Keynote & Plenary Speakers
Opening Keynote Speaker:
Dr Kurt Straif
Section of Evidence Synthesis and Classification
International Agency for Research on Cancer, WHO, Lyon, France
The IARC Monographs and the Burden of Occupational Cancer
Kurt Straif is Head of the IARC Monographs program and the IARC Handbooks of Cancer Prevention. He serves on several national and international committees with a focus on primary and secondary prevention of cancer. He has expertise in medical oncology, occupational and environmental causes of cancer and cancer epidemiology. He studied medicine at the universities of Liège, Heidelberg and Bonn, and received his Master of Public Health and PhD in epidemiology from the University of California, Los Angeles. He is board certified in internal medicine, occupational and environmental medicine.
This presentation will be about the triad of historical insights, scientific evidence and preventive action. By way of introduction, the history of chemical carcinogenesis (from Pott’s soot to the IARC evaluation of benzo[a]pyrene as a Group 1 carcinogen based on a mechanistic upgrade) showcases the important role of occupational carcinogens in understanding the causes of cancer and related paradigm shifts, primarily over the last century. Similarly, the history of radiation carcinogenesis has significantly learned from occupational exposures and served as a foundation of environmental epidemiology.
The IARC Monographs programme is not only the longest running program of cancer hazard identification, it is also on the cutting edge of the latest scientific developments. A short history of the evolution of the program with a focus on causal inference and changing contributions from the different scientific domains (cancer bioassays, epidemiology and toxicology) will be followed by the latest developments in terms of systematic review, key characteristics of carcinogens, high through-put/high content data, and quantitative risk characterisation. The integration of evidence streams into an overall evaluation will be illustrated with a selected carcinogen.
The Monographs’ evaluations often serve as the basis for the estimation of the burden of occupational cancer. Important milestones in burden estimates (from Doll and Peto, 1981, to the ongoing joint WHO/ILO undertaking) will be presented. These results are not for debates in an ivory tower of science, but here to inform public health actions, and particularly a vision of zero occupational cancers. Data on the adverse economic impact of occupational cancer together with evidence that out-phasing of occupational carcinogens like asbestos does not have negative economic impact will further support implementation of control measures and should be employed more often.
Finally, the presentation will name significant challenges on our roadmap, such as the need for better exposure data and exposure assessment, shift of funding to prevention research including occupational cancer prevention, access to data for research and management of conflict of interests.
Professor Antonio Mutti
Gene-Environment Interaction: Promises and Pitfalls of Molecular Epidemiology and Toxicology in Occupational Health
Graduated cum laude in Medicine & Surgery (1974), Specialist cum laude in Occupational Medicine (1977), he is Professor of Occupational Medicine and Director of the Department of Medicine & Surgery at the University of Parma (Italy). Member of the International Commission on Occupational Health since 1975, he served as Secretary (1990-96) and Chairman (1996-2003) of the Scientific Committee on Occupational Toxicology. Thereafter, he served as ICOH Board member for two mandates. Author of over 400 scientific publications, mostly in peer-reviewed international journals, his research interests focused on Occupational Toxicology, Biomarkers, and Gene-Environment interactions in chronic degenerative diseases.
Keywords: polymorphism, metabolism, susceptibility
Most Gene x Environment (G×E) studies focused on polymorphic variants in metabolism genes affecting metabolic function of proteins that activate or detoxify exogenous and endogenous toxins. Examples include members of the cytochrome P-450 (CYP) superfamily of proteins, N-acetyltransferase 2 (NAT2), and glutathione S-transferases (GSTs) that are implicated in cancer, Parkinson disease (PD), and Alzheimer disease. For example, long before the first familial PD gene was identified, the “poor metabolizer” enzymatic phenotype of the cytochrome P450 2D6 (CYP2D6) gene was the first PD candidate gene because the enzyme is active in the brain region linked to PD, metabolizes relevant endogenous neural compounds, and inactivates neurotoxins known to cause Parkinsonism in animal models and humans. Many population studies have shown an increased risk of PD for CYP2D6 poor metabolizers compared with all other metabolizer types, and some PD studies that include pesticide exposures also observed G×Es for poor-metabolizer variants of CYP2D6.
