Continuous Improvement of

Work-related Burden Estimations

EU-OSHA Bilbao, 10-11 Oct 2019

Dr Jukka Takala (Adjunct Prof), DSc MSc BSc, FFOM (Hon) Executive Director emeritusPresident

International Commission on Occupational Health

Commission Internationale de la Santé au Travail

Comisión Internacional de Salud en el Trabajo

2.5%52.1%EU cancer deaths: 106,000 of whichasbestos 85,900 (ILO 2017 and GBD2016)

USA cancer deaths: 70,600 of whichasbestos: 38,700( GBD2016)

5.7%

28.0%

6.0%

0.8% 1.0%2.4%

CommunicableDiseasesMalignantneoplasmsNeuropsychiatricconditionsCirculatorydiseasesRespiratorydiseasesDigestive diseases

GenitourinarydiseasesAccidents &violence

Circulatory

Diseases

Cancers

In EU28, cardiovascular and circulatory diseases account for 28% and cancers at 52%.

They were the top illnesses responsible for 4/5 of deaths from work-related diseases.

Occupational injuries and infectious diseases together amount accounts for less than 5%.

Work-related Deaths caused by Illness and Injury, EU and High Income countries

See “Global estimates” ILO 2017 and GBD2016: https://goo.gl/hTZaW5

Finland cancer deaths: 1163 of which asbestos 760 ILO 2017 and GBD2016

https://vizhub.healthdata.org/gbd-compare/

Global figures2017• Estimated 2.78 million

deaths

• Fatal occupational accidents

380,500

• Non-fatal occupational accidents 374 million (at least 4 days absence)

• Fatal work-related diseases

2.4 million

• Occupational cancer

742,000

2014

• Estimated 2.32 milliondeaths

• Fatal occupational accidents

341,373

• Non-fatal occupational accidents 302 million (at least 4 days absence)

• Fatal work-related diseases

1.98 million

• Occupational cancer 666,000

Sources: ILO, WHO, Scientific reports

Country, region and disease/injury specificdata vs. EU data

Additional Slides

Additional Slides

Death rate (per 100,000)

Non-smoker Smoker

No asbestos 11 123

Asbestos 58 602

Age-standardized lung cancer death rates

Hammond EC, Selikoff IJ, Seidman H. Asbestos exposure, cigarette smoking and death rates.

Ann N Y Acad Sci 1979;330:473-90.

Example of poor emphasis on work exposuresCombined effect of exposures to asbestos and smoking on lung cancer

Applicable to selected other carcinogens

Attributable Fraction, AF is based on

risk ratio, RR

AF = (RR-1)/ RR

or with exposure level P:

AF = P(RR-1)/[P(RR-1)+1]

Adjusting

for smoking

AF Principle

Examples of attributable fractionsbased on job exposure matrix JEM

Additional Slides 313.000

GBD/IHME 2016

In 2017 WHO, ILO and ICOH reached out to experts for systematic

reviews of evidence to support estimation of burden for each pair

Pair Risk factor Health outcome 1 Occupational ergonomic factors Musculoskeletal disorders

(except low back pain) 2 Occupational exposure to dusts and fibres Pneumoconiosis 3 Occupational exposure to ultraviolet radiation Cataracts

Melanoma and non-melanoma skin cancer

4 5 Occupational noise Deaths from cardiovascular

disease 6 Occupational violence Inter-personal violence

(intentional injuries) 7 Psychosocial risk factors (i.e., one of: job strain, job

control, effort-reward imbalance, job insecurity, long working hours or shift work)

Ischemic Heart Disease Stroke

8 Depression 9 Alcohol use (intermediary

Outcome)

10

Slide source: Marilyn Fingerhut, ICOH

Occupational injuries (accidents) should betreated differently from work-related

illnesses

First experiences of the on-site intervention (4)

– Analysis of Eurostat 2014 &-2015 data: fatal accidents

13

Howabout farmers and other self-employed, informal sector?

