The WHO/ILO joint methodology for estimating the work ... · Dr Frank Pega, WHO Dr Yuka Ujita, ILO. Overview •Rationale, objectives, project structure & timeline •Estimation methodology

The WHO/ILO joint methodology for estimating the work-related

burden of disease & injury

Dr Frank Pega, WHODr Yuka Ujita, ILO

Overview

• Rationale, objectives, project structure & timeline

• Estimation methodology

• Data sources

• Estimates

• Next & future steps

Rationale, objectives, project structure & timeline

Rationale

• WHO & ILO have in the past produced inconsistent estimates of work-related burden of disease & injury

• Member States have requested that WHO & ILO harmonize their estimates

• WHO & ILO have legal agreements:o to share data & exchange evidence (since 1948)

o to produce joint estimates on work-related burden of disease & injury (since 2019)

• UN reform requires UN Agencies to work seamlessly as One UN

• The 2030 Agenda for Sustainable Development:o includes targets for environmental health & for decent work

o calls for partnerships for development

Objectives

• To develop a methodology for estimating the numbers of work-related deaths & disability-adjusted life years (DALYs)

• To adopt existing methodologies shared by WHO & ILO for pairs of occupational risk factors & health outcomes

• To develop new methodologies for prioritized additional pairs of occupational risk factors & health outcomes

• To produce the first joint WHO/ILO estimates of the burden of work-related burden of diseases & injuries

Organizational project structure

Partnering organizationsWHO, ILO

Supporting organizationsINAIL, EU, (AU), ICOH

Network of individual experts

200 individual experts from 35 countries

Fiocruz, Ministry of Health, Brazil

National Institute of Occupational Health, South Africa

Ministry of Labour and Social Affairs, Germany

National Institute of Occupational Health & Poison

Control, CDC, China

Ministry of Health, Labour &Welfare, Japan

Ministry of Public Health, Thailand

National Research Centre for the Working Environment, Ministry of

Employment, Denmark

African Union (NEPAD), Africa

European Union (Eurostat), Europe

Ministry of Health, Welfare and Sport, Netherland

FIOH, Ministry of Social Affairs and Health, Finland

Inail, Ministry of Health, Italy

Timeline

2015 WHO & ILO technical units, engaged with WHO & ILO statistics units, agree to develop a joint methodology for estimating the work-related burden of disease & injury

2016-20 WHO & ILO technical units, engaged with WHO & ILO statistics units:• develop estimation methodology• systematically collected input data for modelling• develop statistical models • produce estimates

2019 WHO Assistant Director General & ILO Deputy Director General sign Collaboration Agreement that establishes the joint estimation as a longer-term joint monitoring programme

2020 WHO & ILO release the WHO/ILO joint estimates (first estimation cycle)

Estimation methodology

Established methodology used

• WHO has established the statistical methods applied to produce the joint estimates & has used these methods for over 20 years.

• These same statistical methods are already applied to produce at least three current SDG indicators:

Indicator Tier (as of 13

February 2019)

3.9.1 Mortality rate attributed to household & ambient air pollution Tier I

3.9.2 Mortality rate attributed to unsafe water, unsafe sanitation & lack of hygiene (exposure to unsafe Water, Sanitation & Hygiene for All (WASH) services)

Tier I

3.9.3 Mortality rate attributed to unintentional poisoning Tier I

Comparative risk assessment

• Quantification of disease burden at population level caused by various risk factors in a comparative & internally consistent way

• Comparative:

o same definitions & framework

o similar method for combining exposure & risk information

o same method for expressing results (mortality & DALYs)

• Consistent:

o linkage of disease burden by disease & by risk factor

• Estimation of attributable risk, that is current burden from past exposure

• Use of reported occupational cases where applicable

Exposure-based method

Risk factor distribution in the population

Effect of the risk factor on the health outcome

Population-attributable fraction

Total deaths or DALYs from health outcome

Burden of deaths or DALYs from the health outcome attributable

to the risk factor

Relative risk

X

Joint estimates comprise individual estimates of burdens of 52 pairs of occupational risk factors & health outcomes

• For 39 pairs, we can readily produce estimates, because we have all input data required (i.e. the population-attributable fractions & the total deaths or DALYs from the health outcome).

• For 13 pairs, we are still finalizing the estimates, because we are in the final stage of sourcing one or more input data sets to produce the population-attributable fraction.

