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Disclosure of Interest: None Declared Abstract code:
Challenges of Assessing the Occupational Cancer Burden in Latin America and the Caribbean
The Americas’ Regional CAREX Challenge Julietta Rodriguez-Guzman, MD SOH MScA Regional Advisor On Workers’ & Consumers’ Health – PAHO/SDE
PS.4.115-4
Occupational Cancer milestones in the Americas
WHA65.8 Global Action Plan to
prevent NCDs 2013-2020
2008 2009
2010 2011
2012 2013
2014 2015
2016 2017
2020
WHA61.14 Global Strategy for Prevention of NCDs
2008-2013
Expert Forum Regional Plan to Prevent Occ-Ca World Day OHS
On line Occ.Cancer
Course PAHO/CCOSH
Advance assessment
towards CAREX
Asturias Declaration CALL FOR
ACTION
UN GA 66/2 UN Declaration on Prevention
& control of NCDs
Dr. J. Rodríguez Guzman, PAHO/SDE Melbourne, 5 December 2014
GBD 2004
PAHO Plan of Action for Occupational & Environmental Cancer Prevention and Control
Dr. J. Rodríguez Guzman, PAHO/SDE Melbourne, December 5, 2014
Policy: Plan of Action for Occupational Cancer Prevention and Control (Launched in 2008)
Activities done or in process ü PLAGSALUD 2000-2004 ü World Day for Safety and Health at Work 2008, 2014 ü Americas Silicosis Initiative Started 2007… ü Vaccination Week in the Americas Started 2009… ü Occupational Cancer on-line course began 2010… ü CAREX activities started in 2006… ü Asbestos Atlas for the Americas started in 2009… www.paho.org/saludocupacional/cancer
Current cancer tendencies in the Americas 2nd cause of death in the region: 1.2 M deaths in 2008, 45 % in LAC*
Dr. J. Rodríguez Guzman, PAHO/SDE Melbourne, 5 December 2014
§ Increased mortality of women in most Latin American countries are caused by: § Lung, breast & cervical cancers § Colorectal & stomach cancers
§ Increased mortality on men in most Latin American countries are caused by: § Lung, prostate & colorectal cancers § Stomach & liver cancers
* No. of deaths could increase to 2.1 M by 2030*
Current cancer tendencies in the Americas
Dr. J. Rodríguez Guzman, PAHO/SDE December 5, 2014
Sources: PAHO Lung Cancer fact sheet, 2014:
Cancer registries
“No data = no problem” àGLOBAL Registries cover 1/6 of POPULATION
à In the Americas few countries have registries that
cover all or part of the national populations
à Critical for occupational & environmental cancers
Source: American Cancer Society
Dr. J. Rodríguez Guzman, PAHO/SDE Melbourne, December 5, 2014
0 10 20 30 40 50 60 70 80 90 100
Argen&na (2009) N=7.195 Trabajadores Centros de Trabajo
Colombia (2007) N= 924 Trabajadores Centros de Trabajo
Guatemala (2007) N= 4.026 Trabajadores Centros de Trabajo
Nicaragua (C. de León, 2007) N= 771 Trabajadores
Hogares
Chile (2009-‐2010) N= 9.503 Hogares
Prop
orción
de trab
ajad
ores expue
stos (%)
Ruido Vibraciones Gases y vapores/ Sustancias Químicas Materiales infecciosos Movimientos RepeFFvos Posiciones Incomodas /malas posturas Levantar y movilizar cargas pesadas Nivel de atención alto o muy alto Sin pausas de trabajo Acoso por supervisores o compañeros
sOURCES: ArgenFna: González, J. “Las Encuestas sobre condiciones de trabajo y salud son un instrumento para planificar y evaluar las políFcas en salud laboral”. IV Congreso de Prevención de Riesgos Laborales en Iberoamérica Nuevos Tiempos para la Prevención 2010; Colombia: Ministerio de Protección Social. 2007. Primera Encuesta Nacional de Condiciones de Salud y Trabajo en el Sistema General de Riesgos Profesionales; Guatemala: Consejo nacional de Salud y Seguridad Ocupacional (CONASSO), OIT. 2007. Encuesta Nacional sobre Condiciones de Trabajo, Salud y seguridad ocupacional; Nicaragua: Programa Salud y Trabajo en América Central (SALTRA). Perfiles de salud ocupacional en Centroamérica. 2009; Chile: ENETS CHILE 2010 MINSAL-‐ISL-‐MINTRAB.