Incorporating individual susceptibility in risk assessment has been a challenging endeavour as there is the problem of low statistical power when testing for G×E in studies designed to uncover main effects of variables. There is also the problem of the complexity of measuring environmental exposures and the difficulty in assigning temporality, especially in case-control studies.
Other problems include the limited range of genetic and/or environmental variation, the redundancy of metabolic pathways, the limited scope of minor biotransformation reactions, scale dependence in the definition of statistical interaction, and a lack of biological data on the health impact of many genetic variants.
Risk management implying priority setting and sound resource allocation should rely on risk characterization, which in turn requires deep understanding of mechanisms of action of individual risk factors and relevant dose-response relationships. Most often, however, primary prevention aimed at eliminating exposure and hence also GxE remains the most pragmatic approach and perhaps the most effective one.
Dr Bonnie Rogers
North Carolina Education and Research Center and Occupational health Nursing Program
University of North Carolina, School of Public Health, Chapel Hill, North Carolina, USA
Total Worker Health
Bonnie Rogers is a Professor of Public Health and Nursing and is Director of the North Carolina Occupational Safety and Health Education and Research Center and the Occupational Health Nursing Program at the University of North Carolina, School of Public Health, and Chapel Hill, North Carolina. Dr. Rogers received her diploma in nursing from the Washington Hospital Center School of Nursing, Washington, DC; her baccalaureate in nursing from George Mason University, School of Nursing, Fairfax, VA; and her master of public health degree and doctorate in public health, the latter with a major in environmental health sciences and occupational health nursing from the Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD. She holds a postgraduate certificate as an adult health clinical nurse specialist. She is certified in occupational health nursing, case management as a legal nurse consultant, and is a fellow in the American Academy of Nursing and the American Association of Occupational Health Nurses. Dr. Rogers completed an academic certificate program in Bioethics and Health Policy at Loyola University, Chicago, is an ethicist and was invited to study ethics as a visiting scholar at the Hastings Center in New York. She was granted a (National Institute for Occupational Safety and Health (NIOSH) career award to study ethical issues in occupational health.
Dr. Rogers is honored to serve as Chairperson of the NIOSH Board of Scientific Counselors since 2012. She was elected in 2013 as a Fellow in the Collegium Ramazzini. She completed two terms as Vice President of the International Commission on Occupational Health (ICOH) and previously two terms as Chairperson of the Scientific Committee on Education and Training in Occupational Health, ICOH. Dr. Rogers is past president of the American Association of Occupational Health Nurses, completed several terms as an appointed member of the National Advisory Committee on Occupational Safety and Health, and is Past President of the Association of Occupational and Environmental Clinics, serves on the Board of Directors. She is a consultant in occupational health and ethics. She was appointed in 2016 to the ANSI Z 88 15 Respiratory Standards Committee.
Dr. Rogers has been Chairperson of the NIOSH National Occupational Research Agenda Liaison Committee for 20 years. She has served on numerous Institute of Medicine committees including the Nursing, Health and the Environment Committee, the Committee to Assess Training Needs for Occupational Safety and Health Personnel in the United States, the IOM standing committee on Personal Protective Equipment for Workplace Safety and Health, Respiratory Protection for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A, and PPE for Healthcare Workers During an Influenza Pandemic: Current Research Issues.
Abstract: As defined by the U.S. National Institute for Occupational Safety and Health, Total Worker Health® is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being.
Traditional occupational safety and health protection programs have and continue to focus efforts on ensuring that work is safe and that workers are protected from work-related hazards and working conditions that arise from work itself. The Total Worker Health (TWH) approach seeks to improve worker well-being for the benefit of workers and employers by protecting safety and enhancing health and productivity. As evidenced in research, work-related hazards and unhealthy work environments can contribute to or aggravate health problems experienced by workers such as, sleep disorders, stress, depression, and cardiovascular conditions.
The TWH approach integrates workplace interventions that protect worker safety and health with activities that advance the overall well-being of workers through the establishment and implementation of policies, programs, and practice. This includes, for example, addressing hazard prevention and control, work organization and environmental supports, effective leadership, changing work and worker communities, fair and supportive policies, and worker advocacy.
