Global Collaborations

In 2005, the Institute of Public Health in Chile requested that NIOSH provide technical assistance toward building adequate capacity to eliminate silicosis in the Americas. In response to this request, WHO and its regional office, the Pan American Health Organization (PAHO), ILO, NIOSH, Chile, and countries in South America developed a program called the "Americas Silicosis Initiative". It is the first regional approach to address the ILO/WHO Global Program for the Elimination of Silicosis. Substantial efforts have been underway in Chile, Brazil, Peru, and Columbia.

The Americas Silicosis Initiative includes:

• Training trainers in Chile, Brazil, and Peru in methods of dust control
• Developing simple guidance for employers to put controls in place (e.g., control banding)
• Visiting small quarries, stone crushing, dentistry, and stone craft worksites to develop risk management approaches
• Training of physicians from Chile, Brazil, and Peru in radiographic reading
• Training of health professionals in spirometry
• Developing a regional silica reference laboratory in Chile
• Developing a respirator program suitable for small employers

NIOSH technical assistance was a key factor in the development and adoption by Chile in 2009 of their National Plan to Eliminate Silicosis, the creation of a regional silica laboratory in Chile, and development of the Chilean respiratory protection selection document for Chilean small businesses.

A major component of this program is control banding, a qualitative risk assessment and management strategy that allows non-experts to use task-based hazard data and potential exposure information to determine appropriate controls. Following input from NIOSH on control banding approaches used in the U.S. and the United Kingdom, Chile experts transformed this approach to make it suitable for Chilean small enterprises. The simple guidance is called Evaluación Cualitativa del Riesgo de Exposición a Sílice (ECRES) and is being implemented and evaluated in the country.

Since 1950, the ILO has periodically published guidelines on how to classify radiographs for pneumoconiosis. The latest guidelines were completed in 2011 and were the first to enable classification of modern digital chest images using the ILO system. NIOSH collaborated closely with ILO in this effort. The migration to electronic images will greatly benefit to countries throughout the world by facilitating transfer of chest images, even across great distances and to multiple readers for classification. It will also facilitate development of opportunities for distance learning. In addition to the face-to-face courses that have been offered in the Americas, NIOSH has provided training and exams in recent years in Indonesia, Italy, Israel, and Thailand.

• ILO/WHO Global Program for the Elimination of Silicosis
• Silica, Radiographic Reading and Spirometry
• Control Banding

Road traffic injury is the leading cause of work-related fatalities in most high-income countries. The situation is likely more serious in low- and middle-income countries, where work-related road safety may receive little attention from policy makers or data collectors. In these settings, death, disability, or injury of a family wage earner due to road traffic injury creates physical, emotional, and economic hardship for the injured worker and family members that may persist well beyond the event.

For employers, motor vehicle crashes are often the most costly type of workplace incident, resulting in lost productivity, vehicle repair costs, medical expenses, and substantial liability costs. To address these risks, employers can leverage the employer-employee relationship to complement and enforce road safety laws and regulations. Safe-driving policies implemented in the workplace can promote safer driving by workers and family members away from work. In addition, employers, as purchasers of large fleets of vehicles, can spur improvements in vehicle safety and encourage development of road safety capacity and legislation in the local areas and countries in which they operate, thereby improving road safety for all.

The NIOSH Center for Motor Vehicle Safety coordinates research and outreach activities related to prevention of road traffic injury among workers. Global activities are part of its strategic plan. The Center’s global activities also support a 2010 resolution of the UN General Assembly which proclaimed a Decade of Action for Road Safety 2011-2020. NIOSH is a member of the UN Road Safety Collaboration (UNRSC), a public-private consultative mechanism coordinated by the World Health Organization (WHO), which is instrumental in developing and implementing the plan for the Decade of Action. NIOSH is also active on a UNRSC committee on work-related road safety.

NIOSH and the Center also frequently contribute subject-matter expertise to international and non-governmental organizations such as the WHO and Network of Employers for Traffic Safety (NETS). NIOSH is a member of the U.S. committee for the ISO 39001: 2012 standard, Road-Traffic Safety Management Systems – Requirements with Guidance for Use, a global standard that delineates road-safety management processes to be followed by organizations. ISO 39001 sees workers as a major road user group whose driving must be managed in order to ensure the safety of the entire road system. NIOSH and the Center for Motor Vehicle Safety also participate in international research on road traffic injuries to workers, including a project in India to evaluate post-license training for truck drivers and deliver fleet safety management workshops to transport contractors.

• Specialty Road Safety at Work Library of Training Materials and Practice Tools
• UN Decade of Action
• NIOSH Motor Vehicle Safety Resources

Recognizing the threats faced by healthcare workers, NIOSH supported the World Health Organization (WHO) in developing a training program aimed at preventing transmission of blood borne pathogens. Beginning in South Africa, Tanzania and Vietnam, the project produced a tool kit "Protecting Healthcare Workers: Preventing Needlestick Injuries Toolkit".

In 2005, NIOSH and the Pan American Health Organization (PAHO) and WHO began adapting the toolkit to Latin America with its translation into Spanish and the implementation of a successful pilot program in Venezuela. The toolkit is now available in Spanish "Prevención de lesiones por pinchazo de aguja.