First experiences of the on-site intervention (3)

– Analysis of ILOSTAT 2011-15 data: non-fatal/fatal ratios

14

0

500

1000

1500

2000

2500

3000

3500

ratio_nonfatal_fatal

GBD2016 Western Europe, DALYs

GBD2016 Western Europe, Deaths

Occup.carcinogens, Germany,

22,948 (18,353 – 27,517)

Risk/outcome specific data vs. EU data and Trends

Source: John Cherrie, IOM, ICOH/Takala

CAREX Canada

Not covered by GBD/IHME

Costs in monetary terms have been calculated by multiplying the number of DALY’s for each country and region (and category) by GDP/employed in the same country/ region.

Costs in percentage of GDP have been obtained through dividing DALY (years) value for country/region by the maximum hypothetical number of gainfully productive years if no-one died, or had temporary or permanent disability. This was obtained through the number of years worked by those employed - or full employment number.

Rather than being really a loss of productivity we are estimating the magnitude of missed opportunity for higher output.

How to turn numbers into costs

Method

Deaths: directly from ILO Global Estimates in 2017;

YLL’s: obtained from the ILO death estimates by country and region multiplied by the average years of lives lost by one death from GBD2015 for that country or region, this was done separately for fatal injuries (much more years lost/death ) and illnesses (less years lost/death) by each country and region;

YLD’s: ILO estimates based on WHO mortality data do not have any data of non-fatal cases, ILO non-fatal injury reporting tends to be much less reliable than fatal number and rate reporting. We decided to use the only reasonable YLD source as a baseline: GBD2015. This takes already into account the severity of both injuries and illnesses and these are adjusted so that comparable YLD’s can be used with YLL’s. To compensate for the lower selected risks covered by GBD2015 an adjustment process was created to match the ILO estimates covering wider occupational risks:

YLDGBD2015 was multiplied by the factor obtained by the ratio of YLLILO/ YLLGBD2015 as follows: YLDGBD2015 *(YLLILO2017/ YLLGBD2015).

Both ILO fatal injury numbers and ILO fatal disease numbers were covering wider selection of occupational risks. Once there are more fatal cases we expect more non-fatal cases as well both for injuries and illnesses. This process was done for injuries and diseases separately:

YLDGBD2017injuries *(YLLILO2017injuries/ YLLGBD2015injuries) andYLDGBD2017diseases *(YLLILO2017diseases/ YLLGBD2015diseases)

DALY’s: = YLL + YLD for different categories

Costs in monetary terms have been calculated by multiplying the number of DALY’s for each country and region (and category) by GDP/employed in the same country/ region. Costs in percentage of GDP have been obtained through dividing DALY (years) value for country/region by the maximum hypothetical number of gainfully productive years that could have been produced if no-one died, or had temporary or permanent disability. This was obtained through the number of years worked by those employed, or full employment number.

Method: Table for EU and Global Economic Cost Calculations (ILO) for explaining the procedure of outcomes, China numbers not updated

Number of cases, DALYs, costs EU 28 Finland Germany China ( old data)

1 All fatal occupational accidents 1) 3,757 18 500 99,197

2 All fatal work-related diseases 2) 200,209 2,179 35,505 408,475

3 Non-fatal occupational accidents 3,582,677 42,162 704,819 87,750,997

4 YLL per case, injuries, years 3) 45.49 45.71 44.86 47.18

5 YLL per case, diseases, years 15.33 15.71 15.56 21.62

6 Years of Lost Life, YLL from fatal cases, injuries 4) 171,324 823 22,429 4,680,322

7 Years of Lost Life, YLL from fatal cases, diseases 5) 3,256,319 34,243 552,363 8,830,134

8 Years Lived with Disability , YLD

caused by non-fatal accidents and diseases 6)

3,685,255 46,243 754,544 21,373,867

9 DALY caused by those above, YLLs and YLDs 7) 7,112,898 81,390 1,329,337 34,884,323

10 All costs in terms of monetary values, in USD 8) 527,7*109 7,6*109 111,9*109 498,086*109

11 Cost of YLL, (fatal cases) USD, illnesses &injuries 9) 1.57 % 239.1*109 1.43% 3.3*109 1.44% 48.4*109 1.78% 192.9*109

12 Cost of YLD (non-fatal) USD, illnesses and injuries 9) 1.69 % 288.6*109 1.89% 4.4*109 1.89% 63.5*109 2.80% 305.2*109

13 · Cost of Occupational Cancer in USD 0.81 % 132.2*109 0.75% 1.73*109 0.71% 3.9*109 1.11% 124.3*109