Yue Leon Guo
Psychosocial Conditions After Occupational Injury
Yue Leon Guo (Leon), MD (National Taiwan University), MPH (Harvard University), PHD (Environmental Health, Johns Hopkins University) served residency (Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas, and Occupational Medicine, University of California, San Francisco) and as a faculty member of National Cheng Kung University. He is Director, National Institute of Environmental Health Science, National Health Research Institutes, Taiwan, and distinguished professor, National Taiwan University (NTU). He was president of the president of Asian Congress of Occupational Health (2000-2002). He became a fellow of the Collegium Ramazzini in 2004. His work involved promoting diagnosis and reporting occupational diseases.
Leon Guo1,2,3, Judith Shiao4, Weishan Chin1,2,3
1Environmental & Occupational Medicine, National Taiwan University College of Medicine and Hospital
2National Institute of Environmental Health Science, National Health Research Institutes, Taiwan
3Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health
4School of Nursing, National Taiwan University College of Medicine, Taipei, TAIWAN
Introduction: Annually in the world, more than 300 million nonfatal occupational accidents occur requiring at least 4 days of absence from work. Elevated psychiatric disorders and psychological symptoms are reported after occupational injuries. In addition, those with poorer psychological conditions had lower probability of returning to work, and those who with a disability of the upper or lower extremity tended to have higher mortality from self-harm in later life than did the general population. In cases of severe injury, a proportion of workers spent the rest of their life suffering from psychological ailments.
Methods: Using the available information on incidence rates of occupational injuries, and related psychological and psychiatric ailments after occupational injuries, overall psychosocial impacts as a result of occupational injuries are estimated, including psychiatric diseases, psychological symptoms, disability from work, and suicides.
Result: Psychiatric diseases worldwide are caused directly or indirectly by occupational injuries. The less severe forms of mental consequences are psychological symptoms or preclinical psychiatric conditions. Significant percentage of permanent disabilities are caused by psychiatric conditions related to injuries. In addition, delayed return-to-work, i.e., longer duration of temporary disability is found among injured workers with psychological symptoms. A special form of psychological/psychiatric condition, suicides and suicidal ideation are increased among injured workers. There are still limitations in this analysis due to a great varieties of psychological outcomes obtained, and to lacking of epidemiological assessment of these conditions after occupational injuries.
Discussion: Generally, the psychosocial impacts of occupational injuries are greater than generally understood. In addition to preventing occupational injuries, secondary and tertiary prevention to minimize psychosocial impacts are warranted.
Keywords: Occupational Injuries, post-traumatic stress disorder, return-to-work
Dr Gerry Eijkemans
The Importance of Workers’ Health to Advance the United Nations Sustainable Development Agenda
Dr Gerry Eijkemans has joined PAHO Mexico in February 2016 as Pan American Health Organization and World Health Organization (PAHO/WHO) Representative. Before that, she was PAHO/WHO Representative (PWR) for The Bahamas and Turks and Caicos Islands from February 2011, after having worked as the PWR Suriname.
Dr Eijkemans is a Dutch national, a medical doctor from the University of Nijmegen by training with a Masters Degree in Public Health from Johns Hopkins University, specialized in determinants of health and occupational and environmental health.
As PAHO/WHO Representative, she works on supporting the government in the development and implementation of Public Health Initiatives and strengthening health systems and services. She has showed leadership in various areas of public health in various countries in the Region, notably the the work towards a Health in All Policies and Social Determinants of Health approach, development of the Tobacco Legislation and the strengthening of the NCD Programs. Furthermore, Dr Eijkemans worked closely with the Governments in the development of National Health Sector Plans and the implementation of national health insurance initiatives towards Universal Health.
She lived and worked in Geneva for 8 years, where she served as the WHO focal point for the Global occupational health programme. She also was the senior advisor on child labour and health at the ILO International Programme on the Elimination of Child Labour ( IPEC) for 2 years.
