Occupational injuries and diseases - EPM Niu -ILO.pdfTumors Central Nervous System Respiratory Diseases Accidents ... Musculoskeletal Diseases Skin Diseases Shengli Niu 6 Occupational

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The Occupational Origin of MSDs: An ILO Perspective

ByDr. Shengli Niu

International Labour Office

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Occupational injuries and diseases

� 335,000 deaths

� 250 million accidents

� 160 million occupational

diseases

� 4% of world’s gross

national product is lost

Source: Kofi A. Annan. Occupational health and safety: a high priority on

the global, international and national agenda. Asian-Pacific Newslett on OSH

1997;4:59

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Compensated Costs of Work-Related

Injuries and Diseases

Costs by disease

3% 8%9%

14%

7%16%

40%

3%

Tumors Central Nervous System

Respiratory Diseases Accidents

Mental Disorders Heart Diseases

Musculoskeletal Diseases Skin Diseases Shengli Niu 6

Occupational masculoskeletal disordors

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Ergonomic Problems at the Workplace

Bernardini Ramazzini, an Italian physician and father of occupational medicine, in the 18th century, said the work relatedness of upper-extremity MSDs: “arise from three causes: first constant sitting, the perpetual motion of the hand in the same manner, and thirdly the attention and the application of the mind ”.

The first recorded epidemic of work-related musculoskeletal disorders in the UK occurred in the civil service in the 1830s and was associated with the introduction of the steel nib.

The report of an enquiry into a subsequent epidemic in the early 1900s, among the telegraphists, has been suggested by Lucire to be the origin of the term “nervous breakdown”

Situations within the Workplace & MSDs

� Postural stress such as prolonged sitting, standing, or awkward position

� Stereotyped and repetitive tasks leading to chronic injury

� Peak overload injuries

� Environmental factors

� Psychosocial factors including psychological stresses, job dissatisfaction

� Social issues, such as compensation laws and disability system

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MSDs related Ergonomic Risk Factors

Repeated or forceful efforts

Sustained static loading

Anatomically non-neutral posture

Accelerated movements,

Externally applied compressive forces and

vibration

High intensity or long duration exposure increases the risk of MSDs.

Work related MSDs may occur even when workers are exposed to an occupational risk factor on an occasional basis or for a 25% or less of the day

Work-related MSDs

� Work-related MSDs comprise well over half of all reported occupational illnesses in the United States

� At any one time, 30% of American adults are affected by joint pain, swelling, or limitation of movement

� Musculoskeletal conditions cause more functional limitations in the adult population in most welfare states than any other group of disorders

� They are a major cause of years lived with disability in all continents and economies

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The Fourth European Working ConditionsSurvey in 2005 (EWCS 2005)

� MSDs are the most common work-related problems in the EU-27 countries

� 25% of European workers complain of backache� 23% of muscular pains� In terms of exposure to physical risks a quarter or more of the time

� 62% of respondents are exposed to repetitive hand and arm movements

� 45% report working in painful or tiring positions� 35% are required to handle heavy loads in their work

� For certain risks, prevalence is higher amongst female workers, notably in education and health. For instance, 11% of women say their job requires them to lift or move people a quarter or more of the time, compared to 6% of men.

(http://eurofound.europa.eu/exco/surveys/EWCS2005/index.htm).

Injuries and Diseases Caused by Adverse Ergonomic Working Conditions

Visual, muscular and psychological disturbances:

� eye strain

� Headaches

� Fatigue

� musculoskeletal disorders (MSDs) such as chronic back, neck and shoulder pain, Cumulative Trauma Disorders (CTDs), Repetitive Strain Injuries (RSIs) and Repetitive Motion Injuries (RMIs)

� psychological tension, anxiety and depression

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Occupational Diseases

� Diseases caused by work have to be discovered and their victims be properlytreated and compensated.

� Preventive and protective measures must

be taken at the workplace.

� Definition of occupational diseases is

usually set out in legislation.

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ILO ResponseThe International Labour Organization

was founded to ensure everyone the right to earn a living in freedom, equity, dignity and security, in short, the right to decent work. We have never accepted the belief that injury and disease "go with the job”

Decent Work must be Safe Work

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International Labour Organization

� A tripartite organization

� Member countries: 184

� In 1969 the ILO was awarded the Nobel Peace Prize

www.ilo.org/safework

• Work should take place in a safe and healthy working environment;

• Conditions of work should be consistent with workers' well-being and human dignity;

• Work should offer real possibilities for personal achievement, self-fulfilment and service to society.

