consequences of the exploitation of a migrant that diversity management and the employment
workforce are poor wages, intolerable working of migrant workers may generate conflicts that
565
Chapter 9.3
must be conscientiously dealt with. Conflicts migrate with the intention of earning enough to
may arise because of language barriers, so lan- establish a better life when they return to their
guage training is useful. Conflicts can also arise native ground but for many this is just a dream.
because of different culturally based perceptions Some achieve an acceptable standard of living
and values. The answer to this challenge should and become rooted in their new country, so
not be to streamline behaviour and opinions, but they bring their spouse and children and settle
to encourage tolerance and open-mindedness to permanently. Others get stranded, hardly able
reach effective solutions. to earn a living and unable to improve their
conditions or to return to where they came
Consequences for an individual from. Some of the difficulties endured by many
International migrants generally come from migrant workers come from their inability or
middle income households as migration is a willingness to adapt to their new surroundings
risky and costly enterprise that prevents poor but more often these difficulties are rooted in
families from emigrating. The outcome for an unjust and unequal treatment in the host society.
individual migrant largely depends on how well This treatment comes from public authorities,
informed the migrant is about migration proce- employers, landlords, and generally from ordi-
dures in both the home country and destination nary people such as neighbours, and co-workers.
country, and knowledge of the labour market In spite of that, many migrants do improve their
in the receiving country. A successful outcome lives, in most cases with the support of fellow
depends on the migrant’s aspirations and quali- countrymen and the migrant community. These
fications and how well the receiving country can immigrant communities are the main facilita-
benefit from them. Migrant often follow family tors of successful integration for migrants, given
or friends who have told of their own fate in the that they are recognised as equal partners of the
new country. In the past many less than reliable authorities of the receiving society.
stories of success have seduced kin and friends
in Europe to embark for the US. The same is labour migration
still true for Turks in Scandinavia, Egyptians in The patterns of international labour migra-
the Gulf States, Thais in Japan, amongst oth- tion have changed considerably during the last
ers. While some migrants find a good life or century. During the first half of the 20th century
even make a fortune, most face hardships in the migrants moved to North and South America,
labour market, housing, health, and social life. Northern and Western Europe, and Australia.
This also applies to many skilled migrant work- In the middle of the century migration occurred
ers and professionals who are often unable to for other reasons. One evident cause was World
make full use of their qualifications abroad ir- War II that resulted in millions of refugees and
respective of whether they have recently arrived displaced persons, mainly throughout Europe,
or have a long period in the country. That state- but also in the Middle East, North Africa and
ment is supported by the fact that most Latin Southeast Asia. In addition the reconstruction of
Americans and Africans who obtain their quali- Europe, and the urge to increase the industrial
fied training abroad fail to get established on capacity in countries which had remained un-
the labour market in occupations commensurate damaged by the war, generated an unprecedent-
to their education. Many less skilled workers ed migration of labour. In part this new kind of
566
Migrant workers
migration generated “guest workers,” “seasonal Europe. Until recently Mexico was the world’s
workers,” or “contract workers” most of whom largest exporter of labour migrants, but has been
came from developing countries to work on very surpassed by the Philippines, which now has 8
limited work and residence permits. From 1950- million of its citizens working abroad (10% of
1975 northern Europe received 20-30 million the total population).
labour migrants from the southern and eastern Movements within continents also increased.
parts of the continent, from northern Africa, the Many South Americans were attracted by in-
Indian subcontinent and other former colonies. creasing development in Argentina and Ven-
While many migrated on their own initiative, an ezuela. The oil industries of Nigeria attracted
equal number were directly recruited by govern- labour migrants from neighbouring countries.
ments and expanding European enterprises, such Sub-Saharan emigration to South African min-
as Volvo, Philips, SKF, and the construction ing industries and agriculture has also increased,
industry. Contrary to the intention of the host mostly from Mozambique, Botswana, Lesotho
countries, many migrants brought their families and Swaziland, and lately from Zimbabwe, due
and settled. This permanent settlement was de- to the political situation.
scribed as an immigrant movement “from hos- In the recent past, policy has primarily been
tels to houses”. This unintended and unexpected directed towards the immigration of highly
development challenged the European welfare skilled workers who meet specific labour mar-
states in the 1970s. Their responses ranged from ket needs, however, this must not obscure the
attempts to force assimilation (France), or re- fact that the vast majority of migrant workers
stricted positive special treatment (Germany), to are concentrated in the lowest socio-occupa-
integration based on equal rights and freedom tional categories of their host countries. They
of cultural choice (Netherlands). The common are found in low skill services, agriculture and
ground for these different political strategies was labour intensive manufacturing, very often in
the need to balance the rights and needs of the the informal economy, where they occupy jobs
native population and migrants in demographi- rejected by locals, are paid very low wages and
cally changed societies; the European countries often are subjected to the harshest working con-
“asked for migrant workers, but got people” ditions. The literature labels these jobs as 3D-
according to Max Frisch. jobs, meaning “Dirty, Dangerous and Difficult”.
The gates to these labour markets closed Migrants and indigenous and tribal peoples con-
abruptly with the oil crisis in 1973, and con- sistently fall within this unskilled category due
straints in the welfare systems and labour mar- to systematic exclusion and marginalisation that
kets of Western developed countries followed. prevents them from integrating their traditional
The lost work opportunities within these econo- knowledge within the mainstream perception of
mies were counteracted by new labour markets a skilled workforce.
in the oil producing Gulf States that attracted It is difficult to estimate the total number
workers from throughout the Middle East of migrant workers in the world. Statistics are
and from the Indian subcontinent and eastern incomplete or non-existent in many countries,
Asia. South America experienced a vast exodus and even where they do exist they cannot be
of workers mostly to agricultural, informal or used for international comparisons since there is
sweat-shop jobs in North America but also to no universally accepted definition of the termi-
567
Chapter 9.3
nology. Another difficulty is that large numbers with prevailing national legislation. Many coun-
of migrants are admitted on other grounds than tries restrict migrant workers’ staying by issu-
labour migration and registered accordingly ing temporary permissions, only allowing them
even though many of them join the labour force to work in specified branches of industry. Low
and become migrant workers. Furthermore, data skilled temporary workers are usually not al-
on undocumented migration and employment lowed to bring their families with them. Tempo-
are at best qualified guesses even from the most rary worker programmes have increasingly been
reliable sources. Given these difficulties, ILO implemented in many developing countries over
estimates that there are roughly 100 million the last decades. In Africa the Republic of South
people, about 3% of the global workforce, cur- Africa has a longstanding programme to provide
rently residing and working, legally or illegally, labour for the mining sector. In 2000 more than
in a country other than their own. There is ap- 130,000 (almost 60%) of the work force in the
proximately a 50-50 split between developed and mines were temporary migrant workers. Other
developing host countries. African states heavily relying on admitted tem-
The table below shows the approximate glo- porary migrant workers are Gabon, the Ivory
bal residence and distribution of internationally Coast and Libya. In Asia we find the same pat-
migrated workers. tern in the Gulf States, Brunei, Malaysia, Viet
Nam, and recently also in China. Some devel-
Region Millions oped countries have initiated legalisation pro-
Africa 20 grammes from time to time. In the early 1970s
North America 18 the French government offered undocumented
Latin America 12
migrants residing in the country the opportu-
nity to apply for legal status. Of the resulting
South-East Asia 7
150,000 applications, 130,000 were approved.
Europe 31
A similar programme was introduced in the US
Middle East 9
in the late 1980s, requiring proven residence
Australia 5 of 5 years or proof of 90 days work during the
TOTAL 102 previous year. In 2004 Spain offered legalization
with similar requirements. The main reasons for
Legal labour migration introducing these programmes were to combat
Migrants with legal status (documented mi- illegal immigration, and to give migrants a help-
grants) are those who have been granted a work ing hand to join the formal workforce. However,
and/or residence permit by the national au- although many migrant workers became formal-
thorities in the receiving country. The permit ised, their financial position worsened as their
can be permanent or limited in time, (the most net wage after taxation was less than before. The
renowned being the US Green Card). A person programmes also attracted more undocumented
carrying such a permit has all the rights and migrants arriving with hopes for legalisation.
obligations prescribed by national legislation Since legal labour migration procedures and
but these rights can vary from full equality with migrant workers’ status are regulated by law, it is
the native population to very restricted rights. tempting to suppose that there should be fewer
Both employers and employees must comply problems with documented migrants’ general
568
Migrant workers
working conditions and OSH issues but this is tions that are likely to affect physical, psycho-
not the case. One highly complicating factor is logical and social wellbeing.
that although these persons enjoy a legal status, The ILO “Fundamental Principles & Rights
they very frequently end up in the informal la- at Work” (1998) specifically advises all states to
bour market, which by definition is unregulated. actively strive for the elimination of discrimina-
Another reason is that laws and regulations are tion in employment. Such endeavours shall not
frequently violated by employers at the expense only combat discriminatory practices, but active-
of locals as well as migrant workers, whether ly promote initiatives for equal treatment.
documented or not. Therefore it is an obvious
risk that documented migrants workers will find Irregular labour migration
themselves in the same unfavourable and haz- Migrants get different legal status depending
ardous working conditions as the other catego- on how they are recognised by the host country.
ries of migrants discussed below. Their legal status determines an individual mi-
grant’s rights and duties on a scale from equality
Discrimination with native citizens to a total deprivation of all
Discrimination is directly related to legal labour civil rights. Apart from immigrants with some
migration because in order to be discriminated kind of legal status, in many countries there is an
against in a legal sense, a person has to be legally increasing number who have no legal status at
in the country. The ILO Convention on Dis- all. They have crossed a border without a permit
crimination (No 111, ratified by 164 countries), or are bereft of legal rights while already in a
sets a minimum standard but national laws on country illegally, e.g. by overstaying their visa
discrimination differ greatly between countries, permission. Such persons are often referred to
and do not exist at all in some countries. Fur- as “illegal immigrants”, which is misleading and
thermore, compliance to the law is not upheld unfortunate, since it might place them in a still
as proven by the existence of discrimination in worse position. Three main objections can be
almost all countries, developed and developing raised against the notion of illegal migrants and
alike. A widely accepted definition of discrimi- illegal migrant workers:
nation is “different treatment in similar cases”. • People can never be illegal; illegality refers to
Discrimination towards migrants on the labour actions, not to people. To state that someone
market can occur in many ways, such as unjust is illegal denies the fundamental Principle of
denial of employment, unduly low wages, longer the UN Declaration of Human Rights - all
working hours, child labour, harassment, denial human beings are equal. Such a denial sup-
of rights such as union membership, and access ports the hypocritical Orwellian credo in his
to basic health services. In other words, migrants novel “Animal Farm”- “All animals are equal,
are forced to accept poor working conditions not but some are more equal than others.”
offered to or accepted by others. Discrimination • The notion of “illegal migrant” implies that
on the labour market is often combined with a person is acting against the law. That is not
discrimination in the housing market and access the case with the migrant worker, since there
to general public services. The interaction of is no legal prohibition on work. The crucial
these factors results in poor general living condi- point is that the undocumented worker is not
against the law, but outside the law, and com-
569
Chapter 9.3
pletely at the mercy of employers, bereft of all on social protection, access to health care, la-
legal protection. bour inspection or decent working conditions.
• If a national legislation doesn’t accept or ac- It is impossible to give a precise number of
knowledge undocumented migrants, it is the undocumented migrants in any country or glo-
person who hires them, i.e. the employer, not bally. The ILO estimates that up to 15 percent
the employee, who is acting illegally. of all migrant workers in the world are in this
category. One reason for this situation may be
These migrants can reside in a country where the increasing commercialisation of the recruit-
they have no legal right to residence, which ment process. An ILO migration survey con-
makes their status illegal, but not their persons per ducted in 2003 reports that 45 percent of the 90
se. It is more appropriate to refer to this cat- responding countries allow private recruitment
egory of migrants as undocumented or irregular agencies to bring in migrant labourers. More
migrants. than half of these also allow the agencies to
Nevertheless, these migrants are of great con- charge fees from the migrants. Another reason
cern for most countries. Their presence is often must surely be the increasingly restrictive immi-
seen as a threat by the trade unions, since the gration regulations adopted by the USA, Euro-
exploitation of their labour can result in unem- pean Union member states, Australia, and most
ployment for the native population, lowering of other developed countries. When the regular
wages, and as counteractive for improvements gates to entry are closed, many migrants will see
in occupational safety and health and the work- no other option than an irregular one. In some
ing environment. This is just one of a number of cases this results in less governmental control
reasons why these workers are often completely of migration and increasing vulnerability for
without any rights. There are two different resident migrants. Examples of the worst effects
strategies used to tackle the issue. One is to of undocumented migration include those who
restrict their admission to the labour market and lose their health or lives trying to reach a host
the other is to protect undocumented migrants. country: those trying to reach the Spanish shore
This question is especially difficult to tackle from northern Africa; people who becoming
because undocumented labour is crucial to the severely dehydrated from the desert sun while
economies of basic industrial and service sec- trying to reach Libya, or those who make the
tors in many nations. The competitiveness of hazardous journey from Mexico to the American
the agricultural industry in several states of the border. When nations try to plug these bor-
USA, construction industries in Spain and Por- ders, smugglers and migrants find other ways.
tugal and the mining industry in South Africa Increased patrolling of the Mediterranean has
are just a few cases where undocumented labour redirected the flows to the even more precarious
is of great economic significance. Although most voyage to the Canaries, multiplying the risks for
governments officially combat the existence of the migrants. In the first half of 2006 more than
a grey or black economy, they may turn a blind 1,000 North African migrants drowned in their
eye to the facts, resulting in silent consent on attempt to reach these islands that are part of
the issue of undocumented migrant workers. Of Europe.
course, it is impossible to combine this situation In addition to a general increase in irregular
with adherence to conventions and regulations migration, this climate has contributed to the
570
Migrant workers
opening up of a lucrative market for the smug- economic activities, while others go back and
gling and trafficking of migrant workers. There forth whenever opportunities arise. For example,
has also been an increase in altruistic and organi- in Sweden there is a growing number of Polish
sational efforts, particularly by NGOs, to meet and Baltic citizens who come for temporary jobs
the needs and aspirations of migrants by acting in agriculture, construction and street trading.
as bridges between the migrant communities, People from Thailand also come to Sweden for
authorities, and employers. Other organisations seasonal berry picking. Turkey has the same
provide much needed humanitarian aid and so- experience as citizens, particularly women,
cial protection. However, others find an oppor- from former Soviet states find short-term jobs
tunity to enrich themselves on the misfortune of as maids or selling whatever they can carry in
others, acting as smugglers and job agents. For suitcase. These movements also include prosti-
example, Mexican officials claimed in 2002 that tution and other black economy activities. The
130 small and 15 major smuggling organisations increase in these movements is surely an effect
were moving migrants to the US. This informal of globalisation, related to profound improve-
“industry” had an annual turnover of more than ments in transportation, information technolo-
a billion USD. As a next step, other people may gies, and increased movements of capital, since
take advantage of irregular migrants by acting multinational companies transfer capital, goods
as employment agents who supply employers and personnel across the globe. People moving
with cheap and undemanding labour. Others in such networks are generally more protected
simply exploit the dependence immigrants are and better off than people moving as free agents
subjected to as employees. Women and children who are exposed to more difficulties, risks, dis-
are vulnerable and far too many have become crimination a weaker legal position.
the victims of trafficking into slave labour or
forced prostitution. A recent example of the Internal migration
efficiency of this “industry” is that during the Internal migration differs in many ways from
soccer World Cup in Germany in the summer of international migration. The migrants are na-
2006, 5000 East European, Russian and Ukrain- tives and therefore covered by the same laws
ian women were trafficked to work in temporar- and regulations as every other citizen and they
ily established brothels in the cities hosting the normally speak the language of the country.
sport events. Internal migration is more often seasonal, and
vastly more extensive than international migra-
Transnational migration tion. Geographical conditions can mean that a
Another longstanding migration pattern that seasonal worker can be constantly on the move
has increased during the last decades is “trans within a country. For example, in Chile where
national migration”. This is a circular mobility the harvest season gradually moves along the
pattern where people regularly move between vast south-north axis of the country, agricultural
two or more places where they have different workers follow the shifting longitudinal climatic
kinds of relationships, be they through family, changes. Coffee-pickers in Costa Rica follow
economic interests or cultural ties. People tem- the altitudinal harvest seasons of the mountain
porarily cross borders in order to find jobs or slopes. Most internal migration consists of farm-
to trade. Some follow harvests or other regular ers and their families moving from remote rural
571
Chapter 9.3
areas to cities to find jobs as construction or authorisation to enter or remain in a country so

factory workers, domestic servants, drivers, tour- they lack legal protection.
ism workers and in other low skilled jobs, often
as day labourers. Many fall into the category of international regulations on
entrepreneurs who try to make a living as street migrant workers
hawkers or petty traders. Rural-urban migration There is an international consensus that core
is the fastest growing temporary migration in labour standards provide a minimum set of rules
many developing countries marked by increasing for labour in the global economy, but these
urbanisation and manufacturing. The internal general standards do not explicitly address con-
seasonal migration in India is as large as 50 mil- ditions for migrant workers. Every nation has
lion persons annually and in China the amazing sovereign rights to shape their policies towards
number of 200 million internal labour migrants migrants, but there is a lack of a multilateral
were registered in 2005, i.e. almost one fifth and global framework for governing the cross-
of the entire population. As earlier mentioned, border movement of people. Rules for fair trade
Chinese citizens are only entitled to civil and and capital have advanced, but they need to be
social rights when they live at the place where complemented by fair rules for the movement
they were originally registered. This reminis- of people. Nevertheless, there are a number of
cence from the Maoist era, the hukou system, international regulations and conventions that a
is severely detrimental to the masses of internal number of states have ratified, thereby taking on
migrants who have left their original residence a moral responsibility to fulfil. The most impor-
to find a job in the city or as seasonal workers tant declarations on migrants’ rights and health
in agriculture. A vast number of these migrants, issues are to be found within the body of the
around 80 million factory-workers in 2005, es- United Nations.
tablish the back-bone of Chinas competitiveness UN statutes and declarations are all founded
in the globalized economic system. on the conditions expressed in the Charter of
In spite of some differences, internal migrants the United Nations (1945). Respect for general
share many of the conditions of international human rights is one of the most basic determi-
migrants’ because the vast majority of them end nants of migrants’ well-being and is essential to
up in the informal economy with very limited the achievement of greater social and economic
or no rights. Although internal migrants are development for individuals and societies. This
citizens of their country they may feel quite as implies that all migrants have access to afford-
lost as a foreigner since the life and the cultural able basic social and health services, including
practices and values of the city bears very little reproductive health services.
resemblance to the life they used to lead. Furthermore, the UN International Convention
Conclusively, all categories of migrant work- on the Protection of the Rights of All Migrant Work-
ers face the risk of being subjected to abusive, ers and the Members of Their Families (45/158),
exploitative and discriminatory treatment in host which came into force July 2003, is a detailed
countries, and even in their own country. Adher- statement of views on the rights of migrant
ence to human and labour rights norms for non- workers, both documented and undocumented
citizens is often inadequate in many countries, migrants. Among the 34 states that have ratified
particularly for irregular migrants who have no the convention we find Algeria, Chile, Hondu-
572
Migrant workers
ras, Lesotho, Libya, Nicaragua, Peru, Syria, East • protection against arbitrary expulsion from
Timor and Turkey. Although all these states are the State of employment
classified as “developing”, there are immense • return home if the migrants wishes
differences between their practices with regard • a standard of living adequate for the health
to workers’ and immigrants’ rights. The conven- and well-being of the migrant worker and his
tion defines spouses and dependent children as or her family
family members, and aims to “contribute to the • safe working conditions and a clean and safe
harmonization of the attitudes of States through working environment
the acceptance of basic principles concerning the • reasonable limitation of working hours, rest
treatment of migrant workers and members of and leisure
their families.” In short it expresses equal rights • freedom of association and to join a trade
with natives, unless otherwise stated by agree- union
ments or national law. The convention covers • freedom from sexual harassment in the work-
all kinds of migrants, documented as well as place
undocumented, and explicitly indicates migrant • protection during pregnancy from work prov-
workers’ rights to equal treatment, to join un- en to be harmful
ions and to benefit from the social security sys- • protection for the child from economic ex-
tems to which they contribute. The convention ploitation and from any work that may be
was approved by the General Assembly on 18th hazardous to his or her well-being and devel-
December 1990, and that date is now annually opment.
celebrated as International Migrants Day. • The human right of children of migrant
According to the UN, the human rights of workers to education.
migrant workers and their families include the • The human right of migrants and their fami-
following universal, indivisible, interconnected lies to reunification.
and independent human rights:
The human right to Since it is states, and not enterprises or employ-
• work and receive wages that contribute to an ers that have signed this convention, there is a
adequate standard of living national responsibility to establish and empower
• freedom from discrimination based on race, the institutional infrastructure needed to follow
national or ethnic origin, sex, religion or any up this serious undertaking. There has to be
other status, in all aspects of work, including appropriate legislation, workplace surveillance
in hiring, conditions of work, and promotion, capacity and means to enforce the law.
and in access to housing, health care and basic Additional international agreements are the
services 1994 Cairo Program of Action of the International
• equality before the law and equal protection Conference on Population and Development, and
of the law, particularly in regard to human the Beijing Platform of Action of the Fourth World
rights and labour legislation, regardless of a Conference on Women from 1995. Both affirmed
migrant’s legal status the importance of promoting and protecting
• equal pay for equal work the human rights of migrant workers and their
• freedom from forced labour families, especially women. The UN World
Conference in 2001 issued the Durban Declara-
573
Chapter 9.3
tion and Programme of Action that urges states migrants’ safety and health at
to allow migrants to unite with their families, work
and asks governments to make active efforts to The health of migrants has long been acknowl-
reduce discrimination against migrants in the edged as a public health concern but although
labour market. workers’ rights to health are well established in
ILO has issued 19 conventions directly aimed international law, the health of migrant work-
at OSH issues, covering general measures, par- ers has not been given adequate attention. In
ticular branches or specified materials. These general migrants have poorer health status than
conventions address all employees, whether the native population. There are several plau-
migrants or not. A number of other ILO con- sible explanations (and counter arguments) for
ventions and regulations also refer explicitly this situation. Many people who choose to move
or implicitly to migrants’ rights. Two examples do so because of poor living conditions in their
of such general conventions are the Freedom of home country so their health is already damaged
Association and Protection of the Right to Organ- when they migrate. Some countries use this as
ize Convention (No 87, ratified by 145 countries, a reason to deny migrants basic health services.
2006) and The Right to Organize and Collective A further explanation is that health is damaged
Bargaining (No 98, ratified by 154 countries, by hardships experienced during migration or
2006). Among the conventions explicitly ad- because of poor general living conditions in the
dressing migrant workers the most extensive are country of destination. It is not possible to reach
Conventions 97, Migration for Employment Mi- a general conclusion about the relationships
gration, and 143, Migrant Workers (Supplementary between migration, work and health but requires
Provisions) Convention, that have been ratified by specific examination of the facts in context. Eu-
45and 19 countries respectively (2006). Conven- ropean studies indicate that health status varies
tion 97 defines a migrant for employment pur- between immigrants from different countries,
poses as “a person who migrates from one coun- and that women are generally at greater risk of
try to another with a view to being employed health damage than men, however, results are
otherwise than on his own account”. Such a very imprecise due to a lack of comparable data.
person should be treated equally to other work- One of the most publicised migrant health
ers in terms of wages and other working condi- issues in developing countries is the spread of
tions. Convention 97 also recommends bilateral infectious diseases, particularly HIV/AIDS.
agreements regarding recruitment, migration Since AIDS first appeared in 1981, more than 25
policies and information sharing. Convention million have died from it. In 2005 more than 4
143 recommends policies to minimise illegal mi- million were newly infected, almost 40 million
gration, to combat human trafficking and smug- were living with HIV, and AIDS claimed an esti-
gling, and to promote the integration of settled mated 2.8 million lives. Although the disease has
migrants. These are important and progressive an almost global presence, developing countries
conventions, but it is still a vital task for the ILO are the most affected. A South African research-
and the social partners to convince governments er illustrates how migration has spread AIDS
world-wide to ratify and apply them. with this short description of migrant workers’
conditions: “If you wanted to spread a sexually
574
Migrant workers
transmitted disease, you’d take thousands of men diseases, i.e. almost 4 people die at work every
away from their families, isolate them in single minute. Many studies show a higher prevalence
sex hostels and give them easy access to alcohol of occupational diseases and injuries and fatal
and commercial sex. Then to spread the disease, accidents among immigrants than among na-
you’d send them home every once in a while to tives. In China, statistics from 2005 reveal that
their wives and girlfriends.” This quote sum- out of the 10,807 deaths in mining and construc-
marizes several aspects of the general conditions tion, more than 75% were migrant workers.
experienced by migrant workers in e.g. planta- It is tempting to jump to the conclusion that
tion or mining camps: poor housing, little or no immigrant workers are by nature more acci-
access to health care and information and social dent prone than others but studies reveal more
deprivation. disturbing reasons for these statistics, generally
Migrant employees are likely to be generally related to environmental conditions and work
more vulnerable to illnesses and to HIV/AIDS organisation. Migrant workers are often found
infection due to their general living and work- in dangerous, dirty and difficult jobs, seldom
ing conditions. Since most migrants live under get sufficient training in machine operation
scarce economic conditions, and many of them and safety routines, and are not equipped with
face language barriers, they are less able to get appropriate safety equipment. In addition, mi-
information on HIV/AIDS and prevention grants frequently work on short term contracts,
measures from media. When migrant workers which don’t enable them to get enough practice
succumb to AIDS or other diseases, or get se- to develop safety related skills. They also often
verely injured, they potentially suffer because of work long hours that don’t permit sufficient
their lack of access and restricted medical treat- rest. Language and cultural difficulties are also
ment, if medical treatment exists at all. Illness or safety risks, and safety regulations are often not
injury often means that migrants lose their jobs translated into other languages. Their status as
and means for support for themselves and their undocumented workers and their weak position
families. in the labour market restrain them from de-
While HIV/AIDS is the disease in develop- manding improvements, seeking health care or
ing countries that attract most media attention, reporting accidents. They are seldom aware of
malaria is almost equally lethal. 300-500 million their rights and fear retaliation so it is also rea-
people are infected annually and up to 2 million sonable to assume that there is a larger number
die from it, most of them in sub-Saharan Africa. of unreported accidents and diseases among
The Amazon basin in South America and the migrant workers than among natives. In far too
river deltas of South-East Asia are other highly many cases migrant workers are trapped in a
affected regions. In 2003, 76 countries reported dangerous situation where they are regarded as
the presence of endemic malaria; almost all of an abundant and dispensable labour force.
them were developing countries in Africa, Asia The most hazardous work sectors are agri-
and Latin America. Migrants and other travel- culture, mining and construction. In many parts
lers carrying the infection may transmit the of the world, especially in developing coun-
disease to other regions. tries, these sectors employ the largest number
ILO estimates that more than 2 million peo- of migrant workers, especially temporary and
ple die annually from work related accidents or irregular migrants who are the least protected
575
Chapter 9.3
by social, health and safety regulations. The falling world market prices on important crops
informal parts of many economic sectors, where such as coffee, cocoa, bananas and sugar. This
people work without contract or individual affects wages and general working conditions,
recognition, are not subject to protective regula- mainly resulting in internal migration from
tions. Domestic services, the petroleum industry rural to urban areas. Year round employment
and shipping are other examples of jobs with turns into downgraded seasonal jobs, and the
high accident risks, documented poor working gaps left by those who have internally migrated
conditions and an overrepresentation of migrant from farms or plantations, is filled with seasonal
and/or temporary workers adult and child migrant workers, who earn lower
wages, work longer hours, and enjoy less protec-
Agriculture tion and worse housing. Such workers are often
Agricultural workers account for a particularly contracted by employment agents who compete
high proportion of unprotected workers, both by offering employers the cheapest workers.
in developed and developing countries. Their ILO Convention No 184, “The Safety and
work is generally heavy, with long working Health in Agriculture”, states the minimum age
hours, exposure to difficult climatic conditions, for farm work at 16 years but around 80 mil-
and exposure to hazardous chemicals, especially lion children, aged 5-14 years, are employed in
pesticides. These problems are compounded by agricultural activities. Some countries, e.g. in
poverty, extremely poor living conditions, and the cocoa producing countries of Burkina Faso,
limited access to clean water, fuel and power, Ivory Coast and Mali, systematically hire mi-
adequate shelter and nutrition. Literacy is often grant children to work on the plantations. These
low, and so is the level of organization of work- workers are seldom organised, and therefore not
ers in the sector. represented by any trade union. In many cases
1.3 billion of the world’s total labour force, this is a precondition for employment. Agricul-
(more than 40 percent), are found in the agri- tural workers face occupational risks from ex-
cultural sector. Of these, almost half a billion posure to pesticides that cause all kinds of dam-
are hired workers, and the majority of them are age from cancer to miscarriages and disturbed
women. According to the ILO, more than half mental health; from dehydration due to working
of the recorded fatal workplace accidents in the long hours in sunshine; snake bites and danger-
world occur in the agricultural sector. In the late ous transportation to work sites in unsafe and
1990s, 170,000 persons suffered work related overcrowded vehicles.
deaths in the agriculture labour market. Millions The main problems in agriculture are oc-
are injured or poisoned annually by toxic pesti- cupational injuries and fatalities related to ma-
cides. An illustrating example is derived from the chinery and transport equipment, and chemical
US statistics, where 13% of all fatal accidents in poisoning from pesticides and other substances.
the late 1990s occurred in the agricultural sector, These risks are also aggravated by inappropriate
while it constituted only 2% of overall employ- personal protective devices; inadequate meth-
ment. There are several reasons why agriculture ods for recording and reporting problems, and
stands out as a very migrant dense sector. One conducting relevant surveillance; an inability to
of the most important is the economic pressure respond with preventive, protective, curative,
on farming in many developing countries, due to and rehabilitative measures. Combined with bad
576
Migrant workers
living conditions and poor public health it makes small), including dependants, for a living is likely
agriculture one of the most dangerous work sec- to be over 200 million.
tors. The mining sector also has another significant
health related characteristic because workers,
Mining and sometimes their families, often live in camps
Mines are also one of the most dangerous places in the vicinity of their work sites. These camps
to work. The risks of explosion and collapse are generally offer poor physical and social living
obvious, and the risks posed by dust, heat, hu- conditions, where drug and alcohol abuse threat-
midity, noise and vibration are well documented. ens public health and leads to greater risks at
Although mining only accounts for 0.4% of the work. The commercial sex trade in such camps
global workforce, it is responsible for over 3% also increases the spread of sexually transmitted
of fatal accidents at work (about 11,000 per year, diseases.
about 30 every day). Data on injuries and fatali-
ties exists in most countries, and reveals signifi- Construction
cant numbers of accidents. There are reasons In 1999, global employment in the construc-
to believe that the real numbers of occupational tion sector was estimated to 112 million, 75%
diseases (such as pneumoconiosis, silicosis, tu- of whom were in developing countries. (Actual
berculosis, hearing loss and the effects of vibra- numbers have probably increased). Construction
tion), are larger than official statistics. However, has always exposed workers to physical risks and
it is even more difficult to estimate the number this has worsened due to the changing structure
of workers who suffer premature disability and of the sector. Many construction sites are huge
death from their work. Mines are also the work- undertakings, and work is often carried out by
place for an unknown number of children some a multitude of subcontractors, who hire tempo-
of whom are very young. rary workers with different skill levels. This has
Worldwide, many miners are migrant work- severely undermined the historically high rate of
ers. For example, workers from the whole sub- unionisation in the sector, which in turn has led
Saharan region are recruited in the gold and to worsening working conditions in regard to
diamond mines in South Africa, Brazilian miners both OSH and pay rates in both developed and
migrate to work in the bauxite and gold mines of developing countries. An ILO report notes that
Surinam, and masses of internal migrants work “the increased employment of labour through
in Chinese mines. Migrant miners face the same subcontractors has also had a profound effect
conditions as other migrant workers in terms of on safety and health at the workplace and has
weak or non-existing legal protection and rights, undermined collective bargaining and training
restricted access to health and other public serv- provisions”.
ices, and other kinds of discrimination. Poor conditions have given the construction
For every mining job there is at least one job industry a bad reputation in many parts of the
that directly depends on mining. In addition, world so young people shun work in the sector.
11.5-13 million people, (not included in the These places are often filled with migrant la-
above figure), work in small-scale mines. The bour, working for low wages under bad working
number of people relying on mining (large and conditions and with insufficient or no training in
risk protection and health promotion. This has
577
Chapter 9.3
resulted in a race to the bottom in many coun- mal urban self-employment and employment in
tries, such as the Gulf States, Singapore, Israel, small informal enterprises, thereby leaving out
and Europe (e.g. Spain and Greece) where informal employment in agriculture and formal-
considerable parts of the construction sector ly registered activities. Using a broad definition
are based on mostly irregular migrant low-paid of informal labour, including both urban and
labour. A horrifying example from Greece was rural workers, employed and self-employed, it is
the death of 40 construction workers, all un- possible to state the following facts:
documented migrants from Albania, Iraq and • Informal employment amounts to 50-85%
North Africa, killed during the frenzy to erect of the total non-agricultural employment in
the arenas, hotels and other buildings for the developing countries.
2004 Olympic Games. • When informal employment in agriculture is
included the total amount increases signifi-
The informal economy cantly, e.g. to more than 90% in India.
The informal economy constitutes the main • Informal wage employment represents 30-
part of the labour markets in developing re- 40% of urban informal employment in devel-
gions throughout the world; it is fair to say that oping countries, 60-70% of informal labour
informal labour is the norm, while formal and are self-employed (including unpaid family
regulated labour markets are the exceptions. members).
The informal economy is characterised by the • The contribution of the informal labour
absence of contracts and a total lack or severe market to the total economy is considerably
limitations on workers’ rights. less than its proportion of labour, due to less
The work performed in the informal sector efficiency, limited markets, unfavourable com-
is generally legal (rather than criminal), involv- petition conditions, poor working conditions
ing the legal production of goods and services and other restricting factors.
by legal workers (albeit employed under illegal • Women and migrants are more often in the
conditions or as unregistered self-employed en- informal economy than men and natives, and
trepreneurs). These conditions make large num- they are also are over-represented in low-
bers of workers extremely vulnerable. Women wage informal employment.
and children are worst off due to their generally The table below shows the estimated percentage
weak position in society, and migrants who are of workers in the informal economy in different
often totally dependent on their employers for developing regions. Although there is no known
survival. Undocumented migrants, residing and accurate number of immigrants among the total
working illegally in a country, are often totally estimated number of workers in the informal
at the mercy of employers since they have no economy, it is recognised that migrant work-
way of complaining for fear of repression and/or ers constitute a considerable, (often dominant),
expulsion by authorities. share of the informal workforce, in absolute as
Due to a lack of sufficient data and disagree- well as relative terms. It is therefore reasonable
ments on definitions it is impossible to give to conclude that the percentages of migrants
accurate figures about the informal economy in the informal economy are even higher. The
in any single country, still less on a regional or table also shows that the total informal economy
global level. Existing data often counts for infor- is dominated by female labour.
578
Migrant workers
migrants is regarded as illegal. As a consequence,

Region/country Excl. Incl. % of
undocumented workers lack workers and other
agriculture agriculture total
women civil rights, in a country renowned and proud
workers of its social welfare system. In southern Europe
many unions organize undocumented migrant
North Africa 48% 43% workers who become entitled to some protective
Latin America 51% 58% measures and workers’ rights, without getting
Asia 65% 65% full access to citizen rights. In many developed
Sub-Saharan 72% 84% countries there are civic organizations support-
Africa ing undocumented workers. In several develop-
South Africa 28% 34% ing countries, e.g. India and Brazil, and among
Mexico 55% 62% migrant worker communities in developed coun-
India 83% 93% tries, their strategy is the formation of separate
unions.
A most interesting example occurred within
Unregistered migrant workers and informal la- the US trade unions in the 1990s. Trade unions
bour markets are also crucial in many developed faced difficult time due to the general economic
countries. A US nationwide survey of day la- situation when their traditional membership
bourers shows that almost all urban day labour- base vanished rapidly when factories and pro-
ers are immigrants, mostly from Latin America. duction moved to countries with lower costs.
In relation to health issues the survey reports the Domestic economic expansion was in the service
following data: sector, which offered low paid jobs that were re-
• 75% consider their jobs dangerous jected by most white Americans, but accepted by
• 67% have lost the opportunity to work due to immigrants, both documented and undocument-
a work injury ed. Organisation of these immigrants proved to
• 22% of those injured lost at least one month be the way for the trade unions to survive. They
of work started to penetrate the biggest service compa-
• 19% had suffered a work injury requiring nies. For example, within a decade 70% of the
medical attention. migrant cleaners, (mostly Hispanics from Latin
America), in Los Angeles were organised, thou-
One way to improve the working conditions sands of immigrants had gained legal protection
and secure the rights of workers in the informal and the trade union had regained its strength.
economy is to organize them, either on their The general reasons for unionising undocu-
own initiative or through trade unions. There mented labourers are universal:
are different views among trade unions about • Unions promote the rights of all workers
how to relate to the informal economy, depend- • All workers have the same needs, regardless of
ing on the immigration policy of an individual legal status
state. In the Scandinavian countries unions • Unionisation avoids splits and competition
only organize workers with a formal working between workers
permit, since the residence of undocumented • An unprotected worker is a threat to all work-
ers.
579
Chapter 9.3
The ultimate empowerment device is of course Recommended measures – international level

the legalisation of undocumented workers that
allows them to defend their rights on an equal • Establish transnational agreements on fair migration
management.
basis with native workers. This would also help
• Establish means to implement existing international
to combat the informal economy, and serve agreements and conventions in those countries
public interests through increased tax revenue. which have ratified them.
However, this is not a definitive solution as • Propose and establish measures for fair treatment of
undocumented migrants.
legalised workers will soon be replaced by new
• Propose and establish measures to legalize undocu-
undocumented workers. A long-term solution mented migrants.
must seriously and continuously address the
underlying reasons for the reliance of low wage There is a variety of measures to be taken
sectors on undocumented workers. on different levels to improve general working
conditions and the special needs of immigrants.
what should be done?
On the international level, there are already ac-
The remedies needed to achieve decent work- cepted conventions, regulations and agreements
ing conditions are largely the same whether the on the movement of goods and capital, but glo-
employees are migrants or not, but migrants are bally accepted equivalents for the movement of
generally more vulnerable. people are still lacking. The international com-
Aside from purely humanitarian reasons, there munity should urgently establish such agree-
are also very pragmatic reasons for authorities ments. The promotion of regulations must be
and enterprises to strive to offer everyone de- the responsibility of international organisations
cent living conditions, proper housing, access to of states and social partners, such as ILO, WHO
health service and education, and improvements and international trade union federations.
in working conditions. The most obvious one The main tasks at national level are the imple-
is that healthy and educated people contribute mentation and enforcement of international and
to the development and prosperity of a society national labour conventions and regulations for
and an enterprise. Unhealthy and unproductive fair migration management and treatment in-
people are a burden and while they might be re- cluding measures that will avoid migrants ending
garded as dispensable when there is a surplus of up with illegal status. It is also a national re-
labour, that is a miscalculation as there is always sponsibility to strengthen surveillance capability,
is a cost and production loss when new labour especially in risky economic sectors with a high
is recruited. Improvement in social conditions proportion of migrant workers, such as in con-
avoids social tensions. Social unrest results in struction, agriculture, mining, manufacturing
increasing criminality rates and might also trig- and domestic services. The enhancement of oc-
ger violent outbreaks between social or ethnic cupational safety and health education is another
groups. At company level, improvements will important national obligation. Such improve-
ensure loyalty from labourers, and avoid damag- ments will not only directly improve working
ing actions such as strikes or deliberately slow conditions but will counter desires for emigra-
production. To conclude, sound, responsible and tion and the loss of trained and skilled persons
efficient policies and management prioritises a most needed for infrastructure development and
healthy population and labour force. the economy. Ultimately such improvements
580
Migrant workers
will combat poverty and raise the level of de- can offer the banks financial security. The initial
mocracy in a country. Another important meas- credit given for most newly established firms in
ure is to find means to regulate the informal developed countries, are loans on private hous-
economy, since a large proportion of the native ings (e.g. 70% in the US). In the same vein,
and immigrant population in developing coun- initiatives such as reforms to ease access to loans
tries are forced to find a living in this dangerous and the provision of management training for
part of the economy. The informal economy not migrant entrepreneurs would be useful.
only damages individuals, but society as a whole, Since national and municipal employers are
since it pays very little into general society and the principal actors in the public sector, it goes
limits sustainable growth of an economy. The without saying that they carry direct responsibil-
Peruvian economist, Hernando de Soto, points ity to offer decent working conditions for all jobs
out that one crucial way to decrease the informal in that sector, whether the employees are native
economy is to simplify and improve the possibil- citizens or migrant workers. This also implies
ities for enterprises to be legally registered. This that migrant workers and their families should
would enable people to get a foothold in the for- have access to at least basic education and health
mal economy, and would also increase tax rev- care services. Another important obligation for
enues. Another equally important reform would public authorities is the facilitation and reduction
be to establish easy and cheap ways for people of remittance costs that can increase the inflow of
to register housing and private properties. Such capital sent by migrants working abroad.
legal contracts would increase the possibilities Employers are fully responsible for improve-
to expand business activities as entrepreneurs ments in working conditions, for reducing risks
Recommended measures – national level

• Ratify ILO conventions on migrant workers.
• Incorporate those conventions into national law.
• Secure the right for all workers to organise.
• Sanction employers with the responsibility for maintenance of the legislated working conditions and
make it their duty to report work related injuries, diseases and fatalities.
• Develop and implement national action plans on workers’ health.
• Enforce and implement surveillance of work places and workers’ health, including penalties for non-
compliance.
• Inform employers of the potential gains of decent working conditions.
• Establish national systems for reliable statistics on OSH issues.
• Translate relevant national laws and regulations into appropriate languages.
• Prioritise capacity building for education and training in occupational safety and health.
• Promote access to free occupational health services for all workers.
• Reduce the administration and costs for transfers of remittances.
• Simplify and reduce the costs for registration of enterprises and private property.
• Introduce language training for foreigners
• Identify and disseminate information about best practices in occupational safety and health at work
places.
• Public employers shall be the spearhead in offering decent working conditions for all employees.
581
Chapter 9.3
at the work place and reporting work related The speed of change in societies and the lives
injuries, diseases and fatalities. Employers also of individuals has increased tremendously as
have a duty to inform employees about risks capital, services, ideas and cultural expressions
and dangers related to their work, and about travel between countries and continents in real-
their rights to protection, health care and de- time. While people and goods require more time
cent working conditions. If this is successfully to move, modern transportation has reduced the
achieved, they will improve the quality of life time needed to travel around the globe. Work
for individuals, strengthen their enterprise and life and migration patterns are constantly chang-
contribute to the development of the nation. ing and new work organisations, technology, and
If they are unsuccessful, economic and human tasks will continue to emerge. What will prob-
prosperity will be hampered since development ably not change is the existence of work and mi-
possibilities are undermined. grant workers. An increasing share of all human
At all work places, public or private, the above communication occurs in cyber space, but the
measures towards all workers, particularly mi- value of face-to-face meeting in everyday life can
grant workers, can be introduced in order to never be replaced by global technologies. Migra-
improve working conditions. tion has always been, and will remain a powerful
Although the formal responsibility for offer- force in the process of development. Multicul-
ing stipulated working conditions lies with the tural mixing in schools, housing areas and work-
employer, employees have a responsibility to places will remain a challenge as well as a driver
follow occupational safety and health regula- and inspiration for change and improvement. If
tions at the work place, and to minimize the societies remain closed or segregated they will
risks for themselves and their workmates. Those most probably decline. The issue is not whether
duties include obligations to use available safety we want migration and multiculturalism or not.
devices, follow safety routines and to actively It is already here and it will stay. The key issue is
search for information about risks and how to whether we want to benefit from it or not.
avoid them.
582
Migrant workers
Recommended measures – enterprise level

• Appoint and train work safety supervisors, preferably among migrant workers.
• Establish cooperation between employer and employee representatives to identify and tackle unfa-
vourable working conditions.
• Search, identify and eliminate risks regularly.
• Conduct awareness raising training for representatives of employers and employees about the situa-
tion and contribution of migrant workers.
• It should be compulsory to provide information about the rights and obligations of employers and
employees. General information on health protection, e.g. on drug abuse and sexually transmitted
diseases, should also be provided. This information should be in the languages understood by em-
ployees.
• Workers must be properly informed about work processes, including information about existing
safety measures and how to use them. Newly recruited employees must be properly trained in the
practice and use of safety routines and devices. (There are easily accessible training packages devel-
oped by the ILO and the International Organization for Migration).
• Training packages for cooperative and participative improvements of working conditions, such as
ILO’s WISE (for small size enterprises, e.g. in the informal sector) and WIND (for agricultural work-
ers), should be explored.
• Written regulations and rules about safety at the work place should be translated into the languages
represented at the work place.
• Introducing a mentor system for newly employed migrants.
• Organise the employers as well as the employees.
• Local trade unions find ways to uphold the rights of undocumented migrant workers.
• Language training for migrants.
Recommended measures – individual level

• Learn how to use safety devices, and then use them.
• Learn about safety routines, and then follow them.
• Follow the rule: “safety first”.
• Refrain from macho attitudes and behaviour.
• Report injuries and identified risks.
• Search actively for information about rights, duties and safety measures.
• Never work alone on dangerous work sites.
• Try to learn the basics of the spoken language used at the workplace.
• Organise, if possible.
• Support the workmates.
• Avoid drugs and alcohol.
583
Chapter 9.3

Castles, Stephen and Miller, Mark J., The Age of UN documents
Migration, The Guilford Press, New York, 2003 International Convention on the Protection of the
Rights of All Migrant Workers and Members of
ILO documents their Families, 1990
ILO conventions nr 97and 143 on migrant workers International Migration and Development, Report
and nr 111 on discrimination of the Secretary-General, 2006
Fundamental Principles & Rights at Work, Ge- World Migration 2005. Costs and Benefits of
neva, 1998 International Migration, Int. Organisation for
Migrant workers, Geneva, 2002 Migration, Geneva, 2005
Towards a Fair Deal for Migrant Workers in the Özden, Caglar & Schiff, Maurice (eds.), Interna-
Global Economy, Geneva, 2004 tional Migration, Economics and Policy, World
A Fair Globalization: Creating Opportunities for Bank, Washington, 2007
All, Geneva, 2004
Useful websites
Kuptsch, Christiane (ed.), Merchants of Labour,
Geneva, 2006 WISE Work Improvements in Small Enterprises
Kuptsch, Christiane & Pang Eng Fong (eds.), www.ilo.org/public/english/protection/condtrav/
Competing for Global Talent, Geneva, 2006 workcond/workcond_pamphlets.htm
Schierup, Hansen and Castles, Migration, Citi- WIND Work Improvement in Neighbourhood
zenship and the European Welfare State, Oxford, Development
2006 www.ilo.org/public/english/protection/condtrav/
pdf/agri_wind.pdf
584
10
OSH at the enterprise
10.1 Informal sector and small enterprises 587

10.2 Management and participation 605
10.3 Occupational health services 623
10.1
Informal sector and small enterprises

Peter Hasle & Ann-Beth Antonsson
basic concepts and problems

Small businesses, whether formalized or informal, nationals continues to grow both nationally and
form the basis of the lives of millions of people globally, they also pursue a strategy of out
all over the globe. Small businesses may face sourcing and lean production which is moving
numerous problems and have to fight for sur employment to small and medium-sized
vival every day. Both owners and employees have subcontractors. The strong trend towards de
to live with a high level of uncertainty. Employ regulation and liberalisation of the economy is
ment is insecure, with a risk of losing one’s job at the same time reducing the number of per
from one day to another. Income may also be un manent public jobs and making it easier to set
certain, and vary from one day, week or season up new businesses. Low economic growth or
to another. In addition, working conditions are even decline leaves no opportunities for formal
often tough and risky in this kind of company, employment. For millions of men and women,
especially in developing countries. Working then, their only chance of survival is a small
hours are long and sometimes close to unlimited business. In many developing countries almost
for work carried out at home. Access to drinking the entire business sector consists of small enter
water, food, basic hygienic facilities and medi prises and the informal sector. Small enterprises
cal care is limited. And occupational hazards are are predominant both in agriculture and in the
numerous, with a high risk of both accidents and new urban sector.
long-term tear and wear. For the self-employed The strong competition among subcon
the situation may be even more difficult. Despite tractors and the scarce resources of the informal
all potential problems, small enterprises provide sector put heavy pressure on workplace safety.
income and meaningful daily relations for own The small enterprises have scarce financial and
ers and employees. knowledge resources for proper control of
And society is getting more and more de occupational safety and health (OSH) hazards,
pendent on this type of business. Employment even in the quite many cases when the enterprise
in the informal sector and small enterprises is would benefit economically by improving the
increasing, in both developing and industrial situation.
ised countries. Although the business of multi
587
Chapter 10.1
The ability of enterprises to reduce the safety it is this problem we will discuss in this chapter
and health hazards relates to several factors such as of the book.
• Presence of urgent issues, other than health
and safety, that have to be prioritised, some Definition of small enterprises
times leaving little or no time at all for im Definitions of small enterprises vary from one
provement of working conditions. country to another and from one organisation
• How obvious are the risks? How are the risks to another. Much also depends on the purpose
perceived by the companies, e.g. are they pos of the definition. If it is a question of financial
sible to control or part of the job? Are acci considerations, definition may be according
dents expected to happen often or seldom? Are to turnover or equity capital. If it is a labour
the causes of ill health or accidents identified? market issue, definitions are often based on the
• The costs of reducing the hazards in relation number of employees and may vary according
to available resources. to the characteristics of the national industry.
• Are the means of controlling the risks known A definition often used in the European Union
to the companies? is shown in Figure 10.1.1.
• How the risks at work are judged compared to Many countries have requirements for the
other kinds of risks e.g. in private life. registration of a business. These are normally
• What the cultural attitudes are to risks and connected with size or turnover. Unregistered
accidents, e.g. if pro-activity is a common enterprises are often termed the informal sec
strategy in society. tor. This can vary from sale of vegetables at
the street of a large city to small factories with
At the same time it is difficult for labour inspec production of garment, food, furniture or metal
tors, unions, business advisors and others to get utensils.
in touch with the small enterprises. The available Part of the informal sector is the self-
resources for outreach activities are small and the employed, a group which is more difficult to pin
cost to reach a large number of small enterprises down than the SSEs. It can sometimes be diffi
is high. It is this problem governments, organi cult to distinguish between employment and
sations and OSH professionals have been trying the self-employed. Especially in developing
to grapple with during the last two decades, and countries, homework and contract labour fall
Size category Abbreviation No. of employees
Small and medium-sized enterprises SME < 250

Medium-sized enterprises 50 – 249
Small-scale enterprises SSE 10 – 49
Micro-enterprises 0 – 9
Figure 10.1.1. Definition of enterprise size categories according to the European Commission.
588
between the two categories. A larger enterprise included in the small enterprises if not especially
normally provides both raw material and pro emphasised.
duction equipment, but the worker is only paid Within the category of small enterprises there
for products or services produced and is formally are also sub-categories. This is especially the
responsible for the production. Many countries case with the smaller ones with only one man
are thus considering or have already implemented ager, typically the entrepreneur himself, and the
legislation on employment and OSH in order to larger ones with more than one managerial layer.
remedy this situation. In many countries micro- We will shortly be returning to consider the
enterprises and the informal sector can to a large significance of the role of the sole manager.
extent be equated, the exception being strongly
regulated countries such as Sweden and Den Occupational health and safety in small
mark, where it is virtually impossible to set up a enterprises
true informal enterprise due to strict tax control It is generally difficult to study OSH in small
of almost all economic activities. enterprises. The reporting frequency of work-
Another way of distinguishing between small related accidents and diseases is lower than for
er and larger enterprises is by ownership. In larger enterprises. And making surveys is much
this chapter we will focus on independent small more difficult and expensive in the small enter
enterprises that are not part of a combine. (In prises. In consequence, although most scientists
industrialised countries, the fraction of small en and professionals agree that the risks in small
terprises that are part of a combine is growing.) enterprises are higher than in large enterprises,
These enterprises have a lot in common. We will the evidence is quite scattered.
therefore use the term small enterprises (SSE) Risks are primarily related to the activities in
as the general description covering enterprises the enterprises and thereby the characteristics of
with 0–49 employees. The informal sector is also the particular industrial sector. Similar risks are
Fatal accidents in the European Union 1996

8
6
100,000 empl.
Accidents per
0
1–9 10–49 50–249 250 or more
No. of employees in enterprises
Figure 10.1.2. Fatal accidents in the European Union 1996, by size of enterprise.
589
Chapter 10.1
prevalent in most enterprises in a sector, regard is chaotic, and co-operation between owner
less of the size of the companies. When compar and employees does not function, while others
ing enterprises within the same trade, OSH have a very good working environment. The
conditions are usually poorer and there are usually variation range is larger in small enterprises
more accidents in the smallest enterprises. than in large ones.
Accidents are underreported in almost all • Complicated technical measures to control the
countries, but fatalities are normally consid working environment will be relatively more
ered to have a high reporting rate, and this is expensive for small enterprises and there will
one example where size-related distinctions are often be problems in ensuring ongoing main
possible. Figure 10.1.2 clearly shows that in the tenance. Such technology is often based on
European Union the risk of fatal accidents is production of large volumes and thus not suit
doubled in small enterprises compared to larger able for most small enterprises that produce
ones. Partly this may be due to the fact that smaller volumes. In developing countries the
some sectors dominated by small enterprises investment cost will be prohibitive for almost
have many fatal accidents. Sectors of this kind all technology-based improvements in small
include agriculture, construction and transport. enterprises.
But there may also be variations between
small enterprises. These variations are larger The culture of small enterprises
than between large enterprises in the same sec The culture of a small enterprise starts with its
tor. Consequently, there are also some small ownership. In the majority of small enterprises,
enterprises in hazardous sectors with a compara the owner and daily manager are the same per
bly good working environment. In some respects son, and he or she, as sole manager, occupies
they may have advantages compared to larger the central position in the enterprise. This is
enterprises, viz: quite different from the large enterprise, where
• Work in small enterprises is typically of a ownership and management often are separated
more varied character compared to the large and management consists of several hierarchical
enterprise. This means that there is less layers.
repetitive work, and there will be less full- The basic point of departure is that the owner
time exposure to occupational hazards than strongly identifies with the enterprise. The own
in large enterprises. However, repetitive er’s personality is expressed via his/her ownership
work is also found within small enterprises in and operation of the enterprise. Criticism of
certain industry sectors. the enterprise is therefore viewed as a personal
• In many cases close contact between owner slight against the owner. Work and family life
and employees results in more meaningful flow together. Often, other family members have
work and a better psychosocial working en positions in the enterprise. In some cases the
vironment. On the other hand, workers in enterprise is even located in a direct extension of
small enterprises are more dependent on good the family residence. This is especially the case
relations with the manager. for most informal and micro-enterprises in de
• There is considerable diversity among small veloping countries. The work also occupies more
enterprises, with some having an extremely than average working hours for the owner, but at
poor working environment where everything the same time there is room during work time to
590
attend to family matters should the need arise. enterprises which are growth-oriented and have
In sum, being the owner of a small enterprise is the desire to grow into a large enterprise.
a unique life-style. The owners usually resist every form of state
Ownership and operations give the owner the regulation, which can limit the possibilities of
possibility to achieve a high degree of fulfilment free action in the enterprise. At the same time,
and meaning in his/her life and the enterprise the authorities’ demands are viewed as an ad
provides an experience of existential values in ministrative burden, e.g., sales and income taxes,
the form of: environmental demands, building authorisations,
• personal growth and labour inspections are all seen as bureau
• self-determination and freedom cratic red tape and an unnecessary waste of time.
• fulfilment of own responsibility This is also true of most other external inter
• utility ference in the enterprise from, among others,
• human dignity. consultants and advisors. There will typically
be great reservation, and only when a personal
Identification with the enterprise means that the relationship to an external individual has evolved
owner of a small enterprise often obtains a role will it be possible for the owner to take in advice
where he/she behaves in a manner which is: and suggestions. Outside advisers who offer
• action-oriented (it is important to get things quick fix solutions to difficult problems will typi
done) cally be considered untrustworthy and judged to
• patriarchal (it is I who decide and I am cause unnecessary expenses of no utility for the
responsible for ensuring that things go well, enterprise.
both for my enterprise and my employees) Most small enterprises have a small network
• egocentric (the world revolves around me and of persons whom they consult. These are prima
my enterprise). rily family members who work in the enterprise.
For the formalised small enterprises the
Even though owners of small enterprises as a accountant is also a traditional key person. In
rule are perceived as very economically oriented, addition, a bank counsellor, the enterprise’s prin
pure profitability is not always the decisive fac cipal supplier and the owner of a co-operating
tor for the decisions taken. The survival of the enterprise and perhaps a permanent, trustworthy
enterprise’s independence and the owner’s full client, may also enter into the network. There
control over it, as well as the fulfilment of respon may also be organisations to which the enter
sibility to the employees and society, often as prise is affiliated that are considered trustworthy.
sume greater importance, as long as the costs are This network also becomes a filter for the infor
acceptable. However, in the informal sector in mation received and accepted in the enterprise.
developing countries the daily bread will be the With the owner as sole manager the expecta
almost only priority. tions from employees, customers and other
Identification with the enterprise has several become quite high. He/she almost has to act
consequences for the owner’s strategy. Most the Renaissance man: Leonardo da Vinci with
owners may not be interested in the enterprise knowledge and talents in a number of fields such
growing so large that they lose perspective and as handling sales, suppliers, production plan
control, and it is therefore only a few small ning, product development and human resourc
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Chapter 10.1
es. In many cases the manager also participates only get a work permit for up to five years. In
in the production process. This is reinforced this case the workers have a different nationality
by the owner’s ambition to run everything in and the owners know that employment is in any
the enterprise him/herself, which makes it hard case temporary. The feeling of responsibility will
to delegate competence to others. Naturally, therefore be much weaker.
most owners cannot manage everything and The owner’s strong identification with the
concentrate on those production matters which enterprise also has its negative consequences.
lie most immediately in front of them. In many Most of them work much too hard under great
enterprises, especially the smallest, the owners pressure of time, with long working days. Stress
are very much oriented towards production, as factors are therefore also prevalent among them,
being the activity which obviously generates such as:
money. They concentrate on the organisation of • pressure of time
production and find it difficult to allocate re • mental alertness and tension
sources for other issues. • insecurity regarding their own competence
The owners are typically attentive to the pos • insecurity toward the relation to their
sibility of ensuring their employees’ stable em employees
ployment. In some cases this means that they are • negative spill-over from work to private life.
hesitant to hire new workers for fear of having to
discharge them again later. But the opposite may Some owners have difficulties mastering these
also occur, namely the owner feeling obliged strains, and they find managing in everyday life
to engage members of the extended family in a a heavy burden. This may lead to the emergence
number disproportionate to the economic viabil of psychosomatic symptoms such as fatigue and
ity of the enterprise. headache, and the extra energy needed to
In the same fashion, they will frequently feel develop successful co-operation with the em
a sense of responsibility towards the employees ployees disappears, leading to organisational
who are taken ill, especially if it is a case of a problems. Often such burdens are associated
workplace accident. They will attempt to assure with a downturn for the enterprise, and a vicious
them of continued employment in the enterprise circle may develop where good management and
and try to remove the problem which provoked survival of the enterprise become increasingly
the injury. In this way, the owner feels a clear unattainable.
responsibility for the working environment but However, far from every enterprise owner
often at an individual and very concrete level. At experiences such negative stress. Many owners
the same time, they find it difficult to deal with understand how to master their daily tasks in
diffuse hazards whose long-term effect might such a way that they do not feel overburdened.
entail a risk of an injury. Important parameters are the economy of the
But it is also important to realise that the enterprise, the personal network and the attitude
above observations may vary considerably of the enterprise owner and his/hers experiences
according to the national culture, industrial with the ability to deal with the demands im
relations, available manpower, industrial sec posed by their surroundings.
tor and others. In Malaysia for instance, there
is a widespread use of migrant workers who can
592
constraints and possibilities does not work. If a small enterprise does not
for preventive strategies have management systems for production plan
The one constraint always being pointed out is ning and sales, it will not start to implement
the cost of reaching the huge number of small such a system on OSH, which is not a core issue
enterprises. Visits to 100 firms of 10 employees for the enterprise. Trying to impose it on the
will result in reaching the same number of em small enterprises will have no effect and just be
ployees as one visit in an enterprise of 1000 em a waste of resources.
ployees. It is also likely that the large enterprises Many owners of small enterprises have strong
are more receptive to the OSH professional. reservations about government officials and
They may already have a safety officer and/or OSH professionals. These will quite often meet
a safety committee and routines which OSH with a negative attitude when they approach the
activities can fit into. But the need of the 100 small enterprise. Typical attitudes from small
small enterprises is likely to be much higher, as enterprises can illustrate the barriers which the
they have little OSH knowledge and often lack OSH professional may encounter:
a systematic way of dealing with these issues. • The authorities harass the small enterprise
Therefore they rarely initiate any systematic or with demands, entailing bureaucratic red tape
proactive activities in this field on their own. and extra costs.
For many developing countries the resources • The owner perceives identification of an OSH
for outreach activities are very small. There are problem as personal criticism.
few labour inspectors, transport and occupa • OSH is purely an additional expense, which
tional health services are limited, and publicly the small enterprise with its strained finances
funded business advisory services are scarce. In cannot afford.
addition, the availability of qualified profession • The employees are not interested in OSH,
als is very limited, and the OSH legislation is old and they object to using the safety measures.
and fragmented. Finding ways of overcoming • The OSH professionals are arrogant and do
the resource problem must be a major priority. not understand the special conditions of small
The field of OSH has its point of departure enterprises.
in large enterprises. OSH management, train
ing programmes, measurement strategies, and Some small enterprises profess a more positive
control measures are developed in and for large or neutral attitude, sometimes in order to end
enterprises. That also means that the OSH pro the conversation as fast as possible. The OSH
fessionals, whether a government agency such professionals will thus have little chance of
as labour inspectors, researchers or consultants, achieving anything unless they are aware of and
have experience and understanding of OSH have the proper qualifications to cope with such
from large enterprises. attitudes.
One major constraint therefore is that the It may seem as the constraints pile up, with
thinking and systems do not fit the small enter little room for effective actions. But it does not
prises. The usual approach is to try to bring up need to be so. Experiences from many countries
the small enterprises to work as systematically around the world indicate that possibilities also
with OSH as the large enterprises. This simply exist. Owners of small enterprises are clever
people (otherwise they would soon be out of
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Chapter 10.1
business) and they are action-oriented. They are tions towards their employees. The legislation
used to getting things done, and when convinced should give the owner a clear responsibility for
they want to act immediately. At the same time maintaining a safe and healthy workplace. The
they are rarely, especially in developing coun legislation can also serve as a point of departure
tries, offered any kind of support from anyone. for more voluntary approaches. “Why not get
The right offers of assistance to improve their the best out of it when we are forced to do it
business are thus likely to be met with interest anyway?” is the attitude of many owners. The
and openness. The question therefore is what legislation can thus open up better opportunities
methodologies, services and institutional set-up for the voluntary approaches. At the same time,
should be organised so as to be able to reach the when a labour inspector pays a visit to a small
small enterprises with offers which would make enterprise, this is an effective means to remedy
a difference to them and the working environ concrete and clearly defined problems.
ment. There are limitations to legislative approaches,
just as there are situations where legislation is
the approach to occupational the best solution. In general, legislation is good
safety and health in small when the demands are clearly defined and for
enterprises example can be realised through a technical
The first issue is whether the approach should change of equipment, machinery etc. The
be compulsory or voluntary. For many years, demands can easily be presented to the small
legal requirements have been the fundamen enterprises and it is easy to ascertain whether
tal approach to OSH in both large and small legislation is implemented. Enforcement is
enterprises. From the first OSH legislation in much more difficult when it comes to manage
the middle of the 19th century until late in the ment systems which are much more complicated
20th century, legislation has been the solution to implement and maintain in enterprises and
to OSH problems. In this long period of time also more difficult to inspect.
small enterprises have been badly covered by the Given that enforcement by labour inspectors
legislation, either because they were excluded by will always be limited, the voluntary approach
(legislation only applying beyond a certain size) is a necessary means to improve the working en
or due to lack of inspection resources. However, vironment in small enterprises. But close
during the last few decades voluntary approaches co-operation is needed from legislation and
with various incentives have grown in influence. inspection systems. Wholly voluntary
They include things such as information, train approaches without legislative backing will
ing, occupational health services, campaigns, and mainly appeal to large corporations, which for
certification. And just as for large enterprises, image and efficiency reasons pursue manage
voluntary strategies have gained in importance ment control of OSH as they do with other
for the small enterprises. It is much easier to get business issues.
through to the owner of a small enterprise with
voluntary offers than with strict enforcement. The voluntary approach
But this is not to say that legislation should be The question, then, is how to develop voluntary
scrapped for small enterprises. It is important approaches which will appeal to small enterpris
for the owners to learn that they have obliga es and especially micro and informal ones.
594
No contact between Improvement of