During her carrier she has provided technical assistance in over 70 countries, including China, India, Mexico, Egypt, Brasil, South Africa on topics related to workers health, environmental health, child labour, gender and sustainable development, health systems strengthening in the context of Universal Health. She was one of the contributor to the WHO Commission on Social Determinants of Health and she has created and motivated several regional and global networks
Introduction: The 2030 Agenda embraces the three dimensions of sustainability – economic, social and environmental. It was adopted by world leaders at the United Nations in September 2015. The 2030 Agenda for sustainable development puts people and planet at its centre and gives the international community the impetus it needs to work together to tackle the formidable challenges confronting humanity, including those in the world of work and for improved health for all.
Discussion: WHO has recognized that addressing social determinants of health – the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life- are key for the creation of health; employment conditions are essential in this context.
When examining the situation and role of workers´ health in the SDGs, we see that over the last years limited progress has been made; The latest ILO figures show that work-related fatal injuries and diseases have increased from 2.3 million to 2.78 million per year, increasing the global cost of the failure to adequately address occupational safety and health concerns to an estimated 3.94% of global GDP per year, or 2.99 trillion US dollars. Roughly half the world’s population still lives on the equivalent of about US$2 a day, and in many places, having a job does not guarantee the ability to escape from poverty. This slow and uneven progress requires us to rethink and retool our economic and social policies aimed at eradicating poverty.
The 2030 agenda seeks to reduce poverty and to increasing equity. Some specific SDG objectives are achieving Universal Health Coverage (still only 15% of workers worldwide have access to specialized occupational health services) and achieving full and productive employment and decent work for all women and men.
These are very ambitious goals; but they are essential and they are feasible. But in order to meet those goals, the world needs to focus on people, by implementing public policies that improve employment conditions and health of workers, through a very close coordination among government agencies responsible for health, labour, social security and economic development, together with employers and workers´ organizations.
Keywords: Workers´ Health, 2030 Agenda
Prof John Gallagher
Connected Workplace Health, Safety and Wellbeing in an Irish Context
Dr John Gallagher graduated from University College Cork in 1985. He completed a MMed Sc in Occupational Health at the University of Birmingham in 1991 and received the inaugural John Darwall Prize. He is a Fellow of the Faculty of Occupational Medicine and a Fellow of the Royal College of Physicians of Ireland. He is a Past Dean of the Faculty of Occupational Medicine. He is a Consultant and Head of Department at the Occupational Health Department, HSE South. He is a Clinical Senior Lecturer in Occupational Medicine, UCC. He is Managing Director of Cognate Health Ltd.
Abstract: Irelands industrial heritage is often overlooked. Though not of the same scale as our closest neighbour Ireland has a significant industrial past. The famine not only led to depopulation particularly of rural areas but also to urban drift and the growth of factory labour. Early health and safety legislation focused on extractive, manufacturing and transport industries. Modern Irish legislation has encompassed the terms health, safety and welfare from its inception in 1989. The practical focus has been on the safety component, a reflection of preceding legislation. Over the last 10 years there has been an increased focus on health and welfare and a move toward the concept of wellness. The concept of Total Worker Health though more established overseas and particularly in the United States, is a new arrival in Ireland. This approach attempts to integrate the functions of occupational health, health promotion, and health protection programs with the aim of improving employee health, minimising work-related injuries and illnesses, and reducing employee health care-related costs. It has been embraced to varying degrees by different organisations and with varying levels of success. Prof Gallagher will discuss the reasons behind this and will look at some recent evidence and case examples in Ireland. He will address where occupational medicine fits into the concept of total worker health and how this may develop in the future. This has implications for the discipline of occupational medicine which he will also address. Finally he will look at the challenges and opportunities of connected health approaches.
Vision Zero: A World of Work Without Fatal and Serious Accidents
Hans-Horst Konkolewsky is the Secretary General of the International Social Security Association (ISSA) based in Geneva, Switzerland. Elected in 2005, Mr Konkolewsky heads an extensive programme of activities with the aim to strengthen the governance, performance and service quality of social security administrations, with a strong focus on proactive and preventive measures.
Prior to his election as Secretary General, Mr Konkolewsky served for ten years as Director of the European Agency for Safety and Health at Work, located in Bilbao, Spain.
Mr Konkolewsky, who is a Danish national, also served as Deputy Director General of the Danish Working Environment Authority.