This is a Train-the Trainer teaching program for healthcare settings to reduce bloodborne pathogens among healthcare workers. The training includes a national planning meeting with state and national government officials and a three day "Training-of-Trainers" workshop for frontline workers and leaders from pilot hospitals and state officials. WHO and its regional offices and various countries have hosted trainings by NIOSH and other experts to generate since 2007 at least 13,000 trainers in Latin-America, 700 in Middle Eastern countries, and over 7000 in Africa for a total of approximately 20,000 trainers. The trainings have contributed to passage of national regulations in Venezuela, Vietnam, Peru and Colombia.

In 2012, NIOSH and WHO initiated a project to update the curriculum for this 3-day training course and to develop detailed instructions for those hosting and delivering the training. This new version, to be released in 2015, will include updated PowerPoint slides with detailed speaker notes, pre- and post-test, handouts, and a trainer’s manual with instructions for the delivery of the entire 3-day training-of-trainers program, including options for delivering standalone modules.

NIOSH works internationally with numerous partners including the Working Party on Manufactured Nanomaterials within the Organization for Economic Cooperation and Development (OECD) which has produced a number of publications related to the safety of manufactured nanomaterials, and the International Standards Organization (ISO) Technical Committee 229 on Nanotechnologies.

At the request of WHO, NIOSH is leading the WHO effort to develop WHO Guidelines, "Protecting Workers from Potential Risks of Manufactured Nanomaterials" (WHO/NANOH). Many expert Institutions have volunteered to work on these Guidelines, which aim to facilitate improvements in occupational health and safety of workers potentially exposed to nanomaterials in a broad range of manufacturing and social environments. The Guidelines will incorporate elements of risk assessment and risk management and contextual issues. They will provide recommendations to improve occupational safety and protect the health of workers using nanomaterials in all countries and especially in low and middle-income countries.

Latino immigrants are 50% more likely than all workers in the United States to experience a fatal injury at work¹. Traditional approaches that have been used successfully to promote occupational safety and health (OSH) among U.S.-born workers have been much less effective at reaching Latino immigrant workers. NIOSH has developed a partnership with the Mexican Ministries of Foreign Affairs, Health, and Governance to reduce occupational health disparities for Mexican immigrant workers. The Ministry of Foreign Affairs operates 50 consulates throughout the U.S. that serve over one million Mexican citizens annually. The two primary aims of this ongoing collaboration are:

• To provide consultation and assistance to Mexican Government institutions operating in the U.S. so that they may increase their internal capacity to engage in research and health promotion activities that support occupational safety and health among Mexican immigrants.
• To improve NIOSH’s internal capacity to study, document, and make recommendations that will help reduce occupational health disparities for Mexican immigrants in the United States.

This systems-level approach to reducing health disparities through binational partnership has created opportunities for surveillance, research, and disease cluster identification using the existing data collection infrastructure of the Ministries of Governance and Foreign Affairs. NIOSH is also collaborating with the Ministries of Health and Foreign Affairs on research to evaluate OSH educational materials for immigrant workers. Through professional training and information exchange, NIOSH is helping strengthen the consulates’ capacity to help immigrant workers access resources that will allow them to effectively seek OSH information and understand their options when they encounter unsafe working conditions.

• Health Disparities Research Program
• Improving Occupational Safety and Health Among Mexican Immigrant Workers: A Binational Collaboration²

NIOSH’s mission under the Occupational Safety and Health Act is to prevent injuries and illnesses to all workers including low-wage temporary and informal workers and their employers. However these populations are difficult to reach through traditional channels. NIOSH is working with WHO and partners to learn about successful models for establishing programs to reach hard to reach workers and employers.

WHO has developed a plan for increasing primary care providers competency in recognizing exposures and managing the health of workers’. Resolution WHA 60.26 “Workers’ Health: Global Plan of Action” urged Member States “to work towards full coverage of all workers, including those in the informal economy, small- and medium-sized enterprises, agriculture, and migrant and contractual workers, with essential interventions and basic occupational health services for primary prevention of occupational and work-related diseases and injuries.” WHO secretariat was requested to develop time line and indicators for the establishment of access to occupational health services for all at the global level.

WHO’s work on extending access to the most essential health interventions and services for workers’ health includes:

• Enabling primary care centers to deliver preventive, curative and rehabilitative people-centred care according to the specific health needs of working people, particularly those who do not have access to occupational health services.
• Strenghtening the specialized occupational health services – multidisciplinary and basic- and improving their link to primary care centres and the rest of the health system.
• Stimulating international efforts to build human resource capacities for workers’ health, both in primary care and occupational health specialists. http://www.who.int/occupational_health/activities/universal_health_coverage/en/

In the U.S., community and migrant health programs are primary and trusted sources of health care. They are an important community institution for low-income workers, and offer health and wellness information to urban and rural communities. NIOSH has an interest in engaging with these communities in the prevention of work-related injury/illness/death. For example, recent NIOSH sponsored research has shown that community health center patient populations can be characterized by key factors such as occupation and that this information can be used to anticipate work-related exposures and conditions to improve diagnosis, condition management, and patient education within each community setting. NIOSH has projects that seek to better understanding the effectiveness of intervention strategies at the primary care level and to contribute to a better understanding globally.

References

1. Centers for Disease Control and Prevention (CDC). 2008. Work-related injury deaths among Hispanics – United States, 1992-2006. MMRW 2009; 57:597-600.
2. Flynn, M.A., Check, P., Eggerth, D.E, & Tonda, J., (2013). Improving Occupational Safety and Health among Mexican Immigrant Workers: A Bi-national Collaboration. Public Health Reports: Supplement on Applying Social Determinates of Health to Public Health Practice. 128 (Supplement 3): 33-38.