Development
small enterprises and occupational health
of diaogue
OSH professionals and safety
Means: Means:
• personal contact • seminars
• focus on positive results • exchange of experience
• integration with other • enterprise visits
management goals • consultative advice
• local experience • networking
Figure 10.1.3. The approach to outreach OSH initiatives aimed at small enterprises.
The point of departure must be to establish a • the enterprise’s own experiences and realities
dialogue with the owner of the small enterprise. • relevant and credible offers of support.
This foundation creates the best opportunities
for initiating improvements. At the same time, With a dialogue based on trust and equality, a
different means are to be used for first establish number of different possibilities for support can
ing this dialogue and then initiating OSH im be offered. These offers should be tailored to the
provements, see Figure 10.1.3. specific target group of small enterprises. There
A range of different possibilities can be utilised are many possibilities:
for establishing the dialogue. Establishment of • offers of concrete consultative assistance such
personal contact, however, is an important pre as solutions to concrete OSH problems or
condition for success. Without personal contact, fulfilment of legal requirements
the relationship of trust and sense of equality • seminars
which is a precondition of dialogue cannot be • organisation of network groups
achieved. • training courses
The most important approaches to develop • groups of owners for sharing experiences
the personal contact are based on a visit paid • campaigns
by the OSH professional to the enterprise and • activities via local networks such as employers
include focusing on the following: organisations, trade unions, technical schools,
• a (genuine) interest in the joys and tribula accountants, regional business support centres,
tions of the owner and his/her enterprise etc.
• positive achievements in the enterprise
especially regarding OSH Written information is a frequently applied
• integration of OSH with other present man method. Even though the written information
agement objectives such as productivity, cost may be designed for a special target group of
reduction, sales, quality, and external environ small enterprises, it is the least effective means.
ment Owners of small enterprises will normally not
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Chapter 10.1
read about what to do, and in many cases, Working with small enterprises has typically had
especially in the informal sector in developing low status. Prejudices about small enterprises
countries, they may have reading difficulties. have flourished among OSH professionals,
The advantage of written information is the labour inspectors and consultants.. The first task
potential of reaching out to a very large group for many OSH professionals, therefore, has con
of enterprises, which in some cases may give sisted in learning to be aware of their own pre
enough results to justify the cost. Written judices. They may be critical barriers, although
material is also necessary in order to serve as they are not all that visible at first glance, and
practical guides and information to the owner. one’s own attitudes and prejudices, even if well
Such guides should not be used for mailing a lot suppressed, may impede the onset of a dialogue.
of enterprises but rather be given to the owner Several possible attitudes may be prevalent
during a visit to the enterprise, in order to give among OSH professionals, such as:
some guidance on how to continue working with • small enterprises are uninterested and unwill
specific issues without the personal support from ing to do anything about the working environ
the OSH professional. ment
Experience indicates that special professional • small enterprises are unsystematic because
and personal qualifications are needed to work they do not have formal long-term planing
successfully with small enterprises. It is therefore and a clear organisational structure
necessary that upgrading of their qualifications • the working environment in small enterprises
as OSH professionals be included in any plan is characterised by many elementary working
ning of outreach initiatives. The upgrading of environment problems whose solution is a
qualifications may consist of training activities, trivial task
e.g. regarding how to work with small enter • a small enterprise is a potential large enter
prises. Training can be done through seminars, prise unable to grow
training courses, and exchange of experiences • small enterprises are impossible to work with
among other involved professionals, possibly because there are so many of them, which
supplemented with super-vision. means a limited amount of resources per
enterprise.
Personal contact
The critical issue has proved to be development In sum, the attitude can be described as a “we
of a good personal relationship between the know best”, which is easily revealed by body
owner of the small enterprise and the OSH pro language, tone of voice or style of questioning,
fessional. For some professionals, establishing and the owners of the small enterprise, viewing
this contact may come naturally. They just walk such an attitude as indicating lack of respect, will
into the plant and feel at ease about making con tend to reject further co-operation.
tact. Many others, however, need to work more The OSH professionals’ normal working
directly with preparing their method of contact methods consist of identifying OSH problems
and to improve their interpersonal skills. and proposing solutions. This method has proved
It is therefore important to look at some of the to be less effective in the small enterprise. A
obstacles and potentials with regard to achieving typical sequence of events from using this meth
the personal relationship. od is illustrated below.
596
The owner feels personally responsible for the straint on this kind of voluntary approach. If the
working environment and his or her employees. resources are that scarce, use of legislative ap
Hence, it is difficult for him or her to admit that proaches targeted at specific high risks should be
there are OSH problems which might possibly considered.
damage the health of both the employees and This example shows that it is not realistic to
the owner. In this case, possible OSH problems expect big improvements after the first visit.
are attributed to conditions over which the Results are most likely to appear after continued
owner has no control. The typical comment is contact and probably not in all enterprises. Real
“it can’t be done (technically or financially)”, istic expectations are necessary in order to go on
or “the employees won’t use the protective working with small enterprises for any consider
equipment provided.” Faced with an OSH pro able length of time.
fessional, whom the owner does not know, the Now encouraging results have been obtained by
OSH problems are therefore denied, and the asking positive, interested questions concerning:
professional never enters into a dialogue with • products (special characteristics, special
the owner. orders, customer base, market development)
It is therefore necessary to use a positive • production processes
approach, which gives the OSH professional the • the enterprise’s history
opportunity to express his/her respect for the • the owner’s background.
enterprise and to obtain insight into the culture
of the specific small enterprise. A tour of the enterprise can be undertaken at an
For many OSH professionals it may seem appropriate time. It is important to keep ones’
provocative and improper not to point out OSH eyes open for positive examples and to mention
problems and shortcomings noticed at a visit. At these to the owner, e.g. cases of OSH measures,
the same time, the situation requires the profes products, technical arrangements, a good atmos
sional to be positive and complimentary toward phere or something else which may be relevant.
good examples, even if they are not always the As the conversation unfolds, one can begin
best ones. There is no way around this problem. asking questions about the working environment,
The OSH professional needs to show genu possibly with examples from the tour. The basis
ine and positive interest in the enterprise and is still a positive interest and interest in the de
in the owner as a person. If one does not know velopment of the enterprise. Examples could be:
very much about the enterprise’s special produc • Are you satisfied with (a specific OSH
tion (or about the sector), it is a good idea for a measure)? Have you considered using it in
first-time visit to explain that one would like to other places?
learn more about the enterprise and its produc • How did you solve the problems connected
tion. Subsequent visits may be commenced by with…?
explaining their purpose. From there one can • Have the labour inspectors ever visited you?
go on to ask about the enterprise’s development Did they take note of any irregularities? What
situation since the last visit. did you do about it?
As this example makes clear, scarce resources • Have you tried/heard about…, which I know
limiting face-to-face contact with each enter other enterprises have experienced as a good
prise to one single visit will be a serious con solution?
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Chapter 10.1
• Do you have any plans for the working envi Exchange of experience between owners
ronment? Many attempts have been made to organise
• What do the employees say about…? networking among or meetings for owners of
small enterprises. The rationale behind this idea
Such questions may lead to concrete solutions in is twofold. Firstly, it has a potential for resource
some cases, but they are also tools for developing saving by bringing several owners together.
a good dialogue, which is the point of departure Secondly it may have a greater impact, as owners
for presenting an offer of OSH advisory services are much more likely to listen to each other than
or participation in a training programme. The to outside OSH experts. It has in some cases
professional’s ability to present a credible offer is been difficult to drag the owners away from their
crucial. The offer must be tailored to the enter business because they have so much work to do,
prise’s specific needs and certainly take into con and they are almost always behind schedule, but
sideration its special conditions, e.g., workloads at it has also proved to be successful in many other
certain times of the day or seasonal variations in cases, not least in developing countries. In these
the production process. Another important countries the owners usually never received any
element is the demonstration of practical, offers of support of their business or of training
down-to-earth solutions instead of more general activities.
or theoretical approaches. It is not enough to When the owners show up, the sessions are
present a suggestion based on what the OSH almost always successful if the OSH experts can
professional believes are the enterprise’s needs. curb their inclination to give long technical lec
The suggestion has to be presented and dis tures and can leave time and space for the own
cussed in such a way that the enterprise can react ers themselves. With several subsequent sessions
and a joint dialogue about the best solution can a certain dynamic in the group often evolves in
develop. which the owners vie with each other to prove
It has often been seen that the owners, by themselves active in making improvements.
way of introduction, emphasise that they have The pedagogic approach to the network or
only very little time to spare. Often this already meeting session is crucial. On one hand the
occurs during an initial approach, e.g. on the owners will expect to be lectured about interest
telephone. If the dialogue goes off well, how ing possibilities in OSH and related issues. On
ever, it often happens that far more time is used the other hand they will soon get tired of listen
than was originally agreed on, with the owner ing to lectures and they will be more interested
starting to volunteer information and clearly in actively taking part and listening to fellow-en
feeling happy and proud to talk about his or trepreneurs.
her enterprise. The photo album showing the
history of the enterprise may also be got out, Integration of occupational health and safety
but that is up to the owner. The OSH profes with other management goals
sional must therefore certainly pose engaging Arguing the potential economic benefits of OSH
questions, but never prolong the situation if the improvements is often considered an important
owner shows signs of being pressed for time or catch point. This is also possible in many cases.
seeks a concrete way of ending the meeting. It is especially the case with ergonomic mat
ters such as materials handling and workstation
598
design, in which there are obvious rationalisation ent among their employees. It can therefore be
benefits to be gained from improvements. But in difficult to find ways for workers’ participation.
cost-saving terms as well, there may be mutual The owner will often argue that he or she talks
economic and OSH benefits. That is the case with the individual workers concerned, and that
with waste minimisation and with certain aspects major decisions are the owner’s sole responsibili
of energy and water saving. But the owners in ty anyway. But the owner may also complain that
spite of clear benefits may be reluctant to accept it is difficult to convince the workers in favour of
the possibility. They may lack confidence in the using personal protective equipment or taking
statements by the experts and, most importantly other preventive measures.
perhaps, they are afraid of all the trouble of The same problem goes for commitment in
organising implementation and fear it will cause the enterprise as such. However, experience
unforeseen problems. from Sweden and Denmark indicates that many
Personnel economy is often used as an eco small enterprises benefit from getting worker
nomic argument for improvements of OSH, participation better organised. Brief kick-off
even in small enterprises. Such arguments are meetings every Monday morning or similar
often perceived as irrelevant by small enterprises. pooling of the week’s experience every Friday
Their experiences of personnel costs related to afternoon, have proved beneficial to all parties,
bad OSH conditions may be limited, mainly due as well as opening up a possibility of discussing
to the fact that in a small enterprise, accidents the working environment. Another approach
and occupational diseases are rare events, though is joint risk assessment, with the owner and the
statistically the risk is higher than in large enter workers all participating in a discussion of OSH
prises. Additionally, the owner’s conclusion from problems and of an action plan to solve them.
the accidents or ill-health that occur is not always Promotion of workers’ participation is there
that proactive work is needed. It may equally well fore also part of the approach to improve the
be that the employees have been careless. working environment in small enterprises. How
It is important to realise that the owner has so ever, it is important to realise that promoting
many duties at once that his attention will be a workers’ participation only in matters of OSH
limited resource, even though his business could may not be enough. If the workers are not
benefit from certain actions. informed and encouraged to take part in the
development of their own jobs, they often show
Worker participation low activity also regarding the development of
The importance of worker participation is OSH conditions.
gaining widespread recognition in most coun
tries. In the field of OSH, a legal background tools tailored to small
for safety committees and safety representatives enterprises
has been established in many countries. The Supporting small enterprises is a complex task,
significance of workers’ participation in OSH where the time of the OSH professionals is
as well as in other aspects of the enterprise is limited, resulting in a limited support to small
widely recognised. However, small enterprises enterprises. At the same time there is a lack of
are often exempted from legal requirements knowledge in enterprises about OSH, resulting
and unionisation is almost always non-exist in a need for more detailed advice regarding
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Chapter 10.1
specific problems. If, however, the experts solve related to the world and reality of the small
all the problems for the enterprise, very few enterprise and therefore work better. Therefore
enterprises can get such help. Additionally, the tools for small enterprises have to be adapted
enterprises will not develop their own OSH to the specific target group, often in a specific
competence, resulting in a never-ending depend industrial sector.
ence on OSH professionals. All tools do not have to include detailed in
The solution to this problem is to use differ formation about problems and control measures.
ent kinds of tools, supporting the OSH profes Sometimes one can make do with an open form,
sionals’ interventions in enterprises. Such tools stimulating a dialogue within the enterprise in
are an adjunct to personal contact and will order to start a process aimed at assessing the
• guide the enterprise in further activities, after occupational risks in the enterprise and drawing
the visit from the OSH professional up an action plan to reduce them. Depending
• support learning-by-doing in the enterprises, by on the complexity of the occupational hazards
giving ideas about what to do and how to do it and the present knowledge in the enterprise, this
• result in improvements in OSH conditions may be enough, but it may also result in risks
when used by the enterprises. going undetected or being underestimated. The
dialogue itself, however, has a boosting effect on
Tools tailored to small enterprises are often OSH improvements and is often more important
developed to than detecting all the risks.
• be short
• be simple institutionalisation and
• be action-oriented intermediaries
• build on the knowledge and experiences in the The above discussion illustrates on the one
enterprise. hand that OSH improvements can be initiated
in small enterprises and on the other hand that
Typical examples of tools are checklists, which the difficult point is organisation and institu
are often appreciated by small enterprises. tionalisation. Little happens by itself in small
Checklists correspond to the needs of many enterprises if legislation is the sole driving force.
enterprises, such as the need for tools that give The daily fight for survival will fill the owner’s
results and are easy and quick to use. However, working day and then some more. Intermediar
checklists may be developed in many differ ies are therefore needed who can carry the OSH
ent ways, not all of which are suitable for small issue into small enterprises, and an institutional
enterprises. Checklists asking questions about set-up is needed which can secure funding and
work environment factors such as chemicals, the qualifications of the intermediaries.
noise etc, assuming that the respondent has the The possibilities for such systems vary a lot
necessary knowledge of these factors, are not from country to country. In most developing
usually fit for small enterprises. On the other countries, resources for maintaining a basic OSH
hand, checklists posing questions about the dif system are scarce, and even in the industrialised
ferent parts of production present in the enter countries it is difficult to secure the necessary
prise, about safety devices, ventilation or noise political priority for the problems of small enter
reduction that ought to be present, are more prises. However, all countries have various in
600
Checklist for safety
inspections (General)
Date:
• Answer the questions with yes or no. Answer by putting a
cross in the appropriate square, then fill in the three squares
Company:
next to it. The completed form is an action plan that may be
included in your health and safety work.
Participants:
• Assess the hazards caused by the faults you have noted.
Mark any hazards that are serious.
• Are there any questions or sections in the form that do not
apply to your operation? Cross them out! Do you think
some points are missing? Then add them!
Modify the checklist to meet your requirements!
• We suggest you begin with the questions marked in colour.
They are about the more important issues.
• We suggest that the manager/work supervisor and safety
representative or one or more employees complete the check-
list together. When necessary, the checklist can be broken
down and different managers complete the sections that
concern their particular area.
• Complete the checklist on a regular basis – twice a year, for
example.
• Follow up the inspection to verify that the measures
you recommended have been implemented!
What action must be taken? Who is responsible When shall

Is any additional help needed? for ensuring the it be
work is done? finished?
Housekeeping
1. Is housekeeping at the workplace

satisfactory (waste, rubbish, stored
materials and suchlike)? Are efficient
cleaning procedures in effect?
Yes No
▲
▲
2. Is the workplace orderly enough to

ensure that accidents are avoided,
evacuation routes are not obstructed,
that stacks of material do not collapse,
etc?
Yes No
▲
▲
3. Are there stairs/ladders that need

attention (to be fitted with handrails,
safety railing etc)?
Yes No
▲
▲
4. Are the doors in good condition

and made of good quality matrial?
Yes No
▲
▲
601
Figure 10.1.4. A simple checklist for safety inspections, available at www.prevent.se
Chapter 10.1
stitutions which could be the point of departure other services to succeed, the other services must
for developing activities aimed at small enter have something to gain from the co-operation.
prises. Occupational health services exist in one form
Even with a weak labour inspectorate, the or another in many countries. In some these
most effective way of using limited resources is services are backed by legislation and in other
an issue. In larger enterprises, does this mean they are formed on a voluntary basis. However,
inspecting boilers and pressure vessels, for in nearly all of them cater almost entirely to large
stance, or are resources better employed in small enterprises. Often they are even organised as in-
enterprises? Control of boilers, for instance, house services in larger enterprises. A number of
could be outsourced to certified consultants, European countries do have occupational health
and large enterprises are likelier than small ones service systems which reach many small enter
to be capable of maintaining a reasonable level prises, and in this situation occupational health
of OSH. Even if more resources are allocated, services should also be developed to provide
the inspectors will obviously not be able to visit preventive services to small enterprises.
every small enterprise. So the labour inspectors Health care might be another possibility. It
will have to find other ways of getting in touch has proved especially efficient as a possibility for
with small enterprises. One important oppor the informal sector where living and working
tunity is to work together with small business conditions are virtually the same. Prevention of
associations, large enterprises and their net health risks should therefore both be targeted at
works of small suppliers, craft guilds or similar traditional hygiene, sanitation, and immunisa
organisations. Training of representatives of tion and at prevention of occupational health
the organisations, seminars for the members, or risks posed by chemicals, dust, bad working
possible organisation of direct services could be postures, and accident risks.
a cost-effective approach.
Integration with other services offered to programmes for small enterprises
small enterprises is another possibility. Many The International Labour Organisation (ILO)
countries organise various forms of services for has developed a number of programmes and
small business and entrepreneurs. These can methodologies aimed at small enterprises and
take the form of small credit schemes, business the informal sector, especially in developing
advice, training or technological services. Inte countries. We will briefly outline a few examples
gration of OSH with such services would be a in the following sections. References are given at
good illustration of the working environment the end of the chapter and can be studied at the
as a part of the everyday running of the enter ILO homepage (www.ilo.org).
prise. Even credit schemes would almost always
include some kind of analysis of business op Work improvements in small enterprises
portunities and advice on business development. – the WISE concept
Including OSH in such analysis and advice The oldest and most comprehensive programme
would be a very efficient way of reaching many is named WISE. It was developed in Southeast
small enterprises at a time when the possibilities Asia in the mid-eighties and has been success
for prevention of OSH problems are quite good. fully applied in a large number of countries. A
In order, however, for such co-operation with training package has been elaborated, consisting
602
of a trainer’s manual and an action manual for improvement, presentation and group work)
owners of small enterprises. The original action (one late afternoon/early evening with a
manual covers almost all manufacturing indus meal)
tries. During the last years a number of action • commencement of improvements in the
manuals for specific industries have been pre enterprises (facilitators assist the entrepre
pared. They include among others wood indus neurs with advice during the implementation
try and garment industry. process)
WISE is based on six principles, which are in • final workshop (the resource persons assist the
accordance with the above discussion of entrepreneurs in preparing a presentation of
approaches to small enterprises: their achievement, using slides and transpar
• build on local practice encies) (one late afternoon/early evening, with
• focus on achievements a meal)
• link working environment with other man • follow up workshop (after 3–6 months, in or
agement goals der to evaluate achievements and make slides
• use learning-by-doing for presentation at the workshop).
• encourage exchange of experience
• promote workers involvement. Experience indicates that the result will be 5–10
practical low-cost improvements in each partici
Its organisation includes a number of subsequent pating enterprise, and that owners and manag
workshops and intermediate enterprise activities. ers from 15–25 enterprises will participate in a
A standard wise programme will include the fol programme.
lowing activities:
• recruitment of enterprises (visits to enterprises, Integration with business advice and training
assessment of baseline level, collection of Another approach is the integration of OSH in
examples with slides) business advice and training targeting small en
• initial workshops (one late afternoon/early terprises. Based very much on experience from
evening and one morning or early afternoon wise, the ILO has worked intensively with this
for checklist exercise with meals), presenta approach. It has been through the SEED (boost
tion of practical examples of improvements ing employment through Small EnterprisE De
from participating enterprises, various small velopment) programme and the training package
group works, introduction of a practical ori Improve Your Business (iyb). Both of these
ented enterprise checklist during a plant visit, have job quality in small enterprises as a main
formation of groups of entrepreneurs objective. Job quality in this context means both
• identification of possible improvements in OSH, social security and human resource devel
enterprises (the groups of entrepreneurs visit opment. This integration approach has also been
each other together with facilitators and use tested in a large number of developing countries,
the checklist as a tool for identifying improve both as offers to new entrepreneurs and for the
ments) improvement of existing small enterprises.
• midterm workshop (introduction of methods
for planning implementation of a successful
603
Chapter 10.1
programmes for the informal

sector
A number of different approaches have been de developed in Dar Es Salaam, Tanzania. The idea
veloped for the informal sector. Some are espe was to establish OSH committees between clus
cially aimed at home-workers, who may either ters of small informal enterprises in local areas
be self-employed or in some cases employees of the city. These committees were trained by
and others in small informal businesses with primary health care workers who themselves had
employees. patris (Participatory Action Train received additional OSH training. The training
ing for the Informal Sector) is an example provided by the health care workers was partici
of a fully developed training package. One patory and action-oriented and aimed at both
especially promising methodology has been general health and OSH.
WISE Informal sector

J.E. Thurman, K. Kogi and A.E. Louzine: Higher Improving Safety, Health and the Working Envi
productivity and a better place to work: Trainer’s ronment in the Informal Sector. Patris Opera
manual. Geneva, ilo, 1988. www.ilo.org tor’s Manual (Participatory Action Training for
J.E. Thurman, K. Kogi and A.E. Louzine: Higher Informal Sector Operators). ilo, Geneva 1999.
productivity and a better place to work: Action www.ilo.org
manual. Geneva, ilo, 1988. www.ilo.org Improving Safety, Health and the Working Envi
J.C. Hiba: Improving working conditions and ronment in the Informal Sector. Patris Trainer’s
productivity in the garment industry: Action Manual (Participatory Action Training for Infor
manual. Geneva, ilo, 1998. www.ilo.org mal Sector Operators). ilo, Geneva 1999. www.
H.K. Seng, S. H. Choh, G. K. Seng, J. Nielsen, ilo.org
P. Hasle: Higher productivity and a better place U. Huws: Action programmes for the protection of
to work: Action manual for the furniture indus home-workers. Geneva, ilo, 1995. www.ilo.org
try. Forest Research Institute of Malaysia. Kuala U. Huws and S. Podro: Employment of home
Lumpur, 1998. http://frim.gov.my workers: Examples of good practice. Geneva,
ilo, 1995. www.ilo.org
SEED and IYB V. Forastieri: Improvement of working conditions
M. Borgenvall, H. Jarskog, B. Murray, C. Karlsted: and environment in the informal sector through
Improve your business. Basics. ilo Geneva safety and health measures. Geneva, ilo, 1999.
1999. www.ilo.org www.ilo.org
H. Sahar, Asa’d, S. Shafi, C. Karlstedt, H. Jarskog:
Trainer’s Guide. Geneva, ilo. www.ilo.org
Job Quality and Small Enterprise Development.
SEED working paper no. 4. ilo Geneva, 1999.
www.ilo.org
604
10.2
Management and participation

Nils Petersson
background occupational safety and health

Occupational safety and health (OSH) at the management
workplace is a management responsibility and OSH has not always been considered as a legiti-
this responsibility is formally stated in the legis- mate part of management systems. Instead of
lation in many countries. Management must set being a part of a holistic or systematic approach,
objectives and allocate resources for OSH. If OSH was considered to be a series of “one-off”
high standards of OSH are to be achieved, it is problems to be solved outside of normal man-
also essential to have continuous commitment agement systems. The holistic or systematic
from management and involvement of employ- approach has become more common in many
ees. It is not efficient to have a management countries during the last twenty years.
system that regards OSH as a subject to be dealt There have been three major influences in the
with only by experts, separate from other man- development of OSHMSs. One approach was
agement. Better results can be achieved when developed by the Norwegians for their offshore
OSH becomes an integral part of the daily pro- petroleum industry. The second is associated
duction system, and when all the personnel of an with the moves during the last decades, e.g. in
enterprise or organisation are involved. Great Britain, to deregulate and reduce bureauc-
The Occupational Safety and Health Man- racy in order to achieve more “flexibility” in
agement System (OSHMS) is described in the working life. The third is the development and
first part of this chapter. In the second part the use of ISO quality standards and environmental
participation in OSH of different groups of management systems.
employees is outlined. In the third and last part Because of the difficulties in accessing work
two case studies explain how OSHMS can be sites, the supervision of OSH in the Norwegian
implemented and the productivity increased by offshore petroleum industry could not be carried
using a participatory approach. out in the same way as in industries located on
the mainland. National authorities were forced
to put their trust in the offshore enterprises to
create and maintain their own OSH systems
that could be easily supervised without detailed
605
Chapter 10.2
inspections. These offshore experiences were so and describe organisational structure, planning,
positive that in 1992 Norway released a new reg- responsibilities, practice, routines, processes and
ulation for “internal control” within mainland resources for developing, introducing, meeting,
enterprises and undertakings. The regulation revising and sustaining external environmental
laid down all the measures that any enterprise policy.
was required to implement to ensure the level In 1989 the European Union had already cre-
of OSH set by the legislation. In some coun- ated a framework directive which obligated their
tries, e.g. Sweden, it is not only legislation that member states to establish minimum and similar
sets OSH requirements but also regulations or standards (to the ISO standards), for the work
ordinances from national authorities. All OSH environment. This framework (89/391/EEC)
activities should be planned, organised, carried requires all member states to have correspond-
out and maintained according to the legislation ing statutory rules which contain measures to
and other relevant national requirements. The encourage improvements in safety and health at
concept of internal control also laid down the work.
way in which OSH activities (e.g. inspections In 1996 a British standard and guidelines
or risk measurements), must be documented so (BS8800), for OSHMSs was released. It was
that the national authorities can easily supervise designed to facilitate the integration between
enterprises without time consuming and detailed the management of environmental issues and
inspections. Sweden followed Norway and in- OSH. Other countries have also created their
troduced its internal control regulation one year own national standards, similar to BS 8800. The
later in January 1993. Norway and Sweden are introduction of the British standard was partly
examples of countries that have chosen to use a way to make a rigid supervision system more
legislation to establish OSHMS. flexible and adjusted to the labour market.
The introduction of internal control within Several attempts have been made to issue an
enterprises has resulted in changes in the work ISO standard for OSHMSs, which would cor-
of the supervision bodies, away from detailed respond with the ideas of ISO 9000 and ISO
inspections to supervision of the OSH manage- 14000, but it has not been possible to get ac-
ment system, mainly in big enterprises. Thereby ceptance from the required majority of ISO
much of the bureaucracy has been possible to members, as many countries preferred their
eliminate, making the supervision bodies more own legislation. It seems unlikely that such a
efficient in their control. standard will be established in the near future,
The quality system that later formed the ISO as ISO now has finished to try to overcome the
9000 family of international standards, had its disagreements and no group is working with the
roots in the control system used in the mili- OSHMS standard any more.
tary forces in the USA. In the ISO standards, a In an attempt to overcome the lack of an in-
quality system covers organisational structure, ternationally acceptable standard for OSHMSs,
routines, processes and resources for manag- the International Labour Office (ILO) published
ing and controlling activities regarding qual- a guideline on OSHMSs in 2001. The ILO
ity. Standards for environmental systems, (ISO guideline is aimed at both national and organi-
14000 family of standards), were created later sational levels. Using the guideline as a base, it
(with major input from the ISO 9000 concept), is possible to create or amend national laws and
606
regulations to achieve effective OSHMS regula-

tions. At an organisational level, the guideline
can also be used to implement OSHMSs and
to assist with integration into other manage-
ment structures. The concept of OSHMSs that
has evolved has become increasingly popular in
industrialised countries and more recently in
developing countries.
Fundamental elements of OSHMs

Most standards and guidelines for OSHMS have
many fundamental elements in common al-
though there can be differences in implementa-
tion and maintenance of systems. The following
discussion is largely based on the ILO approach
and focuses upon OSHMS at an enterprise level
rather than at national level.
The following elements are the foundation
for most OSHMSs:
• Policy
Figure 10.2.1. A “system” is characterised by a link
• Organisation between elements, where one element influ-
ences another. If the elements are not linked
• Planning and implementation correctly the result is simply a collection of
• Evaluation elements rather than a useful system. This is
equally true for an OSHMS and a bicycle.
• Action for continuous improvement
namely management commitment and workers’
Taking the two first elements, policy and or- participation. The workers participation in OSH
ganisation, as examples, the organisation of an issues will be further discussed later in this chap-
OSHMS must correspond to what is stated in ter. Workers’ participation in general is regarded
the policy. Enterprises or organisations may not only as a democratic right but also as a tool
have many or all of the elements needed for an to make enterprises or organisation more profit-
OSHMS present. However, if the elements are able and competitive.
not linked or integrated with each other, they Although many national laws and regulations
do not constitute a system capable of handling state that the responsibility for OSH must be
OSH issues efficiently. Because of the nature taken by employers, this does not mean that all
of a system, it is also important to implement employers are committed or active on the issue.
measures for continuous feedback, adjustment Employers must not only be committed but also
and improvement. prepared to create a good climate and an ef-
There are two key factors essential for the ficient system which will encourage workers to
maintenance and creation of efficient OSHMS, actively participate in OSH issues. This requires,
607
Chapter 10.2
amongst other things, that workers are provided OSH policy

with adequate training on OSH. “Policy” has several meanings, of which two are
If an enterprise or organisation seeks cer- the most predominant. The first is setting out
tification of their OSHMS, a certification ar- the terms of a contract and the second being
rangement is needed where all the compulsory an agreement on how to act in specific circum-
elements are defined as ’shall be included’. Sys- stances. The second meaning is applicable to
tems which only suggest elements which may be OSH issues and can be seen as a ‘statement of
included at the manager’s discretion, cannot be ambitions’. For many years, enterprises have
certified. used business policies to tell their customers
what they stand for, e.g. customer service, de-
livery or quality criteria. With the introduction
of various standards on specific subjects, such
Figure 10.2.2. Important elements in OSH and the ways they can be linked to each other to constitute an
efficient management system.
608
as the ISO 9000 quality standards, enterprises written, easy accessible and updated documenta-
have also developed more specific policies in tion on OSH policy, including the objectives,
addition to their business policy. Such policies responsibility, instructions, hazards/risks in the
allow an enterprise to emphasise the importance workplace, prevention activities and records of
they place on particular concerns and to make OSH statistics on accidents, etc.
these concerns visible to their stakeholders such A system for review, evaluation and follow-up
as customers and employees. It also states how of the OSHMS is essential.
management will act on certain concerns. A
policy document is important when it comes to Planning and implementation
setting up enterprise activities. In order to implement or improve the OSH
An OSH policy states the overall objectives of system in an enterprise/organisation, basic
OSH within an enterprise, principally the pro- knowledge of the current situation is essential. It
tection of the safety and health of all employees is appropriate for an initial review to be carried
through the prevention of work-related injuries, out by either an external expert or by a qualified
diseases and near accidents. The policy should staff member, in cooperation with the employ-
be prepared by the employer in consultation ees. External demands, such as national laws,
with employees. It is important that the policy standards and stakeholder requirements, have
states that the OSHMS must be continuously to be included along with identified hazards and
improved and that workers must be consulted the measures required to eliminate the hazards
and encouraged to participate. Each policy or reduce the associated risks. Such a document
should be signed by the employer, comply with can form the basis for the implementation or
the country’s laws and regulations, be specific for improvement of an OSHMS.
each organisation or enterprise and be written in Besides defining the objectives of any im-
clear language and communicated to all employ- provements it is also important to describe what
ees and other stakeholders. activities have to be carried out to achieve the
objectives. A responsible person must be ap-
Organisation of OSH activities pointed, deadlines set and adequate resources
Employers shall organise OSH and appoint assigned.
personnel to identify, evaluate and eliminate Such objectives would normally include sug-
hazards and to prevent or reduce risks. Those gestions for continuous improvement of the
responsible need resources allocated to them, workers’ OSH situation. Objectives must be at-
including time and training. Systems are needed tainable, documented, communicated and their
for cooperation and communication at various attainment evaluated.
levels within the enterprise and to promote the Hazard control includes the ongoing identi-
active participation of the employees. fication and elimination of hazards. If a hazard
Managers and all employees need basic train- cannot be eliminated, the risk should be reduced
ing and refresher courses in OSH. Training has by control at source, e.g. by choosing a safe
to be provided free of charge, if possible during raw material, or reduction of exposure through
working hours, and documented. engineering or organisational measures, e.g. by
Many guidelines and national standards state enclosing the source. The use of personal pro-
that any OSHMS shall include relevant, clearly tective equipment is acceptable only as a tem-
609
Chapter 10.2
porary measure or when all the above measures are fulfilled; compliance with national laws and
have failed. regulations; evaluation, follow up and reporting.
An opportune time to identify hazards is when It may be an advantage if one of the auditors is
new equipment is purchased, when new raw external.
materials are considered or when production
processes are planned or reorganised. It is essen- Action for continuous improvement
tial to consult with potentially affected workers Production systems are always scrutinised to find
in advance of such changes. the weakest link and to discover ways in which
Although outside the core organisation, performance can be improved. The same ap-
contractors are an essential group to include in proach must be taken with any OSH system, i.e.
OSH activities if the workplace is to be safe. It is to find how the OSH can be improved to make
important to have a system whereby contractors workplaces safer and to reduce work related
are informed, requested and committed to fol- injuries and illnesses.
low the existing OSH rules of the enterprise. No OSH problems can ever be regarded as
permanently solved; work has to be continu-
Evaluation ously reviewed. New hazards may be introduced,
The performance of the OSHMS has to be reg- e.g. with new machines, processes or raw materi-
ularly evaluated so it can be judged against the als. Although enterprises should strive to elimi-
stated OSH policy and national legislation, and nate hazards or reduce risks when introducing
be further elaborated. It is important to define new processes or materials, this may not always
indicators, closely linked to the enterprise OSH occur.
policy and objectives, to be used in the evalu- Continuous improvements need to be a natu-
ation. An evaluation should not only be based ral part of everyday working life and are essential
upon reported work-related injuries, ill health or for an efficient OSHMS. You will note the use of
accidents, but should also include monitoring of the term ’continuous’, rather than ’continual’. It
actions. is accepted that OSH activities cannot be car-
Documented investigations of work related ried out continuously, without interruption, but
injuries, diseases, accidents and near-accidents OSH issues must always be on the agenda even
provide important input for the creation of a safer though they cannot be worked on all the time.
workplace. Whenever possible, documentation The so called Plan-Do-Check-Act (PDCA)
should identify failures in the existing OSHMS. approach to improve product quality has been
When corrections are implemented, it is useful to widely used. First made popular by E. Deming
document and communicate the remedies used to through his successful activities to implement
other, relevant parts of the organisation so they continuous improvement, the method is some-
can use the same remedies or avoid similar mis- times called the Deming wheel, or the Shewart
takes. This type of documentation may also be cycle, after the first person to present the con-
helpful for rehabilitation purposes. cept in 1939. PDCA is based on the ’learning-
Audits of the whole OSHMS should cover all by-doing’ concept. It is also known as (PDSA),
the elements in the system, including the way in Plan-Do-Study-Act.
which the elements are linked and support each The PDCA method is usually carried out
other; how well the OSH policy and objectives by small teams. In the planning phase data are
610
but possibly through the use of an easily accessi-

ble checklist and with the participation of all the
employees. Workers need to be trained in OSH,
whatever the size of the enterprise. Documenta-
tion on OSH measures, including actions taken,
results achieved, records, etc, is also important
in small enterprises. Routines for continuous im-
provement of OSH in enterprises are essential.
OSHMS – bureaucratic systems or systems

for action?
It is easy to get the impression from many
Figure 10.2.3. PDCA cycle. standards or guidelines on OSHMS, that they
are purely administrative systems that create
cumbersome and expensive bureaucracy and
collected and analysed to select an improvement
a lot of wasteful work. In fact, an OSHMS is
that the team wants to test. In the do phase the
designed to have the opposite effect – to be an
selected change is implemented. An assessment
efficient system, optimal for the size and nature
of the change is carried out in the check phase.
of the enterprise, to avoid unnecessary work,
Based upon the result the next step is taken in
to prevent costly accidents and to use the valu-
the act phase, when the change is either accept-
able knowledge and experience of employees.
ed as positive or rejected and the PDCA process
In large enterprises, OSHMSs may need input
is started again.
from expert staff but line-managers are largely
responsible for OSH on a day-to-day basis as it
OSHMSs in small enterprises
is an integral part of their work. Experts are only
Standards and guidelines on OSHM are often
needed when the OSH problems to be investi-
very general and intended to cover a broad vari-
gated or solved are so complex that the trained
ety of sectors. They are often written in a format
line-managers or employees cannot handle
that attempts to cover every aspect of OSHMS
them.
and are therefore more directed to large en-
To conclude, the main idea of an OSHMS is
terprises rather than small undertakings. Small
to facilitate action and to implement preventive
undertakings may have an efficient information
measures. Such actions should include investiga-
flow that may shorten the time between decision
tions of hazards and not only be based upon re-
making and action and make results immediately
sults from past accidents or unhealthy exposures.
apparent to everybody. An OSHMS for a small
enterprise can be simple but still efficient. Most The workplace as a “learning” or
national laws, with some exceptions, do not “controlling” environment
make allowances for the size of the enterprise.
All OSHMS standards and guidelines emphasise
The OSHMS, and many of its elements, are
the necessity of workers’ participation. The ap-
still important for small enterprises. Hazard
proach to participation in OSH at the workplace
identification and risk assessment must be done
611
Chapter 10.2
can either take place in a so called “controlling” This is also true for enterprises in a world where
or “learning” environment. competitiveness is accelerating. In the long run
Many national laws and OSHMSs tend to be those enterprises which use only part of their em-
detailed in an attempt to regulate or control the ployees’ abilities will have difficulties to survive
work environment and the behaviour of workers on a global market. Employees working daily in
in a wide variety of specific situations. However, their profession become experts on their jobs and
even a very detailed regulation cannot cover all often have ideas on how production efficiency
the situations that may occur and an OSHMS and the work environment can be improved.
which relies on detailed regulation may fail to These ideas should be taken into account and
deal with unpredicted hazards. A “learning” employees encouraged to come up with new
system which gives workers some freedom to ideas. It is therefore essential to create a system
handle OSH issues, based on general training in that encourage and consider employees’ ideas.
safety, may be more efficient than detailed regu- The promotion of employee participation
lations, not only for unpredicted situations but may make the enterprises more efficient, coin-
also for preventive actions. ciding with their business interests. Another ob-
An OSHMS can be designed to successfully jective may be to increase workplace democracy.
combine to good advantage both a controlling The right of employees’ to exert influence over
and a learning system, but there is always a need their own work environment is an important
to ensure that the controlling system doesn’t issue in many industrialised countries. For exam-
take over. ple, the European Union has a directive stating
that enterprises should involve employees and
participation create true employee participation in OSH ac-
There are two different but complementary tivities. This type of involvement in OSH activi-
methods of participation, direct participation ties is less common in developing countries.
by individual employees and indirect employee The total quality management (TQM) ap-
participation through appointed OSH repre- proach developed by Japanese enterprises fo-
sentatives. cuse both on the implementation of new ideas,
The main problems encountered when intro- enterprise culture and working methods as well
ducing a participatory approach are connected as on the creation of efficient methods to involve
to the “organisational culture” prevalent in workers in enterprise development and ration-
many organisations. For example, a “top-down” alisation. Important aspect of TQM is that it
management afraid of losing power, will hinder encourages and takes employees ideas seriously.
the introduction of participation. A further ob- The continuous improvement approach was
stacle may be that workers have not received any derived from TQM.
training in OSH issues, be illiterate and lacking Participatory is not only a good way to get
self-confidence. new ideas and encourage creativity, but also to
increase the acceptance of changes. Involvement
The objectives of employee participation in changes from the very first discussions is es-
The wealth of a nation depends not only on its sential for understanding the need for a change
natural resources but to a great extent upon how and makes acceptance of change easier, even if
efficiently it takes care of its human resources. it might be threatening or inconvenient. The
612
faster new ideas are accepted, the faster they are establishment of safety committees at enterprise
fully implemented, thus minimising drops in level is one way of organising regular meetings.
production efficiency and profits. So it is essen- In many countries safety committees are com-
tial to have the participation of all those involved mon in enterprises with more than 50 employ-
from the earliest possible stage. ees, although there are generally no obstacles to
While this chapter mainly focuses on partici- have safety committees in smaller enterprises. In
pation in OSH issues there is no difference from order to make an impact and to have continu-
more general participation. If the enterprise has ity, safety committee meetings should be held
not used a participative approach earlier, OSH at least four times a year. National laws may
issues might be a good entrance to a wider im- prescribe more frequent meetings. Safety com-
plementation of participation. mittees normally consist of an equal number of
management and workers’ representatives or
The organisation of participation with a majority of workers’ representatives. If
The commitment of management to create true safety committees are to be effective on OSH
participation is reflected in the way participation issues, an agenda for meetings has to be given
is organised, e.g. by the structures set up, the to the delegates in advance. Minutes from the
time alloted, training given and physical facilities meetings are valuable if they include the activi-
provided for employees to participate. ties agreed upon and state who is responsible for
There are two distinct methods for organising actions and the timeframe. The minutes can be
participation - indirect participation through a communicated to all employees, or for very big
system of representatives and direct participa- enterprises, to employees at the relevant depart-
tion by all employees. Neither system is ideal ments, through notice boards, or emails. Safety
so the most efficient way is often to have both committees can make a more significant impact
direct and indirect participation. The size of the on OSH issues if they are given a yearly budget
enterprise and the questions being dealt with and have the right to take investment decisions
must be considered when deciding which system up to a certain amount. The enterprise OSH
is the most appropriate. policy is the steering document for any safety
However, any structure established for em- committee and the focus should be on preven-
ployee participation in OSH must ensure that tive actions. It is advisable to train safety com-
all employees are given regular possibilities to mittee members if they are not already familiar
express and discuss ideas with the responsible with basic OSH issues.
manager and their workmates. Although sponta- A complement to the safety committee is
neous meetings are valuable for contact between safety inspections or safety rounds. They can
employees and management, they do not replace be organised by the safety committee and may
the need for regular and planned meetings. The include representatives of the committee and
time and place for such meetings have to be management as well as employee representatives
provided by management. from the department being inspected. Direct
The following description is of the methods dialogue with the employees concerned is es-
of participation through representatives, based sential during safety inspections. Safety inspec-
upon the OSH structure found in the legislations are good opportunities to find not only
tion in a number of European countries. The OSH deficiencies but also good solutions. Just
613
Chapter 10.2
as for safety committee meetings, safety inspec- also to create opportunities for dialogue so that
tion reports should state what has to be done, by workers can express their opinions and commu-
whom and when. nicate important findings and ideas. OSH issues
The appointment of safety delegates is ad- are natural elements easily integrated into the
equate for small enterprises where safety com- agenda of such meetings.
mittees are difficult to organise and as a comple- If a department has many employees the
ment to safety committees in larger enterprises. direct approach to participation can be strength-
If they are to be efficient, safety delegates must ened by meetings of smaller groups such as work
be given training in OSH so they are able to teams of five to ten persons, including supervi-
help employees to find hazards and to discuss sors. Such meetings can be organised every
necessary remedial actions with management. week or when required but they should not be
Safety delegates are the employee representa- lengthy.
tives and are normally appointed by the employ-
ees themselves. They should not be employer Creating a climate for participation
representatives who relieve employers of their Genuine and efficient participation is not easily
responsibility for OSH. Safety delegates need achieved. It takes time to overcome the suspi-
not only special and adequate training but also cion which may be present. It is important to
time for activities and meetings. Management allocate sufficient resources from the very begin-
also has to provide safety delegates with the ning of the process and to make participation
necessary documents in advance, e.g. tenders, sustainable in the long-term. Management must
documents relating to the purchase of new be committed to employees’ participation and be
equipment or technical drawings for new build- prepared to express their belief in such an ap-
ing construction. proach.
All the above methods are used when there The resources required are calculated by
is indirect employee participation based upon judging how much time employees need for par-
safety representatives and we will now discuss ticipation. Although the Japanese quality circles
how to implement direct influence. mostly took place outside working time and with
In large enterprises it is not possible or ef- employees unpaid for the time they spent, such
ficient to organise meetings with all employees an approach would be less efficient and likely to
at the same time and in the same place. Instead fail in many other cultures. The European legis-
the direct employee influence must be directed lation on workers participation in OSH activities
towards smaller units as departments or teams. states that it should be on paid time and prefera-
At a departmental level safety inspections can bly during normal working hours. The continu-
be combined with more frequent and regular ous improvement approach, is an important part
meetings between middle management and in many OSHMS standards and is an activity
employees. OSH issues can be integrated into that should take part ‘continuously’, i.e. during
production planning meetings if these already normal working time.
exist within a department. It is necessary to hold A good climate for improvements by partici-
such meetings at least once a month if they are pation can be achieved by starting with small
to be effective. The aim of such meetings is not OSH activities or projects that are easily under-
only for management to inform workers but stood, recognised as important by both manage-
614
ment and workers, and have a chance of success. implement the solutions. Although not all the
Ideas used in continuous improvement can be problems will be solved in the short-term, these
employed, such as getting employees to identify meetings will create awareness and empower the
the hazards or OSH problems in their working employees.
area. These findings can be discussed and ana- A keyword in creating efficient participation
lysed in small team meetings. The analysis can is continuous encouragement from every level of
include a simple risk assessment, suggestions for the organisation.
different solutions and analysis of obstacles to
Checklist on OSHMS and participation
• Is there an enterprise specific OSH policy • Are there regular meetings between workers
signed by top management, communicated and management at departmental level?
and understood by all employees?
• Is there a genuine dialogue where workers
• Are all OSH objectives specified, attain- can freely express their opinions?
able, measurable, and in agreement with
• Do workers have the right to hold meetings
the policy?
on paid time?
• Are OSH issues (e.g. hazards, decisions,
• Do workers have a place where they can hold
training, responsibility) documented?
their own meetings?
• Are the persons responsible for OSH given
• Does management encourage workers to
appropriate training and resources?
come up with their own ideas and to report
• Are all employees informed and given OSH hazards?
adequate training on OSH at their work-
• Is there any system of rewarding good ideas
places?
on OSH or other issues?
• Is there a joint (employee and employer)
• Are workers or their representatives informed
safety committee ?
in advance when new equipment is to be pur-
• Are workers represented in decision mak- chased or new production lines or methods
ing on OSH issues? introduced?
• Are hazards identified and action to elimi- • Do workers have any influence on the layout
nate hazards taken? of the workplace?
• Are risks assessed and preventive actions • Do workers have the right to stop production
taken before PPE is introduced? if they perceive a situation to be dangerous?
615
Chapter 10.2
case studies
Workers’ participation in creating

an Occupational Safety and Health
Management System in a small Brazilian car
repair shop.
This is a summary of a report written by Mr

Dorival Barreiros on a project carried out in
Brazil.
Although the Brazilian Occupational Health

Figure 10.2.4. Psychodrama was used.
and Safety Act requires all companies, regard-
less of their size, to have a risk management
to commit to work for true participation, al-
program, the majority of small enterprises fail to
low transparency in decision-making processes,
meet these requirements. The majority of SMEs
respect and involve everyone. After several visits
regard this requirement as just more paperwork.
to small enterprises, a auto body repair shop in
Consultants are often contracted to prepare risk
Sao Paulo agreed to conduct the project in 1999,
management programs which are designed to
using action research and psychodrama.
satisfy labour inspectors’ demands rather than to
The first step was to get the employer’s com-
contribute to improvements in working condi-
mitment to the program. Then the enterprise
tions. This process usually doesn’t involve work-
had to create a positive environment for work-
ers and the resulting program is more likely to
ers’ participation.
reflect the point of view of the consultant rather
After the first visit to the enterprise, there was
than the workers’ perception of the risks they
agreement by both the employer and employ-
face.
ees, on the need for the project. There was also
A project was established in a small car repair
shop to establish and maintain a risk manage-
ment program based on encouragement for the
employer and the employees to work in a coop-
erative way.
Firstly, when identifying an enterprise willing
to accept the project objectives, it was essential
to not only consider the difficulties faced by
small enterprises when dealing with OHS is-
sues but to also consider both the common and
conflicting interests of employers and employ-
ees on OSH issues. The enterprise involved in Figure 10.2.5. Models were used to visualise and
the project also had to be prepared to promote discuss the layout.
the free flow of information, to compromise,
616
agreement that the layout of the repair shop and individual spontaneity and to obtain positive re-
the car body work and paint process were bot- sponses between the group members. Following
tlenecks in the production process. Employees the warm-up, group members were encouraged
have been forced to increase their pace of work to display their experiences through a role-play.
and to work overtime in order to maintain the Finally, the group was invited to choose a way to
required production level. Car body work and share their feelings through writing, drawing or
paint processes are not only complex tasks but oral expression. A facilitator assisted the employ-
also very physically and mentally demanding. er and the employees to identify the main haz-
Accidents related to car body work and paint ards in their departments and supported them in
process had been recorded. their work towards effective solutions. Solutions
Psychodrama and action research were ap- were discussed collectively and the priorities
plied depending on which method was judged were negotiated between employer and employ-
to be the more appropriate to achieve the objec- ees after consideration of their needs.
tives. Psychodrama was used to: The following were considered to be essential
elements in attaining the defined objectives of
• introduce the project to the workers and to
the project:
make them aware of the importance of their
involvement in the implementation of a risk • The process must be participatory with both
management program; employees and the employer involved in most
aspects of the activities. The issues addressed
• promote positive cooperation between work-
in the project should be generated by the em-
ers, employers and the researchers;
ployees and employer, not by the researchers;
• encourage each worker to reflect on the scope
• The process must be a cooperative one where
and importance of their job in a social, eco-
employees, the employer and researchers
nomic and technological context;
must jointly contribute their expertise in a
• stimulate participants to initiatiate an ex- collaborative way;
change of opinions, feelings and expectations
• It must be a learning process for all the partic-
with respect to the project objectives;
ipants. While the researchers can assist with
• create teams where each participant could get theory and knowledge they must also recog-
to know and understand each other better, nize the importance of the employees practi-
e.g. to define their potential and limitations cal knowledge and ingenuity about identifying
for developing their jobs and the importance and devising solutions to workplace and OSH
of each job. problems;
• The action research process must involve
A psychologist was responsible for conducting
system development. The organisation must
the monthly psychodrama sessions (held be-
develop the competencies to analyse problems
tween March and November, 1999) with both
and to plan, implement and evaluate interven-
workers and researchers participating. When
tions;
necessary the employer took part in these ses-
sions. Each session lasted about 90 minutes, • It must be a process which empowers the
starting with a warm-up activity to stimulate participants. Increased knowledge and partici-
617
Chapter 10.2
pation in decision making related to OHS and showers were introduced; chemical storage and
the work process results in employees gain- trash disposal were improved. Health surveil-
ing increased influence and control over their lance measures were planned. An ongoing main-
own working situation. tenance program was seriously considered in the
risk management program.
A number of limitations in the work flow and The manual handling of heavy and cumber-
the layout were identified and alternatives were some parts were partially solved by lifting de-
proposed and discussed. The group was moti- vices. The workers’ awkward working positions,
vated to study alternatives to improve work flow responsible for major ergonomic problems,
and layout facilities in the repair shop. Other remained a challenge as the solutions proposed
constraints were found such as poor housekeep- required major financial investmen.
ing; congestion in areas where materials and Finally, as a result of the efforts made to es-
components were stored; poor utilisation of tablish the risk management program, it became
space; excessive movement of cars waiting to be increasingly clear that a well trained work group
fixed; bottlenecks in work flow between car body was very much needed. Further activities must
work and paint process (more than one and half rely upon everybody’s commitment and partici-
hours per day was wasted just to make enough pation in a collaborative environment.
space to keep work flowing between the two
buildings). The group also identified hazards at
the workplace through an inspection. It was im-
portant to have agreement on priorities because
this process also contributed to the participants
perception of risk. The seriousness of each situa-
tion was assessed during a brainstorming session.
The initial accomplishment of the project was
the transformation of the existing layout which
rationalised the use of space and made the work
flow more efficient. Motivated by these results,
housekeeping also became better managed. All
sections were furnished with workbenches, spe-
cific places were provided to keep tools in order
and a mezzanine was created to store disassem-
bled parts.
The main hazardous situations related to the
production process were identified and the asso-
ciated risks were qualitatively assessed. Exposure
to solvents was one of the main concerns which
was partly solved by the introduction of a local
exhaust system in the painting area. In addition,
workers were trained to handle solvents with
care and wear the appropriate PPE. Emergency
618
Sustainable OSH improvement at workplace the training consisted of 40 hours of lectures,

through development of ”Change Agents” discussions and workplace visits, attended by 28
participants. On the last day the of the training
This is a summary of a report written by Dr presentations were given by each group regard-
Shyam Pingle on a project carried out in India. ing plans of workplace improvements.
In a fourth step a baseline survey was carried
The project “Sustainable OSH improvement out to identify and assess the OSH problems
at workplace through development of Change within the fields stated in the specific objectives:
Agents” was carried out as an individual project noise, dust and heat.
in the Swedish international training pro- The fifth and most important part was the on
gramme “OSH & Development” 2002 – 2004. It the job implementation. Change agents formed
was carried out in one unit of the Reliance In- project teams with participants from operations,
dustries Ltd, in Jamnagar. The Reliance Group maintenance, safety and occupational health, to
as such is the largest business house in India. It identify problems and prioritize actions. Ac-
was founded by Shri Dhirubhai H Ambani and tions were taken on two fronts: imparting the
its activities span from petrochemicals, refining, knowledge to the field personnel and identify
textiles, oil production to marketing and retail an implement engineering control measures.
services. The project was undertaken at the A road map was developed by the CASH team
Fluidized Catalytic Cracker Plant in the Jamna- including action plans, training, awareness mak-
gar Petrochemical Refinery, one of 16 operating ing, monthly progress review. The project leader
plants at the site. spent at least 20 % of full time to manage the
At the first planning stage of the project the project and the CASH agents about 10 % of
objective was defined as, “To reduce occupa- their working hours.
tional health risks in the work environment with Several improvements were achieved; here
focus on reducing risks due to exposure to heat, just a few will be mentioned. Noise levels were
noise and dust”. reduced with up to 25 dB(A) in several ar-
The second step after having selected the eas, thus arriving to levels below the limit of
unit of the enterprise was a presentation of the 85dB(A). As an average the noise levels were
project to the senior management. During the reduced by 9 dB(A). The reduction was a result
following discussions with the management it from several actions: insulation, relocation of
was decided to name the project “CASH” as machines, installation of silencer (also resulting
an acronym of Change Agents for Safety and in saving steam valued more than USD 60 000
Health. The management agreed upon setting a year!). Dust was reduced, e.g. in loading areas
aside a budget of USD 30 000 for equipment from 5.6 to 2 mg/m3. The profit of these ac-
and training. tions which reduced the loss of catalyst is cal-
The third step was to identify and train culated to USD 300 000 a year. Heat exposure
Change Agents. The Change Agents were se- was reduced by 4 centigrade in certain areas by
lected among supervisors. As training material for example providing ceramic insulation heat
the Swedish Joint Industrial Safety Council’s shields. Finally the project resulted in a great
manual “Workplace Safety and Working Condi- increase of awareness among the working staff
tions” was used, among other manuals. In total and increased compliance with safety rules, e.g.
619
Chapter 10.2
Figure 10.2.6. Noise levels before and after intervention.
use of hard hats and protective equipment when Actually the CASH project, that was initially
needed. a pilot project just in one unit of the enterprise
Some of the improvements were quite easy has now spread to many other units in Reliance.
and not costly to implement. Thanks to the par- Even before the pilot project was over it was
ticipation of the operators these solutions could extended to five other manufacturing sites in
be found. Other improvements were costly and Reliance and ever since it is getting implement-
requested support from engineers. However, ed at more and more new units. Success of this
as can be seen from the above also the costly pilot project was followed up with more similar
improvements paid back in a very short time. projects and their number has grown for the last
The CASH project did not only result in several four years indic. During 2008 there are totally
technical improvements but also in a “cultural about 1 200 projects for improvement of occu-
change” which ensured employee and manage- pational safety and health within different parts
ment involvement of unprecedented scale. The of Reliance, emanating from the CASH project.
“doubting Thomases” who initially expected the Although the support of the top management
project to be “the flavour of the month” which is essential, the projects as such must be decen-
would fade away soon, ultimately became com- tralised and have to be run on a “local level”
mitted brand ambassadors for the project. and by multidisciplinary teams. In doing so the
processes also have a better chance to be incor-
620
porated in daily actions and become sustainable

activities. Finally, the CASH project is a good
example of how to spread information about
projects and their results, and how to give the
involved persons credit for their work. Actually
the management has introduced a special trophy
to acknowledge good OSH initiatives.

http://www.ilo.org/public/english/protection/safe-
work/cops/english/download/e000013.pdf
This link is to the complete ILO OSHMS text,
which can be used for implementing OSHMS in
an enterprise.
http://www.av.se/dokument/inenglish/legislations/
eng0101.pdf
The full text of the provision of the Swedish
Work Environment Authority on systematic
work environment management also including
recommendations on the implementation of the
system.
http://eur-lex.europa.eu/LexUriServ/LexUriServ.
do?uri=CELEX:31989L0655:EN:HTML
The Council Directive 89/655/EEC of 30 No-
vember 1989 concerning the minimum safety
and health requirements for the use of work
equipment by workers at work.
621
10.3
Occupational health services