WORKING CONDITIONS IN SELECTED LAC COUNTRIES
Dr. J. Rodríguez Guzman, PAHO/SDE Melbourne, December 5, 2014
Other ranks: 18. Japan [16] 19.4; 37. Finland [15] 17.6; 55. U.K. [11] 16.0; 56. USA [10] 15.4
Dr. J. Rodríguez Guzman, PAHO/SDE Melbourne, December 5, 2014
Years Life Lost (APYLL): Mesothelioma (years per person; 1994-2010)
Courtesy Prof. Ken Takahashi: Epidemiology & Trends of ARDs A global perspective
Helsinki, FINLAND - February 2014
Rank Country [years] Years 1 Egypt [9] 29.9 2 Cuba [10] 26.2 3 Philippines [6] 25.6 4 Colombia [13] 25.2 5 Ecuador [12] 23.8 6 Moldova [15] 23.6 7 Mexico [13] 22.2 8 Venezuela [12] 22.1 9 Chile [13] 22.0
10 Brazil [15] 21.8 World Average (59 countries) 17.1
Registry of Occupational Diseases LAC
Dr. J. Rodríguez Guzman, PAHO/SDE
Number and rate of Occupational Diseases (x 10,000 workers) in Insured (formal) populations in selected countries of the Americas, 2000 -2010.
5,557 4,101
333,800
224,500
600 394 23,858 17,693 895 9,410 4,274 4,171 5,576 22,872
4.4 2.97
36.7
21.3
9.3 6.2
11.03
5 2.3
13.78 16
11.6 12
18
0
5
10
15
20
25
30
35
40
-‐
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
2000 2010 2001 2009 2000 2003 2003 2009 2000 2010 2001 2009 2000 2009
México Estados Unidos Panama Brasil Colombia Chile ArgenFna
Tasas d
e En
ferm
edades Profesio
nales
por 1
0.000 Trabajado
res
N° C
asos de En
ferm
edades
Profesionales NoF
ficadas
Casos de EP (Numeros) Tasa EP (x 10.000)
European Union
Fuente: Solar, O. Elaboración con base en estadísticas disponibles en-línea de los países mencionados. Consultora OPS, 2011 Melbourne, December 5, 2014
CRITICAL ISSUES OF STATISTICS & QUALITY OF DATA IN THE AMERICAS
INFORMATION NOT RELIABLE BECAUSE: à Varied & multiple sources cause:
à Overlaps, overestimations and/or underestimations à Poor quality, not robust
à Occupational injury rates with big ranges 0.8-34%: Variation & dispersion à Morbidity for OD almost inexistent (< 5%) à Average No. of days lost due to medical absenteeism estimated 8-25.5? Days à Very high under-diagnosis and under-registration of Occupational diseases
2006 & 2011: RPAà Balance & Results
Dr. J. Rodríguez Guzman, PAHO/SDE Melbourne, December 5, 2014
WHA65.8 Global Action Plan to
prevent NCDs 2013-2020
2008 2009
2010 2011
2012 2013
2014 2015
2016 2017
2020
WHA61.14 Global Strategy for Prevention of NCDs
2008-2013
Expert Forum Regional Plan to Prevent Occ-Ca World Day OHS
On line Occ.Cancer
Course PAHO/CCOSH
Advance assessment
towards CAREX
Asturias Declaration CALL FOR
ACTION
REGIONAL CAREX Workshop training
OCRC/IDRC/INC/PAHO
CAREX-Peru Workshop
PAHO-MoH
UN GA 66/2 UN Declaration on Prevention
& control of NCDs
GBD 2004
GBD 2010
Dr. J. Rodríguez Guzman, PAHO/SDE Melbourne, December 5, 2014
TOOL KITS FACT-SHHETS
E-TOOLS PAHO / CAREX
Network
PAHO Guideline for building CAREX in
LAC countries
Occupational Cancer milestones in the Americas
Occupational Cancer CAREX Strategy & Balance up to date
Dr. J. Rodríguez Guzman, PAHO/SDE Melbourne, December 5, 2014