Risk factor Health outcome

1 Occupational exposure to asbestos Larynx cancer

2 Occupational exposure to asbestos Tracheal, bronchus, & lung cancer

3 Occupational exposure to asbestos Ovarian cancer

4 Occupational exposure to asbestos Mesothelioma

5 Occupational exposure to arsenic Tracheal, bronchus, & lung cancer

6 Occupational exposure to benzene Leukaemia

7 Occupational exposure to beryllium Tracheal, bronchus, & lung cancer

8 Occupational exposure to cadmium Tracheal, bronchus, & lung cancer

9 Occupational exposure to chromium Tracheal, bronchus, & lung cancer

10 Occupational exposure to diesel engine exhaust Tracheal, bronchus, & lung cancer

11 Occupational exposure to second-hand smoke Tracheal, bronchus, & lung cancer

12 Occupational exposure to formaldehyde Nasopharynx cancer

13 Occupational exposure to formaldehyde Leukaemia

14 Occupational exposure to nickel Tracheal, bronchus, & lung cancer

15 Occupational exposure to polycyclic aromatic hydrocarbons Tracheal, bronchus, & lung cancer

16 Occupational exposure to silica Tracheal, bronchus, & lung cancer

17 Occupational exposure to sulfuric acid Larynx cancer

18 Occupational exposure to trichloroethylene Kidney cancer

19 Occupational asthmagens Asthma

20 Occupational particulate matter, gases, & fumes Chronic obstructive pulmonary disease

21 Occupational noise Age-related & other hearing loss

22 Occupational ergonomic factors Low back pain

Risk factor Health outcome

23 Occupational injuries Pedestrian road injuries

24 Occupational injuries Cyclist road injuries

25 Occupational injuries Motorcyclist road injuries

26 Occupational injuries Motor vehicle road injuries

27 Occupational injuries Other road injuries

28 Occupational injuries Other transport injuries

29 Occupational injuries Falls

30 Occupational injuries Drowning

31 Occupational injuries Fire, heat, & hot substances

32 Occupational injuries Poisonings

33 Occupational injuries Unintentional firearm injuries

34 Occupational injuries Unintentional suffocation

35 Occupational injuries Other exposure to mechanical forces

36 Occupational injuries Animal contact

37 Occupational injuries Pulmonary aspiration & foreign body in airway

38 Occupational injuries Foreign body in other body part

39 Occupational injuries Other unintentional injuries

Risk factor Health outcome

1 Occupational exposure to asbestos Pneumoconiosis

2 Occupational exposure to silica Pneumoconiosis

3 Occupational exposure to coal dusts Pneumoconiosis

4 Occupational exposure to welding fumes Tracheal, bronchus, & lung cancer

5 Occupational exposure to solar ultraviolet

radiation

Melanoma & non-melanoma skin cancer

6 Occupational exposure to solar ultraviolet radiation *

Cataract

7 Occupational noise * Cardiovascular disease

8 Occupational ergonomic factors Osteoarthritis

9 Occupational ergonomic factors Other musculoskeletal diseases (other than

low back pain, neck pain & osteoarthritis)

10 Long working hours Ischaemic heart disease

11 Long working hours Stroke

12 Long working hours * Depression

13 Long working hours * Alcohol use disorders

Guideline for Accurate & Transparent Health Estimates Reporting (GATHER)• WHO led the development of GATHER to guarantee the quality of

global health estimates

• Compliance with GATHER includes:• systematic review of input data

• documentation of input data, incl meta-data

• description of statistical models, incl confidence intervals

• WHO’s Department of Evidence, Information & Research monitors compliance with GATHER & only clears GATHER-compliant health estimates

Data sources

Input data & their sources

• 39 pairs that can be readily produced1. Data on population-attributable fractions: 2018 Global Burden of Disease

Study2. Data on total deaths or DALYs from health outcome: WHO burden of disease

estimates 2000-2016, based on WHO collections from Member States

• 13 pairs that we are still finalizing estimates for 1. Data on the distribution of the risk factor in the population: ILO collections

from Member States & five systematic reviews (due 1 June 2019) 2. Data on the effect of the risk factor on the health outcome: nine systematic

reviews (due 1 June 2019)3. Data on total deaths or DALYs from health outcome: WHO burden of disease

estimates 2000-2016

WHO/ILO databases of risk factor distribution

Variable Countries (N)

Surveys (N) Comment

Industrial sector (proxy for exposure to risk factors)

120 1,061 Source: National statistics offices

Occupation (proxy for exposure to risk factors)

94 592 Source: National statistics offices

Exposure to long working hours

146 2,298 Source: National statistics offices, Gallup Surveys

Occupational exposure to:• ergonomic risk factors• dusts & fibres• solar ultraviolet radiation• occupational noise• long working hours

tbd tbd Source: Five systematic reviews (due 30 October 2019)