Kaj Elgstrand
the origin of occupational

health services
During the industrial revolution in Europe, or chronic poisoning began to be studied, in-
many reports decried the health risks giving rise cluding heavy physical work, extreme thermal
to diseases and accidents in the workplace. As a conditions, noise and psychosocial stress. The
result, many large industries – such as those con- semi-automation of manufacturing in the 1960s
cerned with mining, iron and steel, chemicals, and early 1970s focused concern on physically
textiles, metal manufacturing, and paper and and psychologically monotonous work. Later,
pulp – organised health services for their work- the emphasis shifted towards the adverse health
ers. The main aims of these industrial health effects of exposure to low levels of carcinogenic,
services were the prevention and medical treat- mutagenic or teratogenic substances, biological
ment of occupational injuries and diseases. In and neuropsychological effects of chemicals and
some places, full medical care was provided for other problems caused by the rapid implemen-
workers and their families. tation of new technology, such as computers,
During the late nineteenth and early twen- process automatics and video display units.
tieth centuries, legislation to protect workers In line with industrial developments, oc-
against occupational injury and disease began cupational health services, particularly those in
sporadically to be introduced. The first regula- the most industrialised countries, adjusted their
tions reduced working hours for women and goals to the changes in work. A concept of com-
children. In the 1920s and 1930s, legislation was prehensive occupational health emerged, dealing
broadened to cover accidents and poisoning in with all work-related factors and those related
the workplace. Safety devices began to be built to lifestyle. The aims were now to promote the
into machines, wet drilling and local exhaust general health of workers (including their physi-
ventilation were introduced to control dust in cal, mental and social well-being), to protect
mines, and the inhalation of gases, metal fumes workers against health impairment from occupa-
and solvent vapours was reduced. tional exposure to hazards, to adjust the work to
After the Second World War, occupational the workers and to optimise working conditions.
health factors other than accidents and acute
623
Chapter 10.3
In the 1950s and 1970s, many European coun- – a service for a safe and healthy working envi-
tries introduced legislation making occupational ronment,
health services compulsory in workplaces. The
– consideration of both the physical-health and
coverage of the entire workforce in both indus-
mental-health aspects of work. The activi-
trial and non-industrial enterprises became a
ties of occupational health services can be
goal. In some countries, the services were based
grouped into five categories, depending on
on collective agreements between employers and
the objectives:
workers organisations. In a few countries, serv-
ices remained voluntary and were left to local – preventive environment-oriented activities,
management and trade unions. – preventive individual-oriented activities,
The concept of occupational health services
was defined 1959 by ILO in a recommendation – first aid and treatment of accidental and other
concerning Occupational Health Services in Places acute causes,
of Employment, stating among other things that – general preventive and curative activities,
the role of occupational health services should
– information, education, training and advice.
be essentially preventive (ILO recommendation
no. 112). This recommendation was superseded
The ILO instruments require the widest pos-
by the Occupational Health Service Convention of
sible coverage of services in order to provide ac-
1985 (ILO Convention No. 161), supplemented
cess to occupational safety services for all work-
by a recommendation in 1987 (ILO Recommen-
ers in all branches of economic activity and in
dation No. 171). These documents are essential
all undertakings, including the public sector and
for development of occupational health services
co-operatives, and also for the self-employed,
and the implementation of an occupational
that is for all participants in working life. This
safety and health policy and functions at the
principle requires flexibility of the models for
enterprise level. They provide a comprehensive
provision of services in order to meet the vary-
approach to the prevention of occupational ac-
ing needs of undertakings of different sizes, dif-
cidents and diseases and also equity, accessibility
ferent types of industry and work, and to enable
and affordability. The documents include a de-
implementation in countries with widely varying
scription of occupational health service models
societal and administrative systems.
and activities to be organised in the workplaces,
WHO’s occupational health strategy accords
as well as a multidisciplinary approach and co-
with the ILO’s. Since the Alma-Ata Declaration
operation between different occupations.
of 1978, the WHO occupational health strategy
The following guidelines for occupational
has been closely bound up with its global strat-
health services can be found in the ILO instru-
egy for health for all. Many of WHO’s essential
ments:
elements of primary health care have features in
– an advisory service common with the ILO list of functions of occu-
– an essentially proactive service, pational health services.
– a service at enterprise level,

– a service for both employers and workers,
624
organisation of occupational – Specialised occupational health services may

health services be organised for special sectors like construc-
Occupational health services (OHS) may be tion, forestry or agriculture. Such services
organised in many different forms. In the fol- may be of the OHS centre model, serving en-
lowing a number of such forms are summarised. terprises in a local area, or bigger, nationwide
The examples given represent a potpourri in- organisations.
tended to give an idea of the many different – The OHS centre model may be established,
forms that are applied in different countries. not based upon initiatives by the enterprises
– In big enterprises with thousands of workers concerned, but as an independent enterprise
and production entailing many occupational seeking occupational health service customers
safety and health risks, occupational health among small, middle sized or big enterprises
services may be organised as an “in-built” in a region.
service. A unit of such services may include a – It is not uncommon for a small enterprise
number of full-time employees: one or two (e.g. in mining and manufacturing) to employ
occupational health physicians, two or three a full-time occupational health nurse and con-
occupational health nurses, one occupational tract an occupational health physician part-
physiotherapist, one safety and hygiene en- time (for, say, two hours per week or one day
gineer or an occupational hygienist. In some per week) to guide the work of the nurse, and
enterprises the technical personnel are not take care of more complicated medical issues.
part of the occupational health service unit – In total, more than 90% of employees in
but belong to another part of the enterprise. Finland have access to occupational health
– If the enterprise is smaller (e.g. 800-1500 services. (For small enterprises with up to
employees) but its production entails many ten employees, in practice only 65% of the
occupational safety and health risks, occupa- employees have access to occupational health
tional health services may be organised as an services, although access is obligatory ac-
in-built service but with less personnel: one cording to Finnish law). There are more than
half-time or full-time physician, one occupa- thousand occupational health service units in
tional health nurse, etc the country, of which one in three is an OHS
– Small enterprises cannot employ their own centre, one in three an in-built unit and one
occupational health service personnel. A in four a private OHS provider.
number of such enterprises in one and the – Big multinational corporations with well-de-
same area may jointly employ occupational veloped internal internet communication (in-
health service personnel through a special tranet) have a forceful tool for programming
OHS centre. The enterprises belonging to an and following up activities to ensure occupa-
OHS centre may be private, municipal and/or tional safety and health for their employees.
state owned. This model has been successfully Such communication may also include de-
applied, for example, in Sweden, but due to tailed standards and training materials, acces-
changing conditions for the small enterprises sible at the corporation’s worksites all over the
and economic constraints, the OHS centre world.
model is less common today than twenty years
ago.
625
Chapter 10.3
– Private insurance companies, mutuales, have health services is lower in small enterprises and
long played an important role in Chile, guid- higher in big ones. The sheer number of small
ing the occupational health services in the enterprises is a problem in itself. Reaching all of
member enterprises. Asociación Chilena de them takes a lot of resources. Establishing con-
Seguridad (ACHS), the biggest of the Chilean tacts, paying visits and evaluating the need for
mutuales, has its own hospitals for employees occupational health services takes a lot of time.
of member enterprises and their families, an The economic outcome is uncertain. The situa-
occupational hygiene laboratory, a department tion becomes even more difficult when it comes
for preventive medicine, and an extensive to organising occupational health services for
information and training programme in oc- self-employed and for those active in the infor-
cupational safety and health. Other countries mal economy.
like Argentina and Colombia have established There are numerous reasons for the many dif-
systems inspired by the Chilean mutuales. ferent organisational forms of services. In some
countries occupational health services are pre-
– The Tanzanian Occupational Health Services
scribed by legislation, in other countries occupa-
(TOHS) is a non-governmental organisation
tional health services are based upon agreements
jointly established in the late 1960s by the
between the social partners. In some countries,
government and the ILO. TOHS is a non
the ILO Convention on Occupational Health
profit association. Although TOHS started
Services plays an important role for the organi-
voluntarily with six member companies in Dar
sation of occupational health services. In other
es Salaam, it has swollen to tens of companies
countries there are no regulations or norms
with upcountry branches serving the health
guiding the organisation of services. The size
needs of industrial workers, their dependants
of enterprises and the character of production
and the general public.
and risks for occupational accidents and diseases
– The WHO Alma-Ata Declaration (1978) put greatly influence the way in which occupational
high priority on the organisation of primary health services are organised. The sources of
health care services for large populations. financing are decisive; in some countries, oc-
Many attempts have been made to establish cupational health services in private enterprises
occupational health services through primary are also subsidised out of public revenue, while
health, some successful others not. Such an in other countries the funding is strictly com-
approach would seem logical, e.g. in Southern mercial.
Africa, considering the scarcity of occupa- The key issue is not the organisational form
tional health specialists in these countries. On of occupational health services but the avail-
the other hand, primary health in this region ability and functionality of the system, so that
is heavily burdened with tasks related to HIV/ the safety and health needs of the employees at
AIDS, tuberculosis, malaria, dengue and other every workplace are adequately addressed. The
infectious diseases. form, however, is crucial for the availability of
the services and the possibilities of addressing
It is small enterprises that have most difficulty safety and health needs.
in providing occupational health services In all
countries of the world, access to occupational
626
prevention versus health care meet a worker as a patient, you have also reason
Occupational health services include three kinds to investigate his or her workplace and work-
of medical activities: prevention of injuries and ing conditions and reflect on what should be
diseases, curative health care and rehabilitation. changed. On the other hand, curative health
A fourth may be added: health promotion. In care may be too time-consuming, not allowing
theory, if the prevention of injuries and diseases enough time for preventive work. It may not
were fully successful, the other activities would be easy for OHS personnel to refuse to carry
not be needed. out general health examinations if the workers,
The content of prevention versus curative the trade union and the employer would like
health care in occupational health services is a them to be carried out. Among OHS personnel,
longstanding topic of discussion. Should the health examinations directed to specific health
services include also curative health care or risks are considered much more meaningful than
should they be merely preventive? These discus- such general health examinations.
sions have produced different results in different
to what extent do occupational
countries (and also changed over time in some
health services exist?
countries). There are countries where occu-
pational health services are strictly preventive, Other parts of this chapter deal with what occu-
while in others both the curative and preventive pational health services are supposed to be. This
parts are included. Nor is it unusual for activities part is a critique of the existence of occupational
called occupational health services to contain health services.
only curative health care and no prevention. In many developing countries, workers have
International documents and statements, like never heard of, still less had any experience of
the ILO conventions and recommendations and occupational health services. In other develop-
the WHO resolutions, are clear in this respect: ing countries, such services may exist within big
occupational health services are essentially pre- companies, or in a few cases as nationwide serv-
ventive but may also include curative health care. ice organisations financed by public and private
There are several reasons for including cura- means. In general, however, very few workers in
tive health care in occupational health services. developing countries have access to organised
Everyone will agree concerning the relevance of occupational health services. What is the situa-
having facilities for first aid and treatment of action in the industrialised countries; do occupa-
cidental and other acute causes within or close to tional health services really exist there?
the workplace. Employers, managers and work- In addressing this question, let us focus on
ers tend to value the possibility of injuries and Europe. Two good reasons can be given for this.
uncomplicated diseases being treated directly in One is that Europe is supposed to be the most
the workplace, instead of causing time-consum- developed region in the world in terms of OHS,
ing travel to primary health care facilities far so we could expect a positive answer to the ques-
away from the workplace. OHS professionals tion. Another is that an extensive Survey of the
may consider curative health care to be a neces- Quality and Effectiveness of Occupational Health
sary opening to the possibilities of preventing Services in the European Union and Norway and
occupational accidents and diseases. When you Switzerland was jointly published in 2001 by the
Finnish Institute of Occupational Health and the
627
Chapter 10.3
Swedish National Institute for Working Life. and regulations are in place”, but coverage “var-
That survey included the 17 richest countries in ies from low to very good” and/or “should be
Europe, so the report should help to answer our higher”. According to the trade unions there are
question related to the part of the world where no data available on OHS coverage.
occupational health services are most developed. Based upon the above figures and the size
We need some criteria for “the existence” of of the working populations in the different
OHS. The following three criteria will be used: countries, it can be estimated that one-third of
employees in these countries have access to an
1. Workers should have access to the OHS;
organised OHS. As an overall measure this is a
therefore the OSH coverage of a nation’s
surprisingly and disappointingly low coverage. A
workforce will be our first criterion.
great majority of the workers in Europe’s richest
2. The focus on preventive action at workplaces countries do not have access to organised OHS.
to many is the most important qualitative It should be noted that OHS coverage is not
criteria of OHS; therefore this will be our sec- always the same as having access to occupational
ond criterion. health services. In some countries, coverage is
3. OHS personnel clearly need a certain profes- considered 100% if the legislation requires em-
sional competence for their tasks; this compe- ployers to provide occupational health services.
tence depends, among other things, on which So there may be countries where the coverage is
professionals are employed within the OHS 100%, at the same time as only 30 or 40% of the
and on the special training they have received workers in those selfsame countries have access
in OHS issues; this is our third criterion. to occupational health services in practice.
OHS coverage Focus on prevention

The normal way of describing OHS coverage The focus on preventive action at workplaces
is in terms of the percentage of a nation’s work- cannot be quantified from the responses to the
force having access to an organised OHS. Eight survey. A few countries report that all or most
of the 17 countries were able to give a quantified occupational health service activities are preven-
answer. Five countries seem to have very good tive. Most countries say that occupational health
coverage: in France 100% of the employees are services “should focus more on primary preven-
covered by organised OHS. Seven countries tion” or that prevention “should be strength-
− among them the big countries of Germany, ened”. A few countries report that there are no
Italy, Spain and the United Kingdom − have preventive activities.
poor OHS coverage or either stated that the In summary, the following is said based upon
coverage was not known or gave answers which the survey:
are impossible to understand. In four of the five “In general, OHS focus on prevention, mainly
countries with big populations (40 million or with respect to safety, personal protection
more), OHS coverage is poor, non-existent or and work environment issues at workplaces.
unknown. Prevention largely means also prevention of
diseases, injuries and the promotion of health.
The information about the OHS coverage The methods and concepts of preventive ac-
in Germany, the European country having the tivities vary according to the country, time of
largest population, is very vague. OHS “laws training of professionals, tradition and the re-
628
quirements of legislation and practices. Such for re-defining and further developing occupa-
new fields as work organisation, absenteeism tional health services. As for the quality of the
and profit from prevention are also being
used as arguments for or against preventive training, the focus should be on preventive ac-
activities. Employers expect to get immediate tion in the workplace. As for the quantity of the
benefits from prevention, whereas profes- training, national manpower planning should be
sionals see their work as long-term activity to employed.
improve the quality of life and work.”
The above figures concerning OHS coverage
and access, and concerning specialists employed
Professional competence and fulfilling competence requirements, date
The competence requirements vary a great deal from 2001, and the conclusions drawn here are
from one country to another. Professional com- based on those figures. There is reason to be-
petence is considered high in some countries lieve that the situation concerning occupational
(Belgium, Denmark, France, Norway, the UK). health services in these European countries has
Needs for increased competence are expressed remained more or less the same during the last
by many countries (Austria, Finland, Germany, ten years.
Italy, the Netherlands, Spain, Sweden).
Surprisingly, only a few countries have men- basic occupational health services
tioned competence related to manpower plan- Since 2003, the ILO, WHO and ICOH have
ning. How many OHS specialists are needed in engaged in the development of what are called
the country? How many are employed? How Basic occupational health services (BOHS), intended
many of those employed fulfil the competence to create more realistic criteria and methods for
requirements? Some countries (Germany, developing occupational health services also in
Greece, France and Ireland) mention a shortage developing countries. The ultimate objective
of OHS personnel. A few countries give details. of the BOHS initiative is to provide occupa-
tional health services for all working people in
Back to the original question the world, regardless of the sector of economy,
Do occupational health services really exist in mode of employment, size of workplace or
industrialised countries? Yes, they do, but only geographical location, i.e. according the princi-
for a small portion of the working population in ple of universal service provision. According to
the 17 richest countries of Europe. The content BOHS, a stepwise strategy is recommended for
of “preventive action at workplaces” is difficult the development of a sustainable infrastructure
to describe and define; it seems to differ greatly for occupational health services:
from country to country. Competence require-
ments for OHS specialists also differ greatly Stage I: Starting level
from country to country; there is a general For workers and workplaces not having any
shortage of OSH specialists meeting these re- occupational health services at all, “field OHS
quirements. Preventive actions at workplaces workers (if possible, a nurse and safety agent)”
should be re-defined and re-established as the should be utilised. They may have had brief
main content of occupational health services. training in OHS and work for a primary
Specialist training of OHS personnel should health care unit. The content of services
nationally and internationally be the main tool focuses on most important and severe health
hazards and on their prevention and control.
629
Chapter 10.3
Stage II: Basic Occupational Health Services mist, a psychologist, a safety engineer, etc.
(BOHS) The content of services is comprehensive
An infrastructure-based service working as covering all aspects of occupational health.
close as possible to the workplaces and com-
munities. The service provision model may The two first stages (I and II) are designed for
vary, depending on local circumstances and the smallest and micro-enterprises, the self-
needs. The personnel (usually a physician and employed and the people employed within the
a nurse) have undergone brief special training informal economy.
in occupational health. Under the leadership of Jorma Rantanen, a
pilot project was initiated in 2004 to establish
Stage III: International Standard Services
Basic Occupational Health Services in China.
The minimum objective for each country as
The project is proceeding in collaboration
stipulated by the ILO Convention No. 161.
with Chinese authorities, WHO, the ILO and
The service infrastructure has several optional
ICOH.
forms and the content is primarily preven-
It is not easy to estimate the quantitative need
tive, although also curative services may be
for OHS personnel in BOHS, as the structures
provided. The service staff should be led by
of constituents and their needs may vary widely.
a specially trained expert (usually a specialist
According to the BOHS document, an experi-
occupational health physician) and the team
ence-based estimate speaks for a minimum need
should preferably be multidisciplinary.
of one physician and two nurses per 5 000 work-
Stage IV: Comprehensive Occupational Health ers with a great deal of variation depending on
Services the branch of industry and size of workplaces,
This level is usually found in the big com- as well as on their geographical distribution.
panies of industrialised countries or it may If this criterion was to be applied to the world
be provided by large OHS centres. The staff working population of 3 billion people, 600 000
work as a multidisciplinary team including occupational health physicians would be needed
several specialists such as an occupational and 1 200 000 occupational health nurses. These
health physician, an occupational health figures are far, far beyond the current numbers
nurse, an occupational hygienist, an ergono- of existing OHS personnel.
630

ILO Convention No. 161 on Occupational An extensive report from an extensive survey
Health Services, 1985. concerning occupational health services in
ILO Recommendation No. 171 on Occupation- 17 European countries, summarizing overall
al Health Services, 1987. impact of OHS, coverage and access, focus
These documents contain essential informa- on preventive actions, effects on health and
tion for development of occupational health workability, cost effectiveness, professional
services and the implementation of an oc- competence, and more issues.
cupational safety and health policy and func- Lehtinen, S (ed.). Challenges to occupational
tions at the enterprise level. By April 2009, health services in the Regions. Proceedings of a
Convention No. 161 had been ratified by 28 WHO/ICOH/ILO Workshop in January 2005,
countries. Helsinki 2005.
Menckel, E & P Westerholm (eds.). Evaluation Reports on the current state of occupational
in Occupational Health Practice. Butterworth health services in a number of developing and
Heinemann, 1999. industrial countries.
A number of articles on evaluation of occupa- Basic Occupational Health Services. 3rd revised
tional health services; general principles and edition, Helsinki September 2007.
methods, quality aspects, ethics, economic This basic guideline has been written by
appraisal, etc. Jorma Rantanen and published by the Finn-
Lehtinen, S, K Räsänen, K Husman & J Ran- ish Institute of Occupational Health, as a
tanen (eds.). Survey of the Quality and Effec- response to the Joint ILO/WHO Commit-
tiveness of Occupational Health Services in the tee on Occupational Health priority area for
European Union and Norway and Switzerland. ILO/WHO/ICOH collaboration. It can be
People and Work Research reports 45, Finnish accessed through the Occupational Health
Institute of Occupational Health, Helsinki 2001, part of the WHO website.
in collaboration with the Swedish National
Institute of Working Life.
631
11
National planning of OSH
11.1 Role of social partners 635

11.2 Education and training 649
11.3 Supervision and control 673
11.1
Role of social partners

Petra Herzfeld Olsson & Kerstin Ahlberg
introduction
The importance of trade union and employer book, however, the role of the trade unions is
involvement in occupational safety and health not discussed in detail. The ILO conventions do
(OSH) work is emphasised by international not give any explicit or prominent role to trade
organisations such as the International Labour unions at enterprise level – it is the workers and
Organisation (ILO) and the World Health their representatives who are guaranteed cer-
Organisation (WHO). The role of the social tain rights connected to work on occupational
partners at national level is emphasised within health and safety at the workplace. A workers’
the ILO’s legal framework. It prescribes that the representative is a person, recognised according
social partners should be consulted when nation- to national law, irrespective of whether they are
al occupational safety and health policy is for- a trade union representative or a representative
mulated and when implementation of any ILO elected by workers not affiliated to trade unions.
conventions on occupational safety and health is In other words, representatives with or without
being enacted. trade union affiliation can be recognised.
The International Labour Organization has This solution has mainly arisen because while
adopted several conventions and recommenda- many enterprises lack trade union representa-
tions on occupational health and safety, consid- tives, it must still be possible to involve employ-
ered to be international minimum standards. ees in work on occupational safety and health.
The role of the social partners is mentioned in However, in many countries trade unions are the
many of these standards and is the major focus representative bodies responsible for these
of this chapter. issues, e.g. in Sweden, local trade unions elect
While the chapter focuses on collaboration at the workers’ safety delegate and workers’ rep-
national level, it should be noted that the social resentatives in health and safety committees. In
partners also play an important role in occu- the UK trade unions appoint the workers’ safety
pational health and safety at international and delegates.
enterprise level. The existence of trade unions is also implied
Occupational health and safety at the enter- – and sometimes mentioned explicitly – in some
prise level is covered in other chapters of this ILO regulations related to work on occupational
635
Chapter 11.1
safety and health at work places. Trade union occupational health including the International
representatives often have better possibilities Organization for Standardization (ISO), the
and resources to pursue workers’ rights so the International Social Security Association (ISSA),
importance of involving trade unions in OSH international trade union secretariats (ITSS) and
work at workplace level is emphasised in the the OECD. This chapter analyses the “OECD
international arena. Guidelines for Multinational Enterprises”, an
The ILO involves the social partners (work- international tool intended to assist workers’ and
ers’ and employers’ associations) together with employers’ involvement in OSH work at national
government representatives, in the development level. The social partners are given a prominent
and adoption of labour standards on occupational role in the implementation of these guidelines.
health and safety at international level. The chapter is organised to firstly present
Trade unions and employers associations relevant provisions on the right to freedom of
play an important role in the development and association followed by explanation of the mean-
implemention of occupational safety and health ing of the ILO norms concerning the roles of
issues at national level as they contribute valu- the social partners in national work on occupa-
able knowledge and experience of the working tional safety and health. The OECD guidelines
environment and working life. To fulfil this role, are then described. The chapter ends with a
it is of crucial importance that associations are section on ways in which the ILO standards on
truly representative and independent. Consulta- health and safety can be implemented at national
tions must take place under conditions which level, using two examples from Latvia and Tan-
give representative associations an opportunity zania to give insight into how principles can be
to express their opinions in total freedom and practically implemented.
independence. That can only be guaranteed
through full respect for freedom of association the right to organise
and consequently full respect for the principles – a human right
embodied in ILO Convention No 87 Freedom The right for workers and employers to associ-
of Association and Protection of the Rights to ate, in order to protect and promote their oc-
Organise (1948) and in ILO Convention No cupational interests, is recognised as a human
98 Right to Organise and Collective Bargaining right in a number of regional and international
(1949). (These international minimum standards human rights instruments. The basis of the
concerning freedom of association will be dealt human right protection is the UN Declaration
with in depth in this chapter.) on Human Rights and the UN Covenants on
In addition to the ILO legal framework, there Human Rights. However, the UN has delegated
are a number of other institutions and interna- labour related issues to the ILO and it is mainly
tional bodies that aim to improve occupational within the ILO context that the meaning of the
safety and health. Within the un system the freedom of association as a human right has
World Health Organisation (WHO), the UN been developed. Two principal ILO conventions
Environment Programme (UNEP) and the deal specifically with the freedom of association,
International Atomic Energy Agency (IAEA) can Convention No 87 on Freedom of Association
be mentioned. Beyond the un system there are and Protection of the Rights to Organise (1948)
also a number of international bodies active in and Convention No 98 on the Right to Organise
636
and Collective Bargaining (1949). The Com- level. Indirect restrictions, such as requirements
mittee of Experts and the Freedom of Associa- that more than 50 per cent of the workers in a
tion Committee investigate whether the ILO unit become members, are unacceptable as the
member states apply the ILO norms correctly effect of such a provision is that only one trade
and publish their conclusions in reports. These union can be established in that unit.
reports more fully develop the meaning and sig- Workers and employers must also be free to
nificance of freedom of association. Taking the establish associations and set the associations’
ILO norms as a starting point for analysis of the rules and constitutions without previous authori-
meaning of workers’ and employers’ freedom of sation or approval from any public authority or
association, this chapter concentrates on issues third party. This freedom must be guaranteed
of specific importance required for effective both in law and in fact, however, simple formal
work on occupational safety and health. requirements could be acceptable, e.g., to have a
registered office, registration of the association,
The right of workers and employers to freely deposition of its by-laws to make them public,
join and establish associations of their own and details of its constituent meeting. An even-
choosing tual registration process may not be so long and
According to article 2 in ILO Convention No complicated that it constitutes an obstacle which
87, every worker and employer has the right to in practice prohibits the establishment of a trade
join and establish trade unions and employers’ union.
associations without previous authorisation and If an administrative authority is required to
without distinction in both the public and approve any aspect of an association, the as-
private sector. Without distinction means that sociation must be able to appeal the decision
this right should be guaranteed without dis- to a court which is supposed to eliminate the
crimination of any kind based on occupation, discretionary element involved in the process,
sex, colour, race, beliefs, nationality, political provided the legal ground for the judicial deci-
opinion, etc. This provision deals with the rela- sion is acceptable.
tionship between an individual and the state so Both public authorities and private third par-
consequently the state is forbidden to interfere ties must be prohibited from interfering with the
in this right. freedom of workers to join and establish asso-
The right of workers and employers to estab- ciations; this is particularly relevant to the rela-
lish and join associations of their own choosing tionship between workers and employers. The
includes a freedom from legislative demands protection offered to workers and trade union
that influence which association the worker or officials against acts of anti-union discrimination
employer should join. Trade union monopolies, is an essential part of freedom of association,
imposed by law, are not compatible with free- (outlined in article 1 of Convention No 98) and
dom of association, however, there is nothing must be applied during recruitment and employ-
that prevents voluntary groupings of workers ment, including when work is terminated. All
or unions into a monopoly to strengthen their acts which prejudice a worker because of union
bargaining position. membership or participation in union activities
Workers should also be able to establish new are forbidden. Examples of discriminatory acts
trade unions at all levels including the enterprise are transfer, relocation, demotion, deprivation
637
Chapter 11.1
or restrictions of all kinds (remuneration, social suspension of a trade union officer must be the
benefits, vocational training) and of course, as result of an internal decision of the trade union,
earlier mentioned, dismissal. a vote by members or normal judicial proceed-
Workers’ and employers’ associations must ings.
also be protected against any acts of interference Workers’ and employers’ associations must
by each other or each other’s agents or members be guaranteed the right to organise their activi-
according to article 2 ILO Convention No 98. ties in full freedom and to formulate their pro-
General legal provisions that prohibit acts of grammes in order to defend the occupational
anti union discrimination must be accompanied interests of their members, including the right
by effective and rapid procedures to ensure their of trade unions to hold meetings and for their
application in practice. Such protection may officers to have access to places of work and to
be adapted to national legislation and practice, communicate with management. Associations
provided they prevent or effectively redress anti- must also be free to organise their administra-
union discrimination. tion and activities to ensure financial independ-
ence and protection of their assets and property.
Freedom and autonomy for associations Other rights inlcude the right to certain political
of workers and employers activities, the right to strike and the right to col-
The consultative function of workers’ and em- lective bargaining.
ployers’ associations on occupational safety Legislative provisions which regulate the
and health issues, can only add quality to the internal functioning of organisations are only
decision making process if the associations are acceptable if they simply establish an overall
free to act and express their opinions according framework in which the greatest possible au-
to their members wishes and objectives. The tonomy is left to the organisations. Restrictions
autonomy of associations must be guaranteed. should have the sole objective of protecting the
Freedom of expression is implicit in the in- interests of members and guaranteeing the demo-
dividual right to freedom of association. Any cratic functioning of organisations. It must be
individual WHO chooses to join a trade union possible to appeal decisions on such restrictions
is using their freedom to express an opinion. A to impartial and independent judicial bodies.
trade union also bears that right which must be A dissolution or a suspension of an organisa-
guaranteed if an association is to work meaning- tion by an administrative authority is one of the
fully on occupational safety and health issues. most extreme forms of interference. Accord-
Another important aspect of autonomy is the ingly, article 4 of Convention No 87 states that
right of the members of associations to elect trade unions and employers’ organisations may
their representatives in full freedom. Public au- not be dissolved or suspended by administra-
thorities should refrain from interference which tive authority. It may only be possible for an
might restrict the exercise of this right, e.g., administrative authority to suspend or dissolve
interference in trade union elections or interfer- an association if it is seeking to undermine the
ence on conditions of eligibility or the re-elec- internal or external security of the state, how-
tion or removal of representatives. However, ever, such measures must include guarantees
interference to enhance the democratic element against arbitrary decisions. Associations affected
of the elections can be acceptable. A removal or by such measures must have the right of appeal
638
to an independent and impartial judicial body Convention No 148 on Air Pollution, Noise
competent to examine the substance of the case, and Vibration directs that these associations can
to study the grounds for the administrative designate technically competent persons to give
measure and, where appropriate, to rescind such their opinion on issues such as the hazards of
a measure. exposure or exposure limits. The most recently
adopted Convention, No 184 on Safety and
The right to establish federations and con- Health in Agriculture, 2001, explicitly recognis-
federations es collective agreements as a means for securing
Workers’ and employers’ associations often workers their rights in occupational safety and
join or establish higher level organisations to health matters.
coordinate and strengthen their efforts. Such Two key concepts in these ILO Conventions
associations often have a broad occupational, are ”most representative organisation” and ”con-
inter-occupational or geographical coverage. sultation”.
Article 5 of Convention No 87 gives workers’
and employers’ associations the right to establish The most representative association
and join federations and confederations and for The term “most representative organisation”
these associations to affiliate with international indicates that only some associations of workers
associations without intervention from public and employers have the right to be consulted,
authorities. All these rights also apply to federa- selected on objective, pre-established and pre-
tions and confederations. cise criteria so as to avoid any possibility of bias
or abuse. These criteria should be set by law,
standards in occupational safety not left to the discretion of the government, but
and health the criteria should not become so excessively
A number of ILO Conventions (and their as- difficult that an organisation is unable to meet
sociated recommendations) deal specifically with them. The law must also offer associations the
occupational safety and health, e.g. Convention opportunity to demonstrate how representative
No 155, the Occupational Safety and Health they are and to challenge the position of “most
Convention. These conventions identify two representative”. A commonly accepted criteria,
principal roles for the social partners at the advocated by the ILO Committee of Freedom
national level. Firstly, there must be consulta- of Association, is that the most representative
tion with the most representative associations of associations are those that represent a majority
employers and workers on any measures which of the workers or employers. Other less quantifi-
implement the conventions. Secondly, each able criteria can be accepted if they are sufficiently
member state should formulate, implement and detailed and objectively based, e.g. an organisation
periodically review a coherent national policy on may be deemed to be represented if it is inde-
occupational safety, occupational health and the pendent, experienced and well established.
working environment, in cooperation with the There are no provisions on how many
most representative associations of workers and representatives must be consulted and it may be
employers. reasonable to involve more than one representa-
Representative worker and employer associa- tive from each side on occasions. If there are two
tions also perform other functions. For example, or more associations of employers or workers,
639
Chapter 11.1
they may all be considered to be “most repre- implementation of plans for economic and social
sentative associations”, even if one organisation development.
is larger than the others, based on the principle The term consultation should be distin-
that they represent a significant body of opinion. guished from other related activities such as
When the kind of tripartite consultation that “information sharing”, “co-determination” and
the conventions prescribe takes place, it is of “negotiation”. Negotiation implies initiatives
fundamental importance that the employers’ taken by parties with differing or competing
and workers’ representatives take part on equal interests with a view to reaching an agreement.
terms. This doesn’t refer to a strictly numerical The consultations required under the terms of
equality but to the substantially equal represen- the ILO provisions are intended to assist the
tation of the respective interests of employers, competent authority in taking a decision rather
and of workers so that their views are given than leading to an agreement.
equal weight. Meaningful consultations should be under-
taken in good faith and given serious considera-
The meaning of consultation tion by the competent authority even though
The meaning of the term “consultation” within they are not bound to accept opinions expressed
the ILO context has mainly been developed as a during consultations. Public authorities remain
general concept, not specific to the occupational entirely responsible for the final decision and are
safety and health area, however, these general not required to justify a refusal but it is of course
standards are also applicable to consultation on possible that the consultation procedure may set
occupational safety and health issues. the objective of reaching a consensus between
ILO Recommendation No 113 on Consulta- the various parties while respecting their au-
tion (National and Industrial Level) prescribes tonomy.
that consultations at the national and industrial Consultations must take place before final
level should have the general objective of pro- decisions are taken, irrespective of the nature or
moting mutual understanding and good rela- form of the procedures adopted. Consultation
tions between public authorities and employers’ can mean either submitting the government’s
and workers’ associations, as well as between proposed decision to employers’ and workers’
these associations with a view to develop the representatives or asking those representatives
economy, to improve conditions of work and to help formulate the proposal by communica-
to raise standards of living. Consultation at the tion or discussions within tripartite bodies. The
national level should aim to ensure that the important factor is that the parties are consulted
competent public authorities seek the views, for their opinions before the competent author-
advice and assistance of employers’ and workers’ ity takes its final decision.
associations in an appropriate manner on such The following example illustrates an accept-
matters as the preparation and implementation able method of consultation. When the gov-
of laws and regulations affecting their interests; ernment of the Czech Republic was drafting a
the establishment and functioning of national new law on occupational safety and health, they
bodies responsible for the organisation of indus- reported to the ILO that the trade unions’ and
trial health and safety and the elaboration and employers’ associations had expressed views and
that their proposals were being discussed in a
640
new round of negotiations concerning the draft- of a national policy is the prevention of accidents
ing of the new law. The ILO was satisfied with and injuries at work, by minimising, so far as
this information. reasonably practicable, the causes of hazards in-
If consultations are to be practical and ef- herent in the working environment. Such policy
fective, employers’ and workers’ representa- should take account of some of the main factors
tives must have all the necessary information which affect occupational safety and health and
and sufficient time to formulate their opinions. the working environment. These factors include:
Communication after the final decision has been a. the design, testing, choice, substitution, instal-
made does not meet the obligation to ensure lation, arrangement, use and maintenance of
effective consultations. In many of the relevant the material elements of work. The material
provisions the term “in consultation” is used elements include workplaces, working envi-
instead of the term “after consultation”. This ronment, tools, machinery and equipment,
wording indicates that there may be several chemical, physical and biological substances
levels of consultation at various stages in the and agents, work processes;
procedure established to give effect to the provi- b. the relationship between the material ele-
sions of the Conventions and that the associa- ments of work and the persons WHO carry
tions should be actively involved in the processes out or supervise the work; the adaptation of
of decision making and implementation. machinery, equipment, working time, or-
Governments should endeavour to secure an ganisation of work and work processes to the
agreement of all the associations concerned in physical and mental capacities of the workers;
establishing the consultative procedures but if c. the training, including additional training
this is not possible a government may decide as a when necessary, qualifications and motivation
last resort. of the people involved in the achievement of
adequate levels of safety and health;
The content of national policies d. the communication and co-operation at all
As mentioned earlier, the ILO Conventions on levels of an enterprise, including at the
occupational safety and health require consulta- national level;
tions to take place when states formulate, imple- e. the protection of workers and their repre-
ment and periodically review national policy on sentatives from disciplinary measures result-
occupational safety, occupational health and the ing from actions properly taken by them in
working environment which includes activities conformity with the policy.
such as occupational health services or safety and
health in mines or agriculture. The connected National OSH policy should also indicate the
recommendation prescribes close co-operation respective functions and responsibilities of
between public authorities and representative public authorities, employers, workers and oth-
employers’ and workers’ associations when na- ers, taking account of both the complementary
tional policy on occupational safety and health is character of such responsibilities and national
formulated and applied. conditions and practice.
National policies on occupational safety and The social partners should also be consulted
health in the ILO context refer to both general on the implementation of national OSH policy,
and specific matters, e.g. air pollution. The aim through laws, regulations or any other method
641
Chapter 11.1
consistent with national conditions and prac- legal character. The section on employment and
tice necessary to progressively implement and industrial relations is based on the eight core
monitor such policy. Recommendation No 164 ILO conventions and the ILO Tripartite Dec-
stresses the importance of close co-operation laration of Principles concerning Multinational
between public authorities and representative Enterprises and Social Policy of 1977, which
employers’ and workers’ associations for both means that it includes all core labour stand-
the formulation and application of the national ards, but also that its scope goes beyond that.
policy, beyond what is required by the consulta- Thus, multinationals must respect the freedom
tion provisions in Convention No 155. of association, recognise the right to bargain
collectively, prohibit all kinds of forced labour
the oecd guidelines for multi (including child labour) and abolish all kinds of
national enterprises discrimination in employment. The Guidelines
The ”Guidelines for Multinational Enterprises” also cover information and consultation of em-
(the Guidelines) adopted by the Organisation ployees, training and health and safety at the
for Economic Co-operation and Development workplace. For example, enterprises are en-
(OECD) also give trade unions and employers’ couraged to raise the level of performance with
organisations an important role in the endeav- respect to occupational health and safety in all
our to secure a safe and healthy work environ- parts of their operation, even where this may not
ment. The Guidelines, first issued in 1976 and be formally required by existing regulations in
regularly updated since then, are non-binding countries where they operate.
standards and principles of responsible business Observance of the Guidelines by enterprises
conduct addressed by the governments to mul- is voluntary and not legally enforceable. How-
tinational enterprises with a seat in any of the ever, there is a mechanism for exerting pressure
thirty OECD countries. In addition, by Janu- on companies that do not respect them, as the
ary 2006 the governments of nine non-member governments of the adhering countries have a
states – Argentina, Brazil, Chile, Estonia, Israel, responsibility to promote the Guidelines and en-
Latvia, Lithuania, Romania and Slovenia – have courage their use. This is done through a system
voluntarily of National Contact Points that handle enquiries
acceded to the guidelines. Since the year 2000, and resolve issues relating to the implementa-
the Guidelines also apply when multinational tion of the Guidelines. In most countries the
companies of all these countries invest in states Contact Point is a government office, in others
that are not members of the OECD, i.e. in most it is a tripartite body where the government,
developing countries. trade unions and employers’ organisations are
The Guidelines cover a broad range of issues, represented. There are even a couple of quad-
such as human rights, disclosure of information, ripartite national contact points, where other
employment and industrial relations, environ- non-governmental organisations are represented
ment, anti-corruption measures, consumer in addition to the organisations for workers and
protection, science and technology, competition employers.
and taxation. They are not a substitute for Unlike the ILO system, the Guidelines allow
national law and regulation, but supplementary trade unions and employers’ organisations at
principles and standards of behaviour of a non- national level in one country to help workers in
642
another country when their employer circum- According to the Malaysian legislation regulat-
vents ILO core labour standards. For example, if ing trade unions’ activities, workers in the elec-
a Swedish company operating an enterprise in a tronics industry could not decide by themselves
developing country does not respect the Guide- to which union they might belong. The Swedish
lines, the trade union in that country can call the trade unions contacted the central management
attention of a National Contact Point. If that in Sweden and pointed to the first paragraph of
country itself has not adhered to the Guidelines, section IV of the OECD Guidelines for Multi-
the natural thing to do will be to turn to the national Enterprises, which states:
Swedish Contact Point, which will investigate
“Enterprises should, within the framework
the matter. If it finds the complaint well found-
of applicable law, regulations and prevailing
ed, it will contact the Swedish company manage-
labour relations and employer practices:
ment and ask it to instruct the local management
to respect the Guidelines. If this does not have 1. a) Respect the right of their employees
the desired effect, the Swedish Government will to be represented by trade unions and other
intervene. bona fide representatives of employees, and
The effectiveness of the complaint procedure engage in constructive negotiations, either
is highly dependent on the individual govern- individually or through employers’ associa-
ment’s commitment, and there has been criticism tions, with such representatives with a view
that National Contact Points are too passive to reaching agreements on employment
and that the procedures take too long. However, conditions;”
there are cases where it has been effective as
It had been perfectly in conformity with Ma-
multinationals fear the loss of goodwill caused
laysian law to do as the local management had
by negative publicity more than the threat of
planned. However, on several occasions since
legal action.
1977, the Malaysian legislation had been subject
There are also cases where trade unions have
to criticism by the ILO Committee on Freedom
contacted the company management directly
of Association. Consequently, the Swedish trade
and managed to influence it simply by referring
unions were able to convince the company to
to the Guidelines, without having to bring the
refrain from its plans.
matter before a National Contact Point. One
example happened in the year 2000, when the
case study – latvia
Swedish Metal Workers’ Union and the Swed-
ish Union of White-collar Workers in Industry In Latvia the laws and systems for occupational
received a call for assistance from the Electrical safety and health have undergone major changes
Industry Workers’ Union (eiwu) in Malaysia. since the country seceded from the Soviet
eiwu organised workers in a factory, owned by Union. While the former laws looked good on
a Swedish multinational company, where eiwu paper, in reality employees were poorly protect-
had collective agreements for its members. The ed. A new system to protect workers safety and
local management wanted to have the company health has gradually evolved, largely motivated
classified as belonging to the electronics indus- by ambitions to reach EU standards and mem-
try, which would have the effect of depriving the bership. In 1995 Latvia signed the Association
workers the right to be represented by eiwu. Agreement of Latvia and the European Union
643
Chapter 11.1
on the approximation of legislation and in 16 The main task of ntcc and TCSLA is to
April 2003 a Treaty of Accession was concluded. ensure and facilitate cooperation between the
Latvia joined the European Union on 1 May government, employers’ associations and trade
2004. During this process, the importance of unions at national level with the aim of securing
involving the social partners in the new co-ordinated solutions to social and economic
structure was emphasised. The Ministry of development problems through the elaboration
Welfare develops national policies on occupa- and implementation of strategies, programmes
tional safety and health and is responsible for and legislation. A further aim is to increase the
the implementation and elaboration of national joint responsibility of social partners for deci-
legislation on labour protection, including sions and their implementation.
compliance with the relevant international For example, ntcc comments on the im-
instruments. plementation of the ILO Conventions ratified
The ministry co-operates closely with both by Latvia and proposes legal improvements in
the Latvian Employers’ Confederation (lec) accordance with the requirements of ILO Con-
and the Latvian Free Trade Union Confedera- ventions and Recommendations.
tion (lftuc). When new legislation on labour According to a working group led by the
protection is being drafted, representatives of Latvian Department of Labour and the Ministry
the social partners are involved from the initial of Welfare, the tripartite system still faces some
stages providing them with an opportunity to general problems. For example, the social part-
voice their opinions from the very beginning of ners frequently attend TCSLA meetings without
the process. There is also close co-operation on prior coordination of the various opinions of
the exchange of information on occupational their respective associations making it necessary
safety and health issues. to postpone discussions, making TCSLA meet-
Two bodies have been established in order to ings fruitless. TCSLA is currently not com-
promote cooperation between the government petent to solve such problems of information
and the social partners in the field of occupational exchange.
safety and health. The National Tripartite Improvements in the information exchange
Co-operation Council (ntcc) was established between the administrative staff of TCSLA and
to encourage co-operation between public insti- their members are needed and the social part-
tutions and associations of employers and em- ners should establish internal procedures for
ployees, and a subordinate body, the Sub-Coun- coordination of issues prior to meetings, so that
cil for Labour Affairs (TCSLA) was later es- they can voice and defend an already agreed and
tablished to increase and make this cooperation representative opinion.
more efficient. The Sub-Council is comprised of Although the tripartite dialogue between the
representatives of the Ministry of Welfare, representatives of government, employers (lec)
Ministry of Justice, State Labour Inspectorate, and employees (lftuc) is quite successful,
Latvian Free Trade Union Confederation and there are some problems according to the work-
Latvian Employers’ Confederation. Both bodies ing group. One concern is the capacity of the
have equal representation from the three groups lec and the lftuc to truly represent Latvian
of participants. employers and employees. The lec only rep-
resents one third of the enterprises in Latvia,
644
mainly large enterprises. Only 20 per cent of the Cooperation Agency (sida) to grant money for
workers are trade union members and lftuc a project aimed at supporting the Zimbabwean
does not have trade unions organised in several agricultural workers in their efforts to control
important high-risk industries leaving many hazardous chemicals.
workers outside the tripartite social dialogue. Over time, trade unions representing agricul-
To make the tripartite dialogue more effective tural workers in other African countries wanted
it is suggested that activities in order to attract to take part in the project. The international
new members should be promoted. The pos- trade union federation International Union of
sibility of involving institutions representing the Food, Agricultural, Hotel, Restaurant, Cater-
interests of small and medium sized enterprises ing, Tobacco and Allied Workers’ Associations
in the social dialogue should be considered and (iuf) also became involved and in 1997 slf
the lftuc needs to establish trade unions in and iuf started the Global Pesticides Project
several important high-risk industries. with Ghana, Tanzania, Uganda and Zimbabwe
as pilot countries. The project had a number of
case study – tanzania objectives. The training of farm workers on the
This example from Tanzania illustrates that prevention of hazards from pesticides was a pri-
tripartite consultations on occupational safety mary objective. Simultaneously, the agricultural
and health do not necessarily have to be initiated workers’ trade unions in each of the four coun-
by the public administration but can result from tries would try to find channels of communica-
international collaboration. In the case of Tanza- tion with their governments, as, according to the
nia, cooperation between trade unions in Sweden “Agenda 21” adopted at the United
and Africa resulted in consultations at national Nations Conference on Environment and
level between trade unions, employers and Development in 1992, states are encouraged to
government representatives. adopt national “profiles”, i.e. action programmes
The story began nearly twenty years ago on chemical safety: states may be entitled to a
when a delegation from the Swedish Agricultural subsidy from the un, provided that all stake-
Workers’ Union (slf), went on a study trip to holders participate in the formulation of pro-
Zimbabwe. The Swedish delegation became gramme plans. It was envisaged that when the
aware of the serious problems that their Afri- farm workers had been trained they would be
can colleagues faced from the use of hazardous able to contribute to this process. A further aim
chemicals, especially pesticides, at work. Work of the project was to exert pressure at the Afri-
environment issues were not really on the agen- can regional and international level, for example
da of the Zimbabwean trade union, (which was in the ILO, to enforce a ban on the most hazard-
primarily dealing with wages and other terms ous pesticides and measures for the safe use of
and conditions), and workers had little knowl- others.
edge of how to deal with the health and safety Ghana, Tanzania, Uganda and Zimbabwe
problems of chemicals. The Swedes went home were chosen as pilot countries for the project
and convinced their own trade union to start because the trade unions there already had a
a campaign against hazardous pesticides both cadre of trade union representatives WHO were
in Sweden and internationally. They also con- trained to lead study circles (small groups of
vinced the Swedish International Development workers WHO meet to discuss subjects such as
645
Chapter 11.1
work environment issues). These study circle responsibilities of each of the three groups. This
leaders travelled around and taught agricultural in turn has led to the Tanzanian Agricultural
workers on farms all over the country about the Workers’ Union reaching collective agreements
general legislation on occupational safety and with some of the largest employers, including
health in and more specifically about the hazards some of the cut flower farms that have a bad
of pesticides and how to prevent them. reputation as regards pesticides, on the use of
In the beginning, Sida paid the costs for pesticides. According to these agreements, cer-
farm workers in Tanzania to attend study cir- tain pesticides should not be used at all. Another
cles. However, employers gradually realised result is the more widespread provision and use
that there could be benefits for them as well. of protective equipment even though it is rela-
The first sign was that some employers let their tively expensive. Health and safety committees
workers participate without deducting the time have been established in workplaces where such
from their workers wages and this was followed committees did not exist.
by some employers sending their own repre- Importantly, the Tanzanian government
sentatives to the same training as their workers, now sees the Agricultural Workers’ Union as a
paying for everyone. The successful culmination knowledgeable partner in the elaboration of the
was a tripartite meeting in Arusha, (organised national profile on chemicals, illustrated by the
by the Global Pesticides Project) where employ- fact that when a new Minister for Environment
ers, government representatives and trade union was appointed, he asked the Agricultural
representatives were trained together for a week Workers’ Union to brief him on the pesticides
and agreed on a joint action plan defining the issue.
646
ILO Conventions and recommendations
Generally:
ILO Constitution, Declaration of Philadelphia. c 167 Safety and Health in Construction Conven-
www.ILO.org tion, 1988. www.ILO.org
c 176 Safety and Health in Mines Convention,
Freedom of association: 1995. www.ILO.org
c 87 Freedom of Association and Protection of the c 184 Safety and Health in Agriculture Conven-
Rights to Organise Convention, 1948. www.ILO. tion, 2001. www.ILO.org
org r 156 Working Environment (Air pollution, Noice
c 98 Right to Organise and Collective Bargaining and Vibration) Recommendation, 1977. www.
Convention, 1949. www.ILO.org ILO.org
c 135 Workers’ Representatives Convention, 1971. r 164 Occupational Safety and Health Recommen-
www.ILO.org dation, 1981. www.ILO.org
r 113 Consultation (Industrial and National Lev- r 175 Safety and Health in Construction Recom-
els) Recommendation, 1960. www.ILO.org mendation, 1988. www.ILO.org
Occupational Health and Safety: r 183 Safety and Health in Mines Recommenda-
c 119 Guarding of Machinery Convention, 1963. tion, 1995. www.ILO.org
www.ILO.org r 192 Safety and Health in Agriculture Recom-
c 148 Working Environment (Air pollution, Noice mendation, 2001. www.ILO.org
and Vibration) Convention, 1977. www.ILO.org OECD guidelines for multinational enterprises:
c 155 Occupational Safety and Health Convention, http://www.OECD.org/topic/0,2686,en
1981. www.ILO.org UN’s Agenda 21:
c 161 Occupational Health Services Convention, http://www.un.org/esa/sustdev/documents/agen-
1985. www.ILO.org da21/
SUGGESTIONS FOR FURTHER READING

Benjamin O. Alli, Fundamental Principles of Occu
pational Health and Safety, International Labour
Office, Geneva, 2001.
647
11.2
Education and training

Kaj Elgstrand
This chapter deals with education and training ties, ending with the acquisition of particular
in occupational safety and health (OSH). The knowledge and skills for a profession.
basic terms will be defined. The need for educa- After education comes training. Training is
tion and training in OSH will be discussed for practical education, learning to do, usually un-
different target groups. The conditions, prob- der supervision within a profession. Vocational
lems and possibilities related to OSH training training aims at learning a trade or an art. Post-
in the basic schooling system as well as for OSH graduate training, like specialist training courses
experts and other professionals will be high- or doctoral studies (= research training), may be
lighted. Comments will be made on training as a carried out at universities or at other kinds of
part of international development cooperation. institutions. Further training is often organised
Methodological aspects will be discussed: selec- within enterprises, by employers’ and workers’
tion of contents, defining of objectives, methods organisations or at special training institutes.
of instruction, presentation techniques, written The terms “education” and “training” are
training materials, attractive teaching. Com- sometimes used as synonyms. They both aim at
ments will be made concerning evaluation of learning through the acquisition of knowledge,
training. skills and/or attitudes. Applying the above defi-
nitions, the focus of education is on knowledge
terms while training focuses on skills.
Education is the term used for the act or process Attitude is a person’s manner and tendency of
of imparting or acquiring general knowledge, thinking or feeling about a certain issue. Their
developing powers of reasoning and judgment, way of thinking and/or feeling about things. At-
and generally preparing oneself or others intel- titude is closely related to value.
lectually for mature life. In other words, educa- Learning could be defined as the acquisition of
tion is concerned with the development of the knowledge, skills and/or attitudes by systematic
abilities of the mind, learning to know. It is study or by trial and error. This chapter is con-
generally used to characterise what goes on in cerned with learning by individuals, individual
primary and secondary schools, and at universi- learning. In an earlier chapter, 8.3, organisation-
al learning has also been discussed.
649
Chapter 11.2
Information applies to facts told, read, or other- this analysis is not a simple, clinical procedure. It
wise communicated. Information may be more is a procedure requiring negotiations and many
or less organised or unorganised, systematic or compromises. There is no country, industrial or
unsystematic, important or unimportant, useful developing, where you can afford to provide all
or useless. An information process is generally important target groups with the OSH training
one-sided: the information goes from the sender needed to prevent risks for occupational ac-
to the receiver. A training activity, on the other cidents and diseases among major parts of the
hand, is more complex and built on two-sided working population. This is true in the short
communication, often including evaluation, terms, let us say 1-2 years, but also in the longer
criticism and questioning of theories and empiri- term. The resources available for this kind of
cal material. training activities are always limited in relation
Defining learning may be one thing, describ- to the needs. Competent teachers represent one
ing what learning really is may be quite another such limited resource in all countries. So priori-
thing. How does this acquisition of knowledge, ties have to be set, among many other reasons
skills and attitudes happen? Why does learning because the need for OSH training is only one
occur in one case but not in another? Giving of very many needs confronting industrial and
scientifically based answers to these questions developing countries and competing for re-
is possible but tricky. For the purposes of this sources.
chapter it is suggested that learning requires ex- Even so, let us try to reach some kind of
posure to information. This information can be agreement on the basic OSH training needs of
intentional or unintentional. Learning not only some key target groups. For the present we will
requires exposure to information, learning also confine ourselves to a quantitative aspect of this
requires an activity by the individual exposed. basic need. (We will be returning to the qualita-
For the acquisition of knowledge, learning re- tive aspects of this need later on). How many
quires reflection and questioning, for the acqui- lesson hours in basic OSH do different target
sition of skills it also requires practice. groups need? An answer to this question, based
on experience collected from many different
basic need for osh training countries, is drafted in Figure 11.2.1.
The analysis of needs for OSH training should The needs indicated in the above table, can-
be one of the initial parts of any preparation of not be met once for all. The continuous devel-
OSH training activities. Such needs should be opment of new technology and new forms of
related to the target group in question, accord- production and work, related to computerisation
ing to its basic knowledge and professional tasks. for instance, puts new demands on different pro-
Needs analysis sounds almost like a clinical fessional groups. These new demands include
procedure; you apply your formula and you get demands for new knowledge of OSH issues and
the answers: current and future needs for knowl- ability to cooperate with new groups of employ-
edge and skills minus already existing knowledge ees.
and skills = training needs. In practice, however,
650
Number of lesson hours

–20 21-50 51–100 101–150 151–
Pupils
Primary and secondary schools x
Vocational training x x
Technical schools and institutes x
Students
Students in engineering x x
Medical students x
Teacher students x x
Students of economy x x
Doctoral students x x
OSH specialists
Personnel in occupational health services x
Labour inspectors x
Specialists in occupational medicine x
Safety experts x
Further training of professionals

Workers x x
Work supervisors, foremen x
Safety delegates x x
Production engineers x x
Product designers x x
Production managers x x
Figure 11.2.1. The need for basic education on occupational safety and health, expressed as number of les-
son hours. Source: Lundgren 1971, modified by Lundgren and Elgstrand 1979, and by Elgstrand 1987
and 2009.
the schooling system related to health and safety at work, the pupils
OSH issues are of importance to all kinds of being producers as well as consumers of our
employees. Appropriate attitudes and knowledge future work environment. Given the powerful
in these issues should therefore be developed influence of example, the work environment of
by pupils already before entering working life. the school itself has an important bearing on its
Primary and secondary schools have the task of lay- prospects of promoting knowledge of and ap-
ing the foundation of the attitudes and thinking propriate attitudes towards OSH issues among
651
Chapter 11.2
the pupils. If the school and the teachers say one and working life. The same difficulties, and
thing but act in another way, the pupils tend to many more, have to be overcome in developing
let actions speak louder than words. countries. In many poor countries, pupils stay
What knowledge and attitudes concerning only a few years at school, many children never
OSH should the pupils have acquired before get to school. Governments and municipalities
entering working life? The school environment have little resources and therefore can offer only
not being the same thing as the environment in very tiny salaries for the teachers. The teachers
working life, we cannot expect that the newly may have to go for a long time before getting
hired, coming from school, to have any detailed paid at all. Such conditions do not support the
technical knowledge about what the work envi- training and recruitment of competent teachers,
ronment and OSH are and should be. Knowl- and teachers can hardly be expected to engage in
edge of this kind requires familiarity with the anything but the most essential, like teaching the
nature of work and has to be attained in prac- pupils to read and write.
tice, in the process of learning one’s duties and Can nothing be done, then, to implement
profession. What is essential is for the pupils to information about OSH in primary and second-
understand that work tasks can be performed in ary schools in developing countries? Of course
different ways, that some ways are “safer” than things can be done. National initiatives may
others, and why the safer ones should be used. not be feasible in the first step, local initiatives
To understand this, one needs to know how may. School teachers with experience from work
work satisfaction, safety and health at short and in industry, or otherwise having good contacts
long term relate to production, work organisa- with industry, may include OSH information
tion, costs and work efficiency. A pupil who is in the curricula. If, in a certain area, there are
well prepared for working life knows, intuitively enterprises recruiting workers, they may also be
and without any doubt, that he or she is respon- interested and able to assist the schooling system
sible for himself or herself. They also know that in providing basic information about work and
their actions are of importance for their fellow about OSH to the pupils. Factory inspectors
workers’ health, safety and work satisfaction. with children in school may be willing to lecture
The above argument and aims may seem about work in industry and how to prevent risks
reasonable. Are they feasible? No, not really, or of occupational accidents and diseases. Parents’
at least not without great effort. Even in indus- work may be interesting subjects for teaching
trial countries, there are great difficulties to be and practical visits, and can also provide oppor-
overcome. One is that the schooling system in tunities for highlighting OSH issues.
most countries is a very conservative structure, In developing countries where there are sec-
not open to changes. Another is that the school- ondary technical schools, conditions favour the
ing system has difficulty combining the general inclusion of information on OSH issues. The
contents related to development of the abili- education in these schools is oriented towards
ties of the mind with contents adjusted to the technical professions, and therefore offers many
changing needs of practical life. A third difficulty opportunities to link up with OSH. Such links
is found when scrutinising the competence of may for example describe the positive relations
the teachers. The teachers are not prepared for between on the one hand production and pro-
promoting knowledge and attitudes about OSH ductivity, and on the other hand nutrition (es-
652
pecially in heavy manual work), work load and it resembles the application of knowledge which
work postures, adequate design of tools, ma- is sought for in practice. If, for example, you
chines and workplaces, hygienic factors (such as want to establish a safety adapted to production,
noise, heat stress, chemical factors). The teach- the OSH issues clearly have to be integrated
ing should give information about the relation with production. In vocational training directly
between occupational health risks and fatigue. oriented to a profession, there may be practical
At universities and colleges, the conditions for parts of the education and thereby opportuni-
including OSH are more favourable than in ties for integrating OSH issues in the teaching
primary and secondary schools. The universities of different subjects. In theoretical education
are often more willing and able to include new at high level, for instance at a technical faculty
subjects than primary and secondary schools or college, such an integrated teaching of OSH
are. The education given at universities is also issues is difficult to organise. In order to include
oriented towards professional careers, like engi- OSH in the teaching at the traditional institu-
neering and medicine, where the links to OSH tions, it may therefore be necessary to establish
are readily apparent. a special subject or course on OSH issues. This
Education for technical professions is of may also be needed to get the necessary teacher
special interest, as technicians and engineers resources. The integration of the OSH teaching
often have a direct influence on their own and with other teaching then has to be organised in
other employees’ work and work environment. other ways, for instance as individual projects or
Production engineers, machine constructors, in- through other types of practical assignments.
dustrial designers and others cooperate not only
in the creation of production systems, machines training of osh specialists
and products but also in the creation of other OSH specialists are those who work part time or
peoples’ work and work environments, including fulltime with OSH issues in enterprises or or-
risks of occupational accidents and diseases. ganisations, and who have taken part in specialist
Also medical schools are of special interest in training focussing on OSH issues. In develop-
this context. Physicians, nurses and other medi- ing countries they are generally far fewer OSH
cal professionals encounter the results of badly specialists than needed. The existing specialists
designed and organised industrial work, e.g. therefore have a multitude of tasks. In addition
injuries and occupational diseases. Their basic to their ordinary work as researcher, factory
education should allow them to look for the inspector or specialist in occupational health
causal links between work, injuries and diseases. services, they are consulted by organisations and
When making a diagnosis, they should always government, act as teachers at universities and
ask questions and include information about the enterprises, and much more besides.
patient’s work and profession. Training of specialists may be organised as
When organising OSH education, within a part of the basic professional education, or as a
faculty of engineering or medicine, there are two postgraduate training after basic education and
alternatives. One is to integrate the OSH issues after some professional experience. The lat-
with the teaching of various subjects, the other ter model has proved successful when it comes
is to establish OSH as a teaching subject in its to OSH specialist training, as specialisation in
own right. The integrated variety is attractive as OSH issues requires the trainee to have had pre-
653
Chapter 11.2
vious, direct and thorough experience of what enists etc. Joint training of this kind can also be
work and working life is and demands. If the considered to be good for collaboration between
trainees have little or no experience from work- these specialists, after completing their specialist
ing life, but there are possibilities of spreading training.
out the theoretical training over a longer pe- The idea of joint specialist training courses
riod and also including practical training in the requires two important conditions to be taken
course, such a course may be very successful. into consideration. One is that the trainees have
The confrontation between and integration of different educational backgrounds. An engineer
theories and practice may even be more fruitful has a very different basic education compared to
if it can also be arranged so that the trainees are a physician. The physician’s educational back-
allowed to make a case study, special assignment, ground in turn is quite different from that of the
etc., which will be carried out during their prac- nurse.This means that their needs and capaci-
tical training and presented and discussed during ties for learning new things differ considerably.
a final, theoretical training period. Another condition that has to be considered
A country may need many different special- when planning joint specialist training courses,
ists in OSH issues: specialists in occupational is that these specialists, when trained, have dif-
health services (occupational health physicians, ferent work tasks. This is another reason why
occupational health nurses, occupational health their needs for specialist training differ. Instead
physiotherapists, and others), occupational of joint or separate specialist training courses, it
hygienists, ventilation experts, safety engineers, might be worthwhile to explore the possibilities
ergonomists, noise experts, and others. But to of organising specialist training courses which
need is one thing, to be able to afford is often are partly the same for different trainees and
another. In Figure 11.2.1 it is suggested that to partly separate.
become an OSH specialist one should have a Cooperation between different OSH special-
special training including more than 150 lesson ists is certainly important. More important and
hours. 150 lesson hours correspond to 3-5 weeks more difficult to achieve, however, is coopera-
full-time study. This must be considered to be tion between OSH experts and the personnel in
very little for a specialist training course, even enterprises who have the real power to change
if it comes on top of a good basic education in production, work and OSH risks: the managers,
engineering, medicine or another relevant basic engineers, supervisors – “the production peo-
discipline, and thorough experience of working ple”. This calls for the OSH specialist training
life. Even so, the organisation of such a specialist courses to include different meetings and inter-
training course goes beyond the resources avail- changes between the trainees and the production
able in many poor developing countries. people. The applied exercise described in Figure
Considering the lack of resources in develop- 11.2.2 gives one example of such a meeting dur-
ing countries, it may be tempting to advocate ing a OSH specialist training course, between
joint specialist training for different OSH spe- the trainees and production people.
cialists, like occupational health physicians, oc-
cupational health nurses, safety engineers, hygi-
654
Topic OSH evaluation of work operations, workplaces or work processes.
Objectives After active participation in the exercise, the trainee will be able to make a pre-
liminary analysis of OSH problems at a workplace (or for a work process). He
or she will be stimulated to further studies.
Participants Students of technology, forestry, agriculture or other fields. Managers, produc-

tion engineers, work supervisors, workers.
Duration of At least one day, if possible one and a half day or two days.
the exercise
Pre-requisites The exercise should occur in the middle or at the end of a course, after study-
ing the basic issues of OSH and the principles of the methods and techniques
to be applied.
The exercise has to be carefully planned by the responsible teachers, by of-
ficials at the work place and also by the students. The responsible teacher has
to make at least one visit on beforehand at the workplace to be studied.
During the exercise, the students should have access to necessary checklists,
handbooks, simple tools for measurements and material for presentation of the
findings (big sheets of paper, overhead projection materials, et cetera).
For more complicated measurements, the teachers should provide the exper-
tise. If available, photographic or video-presentation of work operations may
be a useful part of the preparation of the exercise and at the final discussion.
Plan of the a) 1
-2 hours of information and discussion about factors as organisation, econ-
exercise omy, production prospects, work force situation, etc., should be carried out
in the actual area of work, industry, plant or production process.
b) 3-5 hours of observation, measurements and interviews at the workplace. The

students should be working in groups of 2-5 persons. The teacher assists.
c) 2
-4 hours of analysis of the observations and planning the coming presenta-
tion of the analysis (drawing sketches of the workplace, preparing overhead
projection, et cetera). This should be done separately in each group of stu-
dents, eventually assisted by the teacher.
d) 2-4 hours of presentation of the analysis, including proposals for change

and action, and concluding discussions. The presentations are made in front
of all students, the teachers and representatives of the workers and plant in
question (production manager, production engineer, head of maintenance
department, or others). In the concluding discussion the students should
get feedback from the representatives of the plant about the quality of their
observations and whether their proposals are feasible or not.
Figure 11.2.2. An example of an applied exercise.