ILO Policy on the Improvement of

Working Conditions and Environment

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� The promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations;

� The prevention amongst workers of departures from health caused by their working conditions;

� The protection of workers in their employment from risks resulting from factors adverse to health;

� The placing and maintenance of workers in an occupational environment adapted to their physiological and psychological capabilities.

To summarize, the adaptation of work to the workers and of each worker to his or her job.

Adopted by the Joint ILO/WHO Committee

on Occupational Health at its First Session (1950)

Aims of Occupational Health


Ergonomics stresses fitting the job to the worker as compared to the more usual practice of obliging the worker to fit the job.

The aim of ergonomics is to optimize, first and foremost, the comfort of the worker, as well as his or her health, safety and efficiency.

Ergonomics is a field which integrates knowledge derived from the human sciences in particular anatomy, physiology and psychology to match jobs, systems, products and environments to the physical and mental abilities and limitations of workers.

Ergonomics is an essential and integral part of occupational health practice.

Applying ergonomic principles, however, is beneficial to both the workers and the employers.

Ergonomics and Occupational Health

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International Labour Organization

�Standard-setting is one of the ILO’s major

means of action to improve conditions of life and work worldwide

�ILO standards are Conventions and

Recommendations adopted by the International Labour Conference.

International Labour Conference

• Between 1919 and 2011, 189Conventions, 5 Protocols and 201Recommendations were adopted.

• Many of these instruments relate to occupational safety and health.

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Historical Development in Identification of Occupational Diseases

In 1919

� R.3 Anthrax Prevention

� R.4 Lead Poisoning (Women and children)

In 1925

� C. 18 Workmen’s Compensation (occupational diseases)Poisoning by lead, its alloys or compounds and their sequelae

Poisoning by mercury, its amalgams and compounds and their sequelae and

Anthrax infection

In 1934 - C. 42 Revised C.18

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History and Development

1964, C.121 & R.121 Employment Injury Benefits

� Definition of occupational diseases

� Amendment of the list of occupational diseases

� List of occupational diseases

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Definition of occupational diseases

Paragraph 6(1) of Recommendation No. 121 defines occupational diseases as follows:

Each Member should, under prescribed conditions, regard diseases known to arise out of the exposure to substances and dangerous conditions in process, trades or occupations as occupational diseases.

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Definition of occupational diseases

The Protocol of 2002 to the Occupational Safety and Health Convention, 1981 (No.155) specifies -

occupational diseases as any disease contracted as a result of an exposure to risk factors arising from work activities.

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� The exposure-effect relationship between a specific working environment and/or activity and a specific disease effect

� These diseases occur among the group of persons concerned with a frequency above the average morbidity of the rest of the population

Two Main Elements in the Definition

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Employment Injury Benefits Convention, 1964 (No.121)

(Article 8) Each Member shall� (a) prescribe a list of diseases, comprising at least the diseases

enumerated in Schedule I to this Convention, which shall be regarded as occupational diseases under prescribed conditions; or

� (b) include in its legislation a general definition of occupational diseases broad enough to cover at least the diseases enumerated in Schedule I to this Convention; or

� (c) prescribe a list of diseases in conformity with clause (a), complemented by a general definition of occupational diseases or by other provisions for establishing the occupational origin of diseases not so listed or manifesting themselves under conditions different from those prescribed.

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Committee on Occupational Safety and Health

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90th Session of the International Labour Conference, June 2002, Geneva

Recommendation No. 194

Recommendation concerning the List of

Occupational Diseases and the Recording and

Notification of Occupational Accidents and

Diseases.

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R194 List of Occupational Diseases

Recommendation, 2002

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List of Occupational Diseases R194, (2002)

2.3. Occupational musculo-skeletal disorders

2.3.1. Musculo-skeletal diseases caused by specific work activities or work environment

where particular risk factors are present

Examples of such activities or environment include:

(a) rapid or repetitive motion

(b) forceful exertion

(c) excessive mechanical force concentration

(d) awkward or non-neutral postures

(e) vibration

Local or environmental cold may increase risk

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ILO Convention No. 127 & Recommendation No. 128