Abstract: There is a growing international consensus that efforts to develop a global prevention culture should be reinforced in order to reduce the unacceptably high number of work accidents and occupational diseases worldwide. It is at the same time recognized that business performance is highly depending on a healthy and motivated workforce.
The ISSA has on this background developed a new prevention concept, called “Vision Zero”, which is based on the belief that all accidents and diseases at work can be prevented. The ISSA’s Vision Zero approach is flexible and can be adjusted to any workplace, company or industry.
A global Vision Zero campaign was launched at the XXI World Congress for Safety and Health at Work in September 2017 in Singapore, which aims to mobilise business leaders to integrate safety, health and well-being at work in their core management function as well as company culture.
To this end the ISSA has developed a Vision Zero Guide that outlines a roadmap with 7 Golden Rules to help improve a company’s safety and health performance as well as practical checklists and training materials.
More than 700 Companies and OSH-organisations from more than 90 countries have since its launch joined the campaign as Vision Zero Companies or Partners.
Professor Vidhya Venugopal
Climate Variability Impacts on Occupational Health – Research Evidence and Future Steps
Professor. Vidhya Venugopal, a Certified Industrial Hygienist and Climate Change Scientist works with the Department of Environmental Health Engineering at Sri Ramachandra University in Chennai, India. She passionately explores the links between exposures to Occupational Heat Stress and Health & productivity in formal and informal sectors. She has large scale funded projects and works with about 150 industries across India to study occupational heat and health links and the results show that due to the combined effect of higher temperatures and poor-working conditions/limited welfare facilities, heat related morbidities incl. Acute Kidney Injury (AKI) are expected to increase, especially with the predicted rise in temperatures. Her results were fed into forming certain protective labour polices and were key in framing “Occupational Health“ in the “National action plan for Climate Change and Human Health” for India. She is currently engaged in “Occupational Heat Stress and links to Kidney-related illness”.
Introduction: High-heat exposures at workplaces have particularly increasing adverse occupational health consequences across the globe, which will be an increasing problem as climate change progresses. Working people with moderate or heavywork intensity in hot environments are at particular risk especially in middle- and low-income tropical and subtropical regions, where protective workplace policies/optimal controls are not in place. This lecture presents evidence on occupational heat stress in the context of climate change, reviews the current global status, and reflects on the health implications, presents an overview of the outcomes and the very important next steps.
Methods: Epidemiological evidence from author’s seasonal studies with workers engaged in moderate to heavy labor in ~35 Indian workplaces collected over a 8-year period on occupational heat exposures(n=~3500), self-reported heat-related health symptoms/ productivity losses and physiological data(n=~2000) were analyzed to understand the level and extent of heat stress impacts.
Results: A significant number of workers(~82%) had heat exposures higher than the recommended WBGT (Avg.WBGT of 28.7°C±3.1°C). Workers exposed to chronic high-heat had significant higher odds of adverse-health outcomes(OR=2.43, 95% CI 1.88-3.13,p-value=<0.0001) and productivity losses(OR=1.79, 95% CI 1.32-2.4,p-value=0.0002). Above normal sweat rates, urinary specific gravities, rise in Core Body Temperature and moderate dehydration were common, with compromised renal health prevalence high among exposed workers in certain occupations. Climate Projections show that future temperature rise to impose additional health and productivity risks for workers, especially in hot seasons.
Conclusion: Current workplace exposure standards must be revisited and optimized for tropical settings and be consistent with the approach of protecting workers against adverse effects to health. In-depth research investigations on health implications of heat stress are an urgent need. Though reducing workplace heat stress by interventions has multiple benefits, adaptation and mitigation measures including policy changes are imperative to tackle heat stress at workplaces in the Climate Change future.
Associate Professor Alison Reid
Migration, Work and Occupational Health and Safety
Alison Reid is an Associate Professor in the School of Public Health, Curtin University, Western Australia. She has a background in anthropology and demography and is an occupational epidemiologist with a specific interest in the occupational causes of disease and risks among sub groups of the population. Specifically, she is interested in the working conditions of migrant workers, their hazard risks and prevalence of exposure to workplace hazards.