655
Chapter 11.2
In many African countries factory inspectors of the specialist training abroad not meeting the
represent a well-qualified core of OSH special- real needs of the trainee’s home country.
ists. To a great extent this can be ascribed to The training of specialists requires competent
systematic efforts over a long period of time, institutions and individuals for the establishment
including specialist training, by ILO and the and running of the training programmes. Small
corresponding governments. The Finnish In- and poor countries do not have the resources
stitute of Occupational Health and other Finn- needed. An attempt might therefore be made
ish institutions and sponsors have also played to organise such training for a region, where
important roles. In some countries the factory the different countries and their institutions can
inspectors represent the only corps of qualified contribute with their resources.
OSH specialists. It is an important task for the
governments, international organisations and training of managers and workers
development cooperation agencies to see to that Knowledge about work hazards and ways and
these factory inspectorates do not gradually lose means to counteract them is essential for man-
their resources. On the contrary, they should be agement, supervisors and workers. Poor condi-
enabled to employ new inspectors and also up- tions of work and the working environment may
date their knowledge and skills through further even, to a large extent, be ascribed to lack of
training in OSH issues. such knowledge.
Specialist training in OSH requires national Managers have to attend to many different
planning. The needs for such specialists have demands and their time is always scarce. Pro-
to be analysed, considering both qualitative duction issues have to be dealt with, primary
and quantitative factors. Which specialists are materials have to be supplied, customers’ com-
needed? How much training do they need? How plaints have to be confronted, the financing of
many specialists are needed? Do we have the the enterprise may cause trouble, personnel
resources needed to organise and carry out such need to be recruited and trained, officials of the
specialist training? Which priorities have to be municipality have required the waste from the
agreed upon? enterprise to be better taken care of, authorities
Small and poor developing countries do not have complaints about taxes being paid too late,
have the resources needed to organise OSH competing enterprises have developed cheaper
specialist training courses. They have to look for and better products, a marketing campaign tends
other solutions. Traditionally, those solutions to be too costly, etc. So it is quite natural that
have been to go abroad and get the necessary managers and employers cannot always pay due
OSH specialisation, for instance in England, consideration to issues of occupational safety
France or the USA. Apart from being possible and health, especially if they do not see a posi-
only for very few, this solution entails the risk of tive link between production and occupational
some of the trained specialists staying on in the safety and health.
country where they gained their specialist quali- In 2001 the ILO published guidelines which
fication. (It is a risk seen from the point of view may help to stimulate managers’ interest in
of the national needs. From the personal point OSH issues, integrated with dynamic manage-
of view, the trainee may rather consider it as a ment strategies, “Guidelines on occupational
chance). There may even be the risk, of course, safety and health management systems”. The
656
guidelines have been shaped by internationally Trade union representatives in enterprises, like
agreed occupational safety and health principles. safety delegates and shop-stewards, need special
They provide an instrument for the develop- training on OSH issues. According to Figure
ment of a sustainable safety culture and outline 11.2.1, their basic need for OSH training cor-
the OSH management system in the organisa- responds to 50-100 lesson hours. Besides their
tion: policy, worker participation, organisation, need for basic knowledge about work hazards
responsibility and accountability, competence and ways and means for counteracting them,
and training, etc. The guidelines may serve as a they need to be able to communicate effectively
checklist for managers’ OSH information and with their fellow workers, supervisors and man-
training needs. agers. Trade Union Confederations may have
Every worker should be familiar with the special employees working fulltime with OSH
main hazards of his job and how these are con- issues. They need broader OSH training and
trolled. From the beginning - starting a new more of it than safety delegates, as they have to
job or shifting to new work tasks - the worker work with many different enterprises and work
should be taught that the right way to do a job is environments.
the safe way, and to practise occupational safety Even if the OSH training of workers and
and health at all times. The creation of aware- trade union representatives generally is the
ness of and commitment to safety and health concern of the enterprise or the trade union,
among workers should therefore be an impor- joint initiatives may be needed in order to sup-
tant goal in training activities of enterprises. It port such training. Joint initiatives may be taken
should, however, be preceded and supported by nationally or by business sector (the building
equal awareness and commitment among policy- industry in a country, for example). Common
makers, managers and specialists in order not goals and procedures may need to be agreed
to end in poorly met expectations. Expectations upon. Development of written training materials
which are not met create disappointment and may benefit from joint financing and/or actions.
disillusion.
The training of employees is generally the training within international
concern of the enterprises where these em- development cooperation
ployees work. The possibilities of carrying out Since the 1980s, training and information have
such training are obviously far greater in a big been dominant activities in international devel-
enterprise having hundreds or thousands of opment cooperation within the OSH field. The
employees than in small undertakings with just ILO and WHO have provided many fellowships
a few employees. The big enterprise may have and sponsored many courses in OSH issues for
a special training department, OSH specialists trainees from developing countries. ICOH,
who can organise and carry out the training ac- the International Commission of Occupational
tivities, and supervisors and managers may have Health, has also been active in organising OSH
knowledge about OSH issues. A small enterprise training courses.
may have greater risks of occupational accidents In the beginning of the 1990s there was a shift
and diseases than a big enterprise, but might from national and bilateral training activities
be unaware of them, and have no resources for to regional projects. The ILO carried out two
preventing them. big OSH projects for 20 countries in the Asian-
657
Chapter 11.2
Pacific Region and for 21 countries in Africa. not ends in themselves but tools for the achieve-
These projects were mainly sponsored by the ment of the programme objectives. The two
Finnish Ministry of Foreign Affairs. Within the programmes started in 2003 and 2004, and were
African project more than 100 regional, national originally planned to continue for twelve years
and local workshops, seminars, and courses were each. Due to changes in Swedish development
organised, besides many other activities. The cooperation policy, the Swedish financing of the
Asian project was design to strengthen occupa- programmes will end in 2009. New sponsors are
tional safety and health infrastructure in partici- therefore being contacted in order for the pro-
pating countries, mainly through dissemination grammes to continue.
and sharing of information, and educational and Alternating theoretical and practical train-
training activities. Related to these two projects ing periods are advocated in this chapter. Since
and an East African regional project, the Finn- the end of the 1980s this has been successfully
ish Institute of Occupational Health together applied in two different international training
with the ILO published the African Newsletter on programs for OSH specialists in developing
Occupational Health and Safety and the Asian-Pa- countries. The training programmes have been
cific Newsletter on Occupational Health and Safety, organised by the Swedish National Institute for
four times per year. The publication of these two Working Life (NIWL) in collaboration with
newsletters is still ongoing, providing valuable other Swedish institutions, and financed by the
information useful also for training activities. Swedish International Development Coopera-
The regional component is being addressed tion Agency (Sida). One is a long-term partner-
in two long-term programmes on “Work and ship with universities in Costa Rica and Nicara-
Health”, one involving Central American coun- gua concerning research and research training.
tries another southern African countries, mem- The Central American research students have
bers of SADC. These programmes are mainly spent time in Sweden for collaborative analyses
funded by the Swedish International Develop- and write-ups of the publications, while spend-
ment Cooperation Agency (Sida), and emanate ing 85% of their time in their home countries
from earlier bilateral cooperation between the for data collection. The other is a one or two-year
Swedish National Institute for Working Life training programme, in which 275 OSH special-
and other Swedish institutions with institu- ists from countries in Africa, Asia, Latin America
tions in a few countries in the two regions. The and Eastern Europe have participated between
two programmes have three main components: 1993 and 2008. Each course has consisted of six,
research, training and actions for change. The seven or eight weeks of scheduled activities in
main emphasis lies on actions for prevention of Sweden and one or two participating countries.
OSH risks in building industry, agriculture, min- Between the course periods, the participants
ing, hospitals, and in the informal sector. Profes- have carried out an individual action project
sional capacity building as well as institutional in their home countries, aimed at eliminating
capacity building (for monitoring occupational or reducing of OSH risks. These projects have
hazards and health risks) are supporting the been planned and reported during the scheduled
preventive actions in both the short-term and parts of the course, and carried out in the par-
long-term perspectives. Training and research ticipants’ home countries.
activities are part of the programmes. They are
658
methodology been done, is worth much more than detailed

This part will focus on the methodology of tra- analyses of what is difficult or impossible to
ditional forms of education and training, where achieve.
trainees regularly meet each other and teach-
Defining objectives
ers: courses, workshops, seminars, etc. Distance
education will be briefly touched on later in this Training activities are organised for different
chapter. reasons. An institution may want to be responsi-
ble for organising training because it generates
Selection of contents resources to the institution. Another institution
Contents are the most important component of may want to organise courses because they give
a training course, in the same way as they are the an opportunity for the researchers of the institu-
most important component of a single presentation to meet practitioners, a meeting that may
tion. This simple fact is not infrequently forgot- give valuable information and impulses to the
ten, as planning a training activity stimulates the researchers. In another case, the governments
trainer to think about the forms, how to design and the employers cannot agree upon an ac-
the training or the presentation. How to do the tion to be taken (banning the use of asbestos,
training should be the second concern, the first for example), but they can agree on organising
should be defining the content of training. training activities as more knowledge is always
Which problem areas and what kind of facts needed. Training can sometimes be organised
should be selected for the training activity? for what could be described as formal reasons;
In theory the answer is easily found: contents advancement in certain careers requires the
should be selected to suit the trainees (= the tar- completion of certain training activities.
get group), the needs of the enterprise or coun- Without disregarding any of the above men-
try, and what has to be learnt by the trainees. In tioned reasons for organising training activities,
practice, many confounding factors exist. One is we will now focus on training organised for
that we always tend to be so complete, we try to another reason: for the trainees to learn some-
cover all possible areas and aspects. As the time thing. The objectives of such a training activity
that can be dedicated for the training is limited, should be learning objectives. They should state
our ambition to be complete often results in what the trainees will know and be able to do
contents which are too superficial and general. after participating in the training, which they did
Seen from a national point of view, OSH not know and were not able to do before partici-
training should focus on how to prevent risks pating.
of occupational accidents and diseases that may There are many courses having this kind of
lead to serious accidents and diseases and/or that objective:
may happen to many employees. In order to do “The objective of the course is to teach the
so, the training has to be based on an analysis of basics about what causes silicosis, and to
the national needs, not on what the textbooks inform about methods for reducing exposure
to silica dust.
say are important in other countries. The facts
presented should stimulate to action. A few posi- This is not a learning objective. There is not
tive examples of what can be done and what has a single word that can be linked with learning.
659
Chapter 11.2
Instead, this objective contains instructions for objective has been achieved. The second part of
the teacher. So, it is a teaching objective. Now, the objective requires more than a description. It
let us make it a learning objective: requires that the trainee to carry out in practice
activities which reduce exposure to silica dust at
“After active and successful participation in a workplace. It also requires the activities and
the course, the trainees will
– know what silicosis is and how it is caused their outcome to be documented and possible
– be able to reduce exposure to silica dust in a to evaluate. Dust exposure has to be measured,
workplace.” before and after the activities intended to reduce
As our course is action oriented, we are not quite it. How is all that to be organised for 16 partici-
satisfied with the first part of the objective. We pants in a course? Well, let us assume that the
prefer to express objectives in behavioural terms, course is organised for safety managers in the
that is being able to do things. Therefore, we mining industry in our country. The 16 partici-
change the objective to: pants represent many workplaces in a total of
five different mining enterprises. It is a course
“After active and successful participation in with four weeks of scheduled lecturing. Three
the course, the trainees will
– be able to describe what silicosis is and how weeks in December one year, and one week in
it is caused November the following year. During the first
– be able to reduce exposure to silica dust in a three weeks the trainees study what causes silico-
workplace.” sis. They learn in theory how exposure to silica
Fine, now we are satisfied. These are learning dust can be reduced at workplaces by studying
objectives, expressed in behavioural terms. a number of practical cases where this has been
At this point it should be noted that learning done. They learn in theory and practice how to
objectives need to take account of the trainees’ plan and carry out actions to reduce exposure to
background, needs and future activities. Our silica dust. They learn to measure exposure to
learning objectives are relevant for trainees who silica dust. At the end of the three weeks each
aspire to become safety managers or occupation- trainee has produced a short plan for reduc-
al hygienists. If the training were to be organised ing exposure to silica dust at a workplace in the
for future occupational health physicians, how- enterprise where he is safety manager. The plan
ever, the first learning objective would be “be has been discussed repeatedly and been devel-
able to diagnose silicosis and describe how it is oped together with a tutor. During the period
caused”. The second objective might not be rel- from January to October the second year, the
evant at all or would be changed to “be able to trainees carry out the action plans at their enter-
reduce or at least advice on measures for reduc- prises. They write a short report, summarising
tion of exposure to silica dust in a workplace”. the actions undertaken and describing the results
Next question: How do we know that a achieved. During the fourth week of the course,
trainee has achieved the objective? Well, the all trainees’ actions are presented, discussed and
first part is not difficult. We ask the trainee to evaluated. It is also discussed how the experi-
describe, orally or in writing, what silicosis is ences gained during the actions undertaken
and how it is caused. If the teacher (who may be can be developed into systematic long-term
a pulmonary physician or an experienced occu- programmes for reducing silica dust exposure
pational hygienist) accepts the description, the in the five mining enterprises. Back to the ques-
660
tion: How do we know that the trainees have knowledge can be given by one person to anoth-
achieved the second part of the objective? We er. It suggests that learning is a far more easygo-
will use the approved reports from the actions ing process than we nowadays believe. Today we
as indicators for objective achievement. This means believe that learning always requires work by the
that when the tutor, or the course coordinator or learner, often hard work. Therefore, we prefer
the course faculty, has approved the report, we not to say that a course will “give knowledge”.
consider the trainee to have achieved the second We prefer to say that the trainee, after active
part of the objective. Most trainees will pass. A and successful participation in the course, “will
few will pass only after having completed their know” certain things. The course and the teach-
actions and measurements, or improved the ers are facilitating the learning, not giving it to
written report. One or two trainees will not pass the trainee.
at all, because they were never able to carry out The learning objectives of a course have three
their planned actions. Should a trainee who has main functions. First, they represent a summary
carried out all planned actions but not succeeded of the course, its contents and ambitions. They
in significantly reducing exposure to silica dust are a declaration of the course, useful to people
be passed? Yes, if he really has tried he should be interested in participating and to the employer
passed, even if the objective in the second part paying the trainee’s salary during the course.
has not been achieved. They form part of the basis for decisions to
The above stated learning objective may be apply to the course and participate. Second, the
formulated in a more precise way. “to reduce objectives are important references to organisers
exposure to silica dust” is not very precise. “To and teachers during the planning and process of
reduce exposure to silica dust below the occu- the course. The objectives indicate the direction,
pational exposure limit (OEL)” would be more the orientation of the training activities. Third,
precise. On the other hand, such an objective the objectives constitute the point of departure
would require prior knowledge of the exposures for the evaluation of the course. The effective-
being over the OELs at the workplaces chosen, ness of a course is evaluated in relation to its
and their reduction below the OELs would have achievement of the objectives.
to be feasible during the time and with the re- In order to fulfil these functions, the design of
sources available. the learning objectives has to meet a number of
Earlier it was common to say that a course requirements. These requirements are summa-
should “give knowledge” in certain areas, about rised in Figure 11.2.3.
certain facts. This expression assumes that
661
Chapter 11.2
1. The learning objective shall be oriented towards the trainee. It should express what the
trainee will be able to do after active participation in the training activity, what he or she
could not do before.
2. The learning objective has to be relevant. The achievement of the objective should fulfil a
need for the trainee in his or her professional development, and be socially applicable.
3. The learning objective has to be realistic and feasible. The learning objectives for a short
course have to be less ambitious than those for a course of longer duration. It may have to
be accepted that all trainees in a training course will not be able to achieve the same learning
objectives.
4. The learning objectives have to be established using clear and understandable language. It is
important to avoid using words that are open to many interpretations. Therefore, verbs like
this should be avoided: have knowledge, discuss, understand, appreciate believe, trust, devel-
op. Instead, words like the following should be used: write, identify, differentiate, solve, make
a list, compare, plan, construct, implement.
5. If, in spite of the systematic attempts to meet the above mentioned four requirements, the
meaning of the learning objectives is not completely clear and understandable, indicators
for the achievement of the learning objectives have to be defined. The indicator(s) for the
achievement of learning objectives achievement shall specify: what?, where?, for whom?,
how?, how much?, when?
Figure 11.2.3. Basic requirements for learning objectives.
Methods of instruction questioning of theories and empirical material,

How is OSH training to be designed and or- this process will result in learning not only by
ganised? The suggested recipe is: Confront and the trainees but also by the teachers and organis-
integrate theory and practice! It is an over-simpli- ers.
fied recipe, but it may facilitate the identifica- If the organisation of the training allows
tion of some essential ingredients in an efficient trainee participation at different stages of plan-
OSH training. ning, the process of training and learning is
First of all, the training in itself might be likely to develop not only more smoothly but
regarded as a confrontation between theories also more efficiently. In addition, trainee partici-
and practice. The organisers, the teachers and pation might be considered as a means of de-
the training material (textbooks, et cetera) rep- mocratising the educational process and there-
resenting the theories, the trainees and their fore an end in itself. Different goals and proce-
experiences and their present or future jobs dures must be linked to trainees’ participation in
representing the practice. If the training process the planning of education, depending primarily
includes a continuous evaluation, criticism and on their previous experience of working life. In
662
vocational training of students with no experi- student groups consist of a mixture of produc-
ence of working life, the initial planning will get tion engineers, machine constructors and de-
a stronger and more adequate injection if the signers, trade union representatives, etc.
students are replaced, for instance, by repre- Teamwork in multidisciplinary fields such
sentatives of former students or representatives as occupational safety and health has distinct
of the appropriate professional association. advantages, and is indeed necessary. Efficient
The trainees’ previous experience of working teamwork calls for good communication be-
life is a factor of basic importance to the teach- tween team members and an understanding and
ing and learning process. Ambitious courses on appreciation of each other’s work and achieve-
occupational safety and health, ergonomics, etc, ments. This calls for teamwork practice and, if
have been included in many vocational school possible, education and training in the principles
programmes, with highly unsatisfactory results. of communication and of group dynamics.
It is sometimes said that the students lacked The time factor is present during all train-
motivation for the subject in question. This, ing activities for adult participants as a constant
however, often gives the teacher the idea that he challenge, to organisers and trainees alike. It
has been a poor pedagogue, which is not neces- may be seen as a privilege for a trainee to take
sarily a meaningful and fair explanation. The part in a training course while the employer
students’ experiences of working life are such pays the salary, and your wife or husband alone
a basic requirement for OSH teaching, that if has to take care of the family. Training based
non-existent not even the best teacher and peda- on manifold communication (between lecturers
gogue can replace them. and trainees, between trainees, between train-
Even on a course with no period of practical ees and tutors) takes more time than does more
training involved, there are methods for con- teacher-centred training. The time constraints
fronting the theories with practice: case studies and the many persons involved make it necessary
and the use of checklists, amongst other things. to state precise rules as regards when to talk and
As an example of how to apply and combine when not to talk. In the beginning of a course,
these methods, Figure 11.2.2 describes an exer- such rules may be followed as a courtesy to the
cise that has been arranged successfully as a part eccentric organisers, but little by little this cour-
of many OSH courses given in various countries, tesy may be replaced by respect for all actors
industrial as well as developing. involved in the process and for the fulfilment of
Whenever possible, an OSH training activ- common goals.
ity should include at least one visit by trainees
to a workplace, together with teachers. Suitably Presentation techniques
organised, workplace visits provide valuable It is widely accepted that an oral presentation
information and insights, enabling integration is more efficient if it is accompanied by a visual
between theories and practice. presentation. Which is the most important part,
The composition of mixed, heterogene- the oral or the visual? Maybe both, or none.
ous student groups may be a way of ensuring Both oral and visual parts of a presentation have
a valuable confrontation between theories and to support why the presentation is made: explan-
practice. For instance, the exercise described in ing, reasoning, finding things out, question-
Figure 11.2.2 might have been enriched if the ing, evidence, credible authority (as opposed to
663
Chapter 11.2
patronizing authoritarianism), all in relation to During the 1980s a computer presentation

the content and the objectives of the presenta- package was developed which was eventu-
tion. The content is the most important element ally acquired by Microsoft and turned into the
of a presentation. Presentations largely stand PowerPoint software programme. Since the
or fall depending on the quality, relevance and end of the 1990s, power-point presentations have
integrity of the content, presented orally and/or taken over as the predominant visual aid for
visually. The way to make big improvements in presentations at all kinds of meetings: product
a presentation is to get better content. Exquisite presentation; sales promotion; planning events,
design formats will not salvage weak content. If education and training activities in enterprises,
our numbers are boring, then we have got the universities and even primary and secondary
wrong numbers. If our words or images are not schools; scientific meetings, and many others.
to the point, making them dance in colour will Every year, huge numbers of power-point pres-
not make them relevant. Audience boredom is entations take place. A power-point presentation
usually a sign of content failure, not decoration requires a computer, a power-point programme,
failure. Formats, sequencing, and cognitive ap- a video-projector or LCD screen, electricity, and
proach should be decided by the character of the skills to develop the presentations with help of
content and what is to be explained, not by the the program.
limitations or possibilities of the presentation The main advantage of the overhead and
technology. power-point presentation techniques is that they
Firstly, given the importance of the content allow the teacher to sequence and present the
of the presentation, as stated here, we are, sec- contents in a well-structured way. With both
ondly, allowed concern ourselves with the details techniques, photos and other pictures can easily
of a visual presentation. be included in the presentation. Furthermore,
For the training of adults, photo slideshows came both techniques allow easy storage and further
to be widely used in industrial countries 50 or development of the presentation material. The
60 years ago. Nowadays they are seldom used, fact that the power-point presentation offers so
and in the near future they will probably not be many technical possibilities related to the shapes
used at all. Photos and other kinds of pictures, and movements of the text, colours, illustra-
including videos, can without much problem tions and different kinds of decorations is a great
be included in computer-guided presentations advantage. Many presenters, however, use these
like power-point presentations. So, let us forget possibilities in a way which turns the advantage
about slideshows and instead take a closer look at into a disadvantage. Form comes before content,
presentations aided by overhead or power-point. the presenter’s trigger-happiness comes before
Overhead presentations require an overhead the trainees’ understanding, and the presenta-
projector, electricity, transparencies and (colour) tions tend to be overburdened with information.
pencils. They have been in use for the last 30 When planning an oral and visual presenta-
or 40 years, and have been widespread both in tion, the statements and suggestions gathered in
industrial and developing countries. In many Figure 11.2.4 may come in useful.
countries today, overhead projectors are poten-
tial museum exhibits, due to the widespread use
of the power-point technique.
664
1. Be prepared. If you have little time, much time or no time to prepare the presentation, the
most important thing is always to decide what you want to communicate. What is your mes-
sage? Is it relevant to the audience?
2. Formulate the objective of your presentation. Which are the key points that you want the
audience to remember or be able to do?
3. Encourage spontaneous questions. Listen to them. If necessary, reword the question and
direct your reply to the whole audience.
4. An oral presentation will be more efficient if you not only talk but also use the possibilities
to show pictures. The most important characteristic of a picture is that it can be read and
understood by the onlookers. Don’t show tables which cannot be read. Never say that the
picture is for you, and not for the audience. It will only irritate the audience and maybe make
them negative to your message. How can you know that your pictures can be read by the
audience? Test it in beforehand in the room where the presentation will be made.
5. Don’t use too many pictures. Better to have a few relevant pictures than a lot of half-
relevant ones.
6. When you show a picture which is not a text but a photo, drawing or figure, use simple and
understandable pictures. They should be understood not only by yourself but also by the
audience. Comment the pictures to ensure that they are understood in the way you intend.
7. If you use a video presentation by power point, it is especially important that you prepare
the presentation in advance. Test your presentation in beforehand, so that you are sure that
it functions in the room where you will make your presentation, with the equipment and the
cables available. Don’t arrive with your computer or floppy disc two minutes before your
presentation. It may work, but sometimes it does not.
8. If your presentation does not function, it is due to your lack of preparation. It is not the
organisers’ or the course site’s or the equipment’s fault, it is your fault. As presenter you are
responsible for your presentation functioning the way you want it to.
9. If the presentation has caused few spontaneous questions, finalise by asking the participants
about how they understood the message. Was there anything that was not understandable or
possible to agree with? Any other comments, questions or proposals?
10. Study also and reflect on Figure 11.2.5.
Figure 11.2.4. Guideline for oral presentations.
665
Chapter 11.2
Written training materials places, active participation, action-oriented sup-

The written training material often contains the port and group work aiming at consensus.
main theoretical part of what a trainee is ex- Some of the above mentioned training ma-
pected to learn during a course. Lessons serve as terials are based on the WISE methodology
introduction to and/or summaries of the writ- developed by Dr. Kawakami: Work Improvement
ten material. Practical cases/visits/exercises are for Small Enterprises. WISE is an action-oriented
included to highlight problems to be understood training method which focuses on participatory
and/or to train abilities to be mastered. In the approaches and low-cost improvements. It is
ideal case, these different forms cooperate effi- built on local practice, focuses on achievements,
ciently towards the same end: the trainee’s at- links working conditions with other manage-
tainment of the learning objectives. ment goals, learning by doing, exchange of ex-
Recent decades have witnessed the birth of a pertise, and promotion of worker involvement.
new kind of written OSH training material. Bet- The training materials which have now been
ter work environment was developed in Sweden mentioned are “international”, including ex-
in the 1970s. It was translated into more than 40 amples from different countries and cultures.
languages, and promoted by the ILO. Inspired And, in fact they have been used in many dif-
by the Swedish material and test courses in ferent countries for the basic training not only
South-East Asia, the ILO itself developed Higher of workers, supervisors and safety delegates but
productivity and a better place to work in the 1980s. also of engineers and managers. One wishes,
These two sets of written training material were however, that this kind of international materials
profusely illustrated and had many examples of were used nationally only after very consider-
technical and other solutions to OSH problems, able adjustments to the reality of the country in
questions to be discussed, and checklists to be question. Most people tend to be stimulated by
used during workplace visits and analyses. They information and reference that is closely related
were action-oriented and could be used during to their own reality. Pictures, examples, cases
teacher-led lessons as well as during discussions and other kinds of information should therefore
without any OSH experts present. They can be come from their own country, not from another
used in enterprises of different sizes. The ILO country or as “general” information to fit any
material has been developed in such a way as country. It is valuable, of course, to include some
to be specially useful in small enterprises. The information from other countries or from inter-
quality of these two bodies of training material national organisations or contexts, but the basic
is proved by the fact that they have been con- part of the information should be rooted in the
tinuously developed and are still in use. Kogi trainees’ own country.
& Kawakami have developed another written
distance education
training material, Positive programme, which has
benefited from the experiences gained through Distance education has been practised for hun-
the use of the older materials. Positive programme dreds of years. Correspondence and the use of
is more focused, more to the point and struc- radio and television were the main technological
tured more straightforwardly. The key concepts instruments for distance education during the
are: learning from good examples in local work- twentieth century. In recent decades, comput-
ers and internet have made the use of distance
666
education easier and faster. Nowadays there are ingly mobile population that is not satisfied
numerous concepts and forms of distance educa- with existing learning methodologies.
tion. A few of these are summarised in the fol-
lowing; Virtual school, cyberschool
…describes an institution that teaches courses
Computer-based training, CBT entirely or primarily through online methods.
…refers to the use of computers as a main Courses and schools may be accredited or not,
component of the educational process. CBT and courses may be full-time or part-time.
is especially effective for training people to Courses are given at primary and secondary
use computer applications and for simulations levels, and some universities provide accred-
to learn how to drive airplanes, boats and ited online degrees.
other vehicles.
Open university
E-learning, electronic learning ...refers to a university with an open-door aca-
…is a type of technology supported learning demic policy, i.e. no entry requirements. The
where the medium of instruction is computer term may also refer to universities employing
technology. In an enterprise it may refer to specific teaching methods: open supported
strategies that use the company network to learning where the students receive constant
deliver training courses to employees. In most academic attention from academic staff and
universities, e-learning is used to define a tutors, and/or distance education. There are
specific mode to attend a training programme now many institutions in the world with the
where the students rarely attend on-campus name Open University, some of them being
classes or have face-to-face access to teachers ‘mega-universities’ with more than 100,000
or other educational facilities. Conventional students. The Open University in the UK
e-learning systems were based on instruc- was established in 1969 and has more than
tional packets that were delivered to students 180,000 students enrolled, including more
using internet technologies. The role of the than 25,000 studying from overseas.
student consisted in learning from the read-
ings and preparing assignments. Assignments Access to internet coverage is still very low in
were evaluated by the teacher. More recently, many countries. In 2007, the internet users of
increased emphasis is placed on social learn- countries like Angola, Benin, Cameroon and
ing and the use of social software such as Congo DR averaged 2% of the general popula-
blogs, wikis and podcasts. tion, while in countries like China, India, In-
donesia and Vietnam the average use was 10%.
Mlearning, mobile learning At the same time, in Canada, USA, Germany,
…is learning across contexts and with port- France and Japan the average use was 64%.
able technologies like hand-held computers As for education and training in the field of
and mobile phones. Focus may be on the occupational safety and health, distance educa-
technology, the mobility of the learner, or on tional methods have been employed for many
how society and its institutions can accommo- years. Email-communication is used for tutor-
date and support the learning of an increasing, teleconferences may be used as a part of
667
Chapter 11.2
courses, the web is scanned for articles to support this evaluation to a high degree is dependent on
practical assignments, and discussion groups how well the training objectives have been for-
may be established through the internet, etc. In mulated and communicated to and accepted by
a more ambitious sense, however, there are few trainees and teachers.
examples of complete, sustained OSH training So, the evaluation of results tells us to what
activities carried out online, via distance. On the degree the course objectives have been achieved:
other hand, during the last ten years successful how well the trainees have learnt to know and do
attempts have been made in many countries to what they did not know or were not able to do
establish such online training in occupational before the course. These results can be evaluated
safety and health. Some of the experiences re- during the course and immediately after comple-
lated to these attempts have been documented by tion of it.
ICOH’s Scientific Committee on “Education and Process evaluation of training activities empha-
Training in Occupational Health”. sises how well the training is or has been run-
ning from practical and psychological points of
attractive teaching view. Has adequate information been given in
OSH training activities should be problem- due time? Were the course contents relevant and
based. Trainees should take an active part in the important, considering the needs of the trainees?
training. The training itself should be action- Did the design of the training allow necessary
oriented. New tools, like power-point presenta- adjustments of contents and activities? Has study
tions and textbooks like the present one, will be material been given and proved to be useful?
available to more and more people. In spite of all Have the practical facilities been adequate? Have
new tendencies and ambitions, the teacher will the teachers and organisers given the necessary
continue to play a crucial role in education and support and guidance? And many other ques-
training in OSH issues, in industrial as well as tions. Process evaluation of a training activity
developing countries. is often made asking trainees to respond to this
This part of the chapter is dedicated to the kind of questions in questionnaires and/or dis-
teacher’s role in training. What is attractive cussions. Such questionnaires and discussions
teaching, and what is unattractive teaching? The are likely to elicit much valuable information
author has discussed this question with many in- about the meaning and applicability of the train-
dividuals and groups in many different countries ing, as well about the practical problems that
during the last fifteen years. The answers to the trainees and teachers have been faced with.
question are summarised in Figure 11.2.5. The If applied in a systematic and consistent way,
hypothesis is that attractive teaching facilitates combinations of result and process evaluations
efficient learning. will give important inputs to the further devel-
opment of the training activities.
evaluation of training The effects of the course are the long-term
There are two kinds of evaluations that are gen- effects on the individual trainee, his or her en-
erally applied in relation to training: evaluation terprise, and/or society as a whole. To evaluate
related to the results of the training, and evalua- these long-term effects is not easy, due to the
tion related to the process of training. existence of many confounding factors. Special
The first kind, evaluation of results, is more research projects may need to be carried out.
difficult and also more important. The success of
668
Attractive teaching Unattractive teaching
1. The teacher has a message and the message The teacher has a lot of facts and opinions,
is relevant for the trainees without direction and aim
2. The teacher stimulates activity and reflection The teacher encourages passiveness in the
on the part of the trainees trainees
3. The teacher uses different methods of The teacher uses only one method of
instruction instruction: talking and talking
4. The teacher practices what he or she teaches The teacher is not acting in accordance with
his or her own recommendations
5. The teacher is willing to learn, and shows it The teacher knows everything; the trainees
nothing
6. The teacher adjusts to the trainees; for The teacher is not concerned about the
instance, offering examples according to the trainees’ needs; the examples given – if any –
backgrounds and needs of the trainees are irrelevant or incomprehensible for the
trainees
7. The teaching is stimulating; raises interest The teaching is boring; the trainees feel that
and curiosity, trainees understand that there too much time has been spent on it
is more to learn
8. The teaching is linked in a meaningful way The teaching is without understandable links
with other teaching and/or other activities to other teaching and other activities within
of the same training programme the same training programme
9. The trainees are concentrating on the The trainees are talking and/or thinking of
message, sharing the information things other than the message
Figure 11.2.5. Analysis of what constitutes attractive versus unattractive teaching.
669
Chapter 11.2
Adults participating in vocational training, post- competence of the teachers. “Theoretical” is

graduate courses, etc. not infrequently criticise a sometimes used as an ugly word when talking
lecture, a book, the teaching of a certain subject about education and training, thereby covering
or a whole course for being “too theoretical”. more useful statements. The idea behind the
This may be an opening statement that leads complaint “too theoretical” might have been, for
to a valuable interchange of information be- instance, “too much sitting in the lecture room,
tween the trainee and the teacher, but it does which I have not been used to for a long time”.
not necessarily mean that the course really has Finally, it should not be forgotten that a good
been “too theoretical”. Of course, the training education should allow the student to under-
might have been unsuitable for the trainee, or stand and use new, good theories in order to
vice versa. The information about the course, its change bad practice.
contents and objectives, might have been poor, In some cases the trainees consider that
or a mistake might have been made when select- more time should have been spent on a single
ing the trainee in question. Furthermore, the course element, or the course as a whole. This is
problem areas selected for the course, or some healthy. If, on a certain topic or training activity,
of the lessons given, might have been irrelevant the trainees would like more time to be spent,
for the trainee because of lack of experience of that can be seen as a sign of wanting to learn
working life. Other explanations might be poor more. If, on the other hand, the trainees have
information about the reasons for the teaching the opinion that too much time has been spent,
in question, mistakes when selecting the prob- it is worrisome and should be further analysed
lem areas or lessons, or insufficient pedagogical and maybe acted upon.
670
Basic texts
Benjamin Bloom et al: Taxonomy of Educational ICOHs Scientific Committee on “Education and
Objectives. Handbook I: Cognitive Domain. Training in Occupational Health” organised in
Handbook II: Affective Domain. David McKay 2005 a conference on “Occupational Education
Company Inc., New York 1956, sixteenth print- and Training for Everyone Everywhere”, dealing
ing (1971). 205 + 200 pages. with distance education. During this conference
The definition of objectives is an essential many successful attempts to establish online
part of all planning for education and train- training were reported, some of them jointly
ing. This classical work of Benjamin Bloom et developed by institutions in industrial and devel-
al will allow the reader to enter a sophisticate oping countries. The conference presentations
sphere of learning and understanding. are available through the ICOH website: www.
icohweb.org
Carl R. Rogers: Freedom to Learn. Charles E.
Merril Publishing Company, Columbus Ohio,
Training materials
1969. 160 pages.
Safety-Health and Working Conditions: Train-
Rogers’ book has greatly influenced the edu-
ing Manual, Checklist and Discussion Leader’s
cation and training of both adults and chil-
Guide. Joint Industrial Safety Council, Stock-
dren. It introduced student-centred learning
holm 1987. 130 pages.
as an approach to education focusing on the
A Swedish training material that has been
needs of the students, rather than those of
translated to about 40 languages and pro-
others involved in the educational process,
moted by the ILO. Generously illustrated,
such as teachers and administrators. This ap-
making use of checklists, questions for discus-
proach has many implications for the design
sion, etcetera. Since its appearance in the mid
of curriculum, course content, and interactiv-
1970s, it has been used for the basic occupa-
ity of courses.
tional safety and health training of more than
JJ Guilbert: Educational Handbook for Health one million workers, safety delegates, supervi-
Personnel. WHO Offset Publication No. 35, sors and other personnel in Sweden.
World Health Organization. Geneva 1987, sixth
JE Thurman, AE Louzine & K Kogi: Higher
edition, revised and updated (1992). 390 pages.
Productivity and a Better Place to Work: Ac-
A handbook for teachers and organisers of
tion Manual and Trainers’ Manual. International
health personnel. It provides practical advice,
Labour Office, Geneva 1988. 115 + 80 pages.
in fairly simple language, on how to organise
Practical ideas and advice for owners and
education and training in order to facilitate
managers of small and medium-sized industri-
learning by trainees.
al enterprises on how to take simple, effective,
Edward R. Tufte: The Cognitive Style of Power low-cost actions to raise productivity while
Point. Graphics Press LLC, 2003. 25 pages. improving workplace conditions. Checklists,
A critical appraisal of possibilities and prob- rules and many illustrated examples. Pub-
lems related to the use of Power Point pres- lished in English, French, Spanish and Portu-
entations in communication and training. guese.
671
Chapter 11.2
K Kogi & T Kawakami: Positive Programme

– Trainers’ Manual for Occupational Safety and
Health. Japan International Labour Foundation,
2002. 165 pages.
A trainer’s manual with many photographic
examples related to good solutions for ma-
terials handling, machine safety, worksta-
tion changes, physical environment, welfare
facilities and environmental protection. The
design and running of two kinds of training
activities for workers and trade union mem-
bers are described: a one-day seminar, and a
four-day training course. Detailed suggestions
are given related to objectives, key activities
and methodology.
672
11.3
Supervision and control

Bernt Nilsson
the history of labour inspection the principles

systems The International Labour Organisation (ILO)
Labour Inspection had its roots in the industrial was created at the end of the First World War
revolution in Great Britain and then spread to and its Constitution required all member States
Europe and beyond. In 1802, the British Par- to set up a system of labour inspection. While
liament passed an act on the “preservation of two of its first international instruments dealt
health and morals of apprentices” but there was with labour inspection, i.e. Labour Inspection
no real supervision until 1833 when the Gov- Recommendation 1919 (No 5) and Labour In-
ernment appointed four inspectors to supervise spection Recommendation 1923 (No 20) con-
working hours. A Factory Inspectorate was set tained a number of basic principles of modern
up in the middle of the 19 century. In Germany inspection, the instruments were non-binding.
and France established an Inspectorate in 1870. At the end of the Second World War, work
During the nineteenth century most Euro- was completed on a new set of standards result-
pean countries adopted legislation which ing in the Labour Inspection Convention 1947
reflected not only new developments in industry (No 81) and associated recommendations (Nos
but democratic and social advancements. In 1890, 81, 82 and 85). The following principles formu-
representatives of 15 States, including Great lated in these documents were very far-sighted
Britain and Germany, attended a conference and are still very relevant today:
in Berlin which adopted the first international • labour inspection is a public function
labour standards. It was affirmed that all states • there is a need for cooperation between
that adopted legislation on labour standards, labour inspection, workers and employers
should ensure supervision of such legislation by • there is a need for cooperation between la-
an adequate number of specifically qualified of- bour inspection and other institutions
ficers, appointed by government and independ- • labour inspection is oriented to prevention
ent of both employers and workers. • universal coverage.
673
Chapter 11.3
The first principle is that labour inspection is a legislation. This approach ultimately leads to the
public function and a government responsibil- development of a culture of prevention which
ity, which should be organised within the larger enables individuals to lead long and healthy lives
context of a state system in order to administer to sustain productivity and quality. The vision is
social and labour policy and to supervise com based on a holistic view aimed at avoiding tech-
pliance with legislation and standards. Labour nical, social, medical and psychological hazards.
inspectors should be accorded the status and The fifth principle pertains to the trend to-
independence of public officials, able to exercise wards universal coverage as the work of labour
their power impartially, free from undue pres- inspectorates extend to the largest possible
sures and constraints from outside the system. number of working people in all areas of eco-
The second principle concerns the neces- nomic activities and in workplaces. In principle,
sity for close cooperation between the labour labour inspectorates should not accept that cer-
inspectorate, employers and workers. Such tain categories of employees are protected while
cooperation begins with collaboration between others are excluded. In recent years a number of
the labour inspectorate, government, employers countries have extended their labour inspection
and employees’ organisations in the formulation services to sectors which have traditionally not
of labour protection legislation and its applica- been covered such as central government admin-
tion in the workplace. This type of collaboration istration, the public sector, the armed forces and
presupposes the guaranteed participation of the self- employed.
workers’ representatives and a commitment by The concept of labour inspection is further
employers to their responsibilities. developed and described as part of a larger
The third principle concerns the need for ef- administrative system in the Labour Adminis-
fective cooperation with other institutions such tration Convention 1978 (No 150) and Recom-
as research organisations, universities, preven- mendation, 1978 (No 158). Ratifying states must
tion and welfare services and experts such as organise an effective system of labour adminis-
doctors, engineers, chemists and psychologists. tration with coordinated functions and respon-
Labour inspectors need external cooperation sibilities and within this system consultation,
and help to meet the complex technical and cooperation and negotiations with employers’
legal requirements of today’s enterprises. While and workers’ organisations must be secured.
inspectorates are generally unable to have suf- ILO Convention 150 sets out the adminis-
ficient staff competent in all the relevant aspects trative functions of a labour inspection system
of industrial technology, each inspector should including:
have sufficient general knowledge in order to • preparation of legal instruments
identify, understand and assess hazards and to • administration and coordination of existing
call in specialists when needed, constituting a labour inspection services
coherent supervision role. • monitoring and review of national labour
The fourth principle relates to an increasing policy
orientation and emphasis on prevention being • preparation and implementation of laws and
adopted by labour inspectorates in an effort to regulations
avoid near misses, accidents and occupational • handling various aspects of national employ-
diseases by assuring compliance with existing ment policy and terms of employment
674
• regulating conditions of work and working Under Convention No 81 labour inspectors are
life conditions entitled to certain powers including the power
• service and advise to employers, workers and to:
their organisations • freely enter any workplace liable to inspection
• represent the state in international labour affairs. • freely carry out inquires, in particular to ques-
tion people
ILO Convention No 81 (Labour Inspection • examine documents and take samples of
Convention 1947) describes a system of labour materials and substances
inspection to ensure the enforcement of legal • decide upon and order appropriate remedies
provisions relating to conditions of work and for hazards at the workplace.
protection of workers in industrial and commer-
cial workplaces. The provisions of the convention The numbers of inspectors should be sufficient
include: to secure effective work in regard to the number
• the organisation and functioning of inspection of workplaces and employees. The inspectorate
services should also take measures to ensure that there
• the responsibilities of a central authority are enough technical experts and other special-
• cooperation with other public and private ists to ensure a qualified enforcement of the
services, and with employers and workers or legal provision.
their organisations By May 2004, 134 member states had rati-
• the recruitment of sufficient numbers of fied ILO Convention No 81 (Labour Inspection
qualified staff, both male and female Convention 1947), which is a considerable cov-
• material means and facilities (offices and erage.
transport)
• the thorough and regular inspection of work- the role and scope of labour
places inspection
• the publication of reports and annual statistics While fundamentally similar, the enforcement
on the work of the inspection services. role of labour inspectors varies from country to
country and may be broadly described as either
Inspectors are public officials who should be generalist or specialist. The former describes a
recruited with sole regard to their qualifications. system where inspectors have a broad mandate
They should be protected from improper exter- to deal with a large diversity of matters related
nal influences. Both men and women should be to work such as employment, wages, industrial
eligible for appointment. relations issues, general conditions of work and
Inspectors must also respect certain obliga- safety and health. A specialist system is one that
tions. They are prohibited from having any mainly deals with a specific labour inspection
direct or indirect interests in the undertakings issue, usually occupational safety and health.
under their supervision, they must not reveal The general pattern of intervention also
manufacturing or commercial secrets of work- differs in the labour inspection services in vari-
places they inspect and must not reveal the ous countries and may be broadly categorised
source of any complaint. as sanctioning systems or compliance models.
Sanctioning systems, such as that used in United
675
Chapter 11.3
States, are mainly concerned with punishable • In addition to the principal labour inspector-
contraventions or violations of regulations ate, there might also be a number of smaller
whereas compliance models, such as that used in and specialised inspectorates often providing
Germany, try to secure legal compliance using services to specific industrial sectors such as
prosecution or the imposition of criminal or ad- mines, agriculture, nuclear stations, ports,
ministrative penalties only as a last resort. In this harbours and railways. Other services may
case advice and consultation is used as the main include specialist technical inspection for
method of intervention. hazards such as radiation, explosives, pressure
Furthermore there are some general groups vessels or chemicals.
of inspection services:
• The generalist model where inspectors have a It is obvious that confusion can arise when
wide range of responsibilities including different systems are discussed and compared
occupational safety and health; hours of work; because labour inspection covers a very wide
conditions for migrant workers; wages and range of duties which differ greatly from country
illegal employment. They may also be respon- to country. It is particularly important to keep
sible for industrial relations and conciliation this in mind when resources and competences
services. Such generalist authorities are often are discussed and compared. To summarize, a la-
centrally managed and directly under ministe- bour inspection service is likely to be responsible
rial control. In addition to France, Portugal for two or more of the following functions:
and Spain, most other French and Spanish • occupational safety and health (including
speaking countries belong to this group. working hours)
• The Nordic Countries, United Kingdom, • general conditions of work (including wages)
Netherlands, Ireland, New Zealand and some • industrial relations
countries in Africa are examples of countries • employment (including illegal employment
whose labour inspectorates operate principally and vocational training)
for the enforcement of compliance of legisla- • social security matters (including compensa-
tion on safety and occupational health but also tion for accidents and diseases).
on some regulations on general conditions of
work. In several of these cases the government policies and methods
requires the inspectorate to be accountable to As labour inspection systems are normally part
a bipartite or tripartite board. of the general public administration of a coun-
• Inspection systems in countries with “fed- try, the procedures and practices often reflect
eral states” are often characterised by a wide the predominant social, cultural and economic
range of inspection responsibilities beyond characteristics of that country.
occupational safety and health, e.g. hours of However, despite administrative diversity,
work and wages. Inspectorate functions are every labour inspection system must address a
frequently delegated to regional government number of core issues: the setting of priorities
and authorities. Australia, Brazil, Canada, through the assessment of risk; establishment
Germany, Austria, India, Switzerland and the of a balance between enforcement and advice;
Unites States are (to varying degrees), exam- the effective application of sanctions; training of
ples of this pattern.
676
inspectors and identification of effective inspec- In many countries there are other systems that
tion methods. can provide advice, e.g. safety and health serv-
ices. No matter how the system is structured, it
Setting priorities is important that there is a formulated principle
Inspectors must have defined principles to work on the subject so that a consistent approach is
by when they are setting priorities and deciding assured. It is also important that employers un-
which sites will be inspected so that they can derstand what is expected of them – compulsory
perform their duties in a consistent way that is requirements must be clearly distinguished from
not seen as arbitrary. A systematic knowledge of advice or guidance.
accident risks and ill health in different sectors The scope of any inspection authority is to
is an important tool for deciding on priorities. secure compliance with laws and regulations.
High quality national statistics on occupational The use of sanctions is central in such a system
accidents and ill-health are indispensable. A and generally follows the principles of the pub-
register of enterprises and other inspection sites lic administration in each country. While some
helps inspectors to target individual workplaces, systems invoke sanctions very readily when non-
especially if the register contains information compliance is established, others give employers
about the safety and health situation, current more time to take action following improvement
supervisory activities and complaints. notices. Most systems offer the possibility of
There must also be a strategy to deal with prosecution when serious breaches of the law are
demands for both proactive and reactive inspec- established or when accidents have occurred. A
tions. In many cases a lack of resources, (usually general preventive effect may also be generated
a shortage of inspectors), tends to generate a by reports from court cases regarding health and
multitude of reactive inspections which greatly safety prosecutions published in mass media.
diminishes possibilities for successful priority
setting. If the objectives of a labour inspection Training
system are to be achieved it is vital to develop a There is a wide range of training models for in-
defined programme with clear priorities, planned spectors, as could be expected given the diversity
inspection campaigns and other activities aimed of organisations and mandates for supervision.
at problems, sectors of industry and specific In the field of occupational safety and health,
sites. high quality training is essential if high quality
enforcement is to be achieved. An important
Enforcement requirement is that a newly recruited inspector
Every inspection service must decide on the bal- has experience from working life or gets such
ance between enforcement and advice when ex- experiences as part of the induction training.
ercising their supervisory role. Convention No The training of new inspectors can essentially be
81 gives equal weight to both approaches and divided into three parts.
there is no conclusive evaluation about the most Firstly, inspectors must have knowledge of
effective method. Normally a mix of enforce- potential hazards in the work environment such as
ment and advice is used, although it is important dangerous substances, noise, ergonomics, ma-
to bear in mind that an inspector has legal power chinery, accident risks and psychological factors.
and is not normally replaceable in this capacity. An inspector should be able to identify and assess
677
Chapter 11.3
risk factors at the workplace and to call for spe- • Incident induced inspections which could be
cialist assistance if necessary. Secondly, an inspec- initiated by an accident or a complaint.
tor must have knowledge of relevant laws and
regulations. The third crucial element needed trends in labour inspection systems
for the formation of a professional and effective While labour inspection systems are generally
inspection service is training in the “art of inspec- well established in industrialised countries, many
tion”. Such training would most likely include developing countries still face many difficulties
not only practical training in different inspection such as a lack of resources, corruption, adminis-
methods and formal procedures but also devel- trative shortcomings and war.
opment of communication skills. Some larger, The International Labour Conference 90th
industrialised countries have special training insti- Session 2002 Report of the Committee of
tutes for inspectors while in other countries there Experts on the application of Conventions and
may be special training departments within the Recommendations offers many examples of the
inspection service. In many cases labour inspector situation faced by developing countries. In some
training is organised as a combination of theoreti- cases inspectors have no free access to workplaces,
cal training and on the job training over one or while in others the legal system is ineffective or
two years. companies are not registered. Many countries
have an insufficient number of inspectors and
Inspection methods their training is poor or nonexistent.
All inspection services need a framework Lack of economic resources is a common
which establishes effective inspection methods. problem. Inspectors may have to resort to other
These methods, which should be evaluated and paid activities to compensate for low salaries.
documented in manuals will form the common Travel costs are not properly reimbursed and
ground for training of new inspectors. In general the available means of transport are minimal, in
the methods could be described as: some cases just one car or motorcycle per coun-
• Risk induced inspection, traditional “ba- try. Offices may also be unsuitable and poorly
sic” preventive inspections based on a walk equipped.
through of the establishment leading to a gen- In many countries self-employed workers in
eral assessment of the working conditions and the informal economy comprise a large portion
resulting in detailed demands. of the working population. Family businesses,
• Cause specific inspection targeted at defined other small enterprises and agriculture are domi-
problems like chemicals or noise, with the aim nant. The work environment is often bad, with
of identifying defects which are then cor- hazardous machinery, heavy work, long working
rected by senior management. hours, hazardous chemicals and poor ventilation.
• Programme specific inspections which are Many children are exposed to severe hazards.
part of a project or a campaign combined with This situation is largely related to the eco-
information activities in massmedia. nomic and social situation of the country. There
• System specific inspections which target man- is no realistic possibility to solve these problems
agement arrangements for safety and health with inspection activities. However, with good
within companies. political support Labour Inspection in combina-
tion with a clear legal framework can make a
678
big difference. Good training of inspectors and • To find ways to cooperate with important
effective inspection procedures in combination stakeholders such as union and employers’
with activities to increase the general awareness organisations in the area of work environment.
of work environment issues in society are of • To implement effective methods of inspecting
great importance. the work environment management systems
To summarise, many inspection systems are within companies.
facing important challenges: • To train inspectors to handle “new” problems
• To change the fact that many inspection such as ergonomic risks, psychosocial risks
services have too few inspectors, insufficient and work related stress.
training possibilities, low salaries and com- • To implement systems which generate relevant
pensation and inadequate equipment. and trustworthy statistics on occupational
• To develop integrated systems that would accidents and diseases and effective ways of
eliminate ineffective parallel activities. This setting priorities and targets for inspection.
may result in the elimination of separate • To develop computerised registers of inspec-
inspection systems for safety and for health tion sites.
or it may be a dual system for both insurance • To find ways of using information to support
inspection and labour inspection. inspection systems.
• To develop effective ways of working with • To develop evaluation methods to monitor the
small enterprises and the informal economy. effects and performance of inspection systems.