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Convention No. C127

CountryRatification

dateStatus

Algeria 12:06:1969 ratified

Brazil 21:08:1970 ratified

Bulgaria 21:06:1978 ratified

Chile 03:11:1972 ratified

Costa Rica 16:03:1972 ratified

Ecuador 10:03:1969 ratified

France 31:05:1973 ratified

Guatemala 25:07:1983 ratified

Hungary 04:01:1994 ratified

Italy 05:05:1971 ratified

Lebanon 01:06:1977 ratified

Lithuania 26:09:1994 ratified

Luxembourg 08:04:2008 ratified

Madagascar 04:01:1971 ratified

Malta 09:06:1988 ratified

Republic of Moldova 09:12:1997 ratified

Nicaragua 01:03:1976 ratified

Panama 19:06:1970 ratified

Peru 19:06:2008 ratified

Poland 02:05:1973 ratified

Portugal 02:10:1985 ratified

Romania 28:10:1975 ratified

Spain 07:06:1969 ratified

Thailand 26:02:1969 ratified

Tunisia 14:04:1970 ratified

Turkey 13:11:1975 ratified

Bolivarian Republic of Venezuela 01:02:1984 ratified

Other Relevant ILO Conventions & Recommendations

� C. 155 & R. 164 on Occupational Safety and Health, 1981

� C. 161 & R. 171 on Occupational Health Services, 1985

� C. 81 & R. 81 on Labour Inspection, 1947

� C. 129 & R. 133 on Labour Inspection (Agriculture), 1969

� C. 187 & R. 197 on Promotional Framework for Occupational Safety and Health, 2006

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Global Strategy on Occupational Safety and Health Adopted at the 91st Session of the

International Labour Conference in 2003

The Global Strategy:• reaffirmed the importance for all

countries to apply international labour standards on occupational safety and health

• requested the ILO to give highest priority to the development of new instruments in the areas of ergonomics and biological hazards.

(http://www.ilo.org/public/english/protection/safework/globstrat_e.pdf)

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90th Session of the International Labour Conference, June 2002, Geneva

Recommendation No. 194

Recommendation concerning the List of

Occupational Diseases and the Recording and

Notification of Occupational Accidents and

Diseases.

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2.3. Musculoskeletal disorders

2.3.1. Radial styloid tenosynovitis due to repetitive movements, forceful exertions and extreme postures of the wrist

2.3.2. Chronic tenosynovitis of hand and wrist due to repetitive movements, forceful exertions and extreme postures of the wrist

2.3.3. Olecranon bursitis due to prolonged pressure of the elbow region

2.3.4. Prepatellar bursitis due to prolonged stay in kneeling position

2.3.5. Epicondylitis due to repetitive forceful work

2.3.6. Meniscus lesions following extended periods of work in a kneeling or squatting position

2.3.7. Carpal tunnel syndrome due to extended periods of repetitive forceful work, work involving vibration, extreme postures of the wrist, or a combination of the three

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2.3. Musculoskeletal disorders

2.3.8. Other musculoskeletal disorders not mentioned in the preceding items where a direct link is established scientifically, or determined by methods appropriate to national conditions and practice, between the exposure to risk factors arising from work activities and the musculoskeletal disorder(s) contracted by the worker

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Background: IEA/ILO Checkpoints

1985 International Symposium on Ergonomics in Developing Countries, Jakarta

1988 “Higher Productivity and a Better Place to Work” (ILO)

1991 IEA/ILO project (IEA Technology Transfer Committee)

1991 Geneva Workshop1993 IEA/ILO Roving Seminars (Indonesia, etc.)1996 “Ergonomic Checkpoints” (ILO)1998- (Translation into many languages)

2004 New IEA/ILO projects2005 Bali Workshop (Checkpoints Second

Edition)2007 Kuala Lumpur Workshop (Agriculture

Checkpoints)

2009 2nd Edition of the IEA/ILO Ergonomic Checkpoints

Ergonomic Checkpoints

The practical guides of the checkpoints extends to all the main ergonomic issues which include:

� materials storage and handling,

� hand tools,

� machine safety,

� workstation design,

� lighting,

� Premises,

� control of hazardous substances and agents,

� welfare facilities, and

� Work organization.

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Work Improvements in Small EnterprisesWISE

Training Package for voluntary, participatory and action-oriented actions to improve working conditions and work organizations of the small and medium sized enterprises.

Six basic training principles: build on local practice, focus on achievements, link working conditions with other management goals, use learning-by-doing, encourage exchange of experience and promote workers' involvement.

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Work Improvement in Neighbourhood Development

WIND

WIND is a programme aiming at promoting practical improvements in agricultural households by the initiatives of village families.

WIND approach aims at improving both working and living conditions as inter-related aspects of rural life, ensuring the equal involvement of village men and women together in planning and implementing improvements and its close links with community development and empowerment of agricultural workers and farmers.