146 countries with 2,298 surveys on exposure to long working hours

WHO/ILO Global Working Hour Database

Region World

AFR AMR SEAR EUR EMR WPRO

Surveys (N) 131 456 91 1,326 66 195 2,298

Survey participants (N in

million)11.2 272.4 33.2 166.8 13.5 93.7 591.1

Countries with ≥1 survey (N)

(% of countries covered)36

(76.6%)

24

(68.6%)

10

(90.9%)

43

(81.1%)

10

(45.5%)

23

(85.2%)

146

(74.9%)Population of countries with

≥1 survey as of 2018 in billion

(N) (% of population covered)

0.9

(90.6%)

1.0

(97.6%)

2.0

(98.7%)

0.8

(81.9%)

0.4

(64.4%)

1.9

(80.4%)

7.0

(88.9%)

Systematic reviews of input data

• 14 systematic reviews being finalized to establish evidence base for 13 additional pairs of occupational risk factors & health outcomes o Five systematic reviews of prevalence studies of exposure to occupational risk factorso Nine systematic reviews & meta-analyses of the effect of exposure to occupational

risk factors on health outcomes

• Conducted by WHO & ILO, supported by 200 individual from 35 countries

• National systematic reviews:o For China conducted by Centres for Disease Control, Chinao For Thailand conducted by Ministry of Public Health, Thailand

• Nine systematic review protocols published & 14 systematic reviews to be published open-access in Special Issue in Environment International (IF 7.3)

Innovations & capacity building in evidence synthesis• Innovations

o Systematic reviews for occupational burden of disease study, incl protocolo Systematic reviews of studies estimating prevalence of occupational risk factors

• Tool for assessing risk of bias• Approach for judging quality of evidence

o Microsimulation model to estimate exposure over an exposure window, using longitudinal data

• Capacity building o Global capacity strengthened for evidence synthesis in occupational health

• 200 experts in 35 countries comprehensively trained in all steps of evidences synthesis• 30 experts from ministries of health & labour or national institutes of occupational safety &

health in 10 countries trained in evidence synthesiso Working Group established for evidence synthesis methods in occupational healtho Capacity built to estimate work-related exposures & burden of disease & injury

Previous presentations of our methods & data

• DGs of ILO & WHO announce joint estimates

• IAEG-SDG (28 countries)

• African Union (NEPAD)

• European Union (Eurostat, EU-OSHA)

• ICOH (2018 World Congress)

• OSHAfrica (2019 Regional Conference)

Estimates

Estimates produced

• Standard statistical models have been built (binary, categorical)

• Estimates produced of distribution of occupational risk factors:o Exposure to long working hours

oOccupational exposure to welding fumes (via proxy of occupation)

oOccupational exposure to solar ultraviolet radiation (via proxy of occupation)

• Estimates produced of the burden of disease:o Ischemic heart disease attributable to exposure to long working hours

o Stroke attributable to exposure to long working hours

Leaving no one behind: Data disaggregation

• The join estimates are presented at the levels of:oCountry

oRegion

oGlobal

• The joint estimates are disaggregated by:oOccupational risk factor

oDisease

o Sex

oAge group (10 year age bands)

Next & future steps

Looking into the future

• First estimation cycle completed & estimates reported in 2020

• Second estimation cycle (2020-2023), incl adding additional pairs of occupational risk factors & health outcomes

• Estimates of costs of work-related burden of disease & injury

• Estimates of geo-spatial distribution of work-related burden of disease:oDistrict-level estimates of exposures & disease burdeno Estimates for exposure to occupational risk factors linked to geo-locations

(e.g. heat stress & air pollution) & the attributable disease burden

• Projections of reductions of work-related burden of disease & injury from policies & interventions

Conclusions

Conclusions

• WHO & ILO, supported by key organizations & a large network of experts, are finalizing their joint methodology & estimates of the work-related burden of disease & injury

• The estimates will be based on long-established statistical modelling methods, systematic reviews of evidence, large databases of official data, & consultation & collaboration with countries

• Next steps include finalizing, publishing & disseminating the estimates, & promoting their use in countries

• In the future, additional data & analytical products can be added to the estimates (costs, geo-spatial disaggregation & effects of policies & interventions) & the estimates can be updated regularly

The WHO/ILO joint methodology for estimating the work-related

burden of disease & injury

Dr Frank Pega, PhD [email protected]

Dr Yuka Ujita, MD, PhD [email protected]