Abstract: The number of people leaving their homes and crossing national borders has increased in recent decades. Today, there is an estimated 232 million migrants globally, half of whom work, and this number is anticipated to continue to increase. The migrant workforce is mixed, containing young unskilled workers, highly skilled and educated workers, and latterly females. Migrant workers from developing countries have a tendency to segment into jobs at the bottom and top of the occupational hierarchy, whereas professional migrants habitually move from one wealthy country to another. The literature is mixed about whether migrant workers experience more work -related injuries than their native-born counterparts and little is known about their exposure to carcinogens and/or other workplace hazards and whether that varies with that of their native-born counterparts. Drawing on the findings from the international literature and several studies comparing exposure to workplace hazards between migrant and native-born workers in Australia, I will address why and how migrant workers are vulnerable to adverse working conditions and how this impacts on their occupational health and safety.
Keywords: migration, OH&S vulnerabilities, workplace hazards
Emeritus Professor Rodney Ehrlich
When Occupational Health Becomes Public Health: Occupational Lung Disease in Miners
Rodney Ehrlich is Emeritus Professor in the School of Public Health and Family Medicine, Cape Town, South Africa, and currently co-Editor-in-Chief of the American Journal of Industrial Medicine. He has been engaged with mining lung disease throughout his career as a clinician, educator, advisor to government and researcher, particularly on diseases caused by silica dust, including tuberculosis, their epidemiology in miners, and workers’ compensation more broadly. His current research includes interdisciplinary collaborations on the co-immunology of silica and tuberculosis, mortality estimation among ex-miners and historical analysis of the role of measurement in preventing occupational disease.
Abstract: Despite a century of surveillance of silicosis and tuberculosis in the South African gold mining industry, black gold miners were afflicted with a triple epidemic of silicosis, tuberculosis and HIV at the turn of the 21st century. Fertile ground for this new co-epidemic was provided by a migrant labour system that linked rural areas in South Africa and surrounding countries with the gold mining industry. A surge in the employment of miners and the stabilisation of employment contracts from the 1970s shifted the cumulative service curve, and hence silica exposure, upwards. Despite the availability of treatment for tuberculosis, elevated rates of tuberculosis had persisted in the industry, while the known relationship between silica and tuberculosis had faded from memory. The arrival of HIV, another cofactor for tuberculosis, in the 1980s found a large population of men living in single sex accommodation far from their families.
Understanding of this co-epidemic was also limited by the migrant labour system, which had resulted in two subpopulations numbering in the millions in dynamic association with each other. The first were those employed and thus under radiological, clinical and post-mortem surveillance for lung disease, and subject to health selection into and out of the industry. The other were ex-miners, dispersed through remote rural areas with poorly developed economies and health services, to which the burden of mining related lung disease was shifted and whose health experience remained hidden. The Southern African experience of silicosis and tuberculosis and related disorders holds lessons for other countries with active and growing extractive industries. More generally it should also direct our attention to areas of the world dependent on large number of migrant workers employed under harsh conditions, whose work related ill health is “externalised” in various ways. Occupational health needs to regain its public health perspective.
Keywords: miners, silicosis, tuberculosis, HIV, migrants, Southern Africa
Professor Lap-ah Tse (Shelly)
Shelly obtained her Bachelor of Medicine from Shanghai Medical University in 1991 (now Fudan University), and gained her PhD in Occupational Epidemiology at the Chinese University of Hong Kong (CUHK) in 2003. She was tenured and appointed as Associate Professor and Head of Division of Occupational and Environmental Health of the Jockey Club School of Public Health and Primary Care by CUHK in 2014. Shelly currently is the Chairman of Advisory Committee – Environmental Hygiene of CUHK and Director of Center for Occupational and Environmental Health Studies.
Shelly’s main research interest is in Occupational and Environmental Health, Epidemiology. Her specific research areas are changing economic environment and workers’ health; environmental/ occupational exposures and cancers; shift work, circadian rhythm and adverse health effects. She is also interested in health impacts of BPA, industrial dusts and living environment. She is the PI leader of several government funded research projects including shift worker cohort in China. She has published over 150 research papers, and her representative papers are in Environmental Health Perspectives, Annals of Oncology.