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Ergonomics Approaches to the Prevention of

Work-Related Musculoskeletal Disorders

The following documents have been collected and analyzed:

Australia� National Code of Practice for Manual Handling

[NOHCS: 2005 (1990)] � National Code of Practice for the Prevention of

Occupational Overuse Syndrome [NOHSC: 2013 (1994)]

� Manual Tasks Advisory Standard 2000 –Queensland

� Code of Practice for Manual Handling 2000 –Victoria



European Community� Directive 89/391 Introduction of measures

to encourage improvements in the safety and health of workers at work

� Directive 90/269/EEC Minimum health and safety requirements for the manual handling of loads where there is a risk particularly of back injuries to workers

� Directive 2002/44/EC Minimum health and safety requirements regarding the exposure of workers to the risks arising from physical agents (vibration).

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ISO� ISO 11228-1 Ergonomics – Manual

Handing – Part 1: Lifting and Carrying� ISO 11226 Ergonomics – Evaluation of

static working postures � ISO/FDIS 6385:2003 Ergonomic Principles

in the Design of Work SystemsJapan� Guidelines on the prevention of lumbago

in the workplace (1994).Netherlands� Working Conditions Act 1998



New Zealand

� Code of Practice for Manual Handling

� Approved Code of Practice for the Use of Visual Display Units in the Place of Work

� Occupational Overuse Syndrome (OOS) -Guidelines for prevention and management (1991) and Occupational Overuse Syndrome. Checklists for the evaluation of work. (1991)

Norway

� Act Relating to Worker Protection and Working Environment (2003)

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New Zealand

� Code of Practice for Manual Handling

� Approved Code of Practice for the Use of Visual Display Units in the Place of Work

� Occupational Overuse Syndrome (OOS) -Guidelines for prevention and management (1991) and Occupational Overuse Syndrome. Checklists for the evaluation of work. (1991)

Norway

� Act Relating to Worker Protection and Working Environment (2003)



South Africa� Occupational Health and Safety Act 1993Spain� Royal Decree 487/1997 Minimum health and

safety provision relating to manual load handling involving risks for workers, particularly to the dorsolumbar region and the associated Technical guide for the evaluation and prevention of risks associated with manual load handling.

� Royal decree 488/1997 Minimum health and safety dispositions relating to work with equipment fitted with visual display units and the associated Technical guide for the evaluation and prevention of risks associated with the use of equipment with visual display units.

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Sweden� AFS 2001:1 – Provisions of the Swedish Work Environment

Authority on Systematic Work Environment Management, together with General Recommendations on the implementation of the Provisions.

� AFS 1998:1 – Provisions of the Swedish National Board of Occupational Safety and Health on Ergonomics for the Prevention of Musculoskeletal Disorders, together with the Board’s

� General Recommendations on the implementation of the Provisions

UK� The Manual Handling Operations Regulations 1992� The Health and Safety (Display Screen Equipment)

Regulations 1992.� Upper limb disorders in the workplace. HSE, 2002� Aching arms (or RSI) in small businesses, HSE, 2003 � Manual Handling Assessment Charts. HSE, 2003



USA� OSHA, 2003: Ergonomics for the Prevention of

Musculoskeletal Disorders. Guidelines for Poultry Processing.

� NIOSH: Simple Solutions: Ergonomics For Farm Workers, 2001

� California Dept of Industrial Relations, 1999: Easy Ergonomics. A Practical Approach for Improving the Workplace

� California Dept of Industrial Relations, 2000: Fitting the Task to the Person: Ergonomics for Very Small Businesses

� State of Washington, Dept of Labor: WAC 296-62-051. Ergonomics

� State of Washington, Dept of Labor: Fitting the Job to the Worker: An Ergonomics Program Guideline

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The report concludes that existing ergonomics standards and guidance related to work-related MSDs prevention have some deficiencies, when evaluated in relation to contemporary ergonomics knowledge. These include:

� a narrow focus on a subset of physical hazards (particularly the severity of biomechanical hazards), with inadequate assessment of the effects of temporal exposure and total dose

� a narrow focus on physical hazards, with inadequate coverage of a wide range of other factors that have been clearly established as important in the development of cumulative work-related MSDs, including psychological stress and its work-related precursors

� inadequate coverage of issues related to effective program implementation

� inadequate attention given by document designers to document usability.



Recommendations concerning ILO policy decisions and the proposed ‘issues’ paper to be prepared prior to developing the guidance document:

� Possible purpose(s) and user group(s) of the proposed ILO document need to be reviewed and clarified.

� Following such clarifications, the document’s breadth of coverage needs to be reviewed and determined.

� The document content and presentation style required to maximize the likely effectiveness of program implementation should be reviewed and determined.

� The issue of whether or not quantitative risk assessment criteria should be specified in such a document should be reviewed in light of the document’s intended purpose(s) and users.

� Practicable methods for managing and controlling temporal exposure and overall hazard dose need to be developed.

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Thank you!

Shengli Niu

ILO/SafeWork


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