The core ILO Conventions concerning Labour In the following ILO publication, written by Wolf-
Inspection are: gang von Richthofen you find a guide to Labour
- Convention No 81 (1947), concerning Labour Inspection and its fundamental principles. It de-
Inspection, scribes how major developments in the economy,
- Convention No 129 (1969), concerning Labour the labour market and technology affect Labour
Inspection in Agriculture inspection:
- Convention No 150 (1978), concerning Labour - Wolfgang von Richthofen, 2002. Labour
Administration Inspection – A guide to the profession. ILO.
The following report offers many concrete exam-

ples of the current situation faced by Labour
inspection in developing countries:
- International Labour Conference 90th Session,
2002, Report of the Committee of experts on
the application of Conventions and Recommen-
dations, Report III (Part A)
679
12
A global perspective on OSH
Introduction 682
12.1 Globalisation and working life 683
12.2 Global situation concerning work related injuries and diseases 713
12.3 International governance and partnerships 741
Introduction
The first chapter of this section provides an out for and suggest sources of information on
overview of the major global economic and so- preventive methods with the aim of encourag-
cial driving forces behind the changing patterns ing readers to seek out data and information and
of work and work hazards around the world. to develop an evidence-based approach to OSH
The term globalisation has been used in recent practice.
years to highlight the trend of accelerating trade, Chapter 12.3 introduces various international
liberalised financial transactions, and market- institutional actors and stakeholders involved in
based industrialisation in most countries in the the process of globalisation and have an impact
world. The chapter describes the process from on OSH developments. Many of the interna-
a number of points of view, analyses the mecha- tional agencies in this area have published strong
nisms behind globalisation and highlights the statements on the need for protection of workers
risks and opportunities for OSH development at from OSH hazards and offer specific advice on
country and global level. It is hoped that readers how to achieve safer and healthier workplaces.
will get a better understanding of the links be- The importance of collaboration between OSH
tween globalisation and OSH and the challenges professionals and the workers affected by OSH
that face OSH professionals and administrators hazards is emphasized, and the benefits of col-
when dealing with the impacts of globalisation. laboration among professionals in different
Chapter 12.2 uses statistics and graphs to countries are explored. Readers can find po-
show how occupational injuries and diseases tential partners for OSH preventative actions
are associated with development. It reminds the at local level, or at least virtual partners via the
reader that several major OSH hazards that are Internet. The aim is to encourage policy de-
practically eliminated in developed countries, velopment and local action that will counteract
are still of importance in developing countries negative effects from globalisation on OSH, and
and can be exacerbated by globalisation. Glo- take advantage of any positive opportunities for
balisation has encouraged the rapid growth of OSH enabled by globalisation and international
new workplaces in developing countries. Case cooperation.
studies of OSH issues illustrate problems to look
682
12.1
Globalisation and working life

the concept of globalisation It should be emphasised from the outset that

Previous chapters in this book have outlined globalisation and economic development can
various occupational health hazards and their have both positive and negative impacts on the
potential effects. This chapter analyses the im- world of work, employment levels and condi-
pact of work on health from a global perspective tions and the OSH situation . If the social di-
and within the context of globalisation using mension is properly taken into account, globali-
examples of typical hazard situations for differ- sation can be a positive force for social develop-
ent countries. Issues and problems concerning ment and health. To achieve this would involve
globalisation and OSH require high level policy policies, regulatory and economic instruments
solutions. for globalisation that ensure that:
The Encyclopaedia Brittanica describes glo- – inequalities are lessened rather than amplified
balisation as follows: – decent standards of living and working condi-
tions are achieved
“A process of worldwide economic integration. – population groups are not marginalized by the
Factors that have contributed to globalisation
changing economy
include increasingly sophisticated communications
and transportation technologies and services, mass – unemployment is reduced
migration and the movement of peoples, a level
of economic activity that has outgrown national The term “Progressive Globalisation” has been
markets through industrial combinations and com- used by some to highlight the alternatives to a
mercial groupings that cross national frontiers, and pure neo-liberal agenda for globalisation. The
international agreements that reduce the cost of four cornerstones of the alternative progressive
doing business in foreign countries. Globalisation approach are: equitable global trade; regulation
offers huge potential profits to companies and na- of global commerce; redistribution of global
tions, but has been complicated by widely differing
wealth; and democratic global governance.
expectations, standards of living, cultures and val-
The impacts of globalisation are often differ-
ues, and legal systems as well as unexpected global
cause-and-effect linkages.” ent in developing countries and industrialised
countries and aspects that are positive in one
country may be negative in another. Many com-
683
Chapter 12.1
mentators consider that the main beneficiaries Globalisation is also a process of expanding
of globalisation are large multinational corpora- Western consumer culture into all parts of the
tions while others say globalisation also leads to world. This includes not only new work op-
benefits for workers and the population at large. portunities and work hazards, but also the car
Globalisation is a process that creates many culture, food culture and leisure culture of the
conceptual and practical challenges. most affluent countries. Underpinning these
UNDP’s Human Development Report of developments is a growth culture, implying that
1999, listed features of globalisation, emphasiz- economic growth above a certain percentage
ing the systematic move towards deregulation, level is an absolute requirement for a good qual-
meaning less influence of government on enter- ity of life. Catching up on basic economic devel-
prises and reduced specified protection of work- opment is a must for the developing countries
ers and the community from work hazards, envi- in order to achieve a decent standard of living,
ronmental pollution and social impacts of enter- however, the economic growth need is different
prises. A stronger role for international agencies, once a society has reached a relatively high level
particularly the World Trade Organization of economic development .The growth culture
(WTO), is mentioned as a part of globalisation. brings with it not only occupational health
This has led to greater influence over all coun- hazards, but also environmental health hazards
tries by the dominant powers (governments and and life-style hazards. Globalisation involves a
commercial enterprises), with important conse- number of public health challenges and occupa-
quences for OSH, (explored later in this chap- tional health professionals should play a strong
ter). However, globalisation can lead to stronger advocacy role for policies that protect health.
international collaboration which can also lead A critical analysis of the phenomenon of
to OSH improvements, when particularly haz- globalisation, by the French sociologist Pierre
ardous processes or compounds are phased out Bourdieu , sees this term as “an idea, which
or banned in more and more countries. Unfor- has a social force and obtains belief”, that like
tunately, such bans are seldom implemented or an axiom, nobody can deny or escape. It is the
enforced in developing countries, creating con- main weapon in the battles against the gains of
tinued OSH problems, even when the hazardous the Welfare State that which he expects to be
workplaces are economically controlled from further eroded. Long working hours, weekend
the industrial countries. The increasing role of work, split shifts and other irregular working
unorganised flexible labour further undermines hours are being reintroduced as a part of flexible
regulatory efforts in this area. Examples are working conditions, a key aim of neo-liberalism.
plentiful; e.g. pesticides, solvents, and asbestos. Financial markets have become sensors for
Globalisation has been greatly facilitated by what is good and bad, and market forces pri-
more rapid telecommunications and the Inter- marily determine whether an enterprise, or a
net, which opens up new possibilities for sharing whole country, is able to maintain its activities.
information and developing collaborative net- As has been shown at numerous times in recent
works at grassroots level, but these benefits may years, these markets are often influenced more
take a long time to reach workers in poor urban by emotion and gambling on future events than
and rural areas of developing countries. by the fundamentals of enterprise capital value
and income generation. Bourdieu writes “the
684
The challenges of the social dimension of globalisation

(source: World Commission on the Social Dimension of Globalisation, ILO 2003)
Globalisation is a term that is used in many ways, but the principal underlying idea is an increasing in-
tegration of economies and societies. It is driven by new technologies, new economic relationships and
the national and international policies of a wide range of actors, including governments, international
organizations, business, labour and civil society.
Broadly speaking, the process of globalisation has two aspects. The first refers to those factors - such
as trade, investment, technology, cross-border production systems, flows of information and commu-
nication - which bring societies and citizens closer together.
The second refers to policies and institutions, such as trade and capital market liberalization, inter-
national standards for labour, the environment, corporate behaviour and other issues, agreements on
intellectual property rights, and other policies pursued at both the national and international level
which support the integration of economies and countries. In terms of the latter aspect, the existing
pattern of globalisation is not an inevitable trend - it is at least in part the product of policy choices.
While technological change is irreversible, policies can be changed. Technological advances have also
widened the policy choices available.
The social dimension of globalisation refers to the impact of globalization on the life and work of
people, on their families, and their societies. Concerns and issues are often raised about the impact of
globalisation on employment, working conditions, income and social protection. Beyond the world of
work, the social dimension encompasses security, culture and identity, inclusion or exclusion and the
cohesiveness of families and communities.
Globalisation brings new potentials for development and wealth creation. But there are divergent
views and perceptions among people as concerns its economic and social impact, and indeed widely
varying impacts on the interests and opportunities of different sectors and economic and social ac-
tors. Some argue that the present model of globalisation has exacerbated problems of unemployment,
inequality and poverty, while others contend that globalisation helps to reduce them. Of course, these
problems predated globalisation, but it is clear that for globalisation to be politically and economically
sustainable, it must contribute to their reduction. Hence the goal of a globalisation which meets the
needs of all people.
neo-liberal ideologues want us to believe that investments and decision-making about working
the economic and social world is structured by conditions by banks, development agencies and
equations”, which ignores the importance of commercial corporations. These priorities focus
a social and political will. A community may on short-term financial and employment gains,
consider good health, social equity, democratic but the longer term consequences for health
participation and environmental sustainability to and the environment are generally overlooked.
be more important than mere economic growth While globalisation is nurtured by these equa-
and wealth creation. Such equations include a tions, OSH protection may suffer because of it.
number of assumptions and limitations based on A powerful driving force for health protection
political and social ideas and guide priorities for would be created if global agreements on im-
685
Chapter 12.1
proved OSH systems were incorporated into the for governments to meet the needs for old age
equations. care, health care, education and child care from
These equations are an integral part of taxation. Systemic unemployment and limited
econometric models used to interpret, plan tax resources create health problems for the un-
and fine-tune economic policies and actions at employed, makes workers and unions weary of
the macro level. They depict associations be- demanding improved OSH conditions, and lim-
tween national economic growth, interest rates, its the ability of governments to improve their
foreign exchange rates, government tax rates, OSH services and health services in general.
unemployment rates, consumer price index and Globalisation can also be defined as a set of
inflation, etc. In order to keep the inflation rate processes leading to the creation of a world as
within predetermined ranges, actions are taken a single entity, relatively undivided by national
on other variables (e.g. the central bank inter- borders or other types of boundaries (cultural,
est rate). Important factors for OSH are the economic etc.). This concept has important con-
unemployment and tax rates. Low unemploy- sequences for the role of national governments
ment is seen as an indicator of a risk for inflation in globalisation, e.g. how to deal with a global
and when it goes “too low”, actions are taken health issue that transcends national boundaries
to cool down the economy. Thus, a systemic and requires the involvement of a wide range
unemployment of about 3-6% is maintained of stakeholders to effectively address the issue.
through these equations. Similarly, a high tax All around the world, communities, non-gov-
rate is deemed as a bad indicator for economic ernmental organizations and other members of
growth and the equations make governments civil society need to formulate and implement
mindful of the maximum level of tax that can be preventive actions in conjunction with govern-
collected which in turn reduces the possibilities ments.
Key elements of globalisation
Economic driving forces:

– liberalised trade, “free” trade
– liberalised financial transactions across borders
– reduced government sector, reduced taxes
– reduced government regulations (including OSH regulations)
– multinational enterprises transferring jobs to low-cost countries
– harmonisation of business systems to Anglophone Western model
Cultural trends:
– car culture: motor vehicles for transport, high energy consumption society
– food culture: “McDonaldisation”, more processed foods, more sugar, fat, energy-dense foods, central-
ised production and less local production, higher food transport costs (also called “coca-colonisation”
with special reference to obesogenic environments and diabetes).
– leisure culture: tobacco smoking promotion by tobacco companies, alcohol, gambling, Western style
TV and movies
686
To some degree, engagement in a truly global impacts on other aspects of economic and social
process has developed inside the anti-globalisa- development which may eventually impact on
tion protest movement that had an important occupational safety and health.
impact on the discourse at the Seattle World
Trade Organization (WTO) meeting in 1999. economic forces behind
Naomi Klein argues that the economic proc- globalisation
esses of globalisation, promoted by the WTO, Globalisation was initially seen as purely an eco-
excludes many people from the process and its nomic force, the logical outcome of the elimina-
proceeds create inequalities and “fences” that tion of barriers to capital movement and invest-
separate people from their legitimate partici- ment across borders, barriers to trade, and local
pation in decision-making. True globalisation barriers to enterprise. As indicated in the previ-
would bring people together, would create ous section, social and cultural forces are also
mechanisms to strengthen occupational health important in globalisation, but the economic
protection and improve the living standards for forces are those most amenable to international
the poor. The protest movement has become the agreements and regulations. Economic forces
defenders of such values of global cooperation, can be seen both as a cause of and an outcome
and is therefore seen by Klein as the true expres- of globalisation. Economic growth in developed
sion of a globalised world. countries and expansion of the domain of multi-
The focus of the G8 meeting in Scotland in national enterprises have created strong lob-
July 2005 was debt relief for the poorest coun- bying forces for making the globe into a single
tries, additional aid to Africa and global warm- market (see Box). The International Monetary
ing. Pressure from the protest movement on the Fund (IMF) has underpinned this with demands
world’s richest countries to do something on on developing countries to “open up “ their
these issues may have been one reason for the economies and provide opportunities for global
contents of the meeting agenda. A sign of a true businesses to enter into previously closed na-
global concern among the governments involved tional markets.
would have been another reason. The meeting Foreign direct investments , frequently
was almost derailed by the terrorist attack on the cited as engines for growth, take place mostly
London transport system, but the meeting went between North America, Europe and Japan,
ahead as planned and the outcomes can be con- which together, with China, receive more than
sidered a reflection of positive globalisation. 90% of foreign direct investments. The rest
The globalisation debate continues and the of the world, with 70% of the global popula-
stakes are high. The literature about globalisation, receives less than 10% according to the
tion is divided along many lines: International Union of Health Promotion and
• whether or not globalisation is occurring, Education (IUHPE). Global income growth due
• the extent or speed to which it is happening, to liberalized trade and investment was almost
• whether it is having positive or negative im- $500 billion between 1995 and 2001 and was
pacts on individuals and societies. mainly accrued in wealthy countries.
Currently the globalisation process is not
While this chapter primarily deals with issues ”global” in terms of trade and investments. Least
specifically related to OSH, globalisation also developed countries, with 10% of the world’s
687
Chapter 12.1
people, account for 0.3% of the world trade, for example through privatisation and open-
only half of their share two decades ago when ing up of the economy. A major justification for
the push to global trade first began in earnest. these policies is the objective of creating stable
Trade issues that favour the wealthy countries, economic conditions and making developing
such as trade in services, intellectual property country economies more “competitive” and
rights and global investment and competition attractive for international investors. However,
policy, have resulted in action and agreements at what is good for the investor is not always good
the WTO but those favouring the less affluent for the population as a whole.
countries, such as lower agricultural subsidies in Economic development is an important driv-
industrialized countries, technology transfer, ca- ing force for improved quality of life, but it is
pacity building and debt relief, have not. Work- increasingly understood that development needs
ing conditions and OSH issues have also been to be built on sustainability and positive social
sidelined in the WTO agreements. development. The former was the focus of the
The continued failure to reach an agreement Earth Summit in Rio in 1992 and the latter has
on reducing the enormous agricultural subsidies been taken up strongly by ILO during recent
in the USA, Europe and Japan has highlighted years.
the reluctance of rich countries to “walk the The term “wealth creation” is increasingly
walk” instead of just “talk the talk”. used in corporate reports and the media as a
A parallel development can be seen for mac- positive label for the accumulation of economic
roeconomic objectives advocated by the IMF, gains of the globalisation process. There is a
including currency devaluation, public spend- problem when the wealth created is accumulated
ing reduction, and tighter monetary policy. The as share value in corporations or financial hold-
World Bank’s policies, which followed the IMF ings of the industrialized countries with too little
measures, involve reducing the role of the state, saved or made available for key infrastructure
The “Washington consensus”
During the 1980s conservative economists in the US Treasury, the World Bank and the IMF devel-
oped an agreement on what constituted “good development policies”:
– liberalised financial transactions across borders
– less government interventions, reliance on market wisdom
– privatisation of government assets (e.g. telecommunications, water supply, electricity supply, public
transport)
– free trade
– low inflation
– reduced government borrowing
– low proportion of GDP from aid or loans
These principles have become the foundation for globalisation to date, and are the focus of much of
the criticism of globalisation.
688
such as housing and health services in develop- computers, telecommunications and retailing.
ing countries. Wealth created by corporations Major mergers and other changes in the corpo-
and individuals in developing countries is too rate world change the position of different cor-
often transferred to banks in industrialized porations in these lists over time.
countries, a process made possible by liberaliza- Countries listed in this Figure with the largest
tion of cross-border financial transactions. In economies are mainly from the OECD. Den-
addition, globalisation is linked to growth of mark has the lowest GDP of US$ 162 billion,
intellectual property income from the use of which would have been only barely larger than
technologies created in industrialized countries the largest corporation value in 1995. (N.B. the
and new workplaces in developing countries will GDP numbers here are in actual US$, which
create wealth for multinational enterprises both is different from the PPP$ referred to in other
through patents and through ownership of the parts of this chapter.) In the Figure we take into
new factories. account the fact that the GDP figures include
Multinational enterprises have grown in not only the turn-over of the various corpora-
recent years to the extent that their overall tions, and also consider that government income
market capital value is larger than the GDP of and economic power in general is limited to the
whole countries. The world’s largest economies tax income. Total tax receipts are usually in the
(countries and corporations with a value over range of 30-40% of total GDP. Governments
$ 100 billion) are listed in Figure 12.1.1. The can assert control over the tax income based on
Figure includes the total GDP of countries and democratic principles, where all citizens of vot-
the tax collected, and it is sorted by the tax col- ing age have an influence, however, corporate
lected nationally or the market capital value of boards are controlled by their share-holders, and
the corporations. The largest corporations, such in reality often by a very small group of people.
as General Electric, Cisco Systems and Exxon- There is no direct democratic input from the
Mobil, have a larger market capital value than population into what the corporations do.
the tax collected in industrialized countries like The 20 countries included in the Figure
the Canada or Spain. Wealth is certainly created, 12.1.1 have a combined GDP of US$ 27 trillion,
but where does it end up, how is it applied to which is about two thirds of the global GDP of
contribute to improved social and working con- US$ 40 trillion. The total tax revenue in these
ditions, and who is controlling the economic re- countries is about US$ 8 trillion, while the com-
sources? The comparison of market capital value bined market capital value of the companies in
and GDP is not ideal as they represent different the tables is about US$ 6 trillion.
economic dimensions, but when the comparison Another economic force of globalisation is
is made with tax collected, the comparison re- the constant seeking of a “competitive edge” by
flects the power of economic decision-making of countries and trans-national corporations. This
governments and corporate boards. may lead to an obsession for the creation of
The corporations listed at the top positions in new products and services to sell, rather than a
Figure 12.1.1 are mainly carrying out business in strengthening of social systems and an improved
the areas of military arms systems (e.g. General quality of life. The share of the national GDP or
Electric is a major producer of jet engines for wealth that is devoted to social support, publicly
military aircraft), electronics, oil, medical drugs, provided health services, education, and other
689
Chapter 12.1
Rank Country company a. GDP b. Tax c. Tax revenue

(according total collected or market
to column c) (%) capital value
1 United States 10,065 30 2,979
2 Japan 4,141 27 1,122
3 Germany 1,846 38 700
4 France 1,310 45 593
5 United Kingdom 1,424 37 533
6 General Electric 477
7 Italy 1,089 42 457
8 Cisco Systems 305
9 Exxon Mobil 286
10 Pfizer 264
11 Microsoft 258
12 Wal-Mart stores 251
13 Citigroup 250
14 Canada 695 36 249
15 Vodafone group 227
16 Intel 227
17 Royal Dutch/Shell 206
18 American Int. Group 206
19 Spain 582 35 205
20 Nokia 197
21 Merck 196
22 Oracle 182
23 BP 178
24 NTT DoCoMo 175
25 SBC Communications 175
26 China 1,159 15 174
27 IBM 164
28 GlaxoSmithKline 160
29 The Netherlands 380 41 157
30 EMC 156
31 Verizon Communications 148
32 Coca-Cola 143
33 HSBC Holdings 141
34 Johnson & Johnson 135
35 Toyota 124
36 Novartis 123
37 BristolMeyersSquibb 123
38 Home Depot 120
39 NTT 117
40 Australia 369 32 116
41 Mexico 618 19 115
42 Sweden 210 54 114
43 Nortel Networks 113
44 Rep. of Korea 422 26 110
45 Belgium 230 46 105
Figure 12.1.1. Countries/companies ranked by tax revenue or market capital value (US$, 2001).
Source: OECD and UN statistics.
690
public services is reduced or restricted in order has moved to other developing countries with
to make the economy more investment friendly less costly regulatory environments. Some cor-
or more competitive. This is an inherent charac- porations that moved their production facilities
ter of globalisation, and is based on an economic from the USA to Mexico for cost reasons, are
model that favours pure markets over develop- now moving from Mexico to countries with even
ment with safeguards for community needs and lower costs (e.g. China). When corporations
basic infrastructure. The “structural adjustment” move to other countries, the health and social
policies (SAPs) of the IMF have been used as costs for the workers, are seldom quantified or
tools to achieve the pure market model of glo- considered.
balisation, particularly when dealing with ailing
economies of less affluent countries. SAPs have trade, wto and osh
also been applied as entry requirements to the Increased trade, based on the principle of each
European Monetary Union (EMU). The SAPs country using its competitive advantages, is a key
have led to cuts in public services and their ap- element of globalisation. To achieve this, free
plications without appropriate safety nets under- trade or trade unimpeded by duties, quotas, sub-
mine efforts to improve public health. sidies or non-tariff trade barriers, is a require-
Globalisation can also be viewed as a process ment according to the organizations facilitating
of dividing labour between affluent countries, globalisation. A number of multi-lateral and bi-
which continue to maintain and develop their lateral trade agreements have been established
science and knowledge-based industries while for this purpose. Agreements between relatively
the more menial production tasks are carried out equal partners can be of substantial economic
in the less affluent countries. Increasingly, new benefit, but developing countries cannot be con-
jobs in developing countries are in service indus- sidered as equals in these negotiations.
tries, such as data entry and processing centres, Multilateral free trade agreements have been
and phone call centres. These types of jobs are developed throughout the world during the sec-
not associated with the risks of heavy industry, ond half of the 20th century. These agreements
but they come with other hazards such as mus- aim to facilitate international trade by lowering
culo-skeletal damage in the form of repetitive or removing trade barriers. If these agreements
strain injury, or various forms of work stress. incorporate related social issues such as work-
The globalisation process is facilitated by ing conditions, they may help to advance oc-
lenient occupational and environmental quality cupational safety and health. On the other hand,
standards and lax levels of enforcement in less trade agreements that ignore labour standards
developed countries. Capital for investment in may have a negative impact.
production industries will move to the country The European Union (EU) has paid attention
with the lowest costs, usually the country with to occupational health and safety in its efforts
the least protection for health and the work to develop the social dimension of working life.
environment. Media reports have identified this A comprehensive Framework Directive, on the
process of corporate flight as a new problem for minimum requirements for health and safety at
Mexico. Because their membership in NAFTA work has been approved and supplemented with
has encouraged more health protection in the some 16 special directives. General duties placed
work environment in Mexico, manufacturing upon the employer include duties of awareness,
691
Chapter 12.1
duties to take direct action to ensure safety and health” easily identifies some dubious occupa-
health, duties of strategic planning to avoid risks tional safety and health features of NAFTA.
to safety and health, duties to train and direct The Subcommittee on Social Security and
the workforce, duties to inform, consult and Occupational Safety and Health within the
involve the workforce, and duties of recording Employment and Labour Sector (ELS) of the
and notification. Southern Africa Development Community
The North American Free Trade Association (SADC), was established in 1996 to promote
(NAFTA) of the USA, Canada and Mexico has employment and productivity, and harmonize
initiated a programme for occupational health labor and social protection. The Subcommittee
and is planning to improve the collection of in- plans to implement the Codes on the Safe Use
formation, research, and the training and educa- of Chemicals and HIV/AIDS in the Workplace,
tion of experts, workers and employers within as well as monitoring OSH activities in the
the framework of the new Association. However, region, harmonization of social security schemes
a web-search for “NAFTA and occupational
Case studies on WTO rules and linkage with international guidelines.

Source: WTO/WHO, 2002
Two cases of trade versus health illustrate how the various rules and regulations can interact. In one
case the US Environmental Protection Agency had regulated that, in the most polluted areas of
the country, only gasoline of a specified purity could be sold in an effort to reduce urban air pollu-
tion from motor vehicles. Refineries had to comply if they started up new production, and imported
gasoline had to comply with the regulation. Venezuela and Brazil complained to the WTO that this
was interfering with their exports of gasoline to the USA. After much legal and technical wrangling
and an appeal, the conclusion by the WTO was that the regulation amounted to unjustified discrimi-
nation and to a disguised restriction of trade. Thus, imported gasoline that pollutes air in vulnerable
areas cannot be stopped at the border.
Another case was the decree banning asbestos use in France as well as imports, exports and produc-
tion. Canada challenged the decision based on the argument that controlled use of asbestos would
reduce the health risk to an acceptable level. The case at the WTO was argued by the EU on behalf
of France. The WTO panel concluded that the French ban was allowed, because the health risk
was substantial. Canada appealed, and the WTO Appellate Body confirmed the previous ruling and
concluded:
– WTO Members have an undisputed right to determine the level of health protection they deem
appropriate.
– There is no requirement to quantify the risk to human life or health.
– The ban was considered essential because the alternative of controlled asbestos use, proposed by
Canada, was not demonstrated to be practical.
These are important concepts for OSH and could be used as arguments for stopping trade in other
health-damaging products or practices. The key to success is that there is no discrimination of im-
ported products versus domestically produced products.
692
and the development of training institutions in cluding occupational health services), education,
the relevant fields. social services and community infrastructure (e.g.
The World Trade Organization (WTO) has a drinking water and sanitation). The annual Hu-
very strong influence on OSH practice in devel- man Development Report of UNDP provides
oping countries as it can influence the accept- excellent descriptions of the impacts of globalisa-
able level of preventive practice through trade tion on social development and highlights differ-
rules and their enforcement. The priority for the ent aspects of these social issues each year.
WTO is to promote free trade and any national The 2001 Human Development Report stat-
rules or regulations that appear to be non-tariff ed that as many as 1,200 million people live on
trade barriers can incur economic sanctions. less than 1$ a day (1993 PPP US$), 2,800 mil-
For instance, if the government of Viet Nam lion on less than $2 a day and the richest 1% of
decides to severely restrict the use and importa- the world’s people (60 million) received as much
tion of benzene-containing glues, a country that income as the poorest 57% (3,500 million).
would like to export such glues to Viet Nam, can Furthermore, in 1998, the world’s richest 200
protest if an international ban is not in place. If individuals had a combined net wealth surpass-
Viet Nam maintains its ban, it can be reported ing the world’s poorest 2,500 million people.
to WTO by the exporting country. If WTO The resources controlled by the richest peo-
concludes that the ban was not needed for hu- ple are enormous compared to the needs of
man health protection reasons, Viet Nam can be the poor. A modest 1% tax on the assets of the
penalised by special tariffs on its exports to the world’s wealthiest 200 persons would fund pri-
other country. mary education programs for all of the world’s
The WTO rules mean that a country can only children currently lacking such access. Another
ban or restrict the use of a hazardous chemi- sign of this distortion of resource allocation is
cal compound or process if an internationally the lack of spending on health research that
agreed guideline from WHO, ILO or another benefits the poor. Out of US$56 billion spent by
international agency clearly advices of such bans the public and private sectors on health research,
or restrictions (see Box). This results in great only 10% is devoted to tackling the diseases and
difficulties for any individual country wishing to conditions of the poor that account for 90% of
go beyond the internationally agreed guidelines the global burden of disease. Most of the re-
for worker protection. As international agree- search funds are spent on fine-tuning treatment
ments always involves compromise, it means that of the diseases of affluence in developed coun-
occupational health and safety standards will be tries.
eroded in countries with advanced policies in In order to address health and social depriva-
this area (e.g. Sweden), while developing coun- tion issues, a meeting of the United Nations in
tries that lack OSH policies will be limited to Mexico in 2001 developed the “Millennium de-
internationally agreed minimums. velopment goals” for poverty reduction, Figure
12.1.2. The question is whether globalisation
social and health development will actually take countries towards the develop-
The social impact of globalisation includes a risk ment goals or not.
of increased inequity of income distribution and There are also goals concerning the provision
lack of societal investment in health services (in- of water and sanitation, education and commu-
693
Chapter 12.1
Goals Achievements Unfinished path
1. Halve the proportion of people – Between 1990 and 1998 the – Even if the proportion is halved by 2015,
living in extreme poverty. proportion of people living on there will still be 900 million people living in
less than $1 a day in developing extreme poverty in the developing world.
countries was reduced from 29%
to 24%.
2. Halve the proportion of people – The number of undernourished – The developing world still has 826 million
suffering from hunger. people in the developing world undernourished people.
fell by 40 million between 1990-
92 and 1996-98.
Figure 12.1.2. Two key millennium development goals for 2015.
nicable disease control. While these goals do not longer than one born 30 years ago. Many more
directly touch upon working conditions, if they people can read and write, with the adult literacy
were achieved by 2015, they will create better rate having increased from an estimated 47% in
living conditions for many of the poorest people 1970 to 73% in 1999 (UNDP data). This type
who are most affected by hazardous working and of analysis based on global averages hides the
living conditions. The lack of specific goals for underlying inequalities and the trends for the
working conditions and OSH reflects a notion rich to get much richer and the poor to get a
that OSH hazards contribute only a minor part little bit less poor.
of the global burden of disease and injury - this In the least developed countries, the situ-
may well be an erroneous assumption. There is ation is appalling. For instance, Sierra Leone
also an idea that adult health is less important has been ranked last in the HDI list for several
than child health, probably based on the notion years. A child born there, has a 50% probability
that adults can look after themselves. However, of dying before reaching the age of 39, and only
workers affected by working environment haz- 32 percent of the adults can read. The bottom
ards are often powerless to change their condi- 28 countries on the HDI ranking list are all in
tions, and ultimately, the health of parents will Africa. The epidemic of HIV/AIDS has com-
influence the health of their children. pounded the social problems caused by poverty,
The UNDP Human Development Index, as millions of children become orphans and
HDI, is measured by combining life expect- many in the working age groups succumb to the
ancy, educational attainment (adult literacy disease.
and combined primary, secondary and tertiary It is sometimes argued that improved health
enrolment) and adjusted income per capita in and life expectancy is primarily a question of en-
PPP US dollars. In most of countries the HDI is couraging economic growth in order to improve
improving, but in a number of developing coun- the GDP per capita. However, if the countries
tries´ HDI went backwards during the 1990s, are split into regions according to development
Figure 12.1.3. level, as has been done by the World Bank, the
On average for the whole world population relationships between GDP and health devel-
a child born today can expect to live eight years opment become even clearer. The industrial
694
countries have a very small increase of life ex- resources and wealth redistribution are exactly
pectancy in relation to GDP, while developing what current globalisation processes entail.
countries have a steep increase. Globalisation may create new economic op-
Economic development provides resources portunities in less affluent countries, but the
for better nutrition, housing, health care, fam- fruits of these opportunities are not always
ily planning, etc., including preventive health leading to an improved quality of life for those
activities and OSH programs. However, these working in the new workplaces.
activities to support health do not get initiated As Loewenson points out, while new formal
and maintained without sufficient financial re- employment opportunities have been developed
sources under government control, enlightened in Africa, many others have been lost. New
decision-making by governments and resource processes and forms of work organization have
allocations towards services for the poor. introduced chemical, physical and psychosocial
There are social impacts imposed by limita- work hazards unfamiliar to the workers and
tions on how much of the national resources often to their supervisors as well. New jobs tend
are applied to public services and how income is to offer few advancement opportunities, as the
distributed within society. Impacts include lower poorest countries have to accept the low-skill,
quality working environments and the result- low-technology production that is of least inter-
ing health hazards and consequences. Limited est to the affluent countries. In addition, increas-
60
54
number of countries deteriorating in:
40 37
21 21
20
14
12
0
Economic Income Hunger Child Primary HDI
growth poverty mortality enrolment
Figure 12.1.3. Lack of progress in achieving Millennium Development Goals. Number of countries going
backwards instead of forwards during the 1990s. Source: UNDP.
695
Chapter 12.1
es in productivity, often obtained by increasing rates in developing countries according to UN

the pace and intensity of work and the workload, statistics. If current fertility rates remained, the
have increased occupational health problems, world population would have reached 12.8 bil-
such as musculo-skeletal problems and stress-re- lion by 2050, which is at least 2.2 billion more
lated problems. The economic forces can create than the most pessimistic current estimate by
more inequity in the world, between countries the UN. The good news is that it seems that
and between the haves and have-nots within the global population explosion has been sig-
countries, and can undermine OSH. Globalisa- nificantly defused by family planning programs,
tion needs to incorporate policies that shield education of women, and socio-economic devel-
the workers from these negative forces if it is to opment leading to fewer children per woman.
contribute to positive social development. The potential workforce is often estimated as
The above concerns about OSH and the the proportion of the total population that is in
social impacts of globalisation are of particular the age range 15-59 years. The changing demo-
importance for women workers. Many of the graphics of the world means that this proportion
new workplaces created as a part of globalisa- is increasing in developing countries, while it
tion, primarily employ young women. This may is decreasing in industrialised countries; in the
be because young women are least likely to join former the size of the child population has been
trade unions and present collective demands large and is diminishing, while in the latter, the
for improved working conditions. Women also size of the elderly population is rapidly increas-
have low social ranking and can easily be hired ing. Many people outside this age range are in
and fired without too much fuss. Discriminatory fact actively working, and the participation of
practices, such as pregnancy testing, and poor women in the employed workforce has increased
provision of infra-structure and services for the over the years in most countries, depending on
women workers have been common concerns. social, cultural, religious and other reasons. In
Another high-risk and vulnerable group is chil- addition, the age group above 60 years of age
dren. While gender discrimination cannot be includes a considerable proportion of working
said to be an inherent feature of globalisation, people in many countries, while the 15-19 year
globalisation can definitely increase its impact if olds are increasingly continuing with education.
the social dimensions are not properly incorpo- In traditional societies, all able-bodied people
rated. participate in family and community activities
required to maintain and build their commu-
global workforce and work nity. Work is not isolated from other aspects of
organisation trends daily living, such as child rearing, cooking, and
As the world population has increased, so has other family activities. Work is limited to what
the workforce, and OSH is of importance to is necessary for survival and consolidation of the
more people than ever. In 1960 the world popu- community. Many people in developing coun-
lation was 3.0 billion, which had increased to 6.1 tries are still living in conditions similar to these,
billion by the year 2000. The median estimate and quality of life is measured differently to the
for 2050 is a population of 8.9 billion, but the quality of life in affluent countries.
population may be in the range 7.4 to 10.6 bil- OSH hazards can be of great importance to
lion depending on the developments of fertility the health of these people, but they are often
696
ignored by health authorities because the con- approximately 60 % of the male and 40 % of the
cept of work is not applied to their activities, female population of the world, Figure 12.1.5.
e.g. subsistence agriculture. Globalisation brings The “activity rate” measures the proportion of
industrial development and new structures of the total population that is involved in “econom-
employment to traditional agricultural societies, ic activities”. According to ILO statistics it has
which may further exacerbate the division be- increased slightly (from 45 to 49%), but more
tween work and other family and societal activi- important changes have taken place at the end of
ties. the age spectrum for men and in the middle age
This economically active population (EAP), is range for women. The activity rate among men
described by age and sex group in the ILO Year- has gone down considerably below 25 years of
book of Labour Statistics and in the online ILO age and above 50 years of age during the last few
LABORSTA database. Of the 3.0 billion people decades, while among women there has been a
in the world in 1960 (0.9 + 2.1 billion, Figure significant increase of the activity rate from 60
12.1.4, 1.4 billion were considered economically to 70 %, in the age range 25 to 60 years.
active (0.41 + 0.97), and in 2000 these numbers One of the key differences of activity rates
had increased to 6.1 billion and 2.9 billion, between industrial and developing countries is
respectively. the very high activity rate among children and
Thus, approximately 45% of the world’s young people in developing countries. In in-
population, and 58% of the population over 10 dustrial countries the activity rates for children
years of age, is considered as belonging to the under age 15 is now almost zero, and one can
global “economically active population”, i.e. assume that almost all of them are attending
Year 1960 1970 1980 1990 2000

Industrialized countries, total population
Both sexes 916 1008 1083 1148 1191
Men 440 486 524 558 579
Women 477 522 559 591 612
Industrialized countries, economically active population
Both sexes 410 463 523 566 601
Men 258 280 305 320 332
Women 152 182 218 246 269
Developing countries, total population
Both sexes 2104 2683 3347 4106 4865
Men 1070 1365 1705 2091 2472
Women 1033 1317 1642 2015 2394
Developing countries, economically active population
Both sexes 966 1192 1528 1932 2347
Men 616 750 945 1181 1415
Women 350 442 583 751 931
Figure 12.1.4. Total population and economically active population (in millions) in more and less developed
regions. Source: ILO statistics.
697
Chapter 12.1
Year 1960 1970 1980 1990

Industrialized countries, men
Agriculture 23 16 12 10
Industry (total) 42 45 44 41
Industry (manufacturing) 28 26
Services, etc. 35 39 44 49
Industrialized countries, women
Developing countries, men
Developing countries, women
Figure 12.1.5. Proportion of economically active population in industrialized and developing countries in
different sectors, per cent. Source: ILO statistics.
school. The rate for 15-19 year olds has also de- also industries with high risks for occupational
creased from about 50% to 30% since 1960. In injuries and diseases.
less developed regions reductions of the rates are Figure 12.1.5 shows that by 1960, the more
also taking place, but more slowly. Child labour developed regions had a workforce structure
is an important factor in these trends. that emphasised industry and services, while
Major changes in composition of the work- the less developed regions had not been able to
force, analysed by the type of economic activity come close to that type of workforce structure
have taken place during recent decades accel- by 1990.
erated by economic globalisation during the At an early stage of industrial development
1990s. Agriculture has been, and still is, the workforce change is characterized by rapid
primary workplace for the majority of people growth of manufacturing, construction and
in the less developed countries, Figure 12.1.5. transport industries. Industrialisation comes with
Health hazards of traditional agriculture include increasingly sophisticated technologies, which
vector-borne diseases, injuries, and increasingly, bring new OSH hazards. Globalisation has led
pesticides poisoning. Other primary industries, to a shift of manufacturing from the affluent to
such as mining and forestry, have developed at the developing countries with concomitant shifts
the early stages of industrialization and these are in workforce composition. OSH programs that
698
build on the knowledge accumulated from the organization. What is most efficient from a
use of the new technologies are needed to pro- micro-economic point of view, may lead to
tect workers from a variety of hazards. social and health impacts in the form of stress
Injuries, exposure to physical and chemical or reduced feelings of wellness, satisfaction and
agents, and an increasing pace of work are the achievement. If workers have less job security,
main problems in manufacturing industries, are forced to change work schedules at short
while pesticides, organic dusts, heavy physi- notice, are paid according to output even if the
cal work, biological factors and injury hazards working conditions limit their ability to pro-
are the principal occupational health burdens duce, etc., stress may cause serious mental and
for agricultural workers. As mentioned earlier, physical health problems. The reduced influence
the negative aspects of globalisation can make of trade unions in recent decades has contrib-
these trends worse for workers in developing uted significantly to these developments. Many
countries. A number of case studies show that corporations and governments have made efforts
in the worst conditions, 50-100% of the work- to limit trade union membership and involve-
ers in some hazardous industries in developing ment in work organization and OSH matters.
countries may be exposed to levels of chemical, The result is a workplace environment where
physical or biological factors that exceed the oc- individual rather than collective concerns and
cupational exposure limits applied in industrial actions are emphasized. Competition rather than
countries. collaboration is the basis of daily life. The win-
The latest wave of change also includes major ners are given privileges and higher salaries, and
growth of service industries, again accelerated by are hailed as examples for the majority to emu-
globalisation. This is very evident in the more late, the majority being defined as losers earning
developed regions and is now an emerging trend lower incomes and told to try harder. Job loss
in the less developed regions. The consequence becomes a more frequent crisis as restructur-
for the latter countries is that old occupational ing and downsizing is carried out to protect
health problems persist, at the same time, new shareholder value. In fact, the share prices of
hazards have also emerged causing a double corporations invariably rise after announcement
burden. During the last decade many admin- of substantial reductions of the workforce. Un-
istrative functions that used to be based in the employment has become a normal occurrence
home country of corporations, e.g. accounting, as macro-economic models build in a 3-6%
call-centres, and data management, have been unemployment rate as ideal. If this level drops,
outsourced to subcontractors in developing there are worries about inflation. The social and
countries. This move provides local employment health impacts of any unemployment need to be
for people trained in IT and related fields and built into economic models in order to take full
these workplaces may be seen as rather benign account of the costs to society.
from an OSH point of view. However, new haz- At country level, the proportion of the popu-
ards such as certain musculo-skeletal disorders lation that is economically active and the distri-
and stress-related diseases develop. bution according to sector can change dramati-
An important cause of stress among the cally over time due to the general economic
working population is the trend, associated situation influenced by globalisation forces.
with globalisation, towards more flexible work Unemployment varies in conjunction with these
699
Chapter 12.1
Workforce changes in Thailand in conjunction with the Bhat crisis in 1997.

Source: Stiglitz 2002
In the early 1990s the government of Thailand was encouraged by the IMF (International Monetary
Fund) to liberalize its financial sector and make the local currency, the Bhat, freely convertible on
international financial markets.
In 1997 investors suddenly lost confidence in the Bhat and the currency value fell rapidly. Thai
companies, dependent on foreign exchange, had to pay much more for it. Some companies could
not pay back their loans, and general economic difficulties emerged that led to employers shedding
staff (down-sizing) and increased unemployment. The number of employed was reduced for the first
time in many years see Figure 12.1.6. For men in the construction industry, the loss of employment
from 1997 to 1998 was particularly dramatic, with approximately one third of workers losing their
jobs. Figure 12.1.6 indicates that many of men who had been working in construction or manu-
facturing, went back to agricultural work, where they had been working in earlier years. Women
appear to have been less affected than men, but the growing trends of women’s employment in the
manufacturing and trade sectors were reversed in 1998.
changes. An example is the dramatic changes in pays back the Bhat after the currency has fallen
Thailand , where in 1997 the liberalisation of in value so that much fewer dollars are needed
capital markets made it easy to exchange Bhat to pay back the loan. A person in a position to
with other currencies and led to an attack by spread negative rumours can make big profits in
financial market players. The value of the Bhat this way. Someone has to pay for these profits
plummeted, banks and manufacturing firms rap- and in this case Thailand and its people suffered
idly experienced great difficulties so workers lost the economic consequences.
jobs which in turn impacted on their families. It should be remembered that in the least
A root cause of such dramatic changes often developed countries the major part of the work-
appears to be premature liberalization of the force is still working in agriculture, other types
financial sector and foreign exchange regulations of primary production or in small-scale industry
in a country, moves encouraged by the IMF to and service enterprises. These workers face dif-
stimulate economic growth. Such liberalisation ferent occupational health problems from those
is one of the pillars of globalisation action by experienced in the industrial countries. In the
countries that aim to attract foreign funds for least developed countries, occupational health
investment. The downside is that the foreign hazards are aggravated by numerous non-occu-
capital can be withdrawn at short notice if inves- pational factors such as parasitic and infectious
tors loose confidence, resulting in the currency diseases, poor housing conditions, sanitation,
rapidly loosing value in relation to the major and nutrition, as well as general poverty and
international currencies. Investors can engi- illiteracy .
neer a crisis of confidence in order to make fast
money on so-called short selling. For instance, export processing zones
in the case of Thailand, it means that someone Export processing zones (EPZs) are an impor-
borrows Bhat, sells them to get dollars, and then tant feature of globalisation, intended to attract
700
Variable 1990 1995 1997 1998 1999

Men, total 16.5 17.8 18.1 17.7 17.7
(%) (100) (100) (100) (100) (100)
Men, Agriculture 10.4 9.0 8.9 9.2 8.8
(%) (63) (50)
Men, Manufacturing 1.6 2.2 2.2 2.1 2.2
(%) (10) ( 13)
Men, Construction 0.9 1.5 1.6 1.1 1.1
(%) (5) (6)
Men, trade and hotel services 1.4 1.9 2.2 2.1 2.2
(%) (8) (13)
Men, Personal services 1.5 2.1 2.1 2.2 2.3
(%) (9) (13)
Women, total 14.4 14.8 15.0 14.5 14.4
(%) (100) (100) (100) (100) (100)
Women, agriculture 9.3 7.9 7.7 7.2 6.7
(%) (65) (47)
Women, manufacturing 1.6 2.2 2.1 2.1 2.2
(%) (11) (15)
Women, Trade and hotel services 1.6 2.2 2.4 2.4 2.5
(%) (11) (17)
Women, personal services 1.6 2.1 2.2 2.4 2.6
(%) (11) (18)
Figure 12.1.6. Recent workforce changes in Thailand. Number of employed people (millions).
Source: ILO statistics.
foreign investment for production facilities that – Labour-management relations: the right to
process imported materials into final exported join a union and for the union to be actively
products. Depending on their purpose they have involved with working conditions should be
been called various names, such as free trade applied in EPZs. Collective bargaining and
zones, special economic zones, bonded ware- tri-partite negotiation mechanisms should be
houses, free ports, and maquiladoras (primarily established.
along the US-Mexico border). In many cases – Human resources development: general edu-
key aspects of working conditions and OSH are cation and job skills training should be a key
specifically excluded from EPZs. An ILO list of aspect of EPZ operations, in order to broaden
priorities for improving social and labour condi- the future job opportunities for workers and to
tions in the EPZs highlights the problems that upgrade the level of production towards more
may arise: advanced technologies. This includes retraining
– Labour standards: internationally or nation- of workers as production methods change.
ally established standards for work hazard ex- – Wages and working conditions: remuneration
posures should be applied to EPZs and strongly packages should be fair and contribute to an
enforced improved living standard for the workers. Work-
ing hours is a particular problem to monitor to
701
Chapter 12.1
ensure that excessive demands are not created year growth in employment in China or a third
on the workers. This is of particular importance of the whole industrial manufacturing work-
for women. Safety issues concerning night-work force. The EPZs are clearly key components
need to be resolved. Another issue in tropical of the globalised labour market, and the OSH
countries is the impact of extreme heat on work- conditions in these zones is greatly important for
ers. workers health.
– Social infrastructure: this includes adequate The effect on employment of the EPZs in
and sanitary accommodation, safe and reliable China and other Asian countries, has created
transportation, educational and recreational fa- new job opportunities for millions of young
cilities, health centres and childcare facilities. In women, who through these jobs get an entry to
addition pension and other social security meas- the formal job market with better wages than in
ures should be provided in order to stabilize the agriculture or domestic service. However, poor
EPZ work force. work environment and work practices have been
These zones are an important aspect of For- a common concern. This has included lack of
eign Direct Investment and they have grown in proper accommodation for women workers, and
number, Figure 12.1.7, and taken on more and the creation of social ghettos in barrack style
more diverse economic activities in recent years. living quarters. Pregnancy testing to avoid em-
EPZs started as assembly factories and labour- ploying women who will need maternity leave, is
intensive processing plants, benefiting from low another aspect of gender discrimination. Frame-
salaries in developing countries, however, more work agreements between a few multinational
recent zones include finance operations, tech- corporations and international union federa-
nology and science centres, logistics and trans- tions have played an important role in dealing
port centres, and tourist resorts. with these negative factors and in upgrading the
An analysis for China using ILO statistics working conditions. As the EPZs evolve from
shows the impact that the EPZs may have on the basic manufacturing and assembly work to more
workforce distribution. Between 1990 and 2000 high-tech production and services, more men
the economically active population in China have been employed in the EPZs. Upgrading of
increased by about 80 million people. The in- the production in the EPZs is a key to improv-
dustrial manufacturing sector in China had 83 ing the working conditions and occupational
million economically active people employed in health services for workers.
1999. The 30 million people in EPZs, Figure Both the positive and negative aspects of
12.1.7, amounts to about one third of the ten EPZs have been widely discussed in recent years.
Item / Year 1975 1986 1995 1997 2002

Countries with EPZs 25 47 73 93 116
Number of EPZs 79 176 500 845 3000
Total employment in EPZs (millions) n.a. n.a. n.a. 22.5 37
– of which, China n.a. n.a. n.a. 18 30
– other countries n.a. n.a. n.a. 4.5 7
Figure 12.1.7. ILO estimates of the development of export processing zones (= EPZ). Source: ILO statis-
tics.
702
For instance, a report by a South African NGO, have flexible labour rules. They provide a form
the International Labour resource and Informa- of hidden export subsidies, and have become
tion Group suggests that four countries sur- major centres of money laundering, parallel
veyed (South Africa, Zimbabwe, Tanzania and imports of counterfeit goods and forbidden re-
Namibia) had enjoyed little benefit. A number importation of merchandise destined for other
of potential EPZ sites had been identified in the countries. Governments are getting worried
countries, but few were actually operational and about these practices, and restrictions are now
the cost per job created was extremely high. In being instituted.
Zimbabwe less than half of 138 planned EPZs
are operational. In Namibia, 25 000 new jobs traditional subsistence work
were predicted, but in fact only 370 were in Work in a traditional setting is a part of daily
place. In Tanzania only 500 of 7 000 expected routine where the boundary between work and
jobs had materialized. The report concludes that other household tasks is flexible. Many tasks
export oriented industrialisation strategies are involve health hazards, e.g. indoor cooking us-
wrong for the African region, and these have ing wood, coal, agricultural waste or cow dung
created a race to the bottom as some countries exposes the cook (usually a woman) and young
competed with each other by lowering taxes and children in her care to potentially very high
relaxing labour laws. This orientation risked levels of indoor air pollution. Levels of particu-
keeping the economies of African countries late matter and carbon monoxide are far above
underdeveloped, by encouraging the export of health guidelines and up to 100 times higher
dominant raw materials. than those measured in polluted outdoor areas.
A similar critique of EPZs in Eastern Europe, As many as 500 million women and children
points out that these zones are growing rapidly may be exposed to these conditions according
in the former Soviet Union states. These zones to WHO, 1997, and the health implications in
are free of taxes, pay low customs duties, and terms of Acute Respiratory Infections for the
Pesticides use in Viet Nam after market “reforms” of family farming
Kjellstrom, pers comm. Based on personal observations and information from staff in the Ministries
of Health and Agriculture, Hanoi, 2001.
After “Doi Moi”, formerly communally owned farms were privatised during the 1990s. Since then,
pesticides (mostly imported from China), have often been sold in the local shop with scant attention
to safety information and precautions, leading to a rapid increase of severe pesticides poisonings. In
the previous communal farming situation, specially trained staff would provide pesticides and carry
out the spraying but after Doi Moi, individual farmers were made responsible for this work, with
disastrous effects. Pesticide containers would be stored in the cooking areas, children could be ex-
posed unintentionally and leaking containers could contaminate food preparation surfaces. Pesticide
hazards are often poorly understood by farming family members and protective equipment is not
used. Overuse of pesticides also occurs, because the merchants encourage the notion that “more is
better”. After more than ten years, the Ministry of Health in Hanoi is considering how to return to
specialised pesticides spraying staff.
703
Chapter 12.1
children and Chronic Obstructive Lung Dis- alized agriculture, which uses larger amounts of
eases and mortality for the women are very large fertilizers and pesticides than traditional agri-
(approximately 2.5 million deaths/year). culture. The pesticides used may be those that
Indoor air pollution from cooking and heating have been banned or severely restricted in high-
with solid fuels in the developing countries now income countries and the risk of occupational
ranks among the most important risk factors for poisoning as well as the use of these pesticides
the global burden of disease according to the for suicides has increased. Women often work
WHO World Health Report 2002. longer hours than men and their work tasks
Daily collection of water and firewood are brings them into more contact with pesticides.
also chores that create a high work load and Their risk of poisoning may therefore be higher
many hours of walking, again particularly for than for men, and in addition they are more
women and young children. Increasing popula- vulnerable to certain reproductive effects than
tion density and meteorological conditions such men. In spite of this, studies of pesticide expo-
as droughts, make these chores even more taxing sures and effects among women are rare, and the
for many people. Opportunities for exposure to full health impact on women of this aspect of
insect and snake-bites are high in wood collec- economic development is not known.
tion activities in many tropical areas, and fresh Small-scale industrial and service enterprises
water collection creates risks of schistosomiasis. that emerge with economic development, have
The influence of globalisation on traditional some similarities with traditional work - heavy
farming includes an increasing use of pesticides workloads, poor safety precautions, and long
in family farms with few, if any, safety precau- working hours. Work usually takes place in an
tions. In addition, the globalisation pressures environment that seldom meets decent stand-
to produce foodstuffs and other agricultural ards. Family members and workers including
produce for export, extends plantation farming children, pregnant women and elderly people,
practices with associated high use of pesticides. share the work in these small-scale enterprises,
This process may also result in a reduction of such as home industries, small farms and cottage
the production of local food for family con- industries. In these situations, most workplace
sumption and associated malnutrition. exposures also affect non-working family mem-
The changing situation for women in agri- bers because most of the time is spent in the
cultural settings has been analysed in detail by combined home and work environment. It has
Leslie London. Agriculture has a central eco- been estimated by ILO, that two-thirds of the
nomic role in most developing countries, not workers of the world still work in conditions that
only because food production is a key element do not meet the minimum standards set by ILO.
in survival at community level, but also because
cash crops are seen as a way to economic de- informal and illegal work
velopment. These crops include edible plants arrangements
and fruits, as well as coffee beans, palm oil, and The above description of traditional subsistence
inedible cotton and flowers. Developing coun- work refers to issues of informal work. Much
try societies are encouraged, (or forced through of the work carried out in the world is unpaid,
“structural adjustment” policies), to establish including the daily chores that support basic
new, intensive agricultural production, industri- survival: water collection, firewood collection,
704
ILO Child Labour Convention
(http://www.ilo.org/public/english/standards/ipec/simpoc/ra/index.htm)
In the context of ILO Convention No. 182 concerning the Prohibition and Immediate Action for
the Elimination of the Worst Forms of Child Labour, 1999, the International Labour Organization,
through IPEC/SIMPOC (International Programme on the Elimination of Child Labour/Statistical
Information and Monitoring Programme on Child Labour) has carried out 38 rapid assessments of
the worst forms of child labour in 19 countries and one border area. The investigations have explored
very sensitive areas including illegal, criminal or immoral activities. More specifically, they have
focused on the topics of children in bondage; child domestic workers; children engaged in armed
conflict; child trafficking; drug trafficking; hazardous work in commercial agriculture, fishing, gar-
bage dumps, mining and the urban environment; sexual exploitation; and working street children.
The studies have been made using the ILO/UNICEF rapid assessment methodology on child labour,
which balances statistical precision with qualitative analysis, and aims to provide policy makers with
insights into the magnitude, character, causes and consequences of the worst forms of child labour
quickly and at low cost.
In addition to the 38 rapid assessment reports resulting from this project, two reports on child do-
mestic workers based on national statistics from Brazil and South Africa have been produced. The
purpose of the national reports is to provide an in-depth analysis of child domestic workers - a wide-
spread yet hidden worst form of child labour - at the country level. The findings of all the studies
will be used to determine strategic objectives for the elimination of the worst forms of child labour in
each country or region, and guide policy makers, community leaders, and practitioners to tackle the
persisting existence of these unacceptable forms of child exploitation on the ground. It is also hoped
that these reports will raise awareness and promote the urgency of preventing more children from
entering the worst forms of child labour.
residence building and repair, small-scale agri- ment, and are totally dependent on adults for
culture, fishing, cooking, etc. These activities their protection.
sometimes are more hazardous than formal em- As earlier mentioned, one of the key differ-
ployment and these hazards need to be reduced ences between activity rates in industrial and
if the benefits of modern occupational health developing countries, is the very high activity
ideas and preventive activities are to be achieved. rate among children and young people in de-
Problems in the informal economy are com- veloping countries, Figure 12.1.8. In industrial
pounded by the fact that many of these tasks are countries, the activity rates for children under
carried out by women and children. The low age 15 have now been reduced almost to zero,
status of women in many societies, mean that while in developing countries the rates are also
little attention is paid to the conditions under reducing, but more slowly; for the 15-19 year
which their work is carried out. Similarly, when olds many of these countries are about 40 years
children are the workers, concerns about work behind the more developed regions. For those
hazards get a low priority. Children are power- under 15 years of age, they are even further
less to influence their own working environ- behind, Figure 12.1.8. The high rates of eco-
nomic activity among these young people in less
705
Chapter 12.1
Year 1960 1970 1980 1990 2000

Industrialized countries, boys
Age <15 years 4 2 0.3 0 0
15 – 19 years 59 50 43 36 32
Industrialized countries, girls
Age <15 years 2 1 0.2 0.1 0
15 – 19 years 47 40 37 32 28
Developing countries, boys
Age <15 years 37 31 25 19 14
15 – 19 years 75 71 65 59 52
Developing countries, girls
Age <15 years 28 25 22 16 12
Figure 12.1.8. Percentage economically active in the age groups up to 19 years in more and less developed
regions. Source: ILO statistics.
developed regions, is one indicator of the higher cial strata they are put in. Some drug addicts also
proportion of child labour there. It also reflects use prostitution as a source of income for their
the great inequality of education opportunities pre-existing drug habits.
in the two types of regions. Trafficking of young women, girls and boys, who
There are other work arrangements and work become virtual slaves for sex services, has been
situations associated with particular health risks. given increasing attention in recent years, facili-
These include piece workers working at home, tated by low cost air travel and global outreach
contract labour, and slavery that still exists in of sex tourism and organized crime. Differences
certain countries under different names. Each in ethical and legal standards concerning pros-
situation has its own hazards, and because of titution in different countries, makes it difficult
the illegal aspects of many of these work ar- to develop a coherent international approach to
rangements, it may be very difficult to carry out deal with the problem. The globalisation of the
any OSH activities for these groups apart from sex industry is also facilitated by the Internet,
eliminating the work arrangement itself. which makes it easy for clandestine services to be
A group of workers with particular health established and advertised while its actual physi-
risks are “sex workers” involved in prostitution. cal location is moved as required.
It is mainly women who are involved, but male Informal and illegal work arrangements
prostitution is an increasing concern and their present major challenges for OSH, and eco-
health protection needs have become more nomic globalisation will exacerbate the situation
widely discussed, as a result of the global AIDS unless new global approaches to deal with the
epidemic. Sexually transmitted disease is not the negative social and health consequences can be
only health problem they face. Violence from found.
clients and pimps is a daily threat. Prostitution
is also closely linked to drug abuse, due to the
mentally and socially deprived situation of sex
workers and the ease of access to drugs in the so-
706
migrant workers countries that can ill afford the loosing of these
Migration of people between and within coun- highly trained people. In some developing coun-
tries, is an age-old issue. Wars, environmental tries, e.g. the Philippines, the training of nurses
decay and other cataclysmic events have led is at levels high above national demands, as these
to the movement of large numbers of people nurses can get jobs in industrial countries or the
throughout history. The distribution of nation- Middle East. They often transfer part of their
alities within Europe was shaped by such mass earnings home, which contributes significantly
migrations and the slave trade was another phe- to the export income of the Philippines.
nomenon that moved large population groups However, many migrant workers end up hav-
from Africa to America and the Caribbean. ing to take the jobs that local people don’t want,
In recent decades, this process has again been which can involve jobs with higher hazards.
expanded due to active recruitment of workers Wages and other conditions, such as working
from one country to another, e.g. the “guest hours, are also likely to be worse than those in
worker” phenomenon in Germany, Switzer- the regular work force. Access to health services
land, Sweden and other countries. Some West may also be more limited. All of these factors
Asia countries also have systematically recruited create more health risk related to work than in
workers from abroad, e.g. many domestic work- usual work situations.
ers in Saudi Arabia and Kuwait are from the Internal migration inside countries can be
Philippines or South Asia. driven by systematic efforts to concentrate new
Globalisation may reduce some of these flows industries in border zones or EPZs with less
of people while increasing others. As manufac- taxes, little or no occupational health regulation
turing facilities are established by multinational or protection for workers, and with other limi-
corporations in the EPZs of developing coun- tations on workers health conditions. In Latin
tries, the need for guest workers will be reduced. America, these industries are often maquiladoras
On the other hand, highly trained workers and that carry out only the labour intensive parts of
service workers from developing countries are the production while the actual product is sold
sought by industrial countries in order to fill from an industrial country base.
gaps in their workforce, caused by ageing popu- Migrant workers often have to leave their
lations with a diminishing proportion of the families in their original place of abode, leading
population being economically active. to social isolation, poor living conditions and
Health care personnel are an important group other social health risks. These include alcohol
in this context, as the increasing proportion of abuse, sexually transmitted diseases and violence.
elderly people leads to increased demands for
war, terrorism and violence
health care and services. Some countries, e.g.
New Zealand, have made conscious decisions This is an aspect of global occupational health
to train less medical doctors than required, as it that is sometimes overlooked. We are not think-
is cheaper for New Zealand to import trained ing primarily of war injuries and health dam-
doctors from selected developing countries. age in combatants, even though this is a major
One negative effect of such policies is the ex- public health issue in itself, but of injuries and
acerbation of the brain drain from developing health damage to civilian non-combatants, who
often become the victims of armed conflict. The
707
Chapter 12.1
World Health Organization stated, in an Execu- common feature of wars and conflicts, which has
tive Board paper in 1981, that “the role of health devastating effects on women and children.
workers in promoting and preserving peace is One of the destructive injury hazards that has
a significant factor in achieving health for all”. attracted major attention in recent years, is land
Unfortunately, the last hundred years have been mine damage to non-combatants. The people af-
the most violent period in human history. More fected are most often farmers, agricultural work-
than 190 million people lost their lives directly ers, or women and children collecting water and
or indirectly due to wars between or within na- firewood. It is estimated that 60-70 million land
tions, and more than half of them were civilians. mines are in the ground in at least 70 countries.
Wars or internal conflicts are often based on These cause at least 60,000 injuries and 40,000
struggles over economic resources, such as the deaths each year, and broadly defined many of
diamonds of Angola or the forestry products in these injuries and deaths are occupational. The
West Africa. Globalisation can exacerbate the people who walk into fields with mines do so
risks of such wars by providing open or clandes- because they are attempting to restore agricul-
tine markets for these goods. Global political tural production in otherwise devastated areas.
processes are often needed to control such trade Truck drivers and other transport workers are
and to get the combatants to the negotiating also likely victims of this type of violence, which
table. has the added feature of creating life threatening
Increasingly, armed conflicts involve civilians health hazards that remain as long as the mine in
- labelled collateral damage - and the conflicts the ground.
are not confined to defined battle-fields, but A new feature of violence and its effect on
extend to built-up areas. Conflicts in the Mid- workers is terrorism. Since the attack on the
dle East, Africa, and in the Balkans have caused World Trade Centre in New York in 2001, also
massive numbers of dead and injured in primari- labelled 9/11 or September 11, the US-lead war
ly civilian territory. Some civilians evacuate from on terror has dominated the international dis-
a conflict area, causing large groups of internally course and media headlines in most countries.
displaced people and refugees. Another factor Many of the victims were emergency service
is systematic ethnic cleansing as occurred in workers, or office workers in the buildings. Sub-
Rwanda and Sudan. Many occupational groups sequent attacks on a nightclub in Bali, a hotel in
are compelled to stay in very hazardous conflict Mombasa, commuter trains in Madrid and the
areas including health and emergency service London transport system also injured or killed
workers and workers in essential water and elec- many people, none of them direct participants
tricity services. The majority of civilians injured in an armed conflict. The risk of a terror attack
or killed in conflicts are women and children. may become another occupational hazard, with
Conflicts disrupt legal trade and other nor- very severe consequences but, for most people,
mal community business activities, which will relatively low probability. One of the key politi-
interfere with food production and distribu- cal challenges at the beginning of the 21st cen-
tion. Famine related to conflicts or genocide, tury is to find ways of steering the world away
is estimated to have killed 40 million people in from a path towards more and more violence
the 20th century. In addition, sexual violence is a and terrorism.
708
Many believe that widespread poverty and in- The economic forces linked to globalisation
equality sow the seeds of terrorism, and that the demand:
best way to reduce the risk of terrorist acts is to – more labour flexibility, which threatens OSH
assure that inequalities are reduced. However, with strong variations in employment and
the extremist philosophy of the terrorists is also unemployment,
driven by fundamentalists religious or ethnic – less regulation of working conditions, which
conflicts. means softening of OSH rules or enforcement
The latest major development in the area of of such rules, and
war and conflict is the war in Iraq in 2003. The – less resources provided for OSH services and
conditions in that country under Saddam Hus- preventive activities in workplaces.
sein were difficult for the average worker, but
the war did not improve the situation even years There are many examples of such negative ef-
after the regime change. Security problems have fects on OSH and a concerted effort to improve
created severe difficulties for normal life and the labour standards in all societies through inter-
breakdown of health services and basic infra- national action is an important way to promote
structure continues to be a threat to health. An OSH. The economic forces of globalisation can
important feature of this war and the coninuing also be partly ameliorated through rules and
occupation, is the enormous cost not only to the advice from the major banks and other financial
Iraqi nation, but also to the occupying countries, backers of workplace development in develop-
primarily the USA, UK and Australia. The cost ing countries but overall, there are reasons to be
of the actual fighting has been estimated at US worried about the effects on OSH from globali-
$ 200 billion (by July 2005), and the continu- sation forces.
ing occupation costs about US $ 5 billion per On the other hand, globalisation can be a
month. One estimate of the total cost including major force for a positive development of OSH
indirect costs over several years calculated that it if appropriate concern is given to the social
could reach US$ 2,000 billion. dimensions, for example, if international labour
These major outlays of financial resources standards were accepted as minimum standards
are not supposed to be recovered through or if competitive advantage from poor labour
sales of Iraqi oil, as that income should go to standards were eliminated. Improved access to
the rebuilding of Iraq. The accumulated costs information through globalisation of commu-
after only one year, amount to a figure more nications can make it easier for local agencies
than three times larger than the entire global, to assert themselves when specific OSH issues
international aid budget of approximately US$ are debated with investing enterprises. Global
50 billion. The consequences for health will be agreements on banned chemicals and technolo-
costly, and OSH will be another area that will gies, can be more easily enforced in a globalised
have difficulties getting attention and resources. system of development.
The specific national or local priorities and
challenges for osh during applications for OSH have, of course, a very
globalisation strong local flavour depending on the type of
This chapter has discussed the potential positive agriculture, industries and workplaces that exist.
and negative facets of globalisation on OSH. The degree to which globalisation influences a
709
Chapter 12.1
country will also vary; what is important in one mum standards, and through exchange of posi-
country is not necessarily important in another tive solutions to OSH problems.
because of the predominance of different types A people-centred globalisation will depend
of occupations or geographic conditions. These on resource transfer from the affluent societies
differences are also related to the development to the less affluent ones. This was already ac-
level of the country. At an early stage of devel- cepted in 1970 as a principle for international
opment traditional work in primary industries cooperation within the United Nations, when
dominates but as a country develops economi- the benchmark for foreign aid was 0.7% of the
cally, industrial work and the service sector GDP of affluent countries. Only a few countries,
usually expand and the proportion of people e.g. Norway, Sweden, Denmark, Netherlands
working in agriculture, mining, etc diminishes. and Luxemburg, have ever achieved this and the
At the global level, approximately half of the average for all OECD countries has never risen
population, (3 billion people), still live in tradi- above 0.33%. The G8 meeting in July 2005 that
tional subsistence conditions and the occupa- promised additional aid funding is a step in the
tional health impact of the changes related to right direction, but it remains to be seen how
development is very large. This impact can be much additional aid will actually be provided.
positive as traditional hazards diminish, but poor Resources need to be invested in activities
implementation of development can lead to new that build up long-term development infrastruc-
health risks. ture in the receiving countries; education, public
Globalisation carried out in a people-centred health programs, water and sanitation, housing,
manner can create improvements in living and environment protection, and improvement of
working conditions for areas and population local agriculture and other primary industries.
groups that suffer from social and economic They should not be squandered on military
deprivation and from preventable health prob- spending or luxury excesses of the country lead-
lems. Globalisation can make use of modern ership, which has so often been the case. The
scientific knowledge and available technologies development resources of a country need to be
to improve the quality of life for the billions of under democratic control. Globalisation that
people living in poverty. However, the proc- ignores these basic principles, can make things
ess must take account of the cultural and social worse rather than better.
conditions of each community. People-centred positive globalisation protects
A challenge to this homogenisation of knowledge, shared resources and other features
the world and hegemony of power has been that can be labelled aspects of the “global good”.
launched through the so-called Glocalisation We only have one planet to live on and need
movement. It is a way to build a strong network to be mindful of its limitations and possibili-
of local communities, based on mutual respect ties. Scientific knowledge that is of importance
for cultural and social differences, with an em- for the protection of life on the planet and the
phasis on local government and what it can do to health of its inhabitants should be considered to
protect its community from the negative effects be a global good, not appropriated through in-
of globalisation. The networking involved in tellectual property rights for private profit pur-
the Glocalisation movement can benefit OSH poses. If knowledge has been developed through
through sharing of common principles of mini- privately funded research, it seems reasonable
710
How intellectual property and patent rights may jeopardize