à Country experiences: CAREX: COR – NIC- PAN 2006-2008, - GUA 2012 CAREX-Canada: 2009 à up to date CAREX-Colombia 2011 à up to date COL Public policy, Action Plan & surveillance system INC/UEB 2009 à up to date
Dr. Timo Partanen FIOH/IARC/IRET
Asturias, Spain 2011: Needs to act global/regional/country to: ü improve data & registries ü strengthen information systems ü record exposure to carcinogens (CAREX) ü Estimate burden of disease
Occupational cancer national profiles may vary according to:
Dr. J. Rodríguez Guzman, PAHO/SDE Melbourne, December 5, 2014
ü Principal industrial sectors, defining carcinogen exposures ü Compliance of OHS Standards ü Access to Workers’ Social and legal Protection ü Access to OHS and healthcare services
à Exposure rates are expected to be greater for workers where workplaces do not comply with OHS & Wellbeing regulations, social protection (Workers’ Compensation & Health systems), and no preventive/control measures are taken for airborne carcinogenic contaminants.
Occupational Cancer Balance in the Americas
Occupational Cancer Balance in the Americas
How is the construction of the Regional CAREX advancing?
Dr. J. Rodríguez Guzman, PAHO/SDE Melbourne, December 5, 2014
No CAREX
Exposure measures available
National labor
force stats available
Occupational hygiene & research capacity
Preliminary exposure estimates
Enhanced or refined
exposure estimates (Levels)
Burden of occupational
cancer
Knowledge translation Resources (Website)
Registries, information
systems, surveillance &
prevention plans
ARG BRA CHI CUB GRE MEX PER VEN ENG-CAR
FEW FEW
LABS & ESCARCE SERVICES University
ALL NATIONAL
STATS Institutes
CAN COL COR GUA NIC PAN
CAN COL COR
CAN CAN COL(p) CAN
REG
ION
AL
CA
REX
OF
TH
E A
MER
ICA
S 20
17
Source: Regional CAREX Workshop Proceedings. Draft report. 2014
TOOL KITS FACT-SHHETS
E-TOOLS PAHO / CAREX
Network WHA65.8 Global Action Plan to
prevent NCDs 2013-2020
2008 2009
2010 2011
2012 2013
2014 2015
2016 2017
2020
WHA61.14 Global Strategy for Prevention of NCDs
2008-2013
Expert Forum Regional Plan to Prevent Occ-Ca World Day OHS
On line Occ.Cancer
Course PAHO/CCOSH
Advance assessment
towards CAREX
Asturias Declaration CALL FOR
ACTION
REGIONAL CAREX Workshop training
OCRC/IDRC/INC/PAHO
CAREX-Peru Workshop
PAHO-MoH
CAREX-Workshops ARG / CHI / MEX Caribbean
PAHO / CAREX Network CAREX-update in Central
America PAHO / CAREX Network
UN GA 66/2 UN Declaration on Prevention
& control of NCDs
GBD 2004
GBD 2010
Dr. J. Rodríguez Guzman, PAHO/SDE Melbourne, December 5, 2014
CAREX-PAR-URU-BOL-ECU- SUR-VEN-USA
PAHO / CAREX Network
AMRO Regional CAREX-Report to WHA 2017
Regional Occupational Cancer Burden built Occupational Cancer
rates decreased Prevention enhanced
PAHO Guideline for building CAREX in
LAC countries
Occupational Cancer milestones in the Americas
www.worldcancercongress.org
Disclosure of Interest: None Declared Abstract code:
Thank you! rodriguezj@paho.org – jrodriguez@who.int - occdis@paho.org
Julietta Rodriguez-Guzman, MD SOH MScA Regional Advisor On Workers’ & Consumers’ Health – PAHO/SDE
PS.4.115-4
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