OSH implementation in developing countries
New technologies of importance to health can become so expensive that their use is delayed or totally
blocked and health is damaged. This can be of great importance for OSH implementation.
Examples include:
– the most dangerous industrial solvent, benzene, continues to be used in developing countries in
simple glues, because modern, less dangerous glues need to be imported from industrial countries
or manufactured on a licensing basis, become too expensive
– new industrial products or processes that reduce OSH risks are covered by patents that stops devel-
oping country companies using the same processes
– workplace monitoring and other safety equipment produced in industrial countries can be covered
by intellectual property rights that make them prohibitively expensive in developing countries,
where the market may still be too small for alternative local production
– the same applies to modern and safer technologies used in agriculture or industry, which are out of
reach for many workers due to intellectual property rights.
that the costs of the research are recovered. in 2002 in Doha, but its implementation has not
However, any profit beyond this would be exces- gone smoothly.
sive if it creates high prices of a drug or technol- People-centred globalisation would promote
ogy that then becomes out of reach for those the notion of essential knowledge for health
who need it. The recent controversy over AIDS becoming a global public good, and one step in
drugs in Africa is a key example of this problem. this direction would be to change the WTO-
New drugs to treat HIV-positive people so rules to reduce the Patent validity time from 20
that AIDS is delayed or prevented, are normally years to a shorter time; the time when the re-
sold at a price that is too high for the develop- search costs have been recovered.
ing country patients or their governments to Another “global good” is the global envi-
pay for. The drug companies keep the prices ronment, which is being threatened by over-
high through patents and royalties, ostensibly exploitation, pollution and careless economic
in order to recover research costs. In addition, development . Globalisation of “thought and
a large proportion of the turnover of pharma- awareness” can create a general understand-
ceutical companies is spent on marketing, which ing that decision-makers at all levels need to
for truly essential drugs should not be required. consider the impacts of their decisions on the
These costs have to be recovered, but prices global environment. Development at local level
often stay high even after these costs have been in developing countries, can be influenced by
recovered, as long as the patents make such price such positive globalisation, so that, for instance,
policies possible. An agreement for special low rainforest resources are used and maintained in
price scales on HIV/AIDS medicines for devel- a sustainable manner. Even more important is an
oping countries was reached at a WTO meeting understanding in affluent countries that a waste-
ful lifestyle and societal infrastructure has major
711
Chapter 12.1
consequences for the livelihood of people in Experience from many countries shows that a
other countries and the whole globe. healthy economy, a high quality of products or
Looking into the future, overcoming the services, and long-term productivity gains are
remaining OSH hazards due to poverty and difficult to achieve in poor working conditions
correcting the OSH deficiencies of globalisation, with workers who are exposed to health and
are not the only challenges that OSH profes- safety hazards.
sionals will face. According to a statement in Another major challenge, which all countries
1995 by occupational health institutes collabo- will have to deal with eventually, is the ageing of
rating with the WHO, growing issues of impor- the population and the adaptation of work and
tance for OSH in the future will be: how it is organized in a population with large
– occupational health problems linked to new numbers of elderly people. This is not an effect
information technologies and automation in- of globalisation as such, but this demographic
cluding stressful aspects of work organization development goes hand in hand with the trends
and ergonomic hazards leading to repetitive of globalisation. It will create expanded needs
strain injury (RSI), etc.; for social security systems and changes in work-
– new chemical substances and physical hazards; places and workforce utilisation that will impact
– health hazards associated with new biotech- on OSH. In addition, an ageing workforce may
nologies; be particularly affected by the stress involved in
– transfer of hazardous technologies; a more rapid work pace and more rapid change
– aging working populations; of work content and technologies. The ultimate
– special problems of vulnerable and unders- effects could become “burn out” and many other
erved groups e.g. the chronically ill and disa- stress-induced conditions, which has lead to in-
bled, including migrants and the unemployed; creasing numbers of workers being on sick leave
and, or taking early retirement. The current debate
– problems related to growing mobility of about the issue of an aging workforce in the more
worker populations and occurrence of new affluent countries, including Sweden, is focusing
occupational diseases of various origins. on the economic value of increasing immigra-
tion of young educated people from developing
Globalisation was not mentioned in this state- countries, but this cannot be considered a sus-
ment, probably because in 1995 it had not yet tainable solution to the challenges of an aging
become such a hot international topic. ILO work force. The depletion of people with training
established a special World Commission on the from developing countries (the brain drain) is one
Social Dimension of Globalisation that high- negative impact and another is the further envi-
lights the priority the issue has now been given. ronmental pressure (pollution, greenhouse gases,
It is an overarching driving force for several of etc.) from larger populations in high consump-
the other items mentioned above, and must be tion societies of affluent countries.
considered a key issue for OSH development.
712
12.2
Global situation concerning work related injures

and diseases
Tord Kjellström & Christer Hogstedt
the official picture which makes it difficult to assemble a true, glo-

Work related injuries and diseases come in many bal picture of the extent of work related injuries
different forms and are often difficult to record, and diseases from official records. However, es-
because other causal or risk factors than work timates of the scale of global occupational health
are also involved. A worker injured by machin- problems have been made by WHO and ILO,
ery inside a factory will clearly be classified as an using various assumptions based on the official
occupational injury, but what if the worker was statistics available.
injured in a car crash driving between two work- There are approximately 3 billion economi-
sites during working hours? It is likely that this cally active people, (mainly of working age,
will be classified as a traffic injury rather than 15-64 years), in the world, 80% of whom live in
as an occupational injury. Similarly, if an insula- developing countries. These people are exposed
tion worker who smokes develops lung cancer or to a variety of hazards resulting in major health
other respiratory disease that could be caused by problems as summarized by WHO in 1999:
asbestos, it is unlikely to be classified as an occu- – Each year, work-related injuries and diseases
pational disease in many countries. The smoking kill more than 2 million people worldwide,
will usually be considered as “the cause” of the Figure 12.2.1, which is greater than the global
lung cancer, even if the asbestos exposure was a annual number of deaths from either malaria,
major causal factor. Establishing a link between AIDS or tuberculosis.
occupation and injuries and diseases is a ques- – 250 million occupational accidents result in
tion of awareness and attitude of the diagnosing more than 300 000 fatalities annually (current
medical practitioner, and also relates to the qual- estimate 355 000). Many of these accidents
ity of recorded data on occupational exposure lead to partial or complete incapacity to work
and health effects records. and generate income, which has indirect
These examples highlight some of the reasons health effects on the family of the injured
why official statistics on mortality and morbidity worker.
from OSH hazards is incomplete in most coun- – Annually, an estimated 160 million new cases
tries. Many developing countries make poor or of work-related diseases occur worldwide,
no effort to record work related health problems including communicable diseases, cancers,
713
Chapter 12.2
Estab- Formerly India China Other Asia Sub- Latin Middle Work-
lished Socialist and Islands Saharan America Eastern related
Causes \ Market Econo- Africa and the Cres- mortality,
Regions Econo- mies of Caribbean cent Global total
mies Europe
(EME) (FSE) (IND) (CHN) (OAI) (SSA) (LAC) MEC) World

Communicable 11 2.9 98 11 27 140 20 9.9 320
diseases
Cancers 165 61 51 173 70 28 38 24 610
Respiratory sys- 17 10 13 77 7.6 6.8 6.6 8.0 146
tems diseases
Circulatory sys- 77 66 93 116 50 26 39 52 519
tems diseases
Neuro-psychiat- 7.6 2.2 2.6 2.8 2.1 0.7 1.3 1.2 20
ric conditions
Digestive sys- 2.9 1.5 3.3 4.9 4.7 1.3 2.2 1.8 23
tems diseases
Diseases of the 1.8 0.6 1.0 1.5 1.3 0.6 0.7 1.1 8.5
genitourinary
system
Accidents and 16 21 48 74 83 55 30 28 355
violence
Total mortality 298 166 310 460 247 258 138 126 2,002
Figure 12.2.1. Estimates of annual mortality (thousands) due to occupational injuries and diseases by world
region and cause of death, circa 1995. Source: ILO.
respiratory and circulatory diseases, mental was also used in the major reports by Murray
and neurological illnesses, as well as hearing & Lopez (1996) on “global burden of disease”
loss, musculo-skeletal and reproductive dis (where the DALY method was presented).
orders that rarely kill those affected. At least The established market economies include
1.6 million of these disease cases die each all “Western” industrialised countries, Japan,
year, Figure 12.2.1. Australia and New Zealand. Russia and all of
Eastern Europe is within FSE. India and China
The world regions reported in Figure 12.2.1 are are regions on their own. The most populous
those used by the World Bank (WB) for much countries in Other Asia and Islands are Indo-
of its statistics. It has become more widely used nesia, Bangladesh, Vietnam and Malaysia. This
for health data since the World Development region includes many smaller Asian countries
Report 1993, which was the first by the WB to and Pacific Islands. Sub-Saharan Africa includes
focus on health issues. This regional division all of Africa except the Northern Africa coastal
714
Global situation concerning work related injuries and diseases
World Economi- Total em- Fatalities Fatal 3 days’ ab- All accidents
region cally active ployment (thousands) accidents sence accidents reported to the
population (millions) reported to reported to the ILO (thousands)
(millions) the ILO ILO
(thousands) (thousands)
EME 409 381 16 15 7 632 7 647
FSE 185 162 21 8.7 582 591
IND 459 420 48 0.2 0 0.2
CHN 708 700 74 18 76 94
OAI 404 329 83 5.6 252 258
SSA 261 11 55 1.7 47 49
LAC 193 115 30 7.0 1,699 1,706
MEC 113 49 28 1.9 191 193
WORLD 2 732 2 165 355 57 10 480 10 537
Figure 12.2.2. Occupational injury deaths and non-fatal injuries causing absence from work by world re-
gion, circa 1995. (Injury = accidents and violence). Source: ILO.
States. Latin America and the Caribbean include dominates in the developing countries. The
all of the Americas south of the USA. The Midd ILO estimates takes this into account, but due
le East Crescent includes North Africa, the true to variation in the recording of work related
Middle East, and Pakistan. The economically health problems in different countries and dif-
active population by region varies between 113 ferent occupations, even fatalities can be poorly
and 708 million, Figure 12.2.2. quantified. The problem is highlighted in Figure
While the figures in Figure 12.2.1 give an im- 12.2.2.
pression of great accuracy, they are only calcu- In spite of the basic requirement that all
lated numbers with sizeable confidence intervals. Member States of the ILO should report fatal
The published ILO estimates include lower and work accidents/injuries, the level of under-re-
upper limits for the total occupational mortal- porting is dramatic, Figure 12.2.2. For instance,
ity, ranging from 1.9 to 2.3 million deaths. The of the estimated 48,000 deaths due to occupa-
figures for EMEs, the most affluent countries, tional injury in India, only 211 were reported to
are likely to be the most accurate, but even in ILO! The number of reported non-fatal inju-
these countries the data generally rely on work- ries causing at least 3 days absence from work
ers compensation data, which excludes people amounts to more than 10 million, Figure 12.2.2.
working outside of such insurance systems. Using the ILO reported injuries and dividing
The estimates are based on information about it by the total estimated fatalities gives an in-
the workforce mix between different economic dication of the problem of selective recording
sectors, which as was shown in Figure 12.1.6, is and reporting. For EMEs, the ratio of reported
very different at different development levels. injuries per fatality is 472, while it is 29 for the
Agriculture, with generally high injury rates, whole world and 8 for the non-EME regions of
715
Chapter 12.2
the world. If the EME ratio reflects a more valid Nevertheless, a comparison of the ILO estimate
picture of the number of injuries per fatality, of occupational injury fatality rates by region
the total number of occupational injuries caus- shows some intuitively reasonable differences,
ing at least 3 days absence from work would be Figure 12.2.3. In EME countries the rate is 4
167 million (instead of 10 million), of which 160 rising to about 25 in the MEC countries. East-
million would occur in the non-EME countries. ern Europe, China and India have about twice
It is possible that the lower ratio of injuries per the EME rate, and the other developing country
fatality in non-EME regions is partly due to a regions have higher rates again. The rates are
truly higher fatality rate per injury, but the data based on the economically active populations
available cannot elucidate this issue. listed in Figure 12.2.2. This table also includes
These higher numbers of injuries can be used ILO data on the numbers of people in employ-
to estimate the likely injury rates per worker. It ment, which are lower than the economically
is 1.8 per 100 workers and year in EME coun- active populations, particularly in the SSA, MEC
tries (one in fifty workers having a 3-day absence and LAC regions. These differences reflect
injury each year), and in non-EME countries it difficulties in getting accurate statistics. If the
would be 6.9 per 100 workers and year (one such occupational fatality rates were calculated on
injury per 14 workers each year). Compared the basis of the numbers of employed people,
with other health problems that people in the the rates for developing countries would be even
adult age groups experience, these are high rates, higher.
and with better reporting and recording systems, Most EME countries do not count traffic
and compliance with reporting requirements crash deaths as occupational injury fatalities,
from employers and workers, the true picture is even if the crash happened while the worker was
likely to be that the rates are even higher. on duty. The reason for this situation is the as-
signation of traffic crash deaths to this category
Injury fatality rate per 100,000 without any investigation of whether the person
30.0
killed was actually working when they died. One
25.0 could say that this is convenient, because the
causation of the death is kept within the sphere
20.0 of driver-vehicle-road-environment interactions
and employers are not “blamed”. In countries
15.0
such as Sweden, where complete data are col-
10.0 lected, it can be seen that the driving fatalities at
work are increasing as a proportion of all occu-
5.0
pational fatalities (in 2000 about one third), and
0.0
that fatal accidents that occur during commut-
EME FSE IND CHN OAI SSA LAC MEC ing to and from work create another significant
source of work related deaths. This factor adds
Figure 12.2.3. Occupational injury fatality rates by to the under-reporting worldwide.
world region, 2002 (per 100,000 economically The estimates for developing countries in
active persons; based on data from ILO). Figure 12.2.1, generally do not include tradi-
tional work or other informal work that may
716
in fact be inherently more dangerous than paid cers are difficult to record accurately due to the
employment in the same country. This is anoth- long latency between exposure and effect. The
er way in which the role of work in the health best data available for an occupational cancer are
status of countries is under estimated. likely to be the mesothelioma data. Many studies
The largest single disease category listed in have shown the clear link between mesothelioma
Figure 12.2.1 is cancer (about 610 thousand). mortality and asbestos exposure 20-40 years
The numbers are estimates based on the relative earlier.
proportion of these diseases in total mortality by Another example of problems with the differ-
Leigh et al. in 1999 and the assumed attributable ent estimates is the number of pneumoconiosis
risk from occupational hazards. This method disease cases, Figure 12.2.4. Considering that
involves large uncertainties. For hazardous the global number (36 thousand) represents
substances in the workplace an estimate of the annual deaths (incidence), and assuming that a
associated mortality was made for Australia. The victim is likely to have lived with the disease for
resulting number (2,290 deaths) was four times 10 years before death, and assuming that half of
higher than that caused by occupational acci- the victims die of this occupational disease, one
dents. When the same methodology is applied can calculate that the global prevalence would
globally, exposure to hazardous substances could have to be 720 thousand cases. However, in
cause some 315 thousand cancer deaths per year, Southern Africa alone it has been estimated that
Figure 12.2.4. Note that this is for hazardous there could be 480 thousand cases of silicosis.
substance exposures only, and does not include Loewenson calculated that in Southern Africa
other causes of occupational cancer, such as uncontrolled dust hazards are common, particu-
solar UV-radiation which causes skin cancer in larly in mines, quarries and foundries, and silico-
outdoor workers, are not included. This is one sis and silico-tuberculosis are growing problems.
explanation for the higher figure (610 thousand) Based on prevalence surveys of silicosis, and
in Figure 12.2.1. generalising the results to an estimated 2 million
Cardiovascular diseases, respiratory disease former miners in Southern Africa, indicates that
and pneumoconiosis are three other important there would be 480 thousand cases of silicosis.
effects of hazardous substances contributing Considering the large populations working in
to the estimated total of 438 thousand deaths. in these occupations in China, India and other
For 1990 Takala at ILO estimated that the total Asian countries, 720 thousand appears like a
was 341 thousand. The difference reflects new major underestimate. China alone has about 3
methodology, larger populations and possibly an million mine workers.
increasing trend. Workers with silicosis have an increased risk
Again, these figures are approximate and of tuberculosis, and the surge of HIV infections
only indicate the magnitude of the occupational adds considerably to this risk. The emergence of
disease mortality problem. Figure 12.2.1 re- multi-drug resistant tuberculosis creates major
veals some other inconsistencies, apart from the public health and health service concerns, in ad-
number of cancers. However, as Figure 12.2.4 dition to the occupational health concerns.
was an estimate for hazardous substances only,
the numbers for a particular disease should be
lower than in Figure 12.2.1. Occupational can-
717
Chapter 12.2
Causes of death No. of deaths, whole Estimated percentage attributed No. of deaths
world (thousands) to hazardous substances attributed to
hazardous
Men Women Men Women substances
(thousands)
Cancer (Total) 315

Lung cancer and mesothelioma 996 333 15 % 5% 166
Liver cancer 509 188 4% 1% 22
Bladder cancer 128 42 10 % 5% 15
Leukemia 117 98 10 % 5% 17
Prostate cancer 253 1% 2.5
Cancer of mouth 250 127 1% 0.5 % 3.1
Cancer of oesophagus 336 157 1% 0.5 % 3.5
Stomach cancer 649 360 1 % 0.5 % 8.3
Colorectal cancer 308 282 1% 0.5 % 4.5
Skin cancer 30 28 10 % 2% 3.6
Pancreas cancer 129 99 1% 0.5 % 1.8
Other and unspecified cancer 819 1 350 6.8 % 1.2 % 72
Cardiovascular disease,
15–60 years 3,074 1% 31
Nervous system disorders,
15 + years 658 1% 6.6
Renal disorders, 15 + years 710 1% 7.1
Chronic respiratory disease,
15 + years 3 550 1% 36
Pneumoconioses estimate 36 100 % 36
Asthma 15 + years 179 2% 3.6
TOTAL 438
Figure 12.2.4. Estimated global annual average number of deaths attributable to occupational exposure to
hazardous substances by condition. Source: Takala, ILO, 2000.
718
World Region Economically active population Total occupational Total occupational fatality
(millions) mortality rate/100,000
(thousands)
EME 409 298 72.7
FSE 185 166 90.0
IND 459 310 67.6
CHN 708 460 65.0
OAI 404 247 61.0
SSA 261 258 98.9
LAC 193 138 71.2
MEC 113 126 111.3
WORLD 2,732 2,002 73.3
Figure 12.2.5. Total occupational mortality and mortality rates by region. (rate per 100,000 in economically
active population) Source: ILO.
Considering the overall occupational mortal- Activities, (ISIC – Revision 3), are included in
ity again and calculating the rates for different the table. This is a revision from 1993, which
world regions, Figure 12.2.5, we find that the creates some difficulty in comparing with earlier
some developing country regions (notably China years.
and India) have surprisingly low rates compared Nevertheless, the comparison between four
to EME countries. These numbers do not match countries, Figure 12.2.6, provides a snapshot of
the picture given by Figure 12.2.3 for occu- the higher occupational injury fatality rates in
pational accident injuries. One logical reason developing countries and in certain sectors, such
for the difference is that occupational diseases as agriculture, fishing, mining, construction and
mainly affect older people and often are only transport. As these are sector-specific rates, they
diagnosed after many years latency (e.g. can- are not affected by different numbers of workers
cers). However, it is likely that the occupational in the industry in each country.
fatality rates in Figure 12.2.5 are underestimated Mining and transport are linked to the most
for each region. extreme risks in Zimbabwe, while Argentina has
Another way to analyse this issue is to com- the highest rate for construction. In light of the
pare rates in different economic sectors. Few under-reporting mentioned earlier it is likely
countries provide enough detail in their reports that the true rates are even higher. The trends
to ILO to make such comparisons. Figure 12.2.6 over time are difficult to ascertain, however,
attempts to give an impression of the relative more detailed comparisons of this type can assist
dangers in different sectors. The codes for the in identifying which groups of workers should
different categories in the International Stand- receive priority when OSH programs are estab-
ard Industrial Classification of all Economic lished.
719
Chapter 12.2
Sector (ISIC code) Fatality rates, different countries

Country Sweden USA Argentina Zimbabwe
All occupations 2 5 15 20
Agriculture and fishing 20 23 31 20
(A+B)
Mining and quarrying (C ) 14 26 27 69
Manufacturing (D) 1.6 3.4 13 7.5
Electricity, gas, 5.6 --- 28 13
water supply (E)
Construction (F) 5.4 15 39 21
Trade and restaurants 0.7 --- 8.8 9.0
(G+H)
Transport (I) 4.4 13 32 65
Financial and business 0.8 1.4 11 4.4
(J+K)
Administration, education, 1.0 2 6.5 15
health, and other (L – O)
Figure 12.2.6. Occupational injury fatality rates in different economic sectors, average 1995-2000 (unit:
deaths per 100,000 economically active workers in sector). Source: ILO.
hazards of importance in new monitor developments and to identify and com-

workplaces of developing municate information on hazards to employers,
countries planners and decision-makers.
Mechanical factors such as unguarded ma-
Detailed information on specific occupational
chinery, unsafe workplace structures or danger-
exposures in different work situations can be
ous tools, are among the most prevalent hazards
found in the previous chapters of this book and
in both industrial and developing countries,
a number of recent textbooks and reference
affecting the safety and health of a high propor-
volumes, e.g. the ILO Encyclopaedia of Occupa-
tion of the workforce. The limited comparisons
tional Safety and Health. This section will refer
that can be made, e.g. Figure 12.2.6, indicate
briefly to some key issues concerning important
that injury hazards are particularly common
hazards for globalising economies.
in certain economic sectors of developing
It is important to point out that some of the
countries. Most occupational injuries could
changes in the structure of the workforce in de-
be prevented by relatively simple preventive
veloping countries, as an outcome of globalisa-
measures in the work environment including
tion, may lead to less dangerous workplaces and
improved working practices and safety systems
reduced exposures to hazards. In addition, the
and through appropriate behavioural and man-
investments in new workplaces can be used to
agement practices. Such measures would signifi-
introduce newer, more modern and safer tech-
cantly reduce accident rates within a relatively
nologies. OSH professionals are well placed to
short period of time, however, the experience
720
and safety knowledge that helps to prevent been diagnosed. The symptoms are pain and
injuries needs time to accumulate, and the in- lack of strength in key muscles, which limits the
troduction of new technologies can have serious ability of the worker to perform essential job
impacts. The injury risk is usually much higher tasks or to continue working at all. OOS is a
among inexperienced workers so the responsibil- common outcome of the rapid work pace im-
ity of workplace supervisors and managers/own- posed in mechanized industries, often in export
ers to target prevention activities at new workers processing zones. Prevention requires appropri-
is particularly relevant. Accident prevention pro- ate ergonomic design of the workplace in order
grams in high-risk situations can be highly cost- to reduce strain on muscles and joints in addi-
effective and yield rapid results. Unfortunately, tion to a system of management that establishes
ignorance of such precautions, particularly in regular working hours and rest breaks.
sectors where production has grown rapidly, has Chemical hazards are an increasingly impor-
led to increasing rates of occupational accidents. tant concern as countries develop new industries
Between 10% and 30% of the workforce in as an outcome of globalisation. About 100 000
industrial countries and between 50% and 70% different chemical products are currently used in
in developing countries may be exposed to heavy work environments, and the number is increas-
physical workload or to un-ergonomic working ing constantly. The extent of exposure varies
conditions such as lifting and moving of heavy widely according to the industry, activity and
items or repetitive manual tasks according to the country. However, it should be stressed that
WHO. Repetitive tasks and static muscular load among the 100 000 chemicals there are a few
are found in many industrial and service occupa- that still cause most hazardous exposures, such
tions. In industrial countries musculo-skeletal as lead, organic solvents, organo-phosphate
disorders are the main cause of both short-term pesticides, etc.
and permanent work disability, potentially caus- The most common health effects of chemi-
ing economic losses of up to 5% of the GNP. cal exposures at work are damage to the central
Most exposures can be eliminated or mini- nervous system, liver, skin, respiratory system,
mized through mechanization, safety barriers, cancers and reproductive disorders, as well as
ergonomic improvement and better organization specific poisoning effects of metals, solvents
of work and training. In addition, the growing and pesticides, are among the health effects of
numbers of elderly workers require constant chemical exposures at work. Pesticide exposure
vigilance from those responsible for the work is the major chemical hazard in tropical develop-
organization in order to avoid injuries. ing countries where personal protection is par-
An important aspect of mechanization, as- ticularly difficult to use due to heat exposure and
sembly line production and repetitive tasks, such where preventive means should be implemented.
as continuous computer keyboard work, is the Some pesticides should be banned and ideally, if
wear on muscles, tendons and joints that may a product was banned in an industrial country, it
eventually lead to “repetitive strain injury (RSI)” would then be viewed as hypocritical if its use in
or “occupational overuse syndrome (OOS)”. developing countries was allowed to continue.
This syndrome also has many other names, However, the globalisation of trade and the
depending on the exact anatomical location of agriculture industry does not necessarily create
the injury and the pathological change that has globalised prevention paradigm.
721
Chapter 12.2
A case-study that illustrates this point is given through enforcement of regulations and other
by LaDou in 1999 in his analysis of the use means, was shifted to the developing countries
of DBCP (dibromochloropropane), a chemi- using DBCP while the USA continued to import
cal pesticide banned for use in the USA in the the agricultural products treated with DBCP.
1980s due to its ability to reduce fertility in men. There are often alternative, less toxic methods of
However, the USA continued to produce DBCP pest control available (see Box) . Local access to
and the pesticide continued to be exported to information about the hazards and the options is
developing countries for many years. The re- an essential element in effective OSH programs.
sponsibility for occupational health problems,
Alternative pesticides
Toxic chemical pesticides have important applications when insects, fungi, and plant diseases seriously
reduce harvest yields. However, on average, the potential yield enhancement from the use of chemi-
cal pesticides is often exaggerated by those selling pesticides. Alternative methods of pest control can
often maintain the yield at 90% or more of the yield using chemicals. A similar case has also been
demonstrated by farmers who switch to organic farming when the higher price that can be achieved
for organic food items in Europe and North America more than compensates for any yield loss.
One way of reducing toxic chemical pesticide use is to apply “Integrated Pest Management” (IPM)
techniques as recommended by FAO. These techniques combine the careful monitoring of plant
pests with systematic use of low intensity chemicals, when and as required. This technique requires
farmers to be trained and to be prepared to take the necessary time to monitor their plants, instead
of spraying set volumes of pesticides defined dates in the stage of plant growth, thus reducing the
unnecessary use of pesticides. The IPM approach also uses carefully designed “companion planting”
which works because different insects are attracted to, or repelled by, different plants. For example,
careful mixture of maize and grass planting in Kenya increased the maize yield by 30%.
Another important way to reduce pesticides poisonings is for farmers to use the least toxic pesticide
that does the job and to take the specific precautions required for each pesticide. A voluntary code of
practice developed by FAO and international chemical industry organizations is intended to ensure
that appropriate hazards and safety information is provided throughout all stages of production, ship-
ment, wholesale, retail and application of pesticides. Local OSH professionals can use this code of
practice to request information.
Other means of ensuring that the information reaches the users of the pesticides include the Pesticide
Information System in Malaysia and similar government operated systems in many developing coun-
tries. Poison Control Centres are another source of information. In addition, there are a number of
NGOs active in the prevention of chemical poisoning through the provision of information, includ-
ing internet websites.
(see: http://turva.me.tut.fi/iloagri/case/case.htm)
722
An important OSH concern is the export of women and children. It should be pointed out
agrochemicals, already banned in developed that the chemical industry itself several years ago
countries due to high human toxicity or eco-tox- adopted a voluntary code of conduct under the
icity, to developing countries. An analysis of the auspices of FAO. If followed, this code should
export of highly toxic banned or never registered reduce the risk of poisonings.
pesticides showed that 14 000 kg per day were Many other “historical” chemical exposure
exported from the USA to developing countries. situations from affluent countries have been
The receiving countries usually have very limit- shifted to developing countries. The concept
ed resources to develop and/or enforce effective of “export of hazard” is well established and, in
national regulations concerning pesticide safety. some cases, whole factories using out-of-date
Toxicology expertise is limited and the primary technologies are moved from affluent countries
health care facilities that are the first contact to developing countries. This aspect of globali-
point for poisoned agricultural workers and their sation is particularly detrimental to effective de-
families are likely to have very limited possibili- velopment of OSH in developing countries. One
ties for appropriate tests and effective treatment. example of this is the problem of use of very
Such practices go against official USA declara- toxic solvents in glues used in shoe manufacture
tions and restrictive policies on pesticide exports. and other industries in developing countries,
This is a problem that cannot be solved solely even in production units that have been recently
by action in the developing country receiving installed as part of the process of globalisation.
the pesticides. High risk groups for exposure are
Replacing hazardous solvents with less toxic varieties

Organic solvents are some of the more toxic compounds widely used in industry, primarily in glues,
paints and cleaning fluids (e.g. for cleaning oil and grease of metal items). Benzene was one of the
first solvents used in workplaces, but it is very toxic and carcinogenic (leukaemia) and has now been
eliminated from routine use in industrial countries. However, it is still used in some shoe factories in
developing countries, and is highly hazardous for workers. The multinational company NIKE, was
embarrassed some years ago when it was found that their sub-contractors (usually Korean or Tai-
wanese owned factories in other countries, such as Vietnam), were using benzene-containing glues,
a process long seen as obsolete process in industrial countries. NIKE changed to water-based glues,
and also implemented other OSH improvements to avoid further embarrassment. However, other
shoe factories in Vietnam, many of them owned by the Vietnamese government, are still using the
very toxic glues.
Solvents that are less toxic than benzene include (in order of descending toxicity): toluene, xylene,
kerosene, and water. The level of toxicity is determined not only by the mechanism of toxicity, but
also by the degree of volatility of the compound which determines how much of the solvent will be
found in the workroom air. The ranking of solvents in order of descending toxicity is sometimes
called the solvents ladder, and good OSH practice would check that the least toxic solvent is always
used.
723
Chapter 12.2
Occupational dust diseases are also a common affluent countries . In this context, it is disturb-
and increasing concern in developing coun- ing that corporations from affluent countries
tries, partly caused by the growth of mining and manufacture asbestos products in their subsidi-
quarrying industries in these countries, linked ary companies in developing countries. These
to the growth of the construction industry and products are then sold only in developing coun-
to the development of exports from mines and tries. For example, a German company produces
metal smelting industries. Estimates from epi- asbestos brake linings in Brazil, solely for de-
demiological studies have indicated that many veloping country markets. This practice totally
thousand of silicosis cases are found each year in ignores the future health impacts of asbestos in
China alone, and the situation in other countries developing countries.
with many mines, e.g. India, is likely to be simi- Sweden has reported only a few new cases
lar. of silicosis or asbestosis during the last decade.
Asbestos exposure continues to be an ongoing This is due to a major national campaign in the
global problem, even though all industrial coun- 1970s on the prevention of dust exposures with
tries have placed severe restrictions on the use of high silica content and the banning of asbestos
asbestos or totally banned its use , e.g. Sweden imports in 1975. However, asbestos-induced
and Australia. Asbestos has technically useful mesothelioma and lung cancers continue to oc-
properties for fibre-cement building materials cur and the incidence has actually increased due
and in motor vehicle brake linings and gaskets to long latency periods for most cancers. Even-
but alternatives do exist, and are used in all tually, the incidence will decrease.
Asbestos alternatives
There is very limited need to continue the use of asbestos in building products, brake linings and in-
sulation materials given the extremely hazardous nature of asbestos. Wood-fibre can replace asbestos
in fibre cement product and insulation materials can use glass-fibres and other less hazardous fibres.
However, each replacement material must also be used with caution as almost any fibres can cause
some detrimental health effects if exposure is high. The web-site of the London Hazards Centre,
(http://www.lhc.org.uk/members/pubs/factsht/59fact.htm), lists the hazard of each asbestos alterna-
tive and stresses the need for dust control in all jobs with potential fibre exposure. It is important to
note that all the alternatives to asbestos are considered to have lower risk of cancer and pneumoco-
niosis than asbestos.
The alternatives listed include Ceramic fibre; Glass fibre; Glass and stone wool; Wollastonite; Perlite;
Cotton fibres; Shredded paper; Cellulose fibres (wood fibres); Kevlar
��
(para-aramid) fibre; Polyvinylal-
��
cohol (PVA) Fibre; Polystyrene;
Detailed information on the health hazards of different fibres is available from the World Health
Organisation (WHO), the International Agency for Research on Cancer (IARC) and the UK Health
and Safety Executive (HSE).
724
However, in a number of developing countries, of increase, but with a 20 year delay. There are
e.g. China, Viet Nam, Indonesia, and Brazil, 7 000 asbestos-cement product manufacturing
asbestos fibres continue to be used in produc- workers in Viet Nam and many more who use
tion of fibre-cement building products such as the products in their daily work according to
roofing panels, and brake linings. This is likely Viet Nam Ministry of Health. The future epi-
to lead to significant and dangerous exposures, demic of asbestos related cancers in the develop-
in spite of alternative safer products being avail- ing countries is likely to become a real burden
able. In most of these countries it is either too on the health care systems of these countries, in
early to be able to record an increase of asbestos addition to the pain and suffering of the affected
induced mesothelioma due to the long latency, workers and their families.
or the data for analysis just doesn’t exist. Some Various biological hazards, including viruses,
information from Hanoi in Viet Nam gives an bacteria, parasites, fungi, moulds and organic
indication of what may be on the horizon, when dusts, are common causes of occupational dis-
compared with Sweden, Australia and New Zea- eases in developing countries. Exposures in
land, Figure 12.2.7. traditional subsistence work are of particular
The mortality rate is going up dramatically importance. Lung infections, organic dust dis-
in the three industrial countries during the first eases such as bagassosis (from sugar dust) and
years. In Sweden there is an indication that occupational asthma occur among persons ex-
the increase is slowing down, but this is not in posed to organic dust. Hepatitis B, Hepatitis C
evidence in Australia and New Zealand. The and tuberculosis infections occur particularly
Hanoi data appear to follow a similar pattern among health care workers. The global spread of
120
100
80
60
40
20 NZ
Sweden
0 Australia
1966 1976 1986 1996
Hanoi
Figure 12.2.7. Mesothelioma (or pleural cancer) mortality rates (crude, per million people) in three coun-
tries and Hanoi city at different times.
725
Chapter 12.2
improved health care methods and technology protection, such as ear plugs or ear muffs, is the
would assist in controlling these occupational most common approach to prevention, but it
diseases, but the lack of resources allocated to is less effective than reduction of the noise at
health services in many developing countries source. Modern, quieter manufacturing technol-
mitigates against such OSH improvements. ogy can be introduced when new industries are
It should also be noted that vector-borne established in developing countries, but in many
tropical diseases such as malaria and schisto- cases old technology is exported to these coun-
somiasis are common in the general population tries bringing with it the noise problems that
of many developing countries and are likely to previously affected workers in industrial coun-
be a particular risk for agricultural, forestry and tries. An emerging new concern about noise is
other outdoor workers. The opportunities to the so-called “acoustic shock syndrome” caused
apply protective devices against mosquitoes or by high pitch noise peaks due to malfunction-
other insects spreading these diseases can be ing equipment or wilful noise exposures by the
very limited when work has to be carried out at person at the other end of the phone line. With
a time and place where the vectors are prevalent. the increasing number of people, mainly women,
Protective devices are too expensive for most employed as telephone operators in call centres
workers to buy and these devices may make the and telephone marketing firms, these problems
physical workload greater or at least slow the are likely to increase in the future.
work down. Supervisors and workers may pre- An issue that has received little attention, is
fer that protective devices are not used as the the effect of high temperature and humidity on
demands of globalised agriculture require the people’s ability to work both in traditional and
highest possible production output per worker. modern occupations. This is of particular impor-
Unskilled workers who become ill are easily tance in tropical countries, where temperatures
replaced. and other climate variables in the work environ-
Other occupational diseases such as lept- ment, are already within the danger zone. Glo-
ospirosis, brucellosis and psittacosis, are caused bal warming will exacerbate this hazard in many
by biological factors and spread from domestic parts of the world. The human body needs to
animals to farm workers. In addition, new dis- maintain a balance between surplus heat cre-
eases from mutating viruses spread from farm ated through muscular work and the heat loss or
animals, have become a major concern. One heat uptake from the surrounding environment.
example is SARS, (severe acute respiratory syn- Sweating is an important mechanism to release
drome), which emerged out of farms in southern heat from the body, but the cooling effect of
China at the end of 2002. SARS spread from sweat evaporation is less efficient when the
person to person, and then spread rapidly to humidity outside the body is high making heavy
other countries across the globe, via air travel. work difficult.
Physical factors, such as noise, vibration, ion- The International Standards Organization
izing and non-ionizing radiation and microcli- (ISO) standard for work in hot environments
matic conditions are major occupational health prescribes reduction of work time and increas-
hazards. Noise-induced hearing loss is one of ing the length and number of rest periods as the
the most prevalent occupational diseases in both temperature and humidity get higher, Figure
developing and industrial countries. Personal 12.2.8. The figure shows how “work ability” is
726
decreased when the WBGT increases (wet bulb continue for many hours without the risk of heat
globe temperature, which is a heat stress index stress effects on the individual.
of temperature, humidity and heat radiation). This particular occupational health hazard
Even a small increase of WBGT of only one is related to current, global workforce develop-
degree can cause a dramatic reduction of 20 % ments and the globalisation process. One issue
in work ability. The effect of heat exposure starts is the increasing number of workers in con-
at a lower temperature for people who carry out struction and manufacturing jobs in tropical
very heavy work (500 Watts) compared to office developing countries. In addition, one effect of
workers (200 Watts), Figure 12.2.8. It should be the Western economic development model, that
pointed out that “work ability” as expressed here includes high energy consumption, is increased
does not mean absolute ability to work – clearly greenhouse gas emissions and global climate
many people in tropical countries are working change. The increasing temperatures and more
even if the temperature is higher than 34-39 violent weather patterns associated with global
degrees C. However, such work activity cannot climate change have now been documented all
Work ability (%) as a function of WBGT (degr.C)

at 4 work intensities (Watts), acclimatized
100%
90%
80%
70%
Work Ability %
500 Watts
60%
400 Watts
50%
300 Watts
40%
200 Watts
30%
20%
10%
0%
20 25 30 35 40
Temperature C
Figure 12.2.8. Relationship between the percentage of a work hour that a person can work according to
international guidelines (“work ability”) and the heat stress index (WBGT in degrees C) Source: Kjell-
strom, 2000.
727
Chapter 12.2
over the world. The effect on workers will be munications in developing countries may rely
increased heat stress and lower productivity. The heavily on mobile phone technology, and the is-
latter may be seen as a production obstacle for sue of safety will undoubtedly become a concern.
employers, but in fact the worker may suffer the To be able to respond to any such concerns, the
consequences by having to work longer hours OSH professional will need to seek out the latest
(see Box). reliable information. New evidence may change
Since the 1990´s there has been intense con- the current thinking about this hazard.
cern about the possibility of increased cancer Psychological stress caused by such things
risk from electromagnetic fields (EMF) associ- as time pressure, the high speed of work, and
ated with “cellular phone” technology or high insecure employment, (part time, casual, con-
voltage power lines. Some reports indicate a tract), has become more prevalent during the
small risk increase of leukaemia among children past decade. Globalisation has created a new
living close to power lines, but the exposures emphasis on “competitiveness” between enter-
have to be high, and the conclusions by interna- prises and countries, which has lead to increased
tional review groups are that these risks have not pressure on workers and employees at all levels
yet been proven. It is still too early to fully eval- to work harder and faster. Workers are unable
uate the potentially harmful effects of the expo- to adapt their workload and working hours to
sure to cellular phones and large scale research other needs, such as family needs, because of
efforts are ongoing. This hazard is mentioned long working hours and less flexibility. So called
here because the future development of telecom- work flexibility, such as weekend work or split
Heat and work in Viet Nam
A shoe factory in Haiphong, Viet Nam, employs 2 900 young women producing sports shoes for the
European markets. Haiphong is very hot with temperatures of 30-38C degrees inside the factory in
the summer, with relatively cool temperatures of 15-20C degrees in the winter. The factory is not
air conditioned so during the summer the workers have to work longer hours to maintain the daily
production quota. On hot summer days, workers have to spend at least two hours longer at the work-
place, including at least one hour of extra work, in order to reach their production targets.
A comparison of typical working days in winter and summer:.
• WINTER • SUMMER
• 7.30 start work • 6.30 start work
• 10 - 10.15 break • 10 - 10.30 break
• 11.30 - 12.30 break • 11.30 - 13.00 break (employer provides complimentary
• 15 - 15.15 break bean soup)
• Finish at about 18.00 (when production target • 15 - 15.30 break
reached. Same target in winter and summer) • Finish later at about 19.00 because of heat
728
shifts, may be convenient for enterprises but therefore be argued that lack of OSH services
often means the opposite for workers, leading is in itself a work hazard in newly developing
to mental and physical stress. The problem of workplaces. Only 5-10% of workers in develop-
heat highlighted (see Box) is just one example ing countries and 20-50% of workers in indus-
of enterprise requirements causing stress in the trial countries (with a few exceptions) are esti-
form of time demands on workers. mated to have access to adequate OSH services.
The type of work organization and manage- In the USA, for example, 40% of the workforce
ment of workplaces that goes with the current of approximately 130 million employed people,
form of globalisation creates uncertainty and does not have such access. A consequence is that
often a sense of failure within a very competitive even in advanced economies, a large proportion
environment. The flexibility of work organiza- of work sites are not regularly inspected for
tion is associated with societal trends towards occupational health and safety.
individualization and a loss of social capital. The
result is that young people in modern indus- unemployment as a health hazard
trial society worry more about the future and This chapter and previous chapters describe a
achievement of their goals and aspirations than number of OSH hazards and their effects while
young people do in traditional societies. The ef- people are working. It should be pointed out
fect on mental health can be seen through drug that lack of income due to unemployment or
use, suicide, and depression. under-employment is another important health
Other factors that may have adverse psycho- hazard related to work, particularly in countries
logical effects include heavy responsibility for where the social security system is poorly devel-
human or economic concerns, monotonous oped. ILO estimates that the number of people
work or work that requires constant concentra- unemployed or underemployed in the world
tion. Those who work shift-work, in isolation or today exceeds 800 million, almost one-third of
have jobs where violence is threatened, e.g. in the global labour force.
security, police or prison work, are also prone to It is therefore relevant to consider the role
psychological stress. globalisation has in employment and unem-
Psychological stress and overload have been ployment. As was pointed out in Chapter 12.1,
associated with sleep disturbances, burn-out globalisation may increase economic activity
syndromes, stress, nervousness and depression. or employment in certain sectors, while other
There is also epidemiological evidence of an sectors shrink. While the quantity of available
elevated risk of cardiovascular disorders, particu- work is an issue, the quality of work also affects
larly coronary heart disease and hypertension. various OSH issues. One of the key features of
The European Commission distributed a guide globalisation is the requirement for a “flexible”
on work related stress, subtitled “Spice of life or labour market, which in plain language means
kiss of death”. The guide provides a checklist for that the employer should be able to increase
work related sources of stress and examples of or reduce the workforce at short notice so that
successful intervention programs. only the number of workers needed for produc-
These hazards will be of particular concern tion requirements are paid - a system akin to the
where proper OSH services are not in place to “just-in-time production” paradigm. This kind
monitor exposures and work practices. It could of system creates great insecurity for workers as
729
Chapter 12.2
the number who gain or lose income may vary led to protracted unemployment for groups of
dramatically depending on short term produc- people, already vulnerable in the labour market.
tion requirements. Financial and job cuts in the public sector have
The implementation of flexible labour mar- damaged public health. Cuts in the public health
ket principles has led to a rapid increase in the sector were often demanded by the IMF as a part
number of part-time workers in many countries, of economic re-adjustments in heavily indebted
for instance in the USA. For many families with countries in the 1980s and 1990s.
young children, a part-time job is often the only Insecure employment and the lack of in-
solution to get into the labour market, but the come during periods of unemployment, are
limited income this creates may not be sufficient both stress factors detrimental to the health of
for the family’s needs. Affordable childcare is a workers. Studies of mortality and morbidity
key issue linked to the entry by women into the among unemployed people in industrial coun-
labour market. This has been an essential issue tries regularly show that unemployed people
for government policy in most industrial coun- have poorer health than employed people. This
tries, in e.g. Sweden. Part-time work may repre- effect is likely to be even stronger in developing
sent an aspect of under-employment, which can countries, even though informal and temporary
have similar negative impacts on workers health work can be a way to maintain income dur-
as unemployment does. ing periods of unemployment. The dramatic
While a flexible labour market may cut costs changes in Thailand after the currency crisis in
for the employer, it can also create consider- 1997, caused a drop of employment in manu-
able difficulties if it takes time to find new facturing but a simultaneous increase in the
and/or skilled workers when production needs number employed in agricultural work. This was
to increase. Employers are more likely to retain reversed over the next few years, indicating that
highly skilled workers during leaner times be- manufacturing workers temporarily moved back
cause they are harder to replace. to farming as an alternative to living in poverty
The public sector has experienced specific in the cities.
impacts on employment from globalisation. A key issue is whether globalisation is a solu-
Clearly, in some countries the government has tion to unemployment in developing countries
employed too many people in obsolete jobs and a or whether it creates unemployment - both
restructuring of public workplaces to create more scenarios are claimed. As pointed out in earlier,
meaningful output at reasonable cost is a posi- it is the way in which globalisation is imple-
tive change. However, globalisation incorporates mented that determines its influence on employ-
a general notion that public services are always ment and related health issues. Factors that may
inefficient and that the private enterprise can do destroy more employment than create it, include
a better job of providing water, electricity, mass rapid social change due to reduced capital flow
transport, etc. Tax cuts are promoted along with restrictions across borders, manufacturing in-
privatisation but this often means a reduction in dustries that are itinerant and move at the whim
public services and higher costs for service users. of the multinational corporations, transfer of all
Numerous examples illustrate how privatisation added value (profits) of production to industrial
has created more problems than it has solved. countries, the undermining of traditional eco-
Public sector workforce reductions have often nomic activities, etc.
730
the occupational burden of disease tion, each year of life lost will be given a weight
and injury according the age of the person, so that a very
The measurement of the extent of occupational young and a very old person is given a lower
disease and injury, globally, regionally, nationally weight than is given for a young to middle age
and locally, has become increasingly important adult (a year lost at these extreme ages is consid-
in a world where quantification and cost-benefit ered to be worth less than a year in middle life).
analysis is demanded. The common measures As the aim of this method is to calculate years
of mortality and morbidity cannot be added lost in such a way that these can be converted
together to give an integrated full picture of into lost economic value, each lost year in the
the impact of occupational health hazards. The future is also discounted, based on interest rates,
DALY (DALY = disability-adjusted life years in order to get the final DALY numbers.
lost) method, has been widely applied during In order to quantify the contribution of oc-
recent years, primarily because the World Bank, cupational health hazards to the global burden
and later the WHO, provided major financial of disease and injury, a detailed review of avail-
support for its development and application in able data and epidemiological studies was car-
major international reports, e.g. The World ried out for the World Health Report (WHO,
Bank in 1993 and WHO in 2002. 2002). Five major occupational hazard groups,
The DALY method calculates for each death, for which it was considered that meaningful
the number of years of life that has been lost quantifications could be made, were selected.
(YLL) in comparison with the theoretical life This would create a “conservative” low estimate
expectancy at the age of death. Thus, even a of the global occupational burden of disease in
person who dies at age 100 will contribute some DALYs. These were:
YLLs to the calculation, because according to a – work-related risk factors for injuries
“life-table” he/she could have lived longer. This – work-related carcinogens
is different from some other methods of estimat- – selected airborne particles
ing the burden of disease , such as the quality- – work-related ergonomic stressors
adjusted life years method (QALY) or the Po- – work-related noise
tential-years-of-life-lost method (PYLL), where
The distribution of world-wide DALYs for each
usually a maximum age of 65, 75 or 85 years is
of these hazard groups and the percentage of the
assumed. The DALY method applies a differ-
total for men and women is presented in Figure
ence in the assumed life expectancies at birth of
12.2.9. It is seen that overall it was estimated
men (80 years) and women (82.5 years), creating
that about 1.6% of all DALYs were due to these
higher DALYs for a female death at a certain age
occupational hazards. The order of importance
than for a male death at the same age.
was injuries, air particles, noise, carcinogens and
The DALY method also includes morbidity
ergonomic factors, Figure 12.2.9.
data, i.e. the incidence and severity of key diseas-
The figure shows the great difference in
es. For each type of disease a weight is applied
estimated occupational health burden between
equivalent to the degree of disability compared
men and women. This is logical, as it is assumed
with death. The duration of disease (disability)
that more men are in employment and that they
before death times the weight will add up to the
are working in occupations where more serious
years of life lost to disability (YLD). In addi-
731
Chapter 12.2
OHS hazards occur, but this analysis has the based on the number of deaths and 40 DALYs
drawback of excluding health problems, par- per death, this could add 640 000 DALYs to
ticularly in women, caused by health hazards in the occupational burden of disease and injury;
traditional and informal work arrangements. increasing the OHS contribution to the total
Other important occupational hazards are also DALYs from 1.63% to 1.70%, Figure 12.2.9.
excluded, such as pesticides, heavy metals, infec- Health service personnel are exposed to sharp
tious organisms, agents causing occupational objects that can spread Hepatitis B or HIV/
asthma or COPD, and stress at work causing AIDS, and thousands of such occupationally
increased cardiovascular diseases. To make es- caused cases occur each year.
timates of their contribution, one may consider The health consequences of stress are more
the number of DALYs per death as a conver- difficult to quantify, but a recent review in in-
sion factor. The estimated 355 thousand injury dustrial economies by Nurminen & Karjalainen,
deaths, Figure 12.2.1, are associated with 13.1 2001, has shown “that a substantial proportion
million DALYs. Thus, each injury death was of ischaemic heart disease results from the com-
associated with approximately 40 DALYs, which bined occupational factors of shift work, noise,
may apply to other occupational health impacts exposure to engine exhausts, and environmental
that affect relatively young people. tobacco smoke”. The proportion expressed as
Pesticides alone cause major public health the “attributable fraction” was 19% for men and
impacts. It was estimated by WHO in 1990 that 9% for women, (combined 17%). As cardio-
at a global level occupational exposures may vascular diseases contributes 9.8% of all DALYs
cause each year 700 000 acute pesticides poi- globally, 17% of this would be equivalent to
sonings, about 770 000 chronic poisonings and 1.7% of the total global DALYs, which would
12 000 deaths. Population increase alone may increase the occupational burden of disease and
have increased this to 16 000 in the year 2000. injury from 1.7% to 3.4%.
A conversion to DALYs has not been made, but
Occupational hazard World, both sexes World, males World, females

DALYs % DALYs % DALYs %
(millions) (millions) (millions)
Total, all DALYs 1 467 100 768 100 699 100
Injury factors 13 0.89 12 1.57 1.1 0.15
Carcinogens 1.4 0.10 1.1 0.15 0.3 0.04
Workplace air pollutants 3.0 0.20 2.7 0.35 0.3 0.04
Ergonomic factors 0.8 0.06 0.5 0.06 0.3 0.05
Noise 4.2 0.28 2.8 0.36 1.4 0.19
Occupational hazard DALYs,
total (WHO) 22.4 1.53 19.1 2.5 3.4 0.47
Occupational DALYs
(our revised estimate) > 3.27
Figure 12.2.9. Burden of disease and injury from occupational hazards: whole world, 2000, millions of
DALYs. Source: WHO, 2002.
732
Global occupational DALYs (millions) by age group

Total, all ages 15-59 years 60+ years
Total, all DALYs 1 467 602 168
Injury factors 13 13 (2.1% of 602) not calculated
Carcinogens 1.4 not calculated not calculated
Air pollutants 4.4 not calculated 2.0 (1.2% of 168)
Ergonomic factors 0.8 not calculated not calculated
Noise 4.2 not calculated not calculated
Total, occupational 24 not calculated not calculated
Figure 12.2.10. DALYs by age group, % of attributable DALYs in two age groups. Millions of DALYs
(calculated from WHO, and Murray and Lopez, 1996).
The material used by WHO in these calcula- diseases, etc. play a more prominent role. These
tions in 2002, estimated that there had been countries also have the largest estimated occu-
709 000 occupational deaths. An estimate by pational proportion of the total DALYs (WHO,
ILO in 2002 gives a much higher figure, 2 mil- 2002).
lion with a range from 1.92 to 2.33 million. Another way to express the importance of
WHO or ILO give no reasons for this difference occupational hazards for the global or country
in their reports which implies that the WHO burden of disease and injury, is to analyse it by
figures may be almost three times too low. The age group, Figure 12.2.10. The proportion of
difference would include the missing burden of total DALYs for the 15-59 year age group due to
disease and injury due to pesticides and stress occupational injuries is 2.1%, much higher than
mentioned above. If the new estimates are cor- the 0.89% for all ages, Figure 12.2.9. The figure
rect, it is likely that the previous undervaluing for air pollutants in the 60+ age group is also
occurred mainly in developing countries. A much greater (1.2%) than the average for all age
death in those countries leads to more DALYs, groups, 0.30%, Figure 12.2.9.
as the deaths usually occur at younger ages than By definition, no occupational DALYs oc-
in industrial countries so the occupational DALY cur before age 15 in the WHO calculation
numbers may be more than three times under- (thereby excluding the health impact of child
valued by WHO. labour). In industrial countries, about 30% of
The distribution of the burden of disease and 15-19 year olds are economically active, and in
injury by hazard types, Figure 12.2.9, is another developing countries the figure is about 50%.
interesting feature. Injuries dominate, but air The equivalent number of fulltime workers in
pollutants in the workplace also take on a major this age group may be about 5% of the number
role in the developing countries that have low in the 15-59 year age group, based on popula-
overall mortality rates . These are countries that tion size and likely prevalence of part-time work
have large mining and other metal production among the youth. Injuries will be the dominant
activities, and it is logical that occupational dust problem, and because many young workers are
733
Chapter 12.2
Risk factor Rank DALYs (millions) % of total

External Internal
Underweight, malnutrition 1 138 9.5
Unsafe sex 2 92 6.3
Occupational hazards (revised here) 81 5.4
Blood pressure 3 64 4.4
Tobacco 4 59 4.1
Alcohol 5 58 4.0
Unsafe water, sanitation and hygiene 6 54 3.7
Cholesterol 7 40 2.8
Indoor smoke from solid fuels 8 39 2.6
Iron deficiency 9 35 2.4
Overweight, over-nutrition 10 33 2.3
Occupational hazards (original figures) 24 1.6
Figure 12.2.11. Ranking of risk factors in Global Burden of Disease and Injury calculation. Source: WHO,
2002.
inexperienced, their injury rate may be higher calculated for the working age groups, as the risk
than that of older workers. One may assume that factors with rank 1, 6, 8 and 9 are of particular
injury hazards contribute about 10% as many importance for very young children. In addi-
DALYs for the young as for the older workers so tion, the “internal” risk factors of high blood
child workers could add another 1,312 thousand pressure and cholesterol are not independent of
DALYs to the total, Figure 12.2.9, or another other risk factors on the list, (e.g. over-nutrition
0.09%. and tobacco smoking), and it may be argued that
The occupational burden of disease and injury their DALYs may overlap with some of the other
is one way to express the importance of occu- risk factor DALYs. If estimates are made for an
pational hazards in the overall analysis of public individual country, in order to provide informa-
health risk factors. The estimated figure of 1.6% tion that gives decision-makers a valid picture of
that occupational hazards contribute to global the role of OSH hazards, it is important to pres-
DALYs, may be a considerable underestimate, ent different scenarios for the calculations which
particularly if one focuses on the burden for take account of the issues raised here.
adult age groups. The DALY ranking list of the It is important to note that trends in adult
ten most important risk factors globally starts health are major factors in general popula-
with “underweight” and ends with “overweight”, tion health whereas for life expectancy and the
Figure 12.2.11. burden of disease and injury, child health has
It can be seen that occupational hazards may the greatest influence. The reduction of infant
be ranked much higher. This would be further and child mortality goes hand-in-hand with the
accentuated if the burden of disease and injury is lengthening of average life span. However, one
734
of the most important factors for good child 31 000 billion in the year 2000), or US$ 1 200
health, is the good health and survival of the billion.
childs’ parents. The achievement of good adult – In 1992, the direct cost paid out in compensa-
health requires a decent working environment tion for work-related diseases and injuries in
and OSH practices. European countries, reached Euros 27 billion
An analysis of adult ill health in developing (= US$ 30 billion).
countries, showed that there are great differenc- – In 1992, total direct and indirect costs associ-
es between industrial and developing countries ated with work-related injuries and diseases
in the chance of survival, from age 15 to 60. A in the USA were estimated to be US$ 171
15-year old boy in India has three times higher billion (or about 3 % of the total GDP in the
probability of dying before age 60 than a boy USA), surpassing those of AIDS and on a par
in Sweden. A focus on child health in analysis with those of cancer and heart disease.
of health statistics can easily hide such health
gaps between rich and poor. When estimates improving the quality of data
are made of the contribution to the burden of Effective planning of policy setting and action
disease and injury from different risk factors, it for OSH requires meaningful information about
is important that the situation for different age the extent of problems, time trends, special
groups is presented separately but the detailed problems for vulnerable groups, links between
data required to do this is seldom available. interventions and changes in OSH status. Good
One of the main arguments for making “bur- quality data on health status, occupational haz-
den of disease” calculations, using the DALY ards exposures, size of working populations and
method, was that these estimates could be used timing and extent of interventions taken is im-
in calculations and comparisons of the economic portant to achieve this. No country has complete
cost of different health problems in different and accurate data available for this purpose so
countries. The cost of illness and deaths based improvements are required everywhere. OSH
on the “value of statistical life” are substantial, professionals are important participants in the
and “the cost per DALY” is a way to summarize process of improving the quality of OSH data
these costs. In addition, there are direct treat- and general health data, as they have opportu-
ment costs. The health status of the workforce nities to record, collate and transmit field data
and any associated absence from work will re- that can contribute to local or national datasets.
duce productivity and have a direct impact on They also use OSH data in their daily work and
the local and national economy. can lobby for improved quality of data collected
The estimated total global economic losses by other. Data offices for health statistics are
due to occupational illnesses and injuries are often isolated from the field work and feedback
enormous: and other communication from users of the data
– The International Labour Organization may be welcomed.
(ILO) has estimated that in 1997, the overall Occupational hazards and their health effects
economic losses resulting from work-related are linked to economic factors, legislation, and
diseases and injuries were approximately 4% basic development trends (including globalisa-
of the world’s Gross World Product (US$ tion), in any country. In order to get good qual-
ity OSH data that can be interpreted for policy
735
Chapter 12.2
development,it is important to collect informa- cupational injuries and diseases, numbers of

tion on the driving forces behind OSH problems workers, hazard exposure levels and imple-
in addition to statistics on health. WHO devel- mented interventions. Routine data collection
oped a framework (DPSEEA) for environmental systems that use modern computer technolo-
health analysis in 1990. It visualizes the links gies to record, edit, store and analyze data are
between different variables by identifying Driv- at the heart of better quality data. Policies for
ing forces that create Pressures on the working high quality and complete OSH data need to
environment, which in turn influences the State be established by both employers and workers
of that environment. The State of the environ- in collaboration. Systems for collecting the data
ment links Exposures to the different hazards, and the resources and time needed to carry out
which in turn cause Effects that we are concerned the collection are also essential. This work is
about. Actions to reduce the health risks can be greatly helped by modern computer hardware
taken at each level of the framework. and standard software. Such software can au-
The main reason for the poor quality of oc- tomatically check for typographical errors and
cupational mortality data in many countries is erroneous coding, which speeds up the work and
incomplete and out-of-date mortality data sys- makes the data more accurate. The software can
tems. This can be a major obstacle for efficient also be designed to produce automatic reports
health system planning and priority-setting. in standard formats, which makes it possible for
WHO and the UN Statistical Office have de- OSH professionals to share interim reports of
veloped a number of programs and guidelines new data without delay.
to help countries improve their situation. The Another type of OSH data, which can strong-
efforts to improve routine data collection sys- ly enhance the quality of information available
tems can be supported by OSH professionals, for decision-making, is surveys of workers, usu-
through their requests for valid mortality data ally carried out with questionnaires, either self-
on population groups and causes of death of administered or completed by interviewers (see
particular interest to OSH. If users of the gen- following section for examples). In situations
eral mortality recording systems are not making where OSH data is not collected routinely or is
demands for better quality data, the producers not available, it will take a long time to establish
of the data may not be motivated to improve on such systems. Good quality data are best col-
their work. The same approach can be used for lected through a combination of worker surveys,
hospital admissions data, but the privatization of and information from employers and other key
the hospital services, commonly emerging from participants in OSH, such as government offic-
globalisation, may create difficulties in getting ers. Important information is provided by both
comprehensive datasets. For individual data, qualitative data, (which describes opinions and
valid ethical concerns about privacy issues also experiences of individuals), as well as quantita-
creates limitations to what data is made avail- tive data, (which summarizes questionnaire an-
able, but these problems can be overcome as swers from groups of people in numerical form).
OSH work usually needs only aggregated statis- The qualitative approach can provide invaluable
tical data rather than individual data. information to complement statistical date as
Specific OSH data that should be collected in-depth information from individuals can shows
includes workplace and local level data on oc- linkages between attitudes, behaviors, the work
736
Items included in European Foundation (2003)

survey of working conditions in different countries.
Factors affecting working conditions
• Physical environment of the workplace (exposure to risks, ergonomic design and the availability of
information on risks.)
• Organisation of work:
o job content;
o autonomy and control;
o pace and intensity of work;
o working time patterns;
o flexibility.
• Social and psychosocial environment:

o participation and consultation;
o issues of age, gender, race and disability;
o harassment and violence.
• Management of human resources

o skills and training;
o employment status of workers and their incomes.
• Labour law, collective agreements and systems of industrial relations.
Working conditions have implications in terms of

• health;
• equal opportunities;
• company performance (in both large enterprises and SMEs, including micro-firms)
• and ultimately for the economic performance of regions and states as well as for the quality of life
of citizens.
environment and OSH risks and is often an in- by government agencies but the same survey
valuable complement to statistical information. methods can also be used at local level by OSH
professionals and/or interested groups.
surveys of working life and health In recent years, standardised surveys about
One way to get a picture of the status of OSH in working conditions and health impacts have
a country, a local area or a workplace, is to carry been carried out in the 15 European Union
out a survey of the attitudes and experiences of a (EU) Member States (1990, 1995, 2000) and the
representative group of people. National work- 12 EU Candidate Countries (2001). Each sur-
ing life and health surveys of this type have been vey questioned more than 10 thousand workers
carried out in a number of countries, including in a variety of occupations, about the working
Sweden. These surveys are usually carried out environment, work organization, and the im-
737
Chapter 12.2
pacts on health and other issues (see Box). The were young and self-employed, working in the
methods and questionnaires are available on the most common sectors in Zimbabwe: agriculture,
European Foundation website and could be used manufacturing and retail/services. Questions
for comparable surveys in other countries or lo- were asked about work organization, hygiene,
cal populations. ergonomic problems, chemical exposures, and
The results of these surveys give an indica- other hazards. The most commonly reported
tion of differences between countries and time health hazards and problems were: work that re-
trends. There was an increase of reported noise quired bending forward, exposure to direct sun,
and ergonomic hazard exposures, an increase of poorly organized workplaces, handling heavy
work pace and time pressures, with an apparent loads, and other basic work environment and
small increase in some potentially related health hygiene hazards, Figure 12.2.13. Other concerns
effects, Figure 12.2.12. The intention is to con- raised were poor housekeeping, poor lighting,
tinue to carry out regular surveys in order to long work hours, poor workplace design, and
develop policy proposals for prevention of OSH lack of awareness of chemical risks. The haz-
effects, and to monitor the impacts of such poli- ards listed in Figure 12.2.13 indicate the type of
cies and working life risk factors. questions about hazards likely to be relevant in
These types of surveys are not common in a developing country setting. The survey had an
developing countries, but a detailed report is important impact on the workers themselves, by
available for one such survey of the informal highlighting common concerns that needed col-
and rural sector in Zimbabwe in 1997, by Loe- lective solutions.
wenson (1998). The survey included 1 587 Loewenson’s survey found a much higher
workers interviewed in their households. Most burden of ill health than that reflected in most
Figure 12.2.12. Perceived health effects of work hazard exposures in surveys of 15 EU countries. Source:
European Foundation, 2003.
738
national databases. The survey showed 131 putting together the full picture
work-related injuries per 1000 workers, and 116 This chapter indicates that there are major,
illnesses per 1000 workers in the informal sector, important gaps in our knowledge about the
which exceed the officially reported rates in the global impact of workplace hazards on injuries
formal employment sector by a factor of 10 for and diseases. To establish the true figure requires
injuries and 100 for illnesses. Permanent disabil- significantly more effort to improve recording of
ity was reported in 19% of injuries and 25% of basic mortality and morbidity data at workplace,
illnesses. Almost none of these workers had the local, and national level. The global situation
benefit of any occupational health service. is the aggregate of the information that comes
This example highlights the very large hid- from local and national level so it can never be
den work-related injury and illness burden that of good quality if the source data is deficient.
may exist in many countries. Surveys of self-re- OSH professionals contribute to both the crea-
ported hazard exposures and health problems tion and validation of the data as well as to the
may exaggerate the work-related effects, because interpretation of information and decision-mak-
of “over-reporting”, but they can also guide the ing about policies and actions. Assembling the
occupational health practitioner to issues where fullest possible picture is an important task, but
further more precise data needs to be collected, it is not an easy one. This chapter has given
and preventive action may need to be intensified. examples of the type of information required for
ILO has supported surveys in certain develop- the full picture and while the chapter has offered
ing countries, but a systematic picture of work- a critical analysis, the problems with current data
related injuries and diseases for all countries, should not be seen as a reason for despair.
based on surveys, is not yet available. The first approach, at national level, may be
to assemble a tentative national summary of
work related injuries and diseases from pub-
Agriculture Manufacturing Retail/Service

Exposed to direct sun, 90% Work bending forward, 78% Poorly organized workplace, 76%
Work bending forward, 90% Work with sharp tools, 77% Toilets inadequate/dirty, 62%
Handling heavy loads, 77% Poorly organized workplace, 76% Exposed to direct sun, 60%
Toilets inadequate/dirty, 73% Eating inside workplace, 75% Heat/noise/dust pollution, 60%
Long hours of standing, 67% Toilets inadequate/dirty, 70% Handling heavy loads, 52%
Biological hazards, 67% Long hours of standing, 70% Long hours of standing, 50%
Clean water unavailable, 59% Exposed to direct sun, 63% Seat uncomfortable, 50%
Work with sharp tools, 52% Repetitive movements, 62%
Handling heavy loads, 62%
Heat/noise/dust pollution, 58%
Clean water not available, 58%
Figure 12.2.13. The most common work hazards by sector in Zimbabwe survey. Source: Loewenson, 1998.
739
Chapter 12.2
lished mortality and morbidity data. The follow- health problems, is another way of complement-
ing guidelines may be of help: ing the information base. These assessments/
* don’t accept the number without checking any projections should be evaluated after some time
alternative sources in order to see whether the health situation de-
* assemble data from different sources: census veloped as estimated. This type of trend analysis,
records, mortality records, workers insurance or before-and-after-analysis, can also be a useful
records, hospital records, etc. tool when estimating the impact of implementa-
* check whether the numbers make sense com- tion of preventive interventions.
pared with data from other countries, and In all this work it is important to include some
ILO statistics; calculate rates to check that quality assurance programs in order to estimate
they make sense the extent of measurement error in the data.
* complement routine statistics with surveys Reality checks help, but additional spot-checks
that can be interpreted beyond the survey of coding and recording of data are useful.
population
Exposure variables need to be assembled to be

able to interpret the data. Population distribu-
tion by occupation, and/or industry sector, and
by age and sex for each occupation category
helps to identify special risk groups. Changes
over time give indications of which work-related
health issues are increasing or decreasing. De-
scriptive data of this type also helps in the inter-
pretation of sample surveys or targeted studies
of specific health issues. For instance, a study
of respiratory symptoms and diseases in young
mine workers, can be translated into quantitative
needs for dust monitoring and health surveil-
lance in the mining industry if the population at
risk is known.
National sample surveys of working life and
health are another way of getting a more com-
plete picture. This enables inclusion of data on
self-assessed exposure and health effects and
makes it possible to analyse associations between
different variables. If such surveys are repeated
at regular intervals using the same method, valu-
able information about trends in problem expo-
sures and effects can be collected.
Increased use of health impact assessment and
projections/scenarios for future work-related
740
12.3
International governance and partnerships

global governance organizations UN family that has a tri-partite structure where

with osh responsibilities governments, employers and workers participate
The most important agencies dedicated to im- as equal partners. ILO formulates international
proving occupational safety and health at inter- labour standards in the form of Conventions
national level are the International Labour Or- and Recommendations, which set minimum
ganization (ILO) and the World Health Organi- standards of basic labour rights. To take effect at
zation (WHO). The term governance primarily national level, these standards must be adopted
refers to governments, which represent the will by the member countries and implemented in a
of the people in democratic societies. However, systematic way. Adoption involves “ratification”
civil society also has an important place in mod- by the highest legislative authority in a member
ern governance, representing various interest state, e.g. parliament, but this is often blocked or
groups (stakeholders) views on issues that af- complicated by existing legislation that conflicts
fect their society. In the case of OSH, the main in some way with the text of a specific Conven-
stakeholders are government, employers and tion, (a situation that occurs in both developed
workers. Health services, insurance companies, and developing countries). The conflict may be
and the community at large may also be consid- a minor one, but if the parliament does not see
ered to be stakeholders. the point of making a law change, the Conven-
The International Labour Organization (ILO), tion will not be ratified. Unfortunately, many
based in Geneva, Switzerland, is a member of valuable ILO Conventions on OSH have not
the United Nations “family” of organizations. been ratified because of this situation; only a
ILO has a special mandate for the promotion small number of countries have actually adopted
of social justice and internationally recognised these Conventions.
human and labour rights that encompass the The ILO Conventions and Recommendations
right to safe and decent work in all countries of on OSH are listed on the ILO website: http://
the world. Detailed information about ILOs www.ilo.org/public/english/protection/safe-
programs and the activities mentioned in the work/standard.htm. They define the rights of
text can be found on the ILO website (www.ilo. workers and allocate duties and responsibilities
org). ILO is the only organization within the to the “competent authority” in each country,
741
Chapter 12.3
as well as to employers and workers organiza- and health at work. The ILO “In Focus” Pro-
tions. Two international Conventions Number gramme covers working conditions in general
148/1977 and 151/1981, and their accompany- and the “SafeWork” Programme has specific
ing Recommendations 156/1977 and 164/1981, OSH objectives:
provide for the adoption of national occupa- 1) to create worldwide awareness of the dimen-
tional safety and health policies and describe the sions and consequences of work-related acci-
actions needed at national and at enterprise level dents, injuries and diseases;
to promote occupational safety and health and to 2) to promote the goal of basic protection for
improve the working environment. A number all workers in conformity with international
of Conventions deal with specific industries, labour standards; and
e.g. agriculture, construction and mining, while 3) to enhance the capacity of Member States and
others deal with specific hazards, e.g. chemicals, industry to design and implement effective
asbestos and radiation. preventive and protective OSH policies and
The Occupational Health Services Conven- programmes.
tion 161/1985 and Recommendation 171/1985,
provide for the establishment of occupational The website for Safe Work lists all relevant
health services at country and local level. Such Conventions, Recommendations, Codes of Prac-
services contribute to the implementation of tice, etc.
national OSH policies and guide OSH functions The International Safety and Health Informa-
at enterprise level. One major objective of ILO tion Centre (CIS) is also located within the ILO
in relation to OSH, is to enable countries to (http://www.ilo.org/public/english/protection/
extend social protection to all groups in society safework/cis/). CISs principal objective is to be
and to improve working conditions and safety a worldwide service dedicated to the collection
Items on the “Safe Work” website.

This website provides direct links to most recent ILO documents of importance for the development
of OSH policy at national and local level.
Policy documents Areas of Action Resources
Decent Work, Safe • Accident and Disease • Standards

Work and the related Information • Documents of the ILC90
ILO Report on the XVIth • Hazardous Work • Codes of Practice
World Congress • Chemical Safety • Legislative texts
• Occupational Health • Papers
Scope and mandate • Workers’ Well-being • Publications
of Safe Work • Gender Issues • Databases
• Radiation Protection • Management Systems
Interregional • Labour Inspection • Economic Aspects
Consultation Report • Capacity Building
Contacts
742
and dissemination of information on the preven- less prescriptive and easier to comply with by
tion of occupational accidents and diseases. It countries that would not challenge the corporate
is one of the key sources of practical advice on agendas for globalisation. This also means that
OSH for developing countries. ILO Conventions have been left outside of the
A new umbrella policy for the ILO work on domain of trade policies and WTO enforce-
working conditions and OSH was launched in ment. Sanctions against countries that do not
1999. The “Decent Work” policy was devel- meet requirements of ILO Conventions have
oped as an ILO response to globalisation and been considered “protectionist” by many devel-
was based on the ILO “Declaration on Fun- oping countries and attempts to include a “social
damental Principles and Rights at Work”, also clause” in WTO agreements have failed. This
called the “Social Declaration”. The concept of is also in line with the interests of multi-national
“Decent work” goes beyond the aim of job crea- corporations, which can avoid costs by not
tion but aspires to create jobs of a quality which providing levels of OSH protection considered
will deliver a fair income and decent working “normal” in industrial countries. Neverthe-
conditions. less, under the policy umbrella of Decent Work,
OSH has an important role under the “Safe
“The quantity of employment cannot be di-
vorced from its quality. All societies have a
Work” programme.
notion of decent work, but the quality of em- If the guidance and information from ILO
ployment can mean many things. It could relate was implemented at workplaces in all countries,
to different forms of work, and also to different a large amount of ill health would be prevented.
conditions of work, as well as feelings of value
and satisfaction. The need today is to devise The challenge for OSH at national and local lev-
social and economic systems which ensure basic el is to extend awareness of OSH issues, create
security and employment while remaining ca- willingness among employers, politicians, gov-
pable of adaptation to rapidly changing circum-
stances in a highly competitive global market.”
ernment officials and industry leaders, to take
action on identified problems, and to provide
the time and resources required for remedial
There are criticisms that the role of workers’ action. While ILO is a key information provider,
organizations, and NGOs representing the in- it should be remembered that for a number of
formal sector, is too weak inside the ILO. There controversial issues, e.g. asbestos in the work-
is also concern that individual societies are given ing environment, trade unions and NGOs in
too much leeway in deciding what constitutes the occupational health field have more highly
decent work. Globalisation tends to increase developed policies on prevention.
informal relationships between employers and A major initiative, which may assist in the de-
workers, and this tendency is likely to reduce, velopment of better occupational health protec-
rather than enhance, the quality of jobs. tion in agriculture and industry during economic
The Decent work policy does not emphasize development of less affluent countries, was the
the large number of Conventions of relevance report of the ILO World Commission on the
to working conditions and OSH that have been Social Dimension of Globalisation in 2003 The
adopted by ILO. It would appear that there Commission’s goals were to make globalisation
is an intention to blunt these instruments and processes more attuned to human needs, par-
make the recommendations for Decent Work ticularly in the area of work and employment. It
743
Chapter 12.3
was hoped that dialogue between various repre- Traditionally, many countries have placed re-
sentatives with different interests and opinions sponsibility for occupational safety, largely fo-
on the globalisation process will bring clarity to cused on injuries, with the Ministry of Labour
the issues in a non-confrontational atmosphere. while occupational health, focused primarily
The Commission was comprised of 26 individu- on the prevention of occupational diseases,
als from Government, trade unions, civil society remains the concern of the Ministry of Health.
and academia. However, the conflicts between An increasing number of industrial countries,
the provision of safe and healthy workplaces e.g. USA, UK, Sweden, Australia, have central-
and the cost-cutting efforts of modern industry, ized all work-related health and safety issues
particularly in industries being established in de- under the Ministry of Labour, or its equivalent,
veloping countries, were not possible to resolve through specific OSH legislation. In many de-
even within a high level Commission. Strong veloping countries the Ministry of Health still
statements about the needs for protection of has a role in occupational health and their link
the social aspects of work have been made by with WHO programmes is important.
the Commission, but unless this is backed up by The coordination of OSH activities by
some sort of enforcement system, the “race to Labour and Health Ministries can become a
the bottom” for social protection and OSH may problem at both national and international
still occur. level. However, mechanisms for ILO-WHO
The World Health Organization (WHO), is collaboration have been strengthened during
another United Nations organization with its recent years and many information and guid-
headquarters in Geneva, Switzerland (www.who. ance materials are now produced jointly. The
int). The Ministries of Health of all countries difference in the governance structures of the
are “members” of this organization, which also two organizations, i.e. ILO = tri-partite, WHO
has official relations with some other organiza- = governments only, means that some parallel
tions, e.g., the EU and NGOs, e.g. the Inter- activities cannot be avoided.
national Commission on Occupational Health WHO policies recognize the importance of
(ICOH), international trade unions and employ- improving the health status of working popula-
ers organizations. All issues concerning health tions. It supports international cooperation in
are on its´ agenda, including occupational health. this area primarily through a strong network of
Internationally agreed occupational health and safety advices

In the 1980s WHO published several reports on “Health based permissible exposure levels”, in the
Technical Report Series. These exposure levels still prescribe the most protective levels, (compared
to other available national or international guidelines), for exposure to solvents, lead, other metals
and selected other chemicals. WHO has also produced a series of “Environmental Health Criteria”,
(many of them as a part of the International Programme on Chemical Safety), with advice on protec-
tion against chemical and physical hazards. The criteria for noise, for instance, recommends that
75 dB should be considered a maximum exposure level for effective protection of workers, while most
countries still use 85 or 90 dB as their safety standard.
744
collaborating centres for occupational health. the final report in September 2008. Several of
The WHO Occupational and Environmental the reports to the commission are relevant for
Health Program (OEH) includes data collec- the labour sector and work environment issues.
tion and analysis, development of guidelines, In addition, there are international col-
research, strategies for hazard prevention and laborative programmes on specific issues such
control, and human resource development. A as chemical safety, between the UN and other
special emphasis is placed on work in developing agencies,. The International Programme on
countries. However, in terms of staff and fund- Chemical Safety, (IPCS), (http://www.who.
ing, the OEH programme is small compared to int/pcs/) started in 1976 and is a collaborative
others in WHO. effort between UNEP, WHO and ILO. It has
On the specific issue of globalisation and produced a large number of reports and advisory
OSH, WHO has primarily contributed to the booklets on the hazards of specific chemicals and
development of global guidance and informa- physical hazards, and has promoted training in
tion exchange. Analysis of the health effects of this area in most developing countries. In order
globalisation has been carried by other WHO to develop stronger policy impact for interna-
programmes. tional work on chemical safety, the International
As with all other WHO programmes, OEH Forum on Chemical Safety, (IFCS), (http://www.
has activities at the global, regional and national who.int/ifcs/) was started in 1994 with about 100
level. Regional activities in Europe focus on member states. A third collaborative mechanism
capacity-building in Eastern Europe and the is the Inter-Organization Programme for the
newly independent states of the previous USSR. Sound Management of Chemicals, (IOMC),
Much of that work is developed in both English (http://www.who.int/iomc/en/), which includes
and Russian. The American region develops FAO, UNIDO and OECD.
training and intra-regional collaboration, pri-
marily for Latin America, with much of their trade and economic development
work produced in Spanish. Work for the Eastern organizations influencing osh
Mediterranean region comes from the Alexan- The activities of international economic devel-
dria office and is available in Arabic and English. opment agencies such as the World Bank, the
One important means of implementing coun- International Monetary Fund (IMF), the World
try level programmes, particularly in relation to Trade Organization (WTO), and the United
training and technical/scientific collaboration, Nations Development Program (UNDP), also
is the engagement of the WHO Collaborating have an important bearing on OSH in many
Centres in Occupational Health which number countries. The general economic development
about 40 in different parts of the world. These level of a country significantly influences the mix
are usually national research and training insti- of occupations and hazard types that exist. More
tutions that have substantial staff resources and specifically, the extent to which loans and devel-
experience in investigations and capacity-build- opment aid includes support for relevant OSH
ing in the field. The Centres have regular, joint activities related to a specific industrial or agri-
meetings to evaluate and plan global activities. cultural investment, can greatly affect the provi-
WHO has also initiated a Commission on sion of protection for workers. Until recently,
Social Determinants of Health, which produced investments from international sources have not
745
Chapter 12.3
been guided by Environmental Impact Assess- FAO advises the agriculture industry on pesti-
ments. The inclusion of health in Impact As- cides use and has developed and promoted an
sessments is still in its infancy, and specific Oc- international convention on this subject together
cupational Health Impact Assessments are rare. with UNEP.
When investments come from private sources, Countries that ratify the treaty are obliged to
so-called Foreign Direct Investment (FDI), it enforce the agreement at national level and to
is likely that OSH protection is reduced to the create enforcement mechanisms that will con-
minimum required by the government of the trol commercial exports and exporters. Disputes
recipient country. In many cases, governments between countries regarding the implementation
are desperate for investment and will allow sub- of the Convention will be settled either by arbi-
quality OSH standards in order to procure the tration or by the International Court of Justice.
foreign capital investment. According to UNEP, the Convention will help
Agencies, and individual staff members from solve several major human health and environ-
those agencies, that provide loans or developmental problems. There are large stockpiles
ment aid grants for industrial or agricultural of unwanted and obsolete pesticides and other
development, e.g. UNDP, the World Bank, chemicals in virtually every developing country.
Asian Development Bank, Inter-American De- Each year, thousands of people are poisoned by
velopment Bank, have a very important role in severely hazardous pesticides. There are also a
ensuring that OSH programs are supported and number of highly toxic chemicals that persist in
to ensure occupational health impact assessment the environment, accumulate in both wildlife
are included in project plans and budgets. and people, persist for long periods of time, and
Other inter-country organizations for eco- are spread all over the world when emitted into
nomic cooperation, such as the OECD, EU and the environment. These persistent organic pol-
ASEAN, have opportunities to influence the lutants (POPs), are a major problem.
implementation of OSH. These organizations The global market for pesticides continues
have websites which include information about to grow and is estimated by FAO to be worth
international projects. T��
he OECD (Organiza- approximately $50 billion per year. Companies
tion for Economic Cooperation and Develop- based in Western Europe are currently the
ment), (http://www.oecd.org) is a “rich country world’s largest chemical producers. The fastest
club” whose membership is all the high-income growing markets are in developing countries,
countries, plus Mexico. particularly in Latin America and Asia. Africa is
Other specialized United Nations organiza- increasingly using pesticides on export crops.
tions contribute in some way to knowledge
and advice relevant to OSH, particularly, the international trade union
FAO (Food and Agriculture Organization of organizations and ngos
the United Nations), UNIDO (United Na- International associations of workers trade un-
tions Industrial Development Organization), ions are also important organizations for OSH.
and UNEP (United Nations Environment Pro- The peak body is the International Conference
gramme). UNIDO primarily provides advice to of Free Trade Unions, ICFTU (http://www.
industry on control of environmental pollution, icftu.org/), but there are several large, special-
but some of their projects include OSH items. ised associations of this type, sometimes called
746
Press Release 98/19 UNEP/FAO (shortened)

Source: http://www.fao.org/WAICENT/OIS/PRESS_NE/PRESSENG/1998/pren9819.htm
95 COUNTRIES AGREE ON NEW INTERNATIONAL CONVENTION

ON DANGEROUS CHEMICALS AND PESTICIDES
Brussels, 16 March, 1998-- After two years of negotiations 95 countries unanimously agreed on a legally
binding Convention on international trade and hazardous chemicals and pesticides, the UN Environment
Programme (UNEP) and the Food and Agriculture Organization (FAO) announced today. Through this
treaty governments honoured their commitment made at the 1992 Rio Earth Summit to negotiate a con-
vention to curb the trade in certain hazardous chemicals and pesticides.
”The aim of the Convention is to enable importing countries to decide what chemicals they want to receive
and to keep out the ones they cannot manage safely,” said Maria de Azevedo Rodrigues, Chairperson of the
Conference. ”It is expected that trade can be better controlled and that the risks of these dangerous chemi-
cals can be reduced to benefit people and the environment. Countries also are expected to put national
legislation into force. Until the industry can substitute hazardous chemicals with safer products, especially
those exported to developing countries, a damage control system - as provided by the Convention - is
needed.”
The Convention requires that harmful pesticides and chemicals that have been banned or severely restrict-
ed in at least two countries shall not be exported unless explicitly agreed by the importing country (this is
called Prior Informed Consent Procedure, PIC). The treaty is not a worldwide ban on these chemicals.
Under the new treaty, exporting countries will also be legally bound to inform importing countries about
exports of chemicals banned or severely restricted in the exporting country. This export notification shall be
provided prior to the first export and be repeated for the first export every year.
The PIC list includes the following pesticides: 2,4,5-T, Aldrin, Captafol, Chlordane, Chlordimeform,
Chlorbenzilate, DDT, Dieldrin, Dinoseb, 1,2-dibromoethane (EDB), Fluoroacetamide, HCH, Heptachlor,
Hexachlorobenzene, Lindane, Mercury compounds, certain formulations of Monocrotophos, Methamido-
phos, Phosphamidon, Methyl-parathion, Parathion. The industrial chemicals are: Crocidolite, Polybromi-
nated Biphenyls (PBB), Polychlorinated Biphenyls (PCB), Polychlorinated Terphenyls (PCT), Tris
(2,3 dibromopropyl) phosphate.
“international trade secretariats” (ITSs), with International Metalworkers Federation (IMF),

OSH activities for member unions at regional puts much of its effort into negotiating and
and country level. Figure 12.3.1 lists all the implementing framework agreements with large
ITSs. The ILO website has links to all of them. multinational corporations, principally with
Trade unions are particularly relevant for the large, vehicle manufacturing companies. These
implementation of good OSH practices at local agreements cover all aspects of working condi-
and national level. To support these efforts, the tions, including OSH, which prevents OSH
international trade union federations have de- issues from becoming isolated from mainstream
veloped their own policies, information, training union activities. The ICEM has emphasized
and action programs on OSH. The focus is dif- chemical safety activities and supported the for-
ferent for each organization. For instance, the mulation of protective safety guidelines for the
747
Chapter 12.3
Organization name Location of global office

Education International (EI) Belgium
International Federation of Chemical Energy, Belgium
Mine & General Workers’ Unions (ICEM)
International Federation of Journalists (IFJ) Belgium
International Textile, Garment & Leather Workers’ Belgium
Federation (ITGLWF)
Public Service International (PSI) France
International Transport Workers’ Federation (ITF) Great Britain
International Federation of Building and Woodworkers Switzerland
(IFBWW)
International Metalworkers’ Federation (IMF) Switzerland
International Union of Food Agric. Hotel Rest. Cater. Switzerland
Tobac.& Allied Work. Assoc. (IUF)
Union Network International (UNI) Switzerland
Figure 12.3.1. International trade union organizations involved in OSH activities and affiliated to the
ICFTU (country location of global office indicated).
users of individual chemicals. PSI has focused on ditionally been very active in supporting OSH
the protection of public services, including na- activities in developing countries. In Sweden,
tional government services on OSH, e.g. labour the combined union international cooperation
inspection. program (LO-TCO joint program) has support-
Many of these organizations also have special ed training and union strengthening programs
activities on the impacts of globalisation on their in a number of other countries. In the USA, the
union members and their OSH conditions. PSI United Auto Workers (UAW), the Construc-
is particularly interested in the downgrading or tion Workers Union, the Union of Chemical
privatization of public services frequently carried and Atomic Workers, and the central union
out in conjunction with globalisation. ICEM is (AFL/CIO) are some of the unions that have
concerned about the transfer and use of banned been actively involved in OSH. Unions from, for
chemicals in developing countries. Given that instance, Canada, UK, Netherlands and other
these union organizations must respond to European countries have also been involved.
membership demands for better salaries and A number of international professional or-
other conditions, OSH issues are generally only ganizations are also involved in OSH. These
brought forward when it is a priority for their include, for instance, the International Com-
membership. ICFTU has been in the forefront mission on Occupational Health (ICOH), the
for analysis and reports on the OSH conse- International Occupational Hygiene Association
quences of global economic trends. For example, (IOHA), and the International Ergonomics As-
the impact of World Bank and International sociation (IEA).
Monetary Fund activities, are of prime interest, A number of non-governmental organizations
www.icftu.org. are specifically interested in analyzing and tak-
It should also be pointed out that larger trade ing action on globalisation issues. ATTAC Inter-
unions in some industrial countries have tra- national has branches in many countries, oper-
748
ates in a variety of languages and runs a number – increased training for employees, particularly
of websites, e.g. www.attac.org. ATTAC has a in occupational safety and health.
non-hierarchical structure and works through
networks devoted to providing information and In 2002 the ICFTU made a progress report on
organizing public demonstrations against the OSH developments following the Earth Sum-
negative aspects of globalisation. A number of mit, http://www.icftu.org
��
.��
The report was gen-
other anti-globalisation organisations and net- erally pessimistic but made some positive state-
works also operate at national level within vari- ments about the role of trade unions in OSH
ous countries. and the environment:
Business organizations and other business- • Almost 10 years after the UN Earth Sum-
friendly NGOs are also active promoting a mit in Rio de Janeiro, governments have yet
positive picture of business friendly globalisa- to adopt effective measures for worldwide
tion. The World Business Council for Sustain- action to counter the alarming pace of envi-
able Development is one of the more important ronmental degradation. At the same time, the
organizations (http://www.wbcsd.ch) and discus- pressures of increased competition and budget
sions about alternative economic development cuts are leading to a steady erosion of existing
paths have also been on the agenda at the World health and safety standards and programmes.
Economic Forum in Davos. • Trade unions are taking a leading role in
fighting these trends by extending occupa-
the impact of major global tional health and safety rights into the wider
conferences arena of environmental protection. Together
The United Nations Conference on Environment and with the employers, unions are breaking new
Development in Rio 1992 (UNCED or the Earth ground in collective bargaining in the areas of
Summit) adopted Agenda 21 , which has a chap- health, safety and environmental protection,
ter/section that discusses the increased role of and forging new alliances with environmental
workers and trade unions. Among the activities NGOs. Governments at the UN Commission
to be implemented by the year 2000 were: on Sustainable Development (CSD) have pro-
– promotion of the right to establish trade un- posed that core labour standards and a link to
ions health and safety should become key features
– promotion of ratification of relevant ILO- of Agenda 21. The next step is to insist that
conventions governments, together with employers, trade
– establishment of bipartite and tripartite bodies unions and NGO's translate these principles
for safety, health and sustainable development into concrete programmes of work.
– an increase in the number of treaties concern- A five year evaluation of the results of the
ing the environment, between the labour UNCED process was performed in 1997 at a
market partners special UN General Assembly meeting (UN-
– reduction of the number of work accidents GASS). WHO summarized the health experi-
and occupational diseases. Improvements in ences in a major report in1997, which empha-
reporting and statistics of work accidents and sised the importance of workplace hazards for
diseases general health development. This part of the
report was developed in collaboration with ILO
749
Chapter 12.3
and encouraged research to find more accurate e.g. for treatment of diseases such as HIV/AIDS,
estimates of the number of people killed and Tuberculosis and Malaria. Unfortunately, a fol-
injured by work hazards around the world. Ac- low-up meeting at Doha and subsequent negoti-
curate numbers are still not available, but ILO ations have failed to reach full agreement on the
estimates that there are approximately 2 million waiving of patent royalties for drug companies
occupational deaths per year worldwide, with on some of the key drugs. Some concessions
no indication that the number is decreasing. have been made by the industrial countries and
In fact, updated numbers indicate substantial the negotiations continue.
increases over just a few years. Contributing The WSSD also made statements about the
factors include increasing population and an ap- need to increase efforts on water and sanita-
parently growing number of risks in developing tion supply, but this would require many billion
countries. Nevertheless, available information is dollars of additional financing each year. If this
uncertain. financing was extended in the form of loans to
Both ILO and WHO , have developed glo- developing countries, it would burden them
bal strategies for decent work and occupational with additional debt. One proposal was to get
health that complement the more general state- more private-public partnerships for water and
ments and conclusions from the global confer- sanitation supply, but this too has drawbacks as
ences on development. If these strategies were privatisation of water supplies will not necessar-
implemented, and integrated into the general ily bring the services to the poor, but may just
development policies, OSH would have a higher improve supply for the middle class who are the
profile. only people who can afford to buy water.
The most recent major global conference on The war on Iraq has undermined the stated
development issues was the World Summit on intentions from the WSSD, the Millennium
Sustainable Development (WSSD) in Johan- Goals and Agenda 21, as industrial countries
nesburg, 2002. It became a controversial affair, divert development aid funds into activities to
with the major industrial countries focused on “rebuild” Iraq.
making the conference a forum for discussion
of trade liberalisation – an important issue for a global strategy on
them – while developing countries focused on “occupational health for all”
the general imbalance of resources between Meaningful action on OSH means the transla-
industrial and developing countries. The impact tion of international conference recommenda-
on developing countries from changes in trade tions and international agency programmes, into
regulations and the lack of aid were other is- national policies and programmes. The network
sues of disagreement. The conference did not of WHO Collaborating Centres in Occupational
specifically deal with OSH issues, but the result Health has published a “Global strategy on oc-
of general development and trade policies in the cupational health for all” with 10 priorities, that
process of globalisation does impact on OSH. translate global visions into national policies and
One of the key outcomes of the WSSD, was actions. This strategy was later adopted by the
that trade negotiations within the WTO should World Health Assembly. The 10 priority areas
be more amenable to the needs for developing for action include those listed in the Box . The
countries to produce essential drugs at low cost,
750
Ten priority action areas in the WHO “Global strategy on occupational health
for all”.
1. Strengthening of national policies and policy tools
2. Development of a healthy work environment
3. Healthy work practices and individual health promotion
4. Strengthening of Occupational Safety and Health Services
5. Establishment of support services for occupational health
6. Occupational health standards based on risk assessment
7. Development of human resources for occupational health
8. Establishment of information systems
9. Strengthening of research
10. Collaboration in occupational health and with other activities
following text is based on the strategy but has Successful prevention requires: a) information
been shortened and updated. on the causal relationship between a risk fac-
tor and health outcome and knowledge of the
Strengthening of national policies mechanism of causation, b) knowledge of how
and policy tools the causal relationship can be influenced, c)
Major occupational health risks in traditional resources, tools and mechanisms for the imple-
industries such as agriculture, mining, construc- mentation of preventive measures, and d) politi-
tion, etc. are global hazards. In addition, policy cal, managerial and target group support for the
considerations should be given to the new oc- preventive programme.
cupational health needs that have appeared Without prejudicing the primary responsibil-
due to rapid changes in economic structures, ity of the employer for ensuring safety at work,
technologies and demography. National policies government policy, legal actions and enforce-
and programmes for the development of occu- ment are needed to ensure minimum levels of
pational health should be reviewed and prepared health and safety in all sectors of the economy,
in collaboration between government and social including small-scale enterprises, the informal
partners. Special concern should be devoted to sector, agriculture and the self-employed. OSH
enhancing possibilities to integrate continuous programmes should be integrated as vital com-
improvement of the work environment with the ponents of socio-economic development. How-
overall development of enterprises and organisa- ever, this may be undermined by the develop-
tions. The principles of “sustainable development trends characteristic of globalisation.
ment” should be taken into account.
751
Chapter 12.3
Healthy Workplaces; a setting for supportive environments

The idea of “healthy workplaces” emerged from the application of the 1986 Ottawa Charter for
Health Promotion to different “settings” where health promotion could be carried out. It was ini-
tially considered as an extension of health promotion activities, (largely focused on lifestyle), into
the workplace where workers are a “captive audience” for health messages. The concept was further
developed at the International Health Promotion conference in Sundsvall, Sweden, in 1991, where
the concept of “supportive environments for health” was established. The concept then became an
integral part of the WHO activities to promote “Healthy Cities”.
The workplace became one of the settings within which the promotion of positive health can be
carried out. Other settings include “healthy market-places” (for food safety and nutrition), “healthy
schools” (for a healthy school environment and an integration of health education into school cur-
ricula) and “healthy health services”. For each “setting”, guidance documents have been developed
on how a local project can be established and implemented. Steps towards “health-promoting work-
places” include: health-promoting policies (e.g. through vision and mission statements and strong
directions from top management), concerted actions to create a safe and healthy work environment
(the traditional domain of occupational health and safety), effective worker participation, training and
personal skills development, and strengthening of occupational health services (which may also serve
families of workers).
Development of a healthy work environment Healthy work practices and individual health
Most OSH activities naturally focus on the wide promotion
variety of OSH hazards that still need attention, Many occupational hazards can be avoided and
however, the workplace can also be a place for controlled when workers adopt appropriate
health promotion. A healthy work environment working practices. This is possible when work-
is not only free from hazards that cause injuries ers are provided with information, tools, work
and diseases, but also promotes health through organization and work aids that enable a safe and
the varied physical activity it provides - the sense healthy workplace. This requires knowledge of
of achievement and learning work fosters, the health hazards at work and how to avoid them.
sense of pride in a good product, and the sense In some instances, personal protective equip-
of community from being part of a work team. ment may be needed and workers should be
A suitable job can provide considerable positive actively involved in decision-making about when
effects on mental health. Unemployment is very such devices should be used, if a high level of
poor for health. compliance is to be met.
The above ideas fit well with the aims of the Workers´ lifestyles, unrelated to work itself,
“Healthy Workplace” or “Health-promoting may have specific or general impact on their oc-
Workplace”, concepts promoted by WHO. cupational health and safety and working capac-
ity. Health education should be provided on
ways to avoid the negative effects of combined
lifestyle factors and occupational exposures. A
classical example is smoking cessation education
752
for workers with past and/or present exposure to The preventive approach should be given the
harmful dusts, e.g. asbestos. Even low asbestos highest priority. Due consideration should be
exposures may increase the workers lung cancer given to the needs of OHS for the self-em-
risk, which would be further increased by smok- ployed, agricultural workers, persons employed
ing. in small-scale enterprises, migrant workers and
A health-promoting workplace should not those in the informal sector. Sometimes such
only contribute to better health for staff, but also services can be provided by primary health care
for consumers and the neighbouring community. units specially trained in occupational health.
A workplace can create health risks beyond those
that directly affect their staff so there is a need Establishment of support services for
to prevent such community risks by considering occupational health
the following: Many countries have organized such services
1. The impact of the production facility on the in Institutes of Occupational Safety and Health
local environment via environmental pollu- while others rely on services provided by univer-
tion. sities, large industries or individual consultan-
2. The impact of the production technology and cies. Governments and authorities responsible
materials on the local and wider environment. for occupational health should ensure the avail-
3. The impact on consumers and the wider com- ability of expert services for OSH by guarantee-
munity from product use and/or disposal. ing that institutions have the necessary capacity
4. The impact of the production facility and and staffing levels.
its associated infrastructure (extraction and The potential shortage of experts must be
transport of materials, need for utilities, dis- considered in the planning of the training cur-
tribution and sales, disposal and recycling) on ricula and programmes for OHS. A national
the social and economic conditions of a com- quality assurance and quality management ele-
munity. ment should be included in OHS programmes
and appropriate training should be provided to
Strengthening of occupational safety and responsible personnel.
health services
The emerging problems of occupational health Occupational health standards based
call for the development of Occupational Safety on risk assessment
and Health Services, OHS, for all workers in To ensure the application of minimum levels of
all sectors of the economy and in all enterprises, health and safety at work, standards which define
as well as for the self-employed. Modern OHS the safe levels of various exposures and other
services should draw from relevant professions, conditions of work are needed. These stand-
e.g. occupational medicine and nursing, occupa- ards also serve as references for assessment of
tional hygiene, work physiology, physiotherapy, results from monitoring and provide guidelines
ergonomics, safety and work psychology. for planners. When standards are further devel-
Tripartite collaboration between government, oped, the high variation in workers´ sensitivity
employers and trade unions for implementation to occupational exposures should be considered.
of occupational health activities, should be en- A relevant scientific basis for setting standards
sured through the establishment of formal links.
753
Chapter 12.3
should be ensured through collaboration with ing, occupational hygiene, ergonomics and work
research organizations. physiology, occupational safety, work organisa-
tion and other relevant fields.
Development of human resources for
occupational health Establishment of information systems
There is a universal shortage of both expert Analysis of reliable data, establishment of trends
resources and training in developing and newly in occupational health and recognition of priori-
industrialized countries, principally due to three ties at national and local levels, are of utmost
reasons: importance for policy making and occupational
a) Minimal employment opportunities for ex- health practice. Each country should review its
perts because of lack of effective legislation data and registration systems of occupational
and lack of demand from authorities and diseases and accidents. The comparability of
employers data should be ensured through collaboration
b) In the absence of demand, vocational training between countries.
institutions and universities have not organ-
ized and developed curricula to train OHS Strengthening of research
experts. Research is essential to provide the evidence
c) Where training is available, it is oriented to base for prevention. Each government should
clinical occupational medicine. While this is establish or strengthen its national centre for oc-
important, occupational medicine expertise cupational health and, if appropriate, a network
does not satisfy the needs for expertise in a of centres. A national centre should be given the
preventive, workplace-oriented occupational responsibility for research, information, train-
health service. ing, and appropriate advisory, analytical and
measurement services that support occupational
It was recommended by WHO in 1995 that each health practices.
country should include an element of training A national research programme should con-
of sufficient numbers of experts to implement duct surveys of the OSH situation, develop
the national programme and to ensure sufficient competence and methodology in occupational
personnel resources for OHS, as part of its na- health research and respond to the needs of
tional programme on occupational health. Gov- national occupational health programmes. Ef-
ernments should ensure that the necessary ele- fective international collaboration in research
ments of occupational health are included in the should be ensured.
basic training curricula of all those who may deal
with occupational health issues in the future. Collaboration in occupational health and
Training in occupational health should also be with other activities
given in connection with vocational training and When developing occupational health practices
in training programmes for workers, employers for special groups, e.g. farmers, the self-em-
and managers. The need for a multidisciplinary ployed, small-scale industries and home indus-
approach in occupational health should be taken tries, collaborative links may be needed with
into consideration in all training, ensuring in- various extension organizations, industrial as-
volvement of occupational medicine and nurs- sociations and several types of nongovernmental
754
voluntary organizations. Such links may facili- Occupational safety and health activities have
tate the implementation of occupational health a number of links with other parallel activities,
programmes among economic activities that are such as environmental health and environmental
more informal and difficult to reach than con- protection (see Box ), primary health care and
ventional industry and service enterprises. specialized hospital-based health care. In all such
The Sixtieth World Health Assembly 2007 collaborations, the role of occupational health
adopted a global plan of action on workers´ experts is to provide expert knowledge on po-
health 2008-2017 with a similar and up-dated tential hazards and their effects on the health of
but less detailed content. those exposed to them in the work environment.
Linking occupational health and environmental awareness

There are numerous examples of local pollution causing health risks outside and inside workplaces.
E.g. lead-smelters, other metal smelters, cement factories, paper pulp factories, and other basic
processing industries have a great potential to create local pollution that exposes both staff and the
surrounding community to health risks. The wider and global environment can be affected by in-ef-
ficient energy consumption which contributes to greenhouse gases and climate change, and by the use
of chemicals that damage the wider environment, e.g. ozone layer depletion. Products that affect con-
sumers include paints containing lead, which were widely used in the past and are now affecting those
removing the paint as well as children living in lead-painted houses. Social and economic conditions
can be affected by major relocation of people when industrial facilities are built, or when facilities are
closed as a part of industry “restructuring”, often resulting from the globalisation process.
In recent years, a number of approaches have been developed to encourage and facilitate the integra-
tion of environmental consciousness into business and industry decision-making. A general aim of
these schemes is to “internalize the externalities”, or to make sure that the full impact on the environ-
ment of a business activity is taken into account. In Life-cycle Analysis (UNEP, 1996), the inputs of
raw materials, their conversion into product, and the fate of the waste from the production or use of
the product is described and quantified.
Another approach which describes the environmental impact of the modern, consumption-oriented
way of life, has been to estimate the ecological footprint. “The ecological footprint is the land that
would be required on this planet to support our current lifestyle forever.” (Wackernagel, 1993). If the
ecological footprint greatly exceeds the area available for a particular population, their livelihood and
lifestyle cannot be sustained without depleting the resources of another population.
A number of environmental management tools have been devised to promote these principles e.g.
Cleaner Production (UNEP, 1994), The Natural Step (The Natural Step, Stockholm (www.natural-
step.org), Toxic Use Reduction, Waste Minimization, Zero Waste, etc. Hawken lists organizations in
the USA that have been active in promoting these principles, including Business for Social Responsi-
bility, Social Venture Network, Coalition for Environmentally Responsible Economics.
At the international level, UNEP has been in the forefront of promotion of these principles. A
number of other international agencies have had their own programmes targeted at their special
constituencies; e.g. WHO, ILO, UNIDO, FAO, UN/CSD (UN Commission on Sustainable Devel-
opment), WWF (World Wide Fund for Nature), IUCN (International Union for the Conservation
of Nature).
755
Chapter 12.3
global research needs for osh already available. A focus for new OSH research
Worldwide, health research is characterized by would be the description and quantification of
the 10/90 phenomenon, which means that only the extent of the problem in a particular popula-
10% of the research effort is devoted to the tion and to document the impact of preventive
90% of the global burden of disease primarily actions or policies. Participatory research, with
affecting poor people. That part of the burden the study population as a partner rather than
includes much of the occupational burden of a mere object of study, is preferable. Recom-
disease. OSH research is an important step mendations for ways to strengthen occupational
towards reducing health inequalities, and oc- health research have been published in many
cupational health conferences have called for the different contexts.
incorporation of occupational health evidence OSH research needs at local level are driven
into the requirements for environmental impact to a great degree by the “body-count mental-
assessment of loans and other investments in ity”; OSH hazards already known to have major
workplaces in developing countries. health impacts in industrial countries in the past,
Priorities for occupational health research need to be demonstrated to have effects in lo-
vary by country, but generally the most useful cal workplaces (the body count) if they are to be
would be implementation-research that docu- taken seriously by local OSH personnel. This
ments the impact of preventive interventions phenomenon also occurs in industrial coun-
in the field. Research on OSH problems for tries, e.g. in New Zealand when the risks from
women, children and young workers, as well as asbestos were not taken seriously because local
elderly workers, has been largely neglected so asbestos cancer research was not yet available
far. For many of the work hazards described in even though international research had clearly
previous chapters of this text, basic knowledge demonstrated the risks of asbestos.
about action mechanisms, dose-response rela- Another area of research of importance for
tionships, and potential preventive approaches is OSH in developing countries, is the study of the
impact of different preventive interventions in a
Recommended actions from the Bangkok Occupational Health Research Workshop

2000 (WHO Collaborating Centres meeting)
Research on occupational safety and health risks needs to be carried out in all countries, for all work-
ing people. Special attention should be paid to high-risk branches, such as agriculture and mining,
and small and medium-sized enterprises, and vulnerable groups such as female workers, who are
under-served and under-researched.
“Preventive measures and applied research linked to development processes, e.g. in infrastructural
projects, heavy industry, agriculture and the health care system, might prove successful. Economic
research on occupational health prevention would also be useful.”
“The World Bank should produce, with the help of the WHO and particularly with the network of
the WHO Collaborating Centres in occupational health, evidence-based occupational and environ-
mental health assessments as compulsory elements of all its programmes, and require the necessary
preventive actions as a condition for funding.”
756
local context. Such research can lead to broader similar program (WAHSA) for 14 countries in
application of preventive interventions. Southern Africa was launched in 2004.
At the global level, research is needed to show
the impact of different approaches to OSH as financial resources for osh
globalisation is implement at country level. Such development
research would record successes and failures at Reference has been made in previous sections
the general policy level that could be “ammuni- to the financial and other resources needed for
tion” in the debate about how to get positive positive OSH development in developing coun-
OSH outcomes from globalisation. tries. A major source of these resources should
In the global perspective, more refined analy- come through investments in agricultural and
sis of the importance of OSH to global health, industrial development, whether they be gov-
particularly to the burden of disease and injury, ernmental or private loans or aid. OSH must
is needed. Such analysis can help to put OSH be seen as an essential component of the invest-
on the agenda of general policies on health de- ment, just like transport and energy supply are
terminants, which may in turn, raise the profile for any major investment. Parts of the many
of OSH within the health sector. billions of US$ in foreign direct investment each
The role of national institutes of occupa- year should be used for OSH development.
tional safety and health is of great importance if Aid funding can play a role in upgrading OSH
these areas of research are to be developed and in existing facilities but OSH will then compete
to provide researcher training. A number of for attention with many other basic needs, such
countries, both developing and industrial, have as water and sanitation. The total global aid
substantial institutions with expertise in different flow from industrial countries increased until
areas. Many of these institutions are participants 1990 and then stagnated. In 2005 it was ap-
in the WHO network of Collaborating Cen- proximately US$ 60 billion. The current aid
tres, which includes industrial countries as well flow is only 0.4 % of the GDP in the industrial
as Mexico, Costa Rica, China, India, VietNam, countries, even though in 1970 it was agreed at
Egypt, Thailand, South Africa, and others. In a UN meeting that they would achieve aid at
industrial countries, some of the institutes have 0.7 % of their GDP by 1975. It should also be
long experience of supporting research activities remembered, that much aid actually supports
in developing countries, particularly the insti- military costs, which make no contribution to
tutes in Finland (FIOH), Denmark (DIOH), health or OSH development in the recipient
Singapore and USA (NIOSH). In the USA, a country. The case for a doubling of aid, focus-
special program for collaborative research training on health, education and poverty reduction,
ing through the Fogarty International Centre in order to achieve the Millennium Develop-
has been established. Collaboration in OSH ment Goals has been made repeatedly.
between Sweden, Nicaragua and Costa Rica has Multilateral aid, through the UN system, was
led to a long-term research, education and ac- only US$ 5 billion in 2002, and much of the
tion program (SALTRA). This OSH program remaining bilateral aid is tied to the purchase of
for seven countries in Central America is funded equipment or services from the donor country.
by Sida, Sweden, and was launched in 2003. A This reduces the value of the aid, as the most
cost-effective procurement of the materials
757
Chapter 12.3
cannot be used. For instance, many develop- of infrastructure, education and health (includ-
ing countries could potentially supply goods to ing OSH) in line with the Millennium Develop-
other developing countries, but “tied” aid means ment Goals. To achieve the goals, “only” US$
that this route cannot be used. 50 billion per year is needed until 2015 , so a To-
An interesting possibility to raise funds for bin tax of only 0.01% in each foreign exchange
aid could be through the so-called “Tobin Tax”, transaction would be sufficient.
first proposed by Professor James Tobin at Cam-
bridge University in the 1970s, that would tax an integrated approach for success
foreign exchange transactions. His idea was that Occupational diseases and injuries are essentially
such a tax would discourage speculative foreign preventable. Approaches to prevention include,
exchange transactions, which involves the move- developing awareness of OSH hazards among
ment of billions of dollars from one currency to workers and employers, assessing the nature and
another, and then moving them back when the extent of hazards, and introducing and maintain-
exchange rates have changed to a level, advan- ing effective control and evaluation measures.
tageous to the currency speculator. It is like a International or global policies, statements,
large global gambling casino, where the money guidelines, etc., are also important to facilitate
market managers are playing with billions of good OSH development at local level.
dollars. The Tobin tax proposed a low tax of Historically, OSH strategies and programmes
0.1% or less, for each currency exchange trans- have been developed along with the improve-
action, that would have little impact on normal ment of social conditions for workers. Although
business activities, where foreign exchange is there is an abundant literature on seemingly
transferred for the original investment and simple solutions to many workplace hazards,
transferred back later as return on the invest- e.g. in the ILO Encyclopaedia on Occupational
ment. Health and Safety, there is a need for adequate
The daily turnover of foreign exchange and systematic approaches to implement solu-
transactions is about US$ 1 500 billion, which tions.
is equivalent to US$ 550 trillion per year, or Solutions to OSH problems will vary sub-
about 20 times the global GDP! A tax of 0.1% stantially according to national and local needs
would raise US$ 550 billion per year, (assuming and conditions, cultural influences, resources
that the daily turnover would remain the same), and other local factors. Regional cooperation
equating to 10 times more than current foreign between neighbouring countries for training,
aid contributions or, 50 times more than the research and information can save resources and
total cost of the whole UN system. This idea contribute to more effective national systems.
has been politically dead for more than 30 years, Support from ILO and WHO can be very help-
because industrial countries have resisted any tax ful for regional initiatives.
that could impede foreign exchange transactions. Globalisation adds new challenges as the
Such a small tax is, however, much smaller than dominant culture of the multinational corpora-
the daily fluctuations of exchange rates, so it is tions may clash with local workplace practices.
difficult to see how it could harm legitimate for- Corporations from the USA are greatly influ-
eign investment and trade activities. It would be ential, and this is a country where employers
a global tax that could be set to meet the needs for a long time have been particularly hostile to
758
trade unions. Non-unionised workplaces are the

norm in the USA, and this is being promoted as
the norm when new workplaces are established
as a result of foreign investment in developing
countries.
Because of the complex layers of financial and
production responsibilities which characterises
many globalised industries, confusion is cre-
ated about who is responsible for OSH. For
instance, a major, high-profile brand named
sports shoe corporation transfers its’ production
to Viet Nam. The local factory is not owned by
the major corporation, but owned by a Korean
company, which may in fact, be partly owned by
the major corporation. This company then sub-
contracts companies to perform specific parts of
its’ production so people are working for several
different employers, with their financial base in
different countries, on the same worksite. The
question then is, who is responsible for OSH in
that workplace? The situation could potentially
become even worse if the factory is located in
an “export processing zone” where national
OSH legislation does not apply by decree of the
Vietnamese government. Naturally, organizing
workers into a union has not happened, partly
because all the workers are young women who
have migrated to this factory from rural areas
and are totally dependent on the company for
work, housing and other services.
Effective occupational health programmes
cannot work in isolation and, while priorities
need to be identified, many issues have to be
dealt with in an integrated way to create good
results. For developing countries, information,
encouragement and guidance from other coun-
tries, both developing and industrial, can be a
great asset in OSH development – in this way
globalisation can be made into a positive force.
759
chapter 12.1 chapter 12.2

ILO (2003) World Commission on the Social Castleman B. (1999). Global corporate policies
Dimension of Globalisation. Geneva, Interna- and international “double standards” in occu-
tional Labour Office.http://www.ilo.org/pub- pational and environmental health. Int J Oc-
lic/english/wcsdg/index.htm cup Environ Health, 5, 61-64.
WTO/WHO (2002) WTO agreements and Feachem R, Kjellstrom T, Murray CJL, et al.
public health. A joint study by the WHO and (1990) Adult ill health in developing countries.
WTO secretariats. Geneva, World Trade Or- Washington DC, World Bank.
ganization and World Health Organization. Fustukian S, Sethi D and Zwi A. (2002). Wor-
WHO Commission on Social Determinants of kers health and safety in a globalising world.
Health. Labonte´ R et al. Towards Health- ILO (1998) Stellman JM (ed). Encyclopaedia of
Equitable Globalisation: Rights, Regulation Occupational Health and Safety. 4th Edition.
and Redistribution Globalization and Health Vol 1- 4. Geneva, ILO.
Knowledge Network: Research Papers 2008 Kjellstrom T. (2000). Climate
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(http://www.who.int/social_determinants/ exposure and labour productivity. Proc. ISEE
knowledge_networks/final_reports/en/index. 2000, 12th Conference of the International
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Hogstedt C, Wegman D, Kjellstrom T. The Buffalo, USA, August (2000).
Consequences of Economic Globalization on LaDou J. (1999). DBCP in global context: The
Working Conditions, Labor Relations and unchecked power of multinational corpora-
Workers´ Health. In Kawachi I, Wamala S tions. Int J Occup Environ Health, 5, 151-153.
(eds) Globalization and Health. Oxford Uni- Loewenson R. (1998). Occupational Risks in
versity Press 2007 the informal sector in Zimbabwe. Int J Occup
Klein N. (2002). Fences and windows. Dispatch- Environ Health, 4, 241-245.
es from the front lines of the globalisation London L, de Grosbois S, Wesseling C, Kisting
debate. London, Flamingo Harper Collins S, Rother HA & Mergler D. (2002). Pesticide
Publishers (2002). usage and health consequences for women
Stiglitz J. (2002) Globalization and its discon- in developing countries: Out of sight, out of
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Elgstrand K (ed). Anthology on Industrial De- Murray CJL & Lopez AD (1996) The global
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chapter 12.3
Up-dated information on international organi-
zations can preferably be found at the web pages,
especially as new documents are produced all the
time and reorganizations often occur.
761
13
Actions for change
13.1 Strategy for change 765

13.2 Project guidelines 775
13.1
Strategies for change

Lennart Svensson
How can occupational safety and health be pro intentions, emotions and values, etc? On one
moted? How can accidents and diseases be hand, all change has to include the individu
prevented? While we know much about what als concerned, as any organisation is nothing
is needed to create a healthier working envi without its individual members. On the other
ronment, we know less about how to do this. hand, we can never understand a change proc
Measuring and analysing the risks and causes ess only by an examination of the combination
behind occupational accidents and diseases is not of individual actions. There is something more
enough – we must also find solutions. than individuals – in terms of decision-making
This chapter will focus on a number of strate structure, corporate culture, access to expertise,
gies which can be employed when organising planning systems, time-schedules, networks with
change at work. customers, suppliers, etc.
I am very critical of the increasing tendency to
individual versus organisation individualise and privatise problems of working
change life, especially when it comes to risks to safety
Changes can be analysed at an individual, or and health. Many theories of change consider
ganisational, national or international level and the individual as a major problem; for example
often occurs because of a combination of activi individuals are said to be resistant to change,
ties at various levels. This chapter focuses on an have bad habits, need expert information, and to
analysis of change at the organisational level as be indecisive on complicated matters. A common
work is a social activity where different groups explanation for occupational accidents is ‘the
work together to accomplish an objective. It is human factor’, which in reality says that work
essential that any change strategy takes the social ers cause accidents through their own mistakes
character of work into account and uses a collec and ignorance rather than through poor working
tive strategy, which includes leadership, organi conditions.
sational changes, management, learning capaci Such individualised perspectives can be seen
ties, and human resource development etc. as an expression of an ideology, which rational
While this chapter focuses on change at the ises and legitimates unequal and unsatisfactory
workplace level, questions must be asked about working conditions and can also be used as an
individual aspirations, ambitions, objectives, excuse for doing nothing about complex prob
765
Chapter 13.1
lems in working life. Instead, it is important to (an examination of who has the power to make
understand both the obstacles and possibilities meaningful decisions) it will be easier to see
for individuals to change their situation. If such what options are available for different groups in
possibilities are missing, any strategy based on a specific situation. An important question to ask
discussion, information and education, which is in what way can OSH changes be combined
attempts to affect attitudes towards OSH, are to enhance production. If both these objectives
meaningless. Individual behaviour will not be can be combined a successful change process
affected if the situation is not genuinely open becomes more realistic, e.g. through OSH being
for change, e.g. if participants are not given integrated with production planning and person
sufficient resources like training, time, or profes nel policy. However, there is also a risk with a
sional support to implement change. consensus-based integrated perspective on OSH.
It is not enough to focus on the organisa Conflict can be seen as something atypical,
tional level in order to implement a sustainable strange and disturbing. Energy and activities in a
change. Conflicts of interest between different change process can be created when a construc
groups – such as between the employer and tive and open dialogue is maintained.
employees, different professional groups, or The widespread assumption that it is pos
gender or ethnic groups – limit possibilities sible to find solutions that combine productivity
for a sustainable change because of the existing with improved health and safety can be seriously
power structure at the workplace level. One questioned. Since the early 1980’s we have seen
option in this situation is to enlist support from a period of downsizing, intensive rationalisa
different national organisations – such as OSH tion, work intensification and reorganisation.
agencies, and researchers – and to use relevant For large segments of the labour market the
legislation. consensus model seems to be an expression of a
To make a change process more transparent, dominant ideology or of wishful thinking pro
the following questions may be asked: For whom moted by the gurus of management, who have
is the change being made? Why is it being made? dominated organisational thinking. These theo
Where is it being directed? What will the short ries often focus on the more subjective aspects
and long-term outcomes for different groups be? of work life such as culture, management styles,
It is important to look beyond the rhetoric communication, experiences, constructions and
often used by management or consultants who commitment, while neglecting more objective
present simple and pre-determined solutions. facts such as workload, intensification of work
People involved in a change process often have and rights and responsibilities of employees.
hidden motives for taking part so care must be There is an astonishing lack of research with a
taken to distinguish between what people say critical perspective, using more objective meth
and what they actually mean. A partial solution ods to assess the influence and participation of
is often presented as a general solution which employees, which is detrimental to organising
will benefit everyone. An analysis of the inten long-term and sustainable change. The domi
tions and motives of different actors in a change nance of this new productivity paradigm will
process can be useful to foresee future problems have negative effects on the work environment
and conflicts. and subsequently on absenteeism from sickness,
If an analysis includes a “power perspective” injuries, early retirement, stress, etc, but many
766
of these outcomes are made invisible. Such a techniques, steering methods, follow-up systems
perspective is short-term and opportunistic and and so on. It is primarily used in result-oriented
is motivated purely by economics, while other projects carried out within defined time peri
values are put aside. ods. The methods used are well tested and total
The discussion of OSH regulations must responsibility is taken by management to carry
include a global perspective as currently a lot them out. The participants are often already
of unhealthy work is exported to developing accustomed to working in goal-oriented projects
countries where the legislation is weaker and with strict time schedules and deadlines.
control systems are less developed. What is Projects steered by planning strategies are
needed is a united strategy based on internation traditional and natural to construction indus
al solidarity with ilo, who and other public tries and technically oriented projects. They are
institutions playing a central role. demanding and strict in terms of timing, plans,
This chapter focuses on general change strat cost projections and various specifications – such
egies at the organisational level illustrated by the as quality. In the last decade there has been a
following practical examples of local change. breakthrough, as planning strategies became
used in increasingly diverse areas such as com
strategies for change pany development, community planning, local
Three different strategies for change will be and regional development and labour policy.
described, summarised in Figure 13.1.1. The expanding use of planning strategies
might seem strange against the background of
The planning strategy the shortcomings of these strategies being
The planning strategy can be seen as a way to exposed by comprehensive research. These
organise projects ‘top-down’ through planning shortcomings have become increasingly obvi
A Planning Strategy An Activating Strategy A Networking Strategy
Control From above From below Horizontal

Energy Formal responsibility Involvement Common interest
Method Readymade solutions Participants’ Common solutions
own solutions
Perspective Closed Open Focused
Arena Varying Local development Local or regional
Leadership Bureaucratic Enthusiastic Coordinating
Time- Often short Short or middle term Variable, often long-
perspective time
Theory Rational theories Individual, group theories Network theories,
system theories
Figure 13.1.1. Different strategies for change.
767
Chapter 13.1
ous when applied to new and unknown areas The inadequacies of the activating strategy are
because they are not flexible and cannot adapt increased vulnerability to unforeseen events; lack
to local conditions. There is no motivation for of long-term thinking; decreasing involvement
development among those concerned when over time; isolation from the local environment;
the goals and methods are decided in advance. the absence of support from those higher up in
Participants will be passive, resulting in a lack the hierarchy; a lack of long-term viability; an
of involvement that is necessary both for learn absence of reflection and critical analysis.
ing processes and for taking responsibility dur Real participation in decision-making by
ing and after completion of the project. In this those concerned is important and necessary to
way, because of the passivity among the people create a sustainable change process, but broad
concerned, conditions for self-development participation is costly and even more difficult
after completion of a project will be lacking. A to sustain long-term. There is also a risk that a
sustainable change cannot be organised in such a local change process becomes isolated, which
linear and mechanical way, because the involve makes the dissemination of change extremely
ment of participants is essential for sustainable difficult.
way.
The networking strategy
The activating strategy The networking strategy builds on horizontal
The activating strategy, based on changes from collaborative relationships, and can be viewed
the ‘bottom-up’, was developed as a reaction to as an attempt to reconcile the weaknesses of
the imperfections of the planning strategy. The both planning and activating strategies. The
activating strategy emphasises the involvement networking strategy can be seen as an attempt to
and influence of participants in the change proc combine the ‘bottom-up’ approach of the acti
ess. Often there is an involved and strong project vating strategy with a voluntary and widespread
leader who acts as the driving force. This strat spirit of collaboration between different units.
egy is primarily applied in local development A networking strategy is used when the projects
work, e.g. in peace and environmental work; in are more open, i.e. when the goal and the ex
organisational development in companies; or pected result are less distinct than in a planning
ganisation within the women’s movement; rural strategy. The goals of the project can vary from
development. It is a transparent process based different forms of collaboration between com
on an open dialogue, which avoids programming panies, improving the climate for innovation,
and planning instruments. contributing to regional change developing and
The importance of participation is strongly testing new business ideas and improving
emphasised in most current organisational theo customer/client relations in a company or
ries by both scientists and consultants. However, administrative organisation.
the popularity of a theory is not proof of its The role of the expert is different for net
validity or usefulness. It is difficult to even talk working and activating strategies compared to
about a theory in this case because the concept a planning strategy. Collaboration in a network
of participation is vague and can mean anything requires experts to have good knowledge of the
– from information to codetermination in man production system and an ability to work closely
agement issues. on the process with employers, production
768
managers and workers. The coordination role is useful instrument in certain situations, e.g. for a
central. change project focusing on prevention of physi
The current interest in networking as a de cal, chemical or biological risks. These risks
velopmental strategy has been growing by leaps can be measured and goals can be formulated
and bounds but recent research also indicates in objective terms. Different means for attain
problems with this strategy. It is difficult to ing the goals can be assessed and agreed upon.
organise networks, which should be of an infor The systematic surveillance and control of the
mal and flexible character. It is also problematic risk factors can be used for a planned process of
to create conditions for learning and critical continuous improvement. The outcomes of the
reflection, because the networking will often change can be evaluated during the process and
be of a more supportive kind, which reinforces new steps for improvement taken. Experts will
existing conditions instead of changing them. play a significant role in such a project.
There are different varieties of this strategy The planning strategy is often used when
e.g. development coalitions of vertical networks taking steps to manage safety at work starting
or innovative systems which combine networks with the identification of the hazard, assessment
and the Triple Helix, a cooperation between of the risk and consideration of a number of
companies, universities and public institutions. different actions to lessen the risks. Risk man
These new strategies for change attempt to make agement is often done in a similar analytical and
the networks less vulnerable by connecting them systematic way through the selection and imple
to other networks, actors and organisations. It mentation of activities, risk communication and
is not yet known whether these more developed surveillance.
forms of the network strategy are successful. If, on the other hand, the goal is to prevent
stress by creating a better psychosocial work
How can planning, activating and environment, an activating change strategy will
networking strategies be used? be more useful. In this situation it will be neces
The above strategies should not be seen as sary to change the design of work, the content of
models that prescribe different ways of organis work, the social relationships in the workplace,
ing a change process. Instead, they should be etc. Participation of employees will be necessary
seen as theoretical constructions, presented in a as such changes cannot be organised from outside
pure form as ideal types. Such theories can guide or from above in a predetermined way, but have
action by showing a range of alternatives for to be discussed, tested and evaluated as part of an
reflection on what is possible to accomplish in a innovative process. The role of the experts will
specific situation, which depends on the content be different and based on support, facilitation and
of the change, the size of the company, the tradi structuring of the change process.
tion and culture, the power structure, etc. Successful change requires an eclectic ap
The planning strategy can be criticised be proach where strategies are combined. For a
cause goals are set without appropriate reflec complex issue like OSH improvements, it is not
tion and because planning and evaluation is sufficient to use only one of these strategies.
conducted in a linear way. Planning is important Planned changes initiated from above are not
when organising a sustainable change, but it flexible enough and do not involve the people
must be flexible. The planning strategy is a very concerned. Changes from ‘below’ can create
769
Chapter 13.1
participation but such a change can often be This project was part of a regional programme
isolated and difficult to disseminate. It also takes designed in an integrated way through simul
a lot of effort to keep a high level of long-term taneous consideration of productivity and envi
involvement in an activation strategy. The net ronmental issues. The approach was based on
working strategy tries to handle the problems of participation and active involvement of all con
dissemination of successful changes by organis cerned parties from the very beginning of the
ing cooperation and learning between different project. Individual tanners and representatives
workplaces. A perspective on learning is central from tannery associations participated and were
to such a joint approach, but reflective and criti consulted in the development of the strategy
cal learning is difficult to accomplish. and the preparation of an action plan. The craft
It is a complicated endeavour to initiate, carry tradition and the number of small and medium
through and disseminate a change process suc scale tanneries were important situational factors
cessfully. In any specific situation, a combination to be addressed. The strategy was based on an
of different change strategies must be used but approach termed as ‘know-how through show-
the combination of strategies can also vary over how’. The idea was to use good examples, based
the different phases in a change process, which on an integrated concept of productivity, envi
makes the change even more complicated to ronment and OSH, for training and demonstra
organise. tion in the dissemination process.
The difficulties outlined above should not The main elements in the strategy for sustain
make us pessimistic but inspire us to find new able change can be summarised as follows:
ways to make working life safe and healthy. 1. Practical solutions (the know-how) were de
Below are two examples, one from India and veloped and implemented by the tanners and
the other from Sweden, which present a practi their staff.
cal analysis and implementation of the different 2. Establishment of demonstration sites in
change strategies. These are illustrative exam operational tanneries (show-how).
ples, not models for change. 3. Preparation of a specific manual for the tan
ning industry and on-site training programme
case studies using the demonstration sites as training
Improving OSH and productivity bases.
in leather tanning in India 4. Involvement of leading tanners as trainers and
key promoters of the OSH standards and
The tanning of hides and skins is a big indus
practices.
try in India, employing almost 300,000 people.
5. Coordination of activities in each country
There are major environmental problems in this
by the local Tanners Association, while the
industry for both employees and the external
experts from the regional programme mainly
environment. Most units are small and medium-
provided technical guidance.
scale tanneries, which lack the most basic facili
ties required for a safe work environment. The
The overall assessment of the programme was
United Nations have initiated a number projects
very positive, particularly in creating awareness
to improve working conditions and work prac
and the response of the tanners. I believe that
tices in South East Asia.
the successful outcome can be mainly attributed
770
to the combination of an activating and a net well as in their caring work.

working strategy due to: In the first municipality the management
• a focus on local problems and practices (acti organisation was hierarchical and centralised
vating) (with ten organisational layers), while it was flat
• an emphasis on the improvement of practices and decentralised (with only three hierarchical
already in use (activating) levels) in the second municipality.
• the fostering of close involvement of all con A team organisation was introduced in two
cerned parties and external experts (network municipalities to strengthen the cooperation
ing) between the employees, but there were many
• making a few proactive entrepreneurs active differences in the way work was organised in
advocates for the change programme (net the two municipalities. The first municipality
working). had large teams with 15–20 members, a strong
leadership role inside the teams and a highly
In this case study, flexible and informal plan hierarchical and centralised management struc
ning was used to create a link between the OSH ture (8-10 layers). The second municipality had
work and management goals. The organisers of small teams of 5–8 members with coordination
this change process did not consciously use the from inside the group, rotating between all team
above strategies but they did act in a reflective members.
way to balance the need for active involvement, The research showed important differences
cooperation (networking), and flexible planning. between the two municipalities. The second
By making these elements in the change proc municipality had much better OSH in terms of
ess visible, they can be used for reflection and stress, involvement in OSH issues, absentee
learning. The next time a change is organised, a ism due to sickness, autonomy, competence
more developed strategy can be used which will development, etc. The relationship between the
increase the probability for a more sustainable home-helpers and the clients was more personal,
development. mainly because of improved continuity of carers
working for the same clients.
Improving OSH for municipal When we compared the different results from
employees caring for elderly people the change in organisation in the two munici
The second case study is about municipal em palities, a number of questions arose about what
ployees working as home-helpers for elderly could be done to promote OSH in the mu
people in Sweden. Caring for elderly people nicipality with the hierarchical organisational
as a home helper is hard work both physically structure. What change strategy could be used?
and mentally. Employees often work alone, are Should it be a planning, activating or network
forced to do heavy lifting, are victims of strict ing strategy? In what way could a researcher be
time constraints, and are constantly put into of any help in the change process?
unexpected, high demand situations from their Of primary importance is the understand
clients and clients’ relatives, politicians and ing that any change must be owned and driven
management. The majority of home-helpers are by the home-helpers themselves. They must
women who also have a lot of responsibilities define, analyse and decide what should be done
and demands for work in their own homes as but without interfering with the interests of the
771
Chapter 13.1
clients. To support an activating strategy we going ahead step-by-step; getting positive feed-
presented a number of alternatives for change back from colleagues; learning and reflecting on
which resulted in a joint dialogue and learning the results; getting support from management
experience between the two municipalities. Four and professional groups from both inside and
home-helpers from each municipality exchanged outside the company.
jobs with each other for two weeks. They met
before to prepare and plan the exchange and the role of education, research
afterwards to evaluate their experiences and and change
quickly agreed on the advantages of the more There are often simplistic assumptions about
decentralised organisation with the small teams. how education, research and development re
The next step saw the home-helpers function late to each other, often focusing on the role
ing as change agents in meetings and discus of universities in introducing change in the
sions with the rest of the employees in their own workplace. Basic research on OSH is thought to
municipality. In this way a change process that produce results that are delivered to experts who
had a long-term effect on work organisation and will then use this knowledge in their professional
on OSH was initiated. roles by organising rational ways of solving
A networking strategy was then used in a problems. Such a linear, mechanistic and long-
dissemination process to other municipalities. term perspective on change i.e. a planning strat
The home-helpers took part in a variety of egy will not be useful in coming to grips with
conferences and seminars with employees, un pressing OSH risks in a rapidly changing society
ion representatives, service users, managers and which is becoming globalised, is information
politicians. Their intention was not to present a based, adaptable and experienced in networking.
model of best practice for a healthy work organi Instead, what is needed is a flexible, simulta
sation but to inspire various solutions that could neous and interactive approach based on joint
be discussed by the participants based on their learning. Experts and universities must work
own experiences and needs. These conferences in a new way where they cooperate with the
stimulated innovation and learning and were practitioners in an open, equal and adaptable
often followed by study visits and local seminars way. This developmental support should not be
in various municipalities. seen as something that conflicts with traditional
To summarise, what started as a limited university tasks, but as something that supports
project with eight home-helpers using an ac them.
tivating strategy developed into a networking The ambition is to integrate change with
strategy for joint learning between municipali learning, and developmental work with research,
ties nationwide. The expert’s role was mainly to in order to create a synergy between the differ
support, structure and evaluate the change proc ent tasks. Change can be put at the centre of an
ess. interactive system between a university and vari
The findings point to a number of important ous local and regional actors (companies, trade
factors: involvement of the people concerned; unions, schools, consultants, associations). With
giving them time and resources; starting from an action-oriented approach, change will be a
their own experiences; stimulating innovation natural component of all research projects. If an
with ideas and examples from other workplaces; experience or problem based pedagogy is used in
772
university education, specific, well-documented

case studies are necessary components.
The main idea of interactive research is to
‘open up’ universities for cooperation with wider
society. In this way, university teachers and re
searchers can use their expertise in a more direct
and fruitful process to improve OSH through
joint learning and development of working life.
Collins, David (1998). Organisation Change.

Routledge, London.
Hannak, Jurgen (1998). Improving occupational
safety and health standards in the tanning industry.
In OSH & Development, no 1, August 1998.
Hannak, Jurgen (2001). Practical improvement of
safety and health work – Experiences and lessons
from the small- and medium-scale tanning indus
try in south India. In OSH & Development, no 3,
June 2001.
Svensson, L & von Otter, C (2002): Strategies
for Regional Regeneration: Learning from the
Bergslagen Regional Research Centre. Economic
and Industrial Democracy (Sage), Volume 23.
773
13.2
Project guidelines
Nils F Petersson & Kaj Elgstrand
why conduct projects?

Activities that fall outside the normal core busi- the planning of a new building, the start of new
ness of an enterprise or an organisation may production, or the prevention of a particular
be carried out as one or multiple projects. The OSH risk. All projects must have an objective
establishment of a special project may be moti- that is well defined before the project is decided
vated by a need that demands a wider approach upon. Any objective needs to be expressed in
and deeper collaboration than what can nor- such a way that it can be measured or easily
mally be applied during normal daily duties or evaluated at the end of the project to see how
within an existing organisation. A project can be well the objective has been achieved.
initiated by a newly discovered problem, and/
or an idea for an improvement. A project may One off issue
facilitate cooperation between different groups A project is ideal for a one off activity. On the
or departments beyond ordinary organisational other hand, activities that will be repeated
borders. If a project is well planned and properly several times as part of the core business of an
executed, it can be carried out in parallel with organisation or company, are better achieved if
the core business without causing disturbance or there is a permanent organisation taking care of
interruptions. the work.
characteristics of a project
Defined timeframe
The main characteristics of a project are that it
has a defined objective, and is a one off activity A project always has a starting point and an
with a defined time frame, its own budget and end point. When the objective of a project is
specific organisation. achieved, the final evaluation made and reported
(in writing if requested), the project is finished.
Defined objective Estimates of costs normally require the deadline
Projects may include activities such as the im- for a project to be set in advance as well as total
plementation of new technology or organisation, number of work hours needed.
775
Chapter 13.2
Budget project management

A project must be given its own budget. As a
Project phases
project often involves experts from different
The planning and running of a project can nor-
departments, their time costs normally have to
mally be divided in five phases.
be calculated and covered by the project budget.
During the design phase the subject and title
The budget should be calculated before a project
of a project is decided upon. A detailed problem
starts and management has to set aside the nec-
analysis is then carried out. This analysis should
essary money. If possible, the project budget
give the justification for the project, stating why
should be broken down into different phases or
it is important and who will benefit from it. The
activities that can be assessed during the project
objectives are defined to express what will be
allowing corrective action to be taken if needed.
achieved by the end of the project should it suc-
Organisation ceed. In many cases, too little time is spent on
the problem analysis and the definition of objec-
When a project is designed and the objectives
tives that leads to difficulties in later phases.
defined, a decision about what experts are need-
During the planning phase, a project organi-
ed will be taken. There must always be a project
zation and a work plan are set up. The project
leader who is responsible for the running the
activities to be carried out are described and a
project, including the budget. Depending on the
time plan set up. This includes a starting date,
character of the project, experts from different
a schedule for the different activities, and the
disciplines may be included in the project team.
finish date. An analysis of needed resources
Their roles and the amount of time they require
(personnel, time, money, equipment, etc) and
for the project need to be defined. It is also
available resources must be undertaken. If the
desirable to identify the stakeholders in a project
required resources are greater than the resources
before the design is finalised. Stakeholders are
available, adjustments must be made to the
not part of the project team, but they may facili-
project (less ambitious objectives, for instance)
tate or obstruct the running of a project.
or more resources found.
Although project organisation is predefined, it
Implementation of project activities may
may be found that other experts or more human
deepen the knowledge about the problems to be
resources are needed once the project is under-
solved by the project. This experience may re-
way.
quire adjustments to the project plan (objectives,
All projects, independent of their size, can
activities, time plan, resources needed), or may
be divided into different phases. It is essential
stimulate the establishment of new projects, or
to spend sufficient time on planning in order to
even motivate termination of the project before
avoid problems during implementation. Some-
the objectives have been achieved.
times it can be useful to extend the planning
Achievements are reported during the report-
phase to a pilot project that tests project ideas
ing phase, usually in writing and orally. Some-
before full implementation.
times it may be of value to describe the activities
that led to achievements. It is always important
during reporting to relate, discuss and document
how project objectives have been fulfilled. If spe-
776
Project guidelines
cific questions have been formulated during the those that depend on each other so requiring a
design phase of a project, these questions should sequential approach. Critical Path Analysis (CPA)
be answered in the reporting. is another powerful method for bigger projects,
Evaluation of projects should be focused similar to Gannt. The Program Evaluation and
on how well the project objectives have been Review Technique (PERT) is similar to the CPA
achieved. Evaluation is easy if the objectives are but less “optimistic” in its time calculation as it
well defined and the project has been successful. considers not only the shortest time requirement
An evaluation should not only include measure- but the most likely and the longest time the
ment components but comment on judgments project may take.
and decisions. As the decisions based on the In this chapter we will go into detail only in
evaluation often involve different stakehold- relation to one such planning technique: the Log-
ers, the evaluation needs to be documented in ical Framework Approach, LFA. It is a step by step
writing to allow for common interpretation and method to prepare, plan, carry out and evaluate
understanding. projects. LFA integrates a number of different
planning techniques (Problem Tree Analysis,
Planning techniques Objectives Analysis including defining of objec-
There are very many different techniques for tive indicators, SWOT Analysis, etc), and has
the planning and running of projects. Here a few been used widely for more than ten years by sev-
examples. eral development cooperation agencies including
Goal Oriented Project Planning (GOPP) is a Norad in Norway and Sida in Sweden.
participatory approach to analyse and prepare The first step is a problem analysis that may be
a project in a group. The Gannt chart is one done by setting up a “problem tree” that identi-
way to plan different project activities to find fies the effects of the problem. The following
the quickest way to carry out the project and uses the high noise level in a mechanical work-
avoid costly waiting periods. Activities that can shop as an example of the main problem. Figure
be done in parallel are distinguished, as are 13.2.1 outlines some of the primary effects.
Can induce hearing loss Increased fatigue Disturbs communication
High noise level
Figure 13.2.1. Some of the primary effects of a high noise level in a workshop.
777
Chapter 13.2
Loss in social life Increased risk for Masks warning sounds

accidents
High noise level
Figure 13.2.2. Primary and secondary effects of a high noise level in a workshop.
These problems may cause other problems, The next step in the problem analysis is to
secondary effects, and Figure 13.2.2 shows identify the causes of the problems, and Figure
added examples of such effects, some of which 13.2.3 gives some examples. When you have
may be linked to each other. found all the effects and causes you have created
a complete problem tree.
Loss in social life Increased risk for Masks warning sounds

accidents
Effects
High noise level
No absorbents on walls Noisy machines
Causes
Bad acoustic design of Silent machines not Bad maintenance

workshop requested when
purchased
Figure 13.2.3. A problem tree with effects and causes.
778
Project guidelines
No loss in social life No increased risk for Warning sounds heard

accidents
Objectives
No induced hearing loss No increased fatigue Communication possible
No high noise level
Absorbents on walls No noisy machines

Means
Good acoustic design of Silent machines Good maintenance

purchased
Figure 13.2.4. The objective tree.
The objective analysis is carried out by turning • Beneficiaries

the problem tree into an objective tree which is
• Implementers
done in Figure 13.2.4. The effects and causes in
the problem tree are now turned into objectives • Financing agents
and means. In an objective tree you can find the • Decision makers.
most important problem(s) and at the same time
establish the most appropriate means to elimi- When you have identified the stakeholders and
nate them. Your tree may also indicate that you their roles you will have a clear view how they
don’t have the necessary means to carry out the can facilitate or obstruct your project. Based
project and should cancel the project at an early upon your objective tree, and stakeholder analy-
stage. sis, you may now find the most appropriate
Stakeholder analysis identifies stakeholders, means to obtain your objective. Figure 13.2.5
examples of which are shown in Figure 13.2.5. shows this relationship.
Stakeholders can often be placed in one of the
following groups according to their roles in the
project:
779
Chapter 13.2
Family, friends
No loss in social life No increased risk for Warning sounds heard

accidents
Worker
No induced hearing loss No increased fatigue Communication possible
Insurance company Employer

No high noise level
Absorbents on walls No noisy machines
Good acoustic design of Silent machines Good maintenance

purchased Maintenance staff
Production engineers
Consultants Purchaser
Vendors
Figure 13.2.5. Stakeholders in an objective tree, and the project objectives and means chosen (dotted).
The objective in this example may then be speci- In our example about noise, an indicator may be
fied: formulated as:
“Eliminate hearing loss due to high noise “The noise level in the workshop will be be-
level in the workshop by undertaking, regu- low 85dB(A) for all workers before the end of
lar machine maintenance and insulating the the next year by mounting insulation on the
walls.” walls and performing regular machine main-
tenance.”
Indicators for the attainment of project objec-
tives may be needed if the objectives are not A complete LFA also includes a Strength-Weak-
specific enough. Such indicators should specify: ness-Opportunities-Threats (SWOT) analysis.
• what? When you have created your objective tree
and decided what objectives are to be achieved
• where? through a project, including the means to
• for whom? achieve them, you try to identify and describe
the strength, weakness, opportunities and threats
• how much?
presented by your project. What is the strength
• how? with this particular project compared to another
way of carrying out this work e.g. is it cheaper,
• when?
780
Project guidelines
faster, more sustainable? Weaknesses in a project Weak support from managers or

may include reliance on uncertain stakeholders, stakeholders
untried methods or weak support from manage- OSH projects aiming to prevent accidents and
ment. Aside from the main objective(s) a project diseases require the support and engagement
may also present opportunities for other ben- of managers and workers so consultations with
efits such as attracting experienced personnel or concerned managers and other stakeholders
finding improvements that can be implemented should be held at an early stage of project plan-
in other departments. Finally, threats can make ning. If managers and stakeholders are ap-
a project impossible to finalize e.g. if external proached and consulted about the design of the
funders change their rules for support and stop project, including the decision about its objec-
financing a project. tives, they are more likely to have and feel own-
ership of the project. A lack of such ownership
project pitfalls by management and workers means their sup-
Overly ambitious planning port for the project activities and the acceptance
There are many problems to be solved in efforts of its result is likely to be weak.
to prevent occupational accidents and diseases so
Conflicts within the project team
it is natural to be ambitious when designing and
planning a project. However, it is common and Although conflicts can appear in any workplace
disastrous to be overly ambitious by including or team, the risks are more common within a
very wide ranging objectives that are unreason- project team for a number of reasons.
able in terms of the time and other resources Generally project team members are expected
available. The following short checklist may be to carry out their normal work duties as well,
helpful to avoid being overly ambitious: so there is competition for their time. If project
members have to make their normal work duties
1. If the project is decided by someone else than a priority, this can cause a delay in the project
yourself, check what is required before de- and be an obstacle for the other project mem-
signing or accepting the project. What has to bers to fulfil their duties.
be achieved? When does it have to be com- A second reason is that project members often
pleted? have different professional backgrounds and
2. Spend ample time on problem analysis. professional languages which may lead to misun-
derstandings. This is often apparent when OSH
3. Spend ample time on defining objectives to
professionals and production staff try to cooper-
ensure that they are clear and realistic.
ate in a project.
4. Analyze carefully whether the necessary time Finally, a project member may feel that his/
and resources (money, personnel, etc) match her arguments are not sufficiently considered,
the available time and resources. If not, what and that other project members have too much
can be done? influence in running the project.
All these reasons for conflicts must be dealt
with by the project leader. It is important that at
the beginning of a project enough time is given
to all members to express their ideas, and to
781
Chapter 13.2
socialize within the group. Continual informa- suggestions for further reading
tion for all team members is important, and they A detailed description of the Logical Framework
all need to have the same information about the Approach can be downloaded from: www.sida.
progress and problems of the project. se/sida/jsp/sida.jsp?d=118&a=2379&language=
en_US
Lack of information
It is very important to keep all stakeholders in-
formed about project objectives and progress. If
all the stakeholders are not convinced about the
value of a project, they may feel threatened and
try to stop it. Early information and discussion
meetings with stakeholders are essential in order
to get better acceptance to implement changes.
Poor control over costs

Underfunding due to over optimism when
designing a project, may result in that the
project has to be stopped before the objectives
are attained. Under calculating of costs is very
common in project planning, sometimes done
deliberately to get agreement to run a project.
However, if additional funds cannot be raised
the invested money is often lost. The financing
body may be an external funder that divides the
project into several phases and will not release
money for the next phase until the earlier one is
fulfilled and evaluated.
For large projects that involve several depart-
ments it is very important to keep track of costs
on an almost daily basis. If project members
work much longer on a project than the hours
foreseen in a project plan, costs exceed the
budget so it is necessary to have a financial sys-
tem allowing for continuous and easy control.
782
Notes on authors
Kerstin Ahlberg kerstin.ahlberg@juridicum.su.se

Department of Law, Stockholm University, SE-106 91 Stockholm, Sweden
Kerstin Ahlberg is a lawyer and journalist. 1996-2007 she worked at the Swedish National Institute
for Working Life as a researcher and editor. From 2003 she was the Head of the Institute’s Depart-
ment of Labour Law, Labour Market and Citizenship and a member of the Institute’s management
committee. In 2002 she received an Honorary Doctorate from Stockholm University. Her work has
focused mainly on EU labour law and industrial relations including legislation on occupational health
and safety. She is currently a Research Editor at the Institute for Social Private Law, Department of
Law, Stockholm University.
Eliana Alvarez de Davila eliana.alvarez@ivl.se

IVL Swedish Environmental Research Institute, Box 21060, SE-100 31 Stockholm, Sweden
Eliana Alvarez de Davila is Master of Science in Chemistry from Moscow University, Russia, Master
of Science in Chemical Engineering from the Royal Institute of Technology, Stockholm, Sweden,
and Safety Engineer from the National Institute of Occupational Health, Solna, Sweden. In the last
decades she has been working as researcher and project leader within working environment in many
different sectors, e.g. industry, construction, service, transportation.
Ann-Beth Antonsson ann-beth.antonsson@ivl.se

IVL Swedish Environmental Research Institute, Box 21060, SE-100 31 Stockholm, Sweden
Ann-Beth Antonsson is Master of Science in Chemical Engineering and PhD in Industrial Ergo-
nomics. She graduated from Chalmers Institute of Technology in Gothenburg 1979, and received her
PhD at the Royal Institute of Technology in Stockholm in 1991. She has been working with occupa-
tional safety and health as a researcher, manager and lecturer. Ann-Beth has studied OSH manage-
ment in small enterprises and developed a variety of tools and methods supporting this subject. Her
recent works focuse on methods to reduce occupational injuries including good practice combined
with dissemination strategies based on partnership between various actors in business.
783
Notes on authors
João José Barrico de Souza jbarrico@sti.com.br

Rua Eduardo da Silva Magalhães 404, Parque Continental – Sao Paulo, CEP 05324-000, Brazil
João José Barrico de Souza is an Electrical Engineer (Civil Eng). He was Director of the Safety Work
and Health Division (DSST) of the São Paulo State Government in Brazil, from 1990 to 2000. He is
a member of the Regional Engineering Committee (CREA) and Deputy President of the São Paulo
Safety Engineering Association (APAEST). His work has concerned safety in electrical installations
and services and he has taught in several universities and worked as a consultant for companies. He
has been part of the governmental team responsible for the elaboration and implementation of the
National Electrical Standard in
��
Brazil.
Martha Blomqvist martha.blomqvist@gender.uu.se

Centre for Gender Research, Uppsala University, SE-751 26 Uppsala, Sweden
Martha Blomqvist is Associate Professor in sociology and senior lecturer at Centre for Gender
Research, Uppsala University. Her main research interest is gender in working life with focus on
information technology and organizational change. She is the editor of Crossroads of knowledge, an
interdisciplinary research publication. Among her works are a chapter in the anthology Work Life,
Work Environment and Work Safety in Transition (Working Life Institute, 2001) and reports from the
ongoing project “Gender Relations and Working Conditions in the ICT sector”.
Anders Boman anders.boman@ki.se

Department of Occupational and Environmental Dermatology, Institute of Environmental Medicine,
Karolinska Institutet, SE-171 76 Stockholm, Sweden
Anders Boman is a dermatoxicologist and senior scientist at the Karolinska Institutet. He studied
chemistry and biology and worked in the field of experimental occupational dermatology at the
National Institute of Working Life from 1976 to 1997. He has worked in the Department of Occupa-
tional Dermatology in Stockholm since 1997. His main research interests are skin exposure, percuta-
neous absorption and skin barrier properties, and he works as a clinician on prevention hazardous skin
exposure. He has been an expert adviser to several Swedish federal agencies for their international
work on global harmonization on classification, marking and regulation of skin exposure.
784
Notes on authors
Gunnar Broms gunnar.broms@ifa.se

Ifa Production Development AB, Finnboda Kajväg 15, SE-131 73 Nacka, Sweden
Gunnar Broms is founder, Managing Director and consultant of Ifa Production Development AB
specializing in production layout, work organisation, and workplace structure and design. Ifa’s main
clients are major process industries in Sweden. He has a Master of Science in Production Tech-
nology from the Royal Institute of Technology and worked as a researcher in the Royal Institute of
Technology from 1980-1988 before starting Ifa. Within Ifa he has been responsible for international
training and development programmes in Ecuador, El Salvador and Botswana and has taught in
training programmes organized by the National Institute for Working Life.
Ulf Bäverstam ulf.baverstam@ssm.se

Strålsäkerhetsmyndigheten, SE-171 16 Stockholm, Sweden
Ulf Bäverstam joined the Swedish Radiation Protection Institute in 1978, was Research Director there
between 1987 and 2005, and Deputy Director General from 1998 to 2004. He has a PhD in Nuclear
Physics, and worked at the Physics Department, University of Stockholm from 1964 to 1978.
Tom Dwyer tom@unicamp.br

University of Campinas, DS-IFCH, Caixa Postal 6110, 13083-970, Campinas, SP, Brazil
Tom Dwyer teaches in the doctoral programme in social sciences at the University of Campinas
(UNICAMP) and is a researcher at the Brazilian National Council for Scientific and Technological
Research (CNPq). His PhD in sociology is from the Ecole des Hautes Etudes en Sciences Sociales,
Paris. He is the author of Life and death at work (1991, Plenum, New York), and has been a member of
the editorial boards of a number of leading accident and risk research journals, he was guest editor of
OSH & Development no.8 (2006). Currently he is President of the Brazilian Sociological Society.
Marianne Döös marianne.doos@ped.su.se

Department of Education, Stockholm University, SE-106 91 Stockholm, Sweden
Marianne Döös works at the Department of Education at Stockholm University and is Adjunct
Professor in Educational Psychology within the field of organisation pedagogics at Lund University,
Sweden. Her research deals with the processes of experiential learning in contemporary settings,
on individual, collective and organizational levels. Topical issues concern interaction as a carrier
of competence in relations, shared or joint leadership, conditions for competence in work-life and
organisational change and development. Döös has ��
authored or co-authored many articles and books,
including some in English. Her publications include Thoughts linked in digital conversations (2007).
785
Notes on authors
Kaj Elgstrand kajelg@kth.se

Department of Industrial Ecology, Royal Institute of Technology, SE-100 44 Stockholm, Sweden
Kaj Elgstrand was a researcher in work physiology and ergonomics in Stockholm, 1964–1968. He
worked at the University of Cauca, Colombia, 1968–1970. He was Director of the Swedish national
training programs for specialists in occupational health services and labour inspection, 1971–1988,
and was Director of the Nordic Institute for Advanced Training in Occupational Health in Helsinki,
Finland, 1988–1992. 1993–2007 he worked at the Swedish National Institute for Working Life as
Director of international training programs, and on international technical cooperation projects in
Poland, Central America and Southern Africa. From 2007 he has been a project manager at the Royal
Institute of Technology, Stockholm.
Håkan Frantzich hakan.frantzich@brand.lth.se

Department of Fire Safety Engineering and Systems Safety, Lund University, PO Box 118, SE-221 00
Lund, Sweden
Håkan Frantzich is Assistant Professor at Lund University and has a PhD in Fire Safety Engineering.
He teaches and conducts research particularly on human behaviour during fire evacuations, fire safety
engineering design principles and risk analysis methods and applications. He has contributed to
several books including The SFPE Handbook of Fire Protection Engineering (NFPA, 2009) and Risks in
Technological Systems (Springer, 2009). He has also published scientific papers and research reports in
the field of fire protection engineering and has participated in developing building codes and interna-
tional standards for fire safety.
Gideon Gerhardsson
1920-2008
Gideon Gerhardsson graduated in civil engineeing at the Royal Institute of Technology, Stockholm.
He was a researcher at the Swedish National Institute of Public Health, 1948–1967, and Professor in
Technical Hygiene at the Swedish National Institute of Occupational Medicine, 1967–1970. In 1975
he received an Honorary Doctorate in Medicine from Umeå University. He was a technical advisor in
occupational hygiene to the Swedish Employers Confederation for more than 30 years and pioneered
specialist training for industrial safety and hygiene engineers, and programmes to eliminate silicosis in
Sweden. Gideon Gerhardsson was actively involved in many international activities.
786
Notes on authors
Leif Hambraeus leif.hambraeus@ki.se

Brahevägen 8B, SE-185 31 Vaxholm, Sweden
Leif Hambraeus, MD PhD, was Professor of Human Nutrition, Uppsala University, ��
1971–2001. He
became affiliated to the Department of Biosciences and Nutrition, Karolinska Institute, Stockholm
since 2002. He has authored or edited 380 scientific articles and 10 books. The major topics of his
publications have been on protein and energy turnover in humans using direct calorimetry and stable
isotope techniques; infant nutrition; nutrition in athletes; global nutrition; IT in nutrition education.
He is a member of the Royal Swedish Academy of Agricultural and Forestry Sciences, the Finnish
Academy of Science and Letters, the Nutrition Society (London), and a Fellow of the American
Society for Nutritional Sciences.
Kjell Hansson Mild kjell.hansson.mild@radfys.umu.se

Department of Radiation Sciences, Umeå University, SE-901 87 Umeå, Sweden
Kjell Hansson Mild worked at the Swedish National Institute for Working Life from 1976 until its
closure in 2007. He is now at Umeå University. His research has been on the biological effects of
electromagnetic fields. His academic background is physics and theoretical physics. His publication
list comprises over 280 scientific papers. He was the first person from Europe to serve on the board of
the Bioelectromagnetics Society and was President from 1995 to 1996. He has also served as associate
editor for the journal Bioelectromagnetics. He is presently board member of the European Bioelec-
tromagnetics Association.
Lars Harms-Ringdahl LHR@irisk.se

Institute for Risk Management and Safety Analysis, Bergsprängargränd 2A,
SE-116 35 Stockholm, Sweden
Lars Harms-Ringdahl has an engineering background and a PhD in physics. He has been involved
in safety research for almost 30 years. His interest has been in methodologies for risk analysis,
accident investigation, and risk management. The approach is based on a systems perspective which
includes human activities, technique and organisation. He has been working as researcher, teacher
and consultant; a combination that he has found to be a fruitful combination of theory and practice.
He has been part time Professor at the Royal Institute of Technology in Stockholm, and at Karlstad
University. He is author of Safety Analysis – Principles and Practice in Occupational Safety (Taylor &
Francis, 2001).
787
Notes on authors
Peter Hasle pha@nrcwe.dk

The National Research Center for the Working Environment, Lersø Parkallé 105,
DK-2100 Copenhagen, Denmark
Peter Hasle is a PhD in Occupational Health and Safety. He has a broad experience in OSH
including work as a consultant in occupational health services, as an ILO adviser in Thailand, and as
an Associate Professor at the Technical University of Denmark. Currently he is a senior researcher
at the National Research Centre for the Working Environment, heading a research programme on
leadership, organisation and quality of work. He has published widely on a number of topics related
to OSH. His main research interest is the development of strategies to improve the quality of work
based on employee involvement.
Petra Herzfeld Olsson petra.herzfeld-olsson@employment.ministry.se

Ministry of Employment, Swedish Government Offices, SE-103 33 Stockholm, Sweden
Petra Herzfeld Olsson is Doctor of Laws and graduated at Stockholm University in 2004 on the study
The workers’ freedom of association as a human right. Her research field included labour law and human
rights. Since 2005 she works at the Swedish Ministry of Employment with national and international
labour law issues, i.e. ILO related matters. She is the secretary of the Swedish ILO Committee and
has been attending International Labour Conferences and Governing Body meetings. Her ILO work
is focused on the norm based activities.
Christer Hogstedt christer.hogstedt@fhi.se

Tullgårdsgatan 28, SE-116 68 Stockholm, Sweden
Christer Hogstedt is a medical doctor and specialist in occupational medicine. ��
He was Professor in
Occupational Medicine at the National Institute for Working Life and at the Karolinska Hospital,
1982–2000. His main research activities were on occupational epidemiology. In 2001 he became
Research Director at the Swedish National Institute of Public Health, directing research on evidence-
based public health interventions, social epidemiology, policy analysis and the effects of globalisation
on health. He has edited 20 books, and has more than 300 scientific publications. Currently he works
on two major R&D programmes on Work and Health in Central America and Southern Africa.
788
Notes on authors
Ingvar Holmér ingvar.holmer@design.lth.se

Department of Design Sciences, Faculty of Engineering, Lund University, SE-221 00 Lund, Sweden
Ingvar Holmér is Professor in Climate physiology and leader of the Thermal Environment Labora-
tory at the Faculty of Engineering at Lund University. He has worked on the causes of thermal stress
and methods for their assessment and prevention. The Lund laboratory belongs to a number of
international networks of research laboratories participating in European research projects and inter-
national conferences related to thermal stress, protective clothing and environmental ergonomics.
Professor Holmér is active in international standardization work related to thermal stress and the
performance of protective clothing. He is a board member of several international scientific journals
and secretary of ICOH Scientific Committee on Thermal Factors.
Annika Härenstam annika.harenstam@av.gu.se

Faculty of Education, Department of Work Science, University of Gothenburg, Box 705, SE-405 30
Göteborg, Sweden
Annika Härenstam trained as a psychologist and was appointed Associate Professor at Karolinska
Institute in 2004. She has been Professor at the Department of Work Science, University of Gothen-
burg since 2007. Her research focuses on work organization, and working and living conditions and
health. She currently leads a research project on organisational prerequisites for managers and a
project on social interaction in working life. She is also responsible for the Swedish contribution to an
EU-project establishing guidelines for measuring organizational change and the social and economic
consequences. Her other interests are development of methodologies and a gender perspective on
working life.
Mohamed Fareed Jeebhay mohamed.jeebhay@uct.ac.za

Occupational and Environmental Health Research Unit, University of Cape Town, Observatory,
7925, South Africa
Mohamed Jeebhay, MD PhD, is occupational medicine specialist and Associate Professor at the
University of Cape Town. He manages the Fogarty International Centre programme aimed at
promoting research and training in occupational and environmental health in Southern Africa. His
main research interest focuses on risks, surveillance and interventions in occupational allergy and
asthma. He has served on many statutory technical committees related to OSH in South Africa. He
is on the editorial board of Current Allergy & Clinical Immunology and the International Journal of
Maritime Health and has written many book chapters and scientific articles in the field of OSH.
789
Notes on authors
Bo Johansson bo.johansson@ekhist.uu.se
Almunge-Söderby 103, SE-740 10 Almunge, Sweden
Bo Johansson has a MA in social sciences, religion and anthropology. He has been working on
migration and integration issues for the last 20 years as a teacher at several Swedish universities and
colleges, and as a consultant for national and municipal authorities and in the private sector. He
worked at the Swedish National Institute for Working Life from 1999, as a manager responsible for
projects on European migration policies. He continues to work in programmes on occupational safety
and health in developing countries, particularly on migration issues.
Roland Kadefors roland.kadefors@av.gu.se

Department of Work Science, University of Gothenburg, Box 705, SE-405 30 Gothenburg, Sweden
Roland Kadefors, PhD, is currently Visiting Professor with the Department of Work Science, Univer-
sity of Gothenburg. He was previously affiliated to the Swedish National Institute for Working Life
as Senior Researcher and Manager of the Gothenburg branch. He has authored more than 120 papers
in peer reviewed scientific journals. His research is in biomedical engineering, biomechanics, neuro-
physiology and rehabilitation. His current interests are in ergonomics and musculoskeletal strain, with
particular focus on ageing and work. In 2006, he managed a study for the Swedish government of the
working life consequences of demographic change.
Tord Kjellström tord.kjellstrom@fhi.se

168 Stafford Drive, Mapua 7005, Nelson, New Zealand
Tord Kjellström is part-time Professor, Australian National University and works as a researcher and
consultant for Swedish and New Zealand government agencies, WHO, and the Wellington School
of Medicine. He has MD and MEng degrees from universities in Stockholm and worked as teacher
and researcher in epidemiology, environmental and occupational health in Sweden, New Zealand
and Australia. He has over 300 publications on the health effects of metals, air pollution, climate
change, transport and urbanisation. Tord worked at the World Health Organization, Geneva, from
1985–1997, firstly as an environmental epidemiologist and later as Director of Global and Integrated
Environmental Health.
790
Notes on authors
Carola Lidén carola.liden@ki.se

Institute of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
Carola Lidén, MD, PhD, has been Professor of Occupational and Environmental Dermatology at
Karolinska Institute, Stockholm since 2000, currently at the Institute of Environmental Medicine. She
was head of the Department of Occupational and Environmental Health in the Stockholm Centre for
Public Health from 2003–2008. She was also employed at the former Swedish National Institute for
Working Life. Her research is focused on skin hazards and their prevention, and she is active in inter-
national risk assessment of skin sensitizers. She has worked in a research education programme on
pesticides in Nicaragua.
Linnéa Lillienberg linnea.lillienberg@lillinova.se

Knektevägen 8, SE-433 69 Sävedalen, Sweden
Associate Professor Linnéa Lillienberg is a certified senior occupational hygienist at the Depart-
ment of Occupational and Environmental Medicine at Sahlgrenska University Hospital in Göteborg,
Sweden. She graduated in chemistry at Göteborg University in 1981. Her research focuses on
exposure assessment of dust and aerosols, determinants of exposure and epidemiological studies on
obstructive airway diseases. Linnéa Lillienberg has been a board member in a number of occupational
health organizations including the International Occupational Hygiene Association (IOHA), the
International Commission of Occupational Health (ICOH) and the Swedish Association for Occupa-
tional and Environmental Hygiene (SYMF).
Bahira Mohamed Said Lotfy bahira_lotfy@yahoo.com

6, street Youssef El-Degwy, El-Manial, Cairo, Egypt
Bahira Lotfy is a Professor of Industrial Medicine and Occupational Diseases at Kasr El-Aini Faculty
of Medicine, Cairo University since 2005. She is also a member of a number of national committees
dealing with Infection Control, Hazardous Waste Management, Environmental and Public Health
issues. She has provided technical assistance on numerous government health plans and audits of
many economic facilities throughout Egypt. She worked in a number of research and training assign-
ments with the regional offices of the WHO and ILO including child labour issues, and OSH&E
issues in construction.
791
Notes on authors
Vimal Mahendru vimalm@indoasian.com

Indo Asian Fusegear Limited, B88, Sector 83, Noida, India 201305
Vimal Mahendru is a practicing business manager. He graduated as an Industrial Engineer from the
Thapar Institute of Engineering and Technology, India and then did an MBA at the George Wash-
ington University, Washington DC, USA. After working in USA for two years, he returned to India
and set up the manufacturing operations for his company and his experiences are summarized in
chapter 8.7 of this book. Today he is deeply involved with strategic initiatives and business develop-
ment as President, Corporate Affairs. He is also the Vice President of the leading industry association,
IEEMA (Indian Electrical and Electronics Manufacturers’ Association).
Staffan Marklund staffan.marklund@ki.se

Gästrikegatan 3, SE-113 62, Stockholm, Sweden
Staffan Marklund trained as a sociologist in Sweden and England. His main interests have been
research and teaching on occupational health and social security. He became a Professor at Umeå
University in 1989 and moved to the National Institute for Working Life in Stockholm in 1999 as
a Professor of Work and Health. Currently he is Professor at the Karolinska Institute in Stockholm
working on personal injury prevention. He has worked on issues related to sickness absenteeism,
occupational rehabilitation and occupational diseases and the effects of organisational change. He has
taught and supervised international courses in Occupational Safety and Health and Development.
Bernt Nilsson bernt.nilsson@av.se

Swedish Work Environment Authority, SE-112 79 Stockholm, Sweden
Bernt Nilsson is Master of Engineering (University of Lund) with specialist training in Occupational
Safety and Hygiene Engineering. He has been head of the Inspection Department of the Swedish
Work Environment Authority (SWEA) for several years and is currently head of the Department
of Regulation and Expert Support at SWEA. He is a member of the EU Senior Labour Inspectors
Committee (SLIC) and has been an EU project leader and worked on EU evaluations of Systems
of Supervision in several Member States. He has involved in international courses on Occupational
Safety and Health and Development over many years.
Tommy Nilsson tommy.nilsson@riksrevisionen.se

Swedish National Audit Office, SE-114 90 Stockholm, Sweden
Tommy Nilsson is a sociologist and associate professor at Stockholm University. He has worked as
researcher at the National Institute for Working Life, and before that at the Royal Institute of Tech-
nology. His main research interests have focused on work organization, the Swedish bargaining model
and pay systems. He has published several books and articles within those three areas. He now holds a
post as audit director at the Swedish National Audit Office.
792
Notes on authors
Gun Nise gun.nise@gmail.com

Sandfjärdsgatan 124, SE-120 56 Årsta, Sweden
Gun Nise is a certified occupational hygienist who has worked in this field since the early 1970s. Her
PhD thesis was entitled Toluene exposure in rotogravure printing and its relation to some biological effects.
Her work has involved a) workplace investigations in relation to adverse health effects among workers,
b) education and training nationally and internationally and c) research. Her main research interest is
exposure assessment, health effects from solvent exposure, and development of Job Exposure Matrices
for chemical and noise exposure. She
��
has been engaged in a research education programme on pesti-
cides in Nicaragua.
Nils ’Ocka’ Petersson ocka@kth.se

Royal Institute of Technology, SE–100 44 Stockholm, Sweden
Nils F Petersson is Master of Science in Production Engineering and Licentiate of Engineering in
Ergonomics. He graduated from the Royal Institute of Technology in Stockholm in 1971, and has
been working nationally and internationally as a researcher, manager, consultant and lecturer on
Occupational Safety and Health. He has managed many developments projects during his positions
at the National Institute for Working Life, the Royal Institute of Technology and K-Konsult, where
he was also Head of the OSH Department. He has reviewed Swedish OSH research and development
projects and has written several books/training materials on OSH.
Rauno Pääkkönen rauno.paakkonen@ttl.fi

Timpurinkatu 7, FI-33720 Tampere, Finland
Rauno Pääkkönen, Dr Tech,
��
MSc, is a Team Leader of Physical Factors and Technical Solutions at
the Finnish Institute of Occupational Health. He has worked at the Finnish Institute of Occupational
Health since 1977 and also works as an Adjunct Professor at the Tampere University of Technology,
and teaches at the University of Applied Sciences in Tampere. He has written 250 scientific articles
and edited or authored 20 books. His major topics include: noise, vibration, physical factors, and
health risks in the environment and at workplaces. He has worked as a risk consultant for the military.
793
Notes on authors
Jörgen Sandberg j.sandberg@business.uq.edu.au

UQ Business School, The University of Queensland, Brisbane, Qld 4072 Australia
Jörgen Sandberg is a Reader in Management and Organization Studies in the School of Business at
the University of Queensland, Australia. His research interests include competence and learning in
organisations, leadership, qualitative research methods, and the philosophy of science. His work has
appeared in several journals, including Academy of Management Journal, Harvard Business Review,
Journal of Management Studies, and Organisational Research Methods, and in books and book
chapters published by Kluwer, Thomson and Routledge. His most recent book is Managing under-
standing in organizations published by Sage 2007. He is currently carrying out research on professional
practice and its
��
development.
Bengt Sjögren bengt.sjogren@ki.se

Institute of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
Bengt Sjögren MD, PhD, is ��
a specialist in Occupational Medicine currently working as a Senior
Researcher at the Institute of Environmental Medicine at Karolinska Institutet. He has worked for
more than 30 years on chemical hazards and their health effects, principally on air pollutants related
to welding; stainless steel welding and lung cancer; aluminium exposure and neurotoxic effects; and
air pollutants and coronary heart disease. He was a course faculty member in the Swedish National
Training Courses for Occupational Health Nurses and Physicians and in the Advanced International
Training Programme on Occupational Safety and Health in Practice and Development.
Ulrik Sundbäck ulrik@sundback.com

Klara Ö. Kyrkogata 8B, SE-111 52 Stockholm, Sweden
Ulrik Sundbäck, PhD, was Professor of Physical Environment Technology in the department of
Human Work Sciences at Luleå University of Technology from 1988 to 1998. He became Professor
Emeritus in 1999. His main research interests focus on noise control principally the identification
of noise sources, and the development and implementation of new technical equipment. Most of his
research projects are action-oriented projects to improve working conditions and productivity in steel
industries. He has been engaged in many international cooperation projects and his research results
have been presented at several international conferences and seminars.
794
Notes on authors
Carin Sundström-Frisk carin.sundstrom-frisk@telia.com

Marielund Funbo, SE-755 97 Uppsala, Sweden
Carin Sundström-Frisk, MSc, is a chartered psychologist, and was a senior research scientist at the
Swedish Institute for Working Life until it closed in 2007. She currently works as risk management
consultant. Her research has mainly concerned the genesis of occupational accidents particularly
focusing on human behavior of both employers and/or employees, aiming to identify conditions that
provoke human errors and deliberate risk taking. Her research has provided a foundation for preven-
tion programmes, tailor-made for different kinds of work organizations. From 1997 to 2006 she was
the secretary of the Scientific Committee on Accident Prevention of the International Commission on
Occupational Health.
Lennart Svensson lennart.svensson@liu.se

Linköping University, SE-581 83 Linköping, Sweden
Lennart Svensson is a Professor in Sociology at Linkoping University. His research has focused on
work environment, work organisation, workplace learning, project work, sustainable change, trade
unions, and regional change. He has developed and used an interactive research approach with the
ambition of making research an activity that involves participants rather than using them as study
objects. Lennart Svensson is also the research leader at APeL, a Swedish based research and develop-
ment centre for workplace learning (see www.apel-fou.se). APeL works with R&D from a benefit
perspective so that their projects lead to sustainable developments and long term effects.
Axel Targama axel.targama@handels.gu.se

School of Business, Economics and Law, Gothenburg University, PO Box 610,
SE-405 30 Gothenburg, Sweden
Axel Targama is Associate Professor in Organization and Management at Gothenburg University. He
has done research work in the area of change and development in organizations with an emphasis on
learning processes and with a particular interest in professional organizations. He has also been much
involved in executive development efforts and worked as the director of a management institute for
over a decade. His most recent book is Managing understanding in organizations together with Jörgen
Sandberg (2007).
795
Notes on authors
Eva Vingård eva.vingard@medsci.uu.se

Arbets- och miljömedicin, Akademiska sjukhuset, Ulleråkersvägen 38-40, SE-751 85 Uppsala, Sweden
Eva Vingård, MD, PhD, is Professor in Occupational and Environmental Medicine at Uppsala
Akademiska University, and Head of the Occupational and Environmental Department at Uppsala
Hospital. She has worked with occupational health for 25 years as a clinician, teacher and researcher.
Her main research areas are musculoskeletal disorders and work, investigating the associations
between such disorders and pain and physical and psychosocial exposures at work. She is also involved
in research on health in the public sector considering work exposures, life style factors, social factors
and work satisfaction to investigate sickness absence, return to work and healthy workplaces.
Catharina Wesseling cwesseli@una.ac.cr

Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional,
PO Box 86-3000, Heredia, Costa Rica
Catharina Wesseling is a Professor at the Universidad Nacional in Costa Rica. She is also associated
with Uppsala University in Sweden. She is an MD with a doctoral degree in epidemiology, with a
particular expertise in occupational and environmental epidemiology. She has extensively published
on pesticide exposure and health effects. Her main interest is in promoting the application of occu-
pational and environmental health research results at local, national and international levels, through
teaching programmes and collaboration with grass root organisations and policy makers. She has been
the Regional Director of the Programme Work & Health in Central America since 2003.
Hanna Westberg hanna.westberg@telia.com

Gamla Lundagatan 4, SE-118 23 Stockholm, Sweden
Associate Professor Hanna Westberg is a Swede specialising in research on gender and equal opportu-
nity in working life. She now works as a consultant in cooperation with researchers at Luleå Technical
University, in the Division of Gender, Technology and Organization. She also works with the
Högskolan Dalarna, in the Institute of Economy and Society. Recent publications include articles on
Gender and Sustainable Growth; Gender Segregation and Equal Opportunity work in Organisations
and Gender Segregation and Learning in Working Life. She is a member of the international advisory
committee of the Women Work and Health Initiative.
796
Notes on authors
Ewa Wigaeus Tornqvist ewa.wigaeus.tornqvist@sth.kth.se

Royal Institute of Technology, School of Technology and Health, Alfred Nobels Allé 10,
SE-141 52 Huddinge, Sweden
Ewa Wigaeus Tornqvist, has a PhD in Physiology, and is a guest Professor in Ergonomics, at ��
the
Royal Institute of Technology, School of Technology and Health, Stockholm, Sweden. Her work
focuses on care and health promotion. She was a Professor in Ergonomics at the National Institute for
Working Life until 2007 when it closed. Her main research interests over the last 20 years have been
on work-related physical and psychosocial exposures and musculoskeletal health. She has published
more than 250 scientific reports, book chapters and conference contributions.
797
English language editors
English language editors
Adrienne Taylor has been the English language editor for the main part of this book. She has also
assisted the editors by reviewing the technical content of many of the chapters. Roger Tanner has
edited 11 chapters (4.7, 8.1-7, 9.2, 10.3, and 11.2). It has been a challenging task being the English
language editors for this book because of both the number of authors and the fact that many authors
don’t have English as their mother tongue. We have done our best to put the text into readable plain
English (rather than Queen’s English!) in the hope that readers will find the text comprehensible and
readable.
Adrienne Taylor ade fun@yahoo.com

168 Stafford Drive, Mapua 7005, Nelson, New Zealand
Adrienne Taylor was Regional Secretary for the Asia Pacific region for Public Services International
(PSI) from 1992-1998. She also had a global responsibility for equality issues. Her other area of
expertise and experience is in health, safety and environment. As International Director for Health,
Safety and Environment for the International Metalworkers Federation in Geneva, she administered
substantial donor funds and implemented projects to improve working conditions for metal workers
and miners in developing countries. Adrienne has also managed projects for food and agricultural
workers. Currently she works as an editor on occupational and public health, development and envi-
ronment issues.
Roger Tanner roger.tanner@ordvaxling.se

Ordväxlingen AB, Neptunistigen 17, SE-165 71 Hässelby, Sweden
Roger Tanner is an authorised Public Translator (Aukt. transl.). He settled in Sweden in 1964 after
graduating from Cambridge University, UK, where he read history and law. After some years in adult
education, teaching English, he became a full-time translator in 1975. He is also active as a church
organist and, although somewhat over retiring age, he is incurably fond of working.
798

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OSH for Development

OSH for Development

Royal Institute of Technology

219401 omslag The Bookvit.indd 1 09-05-28 11.03.55

Kaj Elgstrand & Nils F Petersson

Publisher Royal Institute of Technology

English language editors Adrienne Taylor and Roger Tanner

Graphic design Amer Assad, Eva Lidén and Eva Söder

Financial support Swedish National Institute for Working Life

Printed by Elanders Sverige AB, www.elanders.com

1. INTRODUCTION; Kaj Elgstrand & Nils F Petersson

2. HISTORY AND FUTURE

2.1 HISTORICAL DEVELOPMENT OF THE RISK CONCEPT; Gideon Gerhardsson

3.1 BASIC WORK PHYSIOLOGY; Ewa Wigaeus Tornqvist

3.2 FOOD, NUTRITION AND WORK; Leif Hambraeus

3.3 MUSCULOSKELETAL DISORDERS; Eva Vingård

3.4 WORKPLACE DESIGN AND EVALUATION; Roland Kadefors

4.1 RISK AND RISK CONTROL; Lars Harms-Ringdahl

4.2 ACCIDENTS; Carin Sundström-Frisk

4.3 HEAT AND COLD STRESS; Ingvar Holmér

4.4 NOISE; Ulrik Sundbäck

4.5 VIBRATIONS; Rauno Pääkkönen

4.7 ELECTRICAL SAFETY; João José Barrico de Souza

4.8 FIRE SAFETY; Håkan Frantzich

5. PREVENTION OF CHEMICAL RISKS

5.3 SOLVENTS AND GASES; Gun Nise

5.4 DUSTS AND METALS; Linnéa Lillienberg & Bengt Sjögren

5.5 SKIN DISORDERS; Carola Lidén & Anders Boman

6. PREVENTION OF BIOLOGICAL RISKS; Mohamed Jeebhay & Eliana Alvarez

7. PREVENTION OF PSYCHOSOCIAL RISKS

7.1 PSYCHOSOCIAL RISKS AND WORK; Staffan Marklund

7.2 IMPROVEMENT OF PSYCHOSOCIAL CONDITIONS; Annika Härenstam

8.1 ENTERPRISE SURVIVAL – CHALLENGES AND OPTIONS

8.2 NEW PRINCIPLES OF WORK ORGANISATION; Tommy Nilsson

8.3 LEARNING AT WORK; Marianne Döös

8.4 MANAGING UNDERSTANDING – A NEW LEADERSHIP CHALLENGE

8.5 ORGANISATIONAL DEVELOPMENT AND GENDER INTEGRATION

8.7 A REWARDING CHANGE – AN EXAMPLE FROM INDIA; Vimal Mahendru

9. AGE, GENDER AND MIGRATION

9.1 CHILD LABOUR; Bahira Lotfy

9.2 GENDER AND WORK; Hanna Westberg

10. OSH AT THE ENTERPRISE

10.2 MANAGEMENT AND PARTICIPATION; Nils F Petersson

10.3 OCCUPATIONAL HEALTH SERVICES; Kaj Elgstrand

11.2 EDUCATION AND TRAINING; Kaj Elgstrand

11.3 SUPERVISION AND CONTROL; Bernt Nilsson

12.2 GLOBAL SITUATION CONCERNING WORK RELATED INJURIES AND

12.3 INTERNATIONAL GOVERNANCE AND PARTNERSHIPS

13.1 STRATEGY FOR CHANGE; Lennart Svensson

13.2 PROJECT GUIDELINES; Nils F Petersson & Kaj Elgstrand

NOTES ON AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 783

ENGLISH LANGUAGE EDITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 798

aims and contents

basic concepts “occupational safety and health” as they are

Categorising countries Hazards can also be of biological or psychosocial

Risk assessment Selecting and Risk

Figure 1.2. Basic concepts related to risk management.

History and future

2.1 Historical development of the risk concept 27

Historical development of the risk concept

from hazard to risks that we reflect it to our people in decisions

Figure 2.1.2. Henry Mayhew, London, 1861.

of articles in the Morning Chronicle in 1849-50. Who are real workers?