14 · Cost of MSD in USD, from GBD occ.ergon.actors 0.48 % 77.5*109 0.42% 1.0*109 0.51% 17.1*109 0.80% 87.3*109

15 · Cost of work-related circulatory diseases in USD 0.40 % 64.9*109 0.39% 0.89*109 0.35% 11.8*109

16 · Cost of work-related injuries in USD 0.37 % 60.7*109 0.29% 0.68*109 0.27% 9.2*109

17 · DALYloss%=TOTAL of GDP of country/region 3.26% 3.33% 3.33 4.56% ,3.96% new

18 Distribution of DALY by illness/injury group (% of all)Occupational cancerMSDCirculatory diseasesInjuriesOther diseases

25.0%14.74%12.3%11.5%36.5%

22.1%12.2%11.4%8.7%

45.7%

21.3%15.3%10.7%8.2%

44.6%

19 Distribution of mortality by illness group (%)Occupational cancerMSDCirculatory diseasesInjuriesOther diseases

52.1%0.0%

24.2%1.8%

21.8%

53.4%0.0%

24.5%1.3%

20.8%

50.5%0.0%

23.2%1.4%

24.9%

Are these over- or under-estimates ?

Over-estimates:- DALY’s cover losses caused by work also for those that

are over retirement age, e.g. 68 years

Under-estimates, not properly covered:- Those permanently disabled with disability pension- Unemployed for poor working capacity by past work- Those outside the workforce, limited/no workability- Those compelled to retire prematurely, e.g. 61y/68years - Work disability or workability radically stricter than life

disability (YLD/DALY) calculations are very different fromthose of workers’ compensation system

Cost Comparison with selected countries

As a proportion of GDP, cost of work-related injuries and ill-health

Korea, 3.58%

Australia, 3.00%

Singapore, 3.46%

Global, 3.94%

New Zealand, 3.19%United States, 3.25%

United Kingdom, 2.90%

Finland, 3.34%

Germany, 3.33%

Netherlands, 3.12%

Japan, 2.65%

9

WHO Western Pacific 3.98%

WHO South East Asia 4.40%

EU 28 3.26%

Source: ILO/EU Cost

Estimates of Occupational

Accidents and Work-

related Diseases, 2015

ASEAN 4.12%

Sources: ILO, WHO, Scientific reports

https://goo.gl/

Global figuresSources: ILO, WHO, Scientific reports

Comparative analysis

based on past 2014 country data

Latest 2017 data, EU-OSHA

https://osha.europa.eu/en/about-eu-osha/press-room/eu-osha-presents-new-figures-costs-poor-workplace-safety-and-health-world

http://www.omfi.hu/cejoem/accident.htmhttps://goo.gl/ZFH9un

Latest 2017 data, EU-OSHA,

WSH-Institute, ICOH

https://osha.europa.eu/en/about-eu-osha/press-room/eu-osha-presents-new-figures-costs-poor-workplace-safety-and-health-world

EU-28 proportion (%) of the main causes for work-related mortality and morbidity in DALYs per 100,000 employees

EU28 losses 528 * 109 USD, 3.26% of the EU GDP

Occupational cancer 132 * 109 USD, 0.815% of the EU GDP

- RIVM Institute, Netherlands: (range 242-440 * 109 EUR) 334 * 109 EUR

- EU Commission: Value of Statistical Life, VSL=4 million EUR 425 * 109 EUR

United States losses 583 * 109 USD, 3.25% of USA GDP

China 430 * 109 USD, 3.96% of China GDP

----------------------------------------------Global, estimated countr. 2,547 * 109 USD, 3.94% of global GDP

Global, latest GDP, all cntr. 2,966 * 109 USD, 3.94% of global GDP

……US+EU+CN = combined total GDP of poorest 130 countries

Economic Costs of Work-related injuries and ill-health Study Coalition Estimates NEW

Country data vs. EU data

U.K/HSE estimate for U.K.: 12.3 * 109 GBP = 15.1 * 109 USD in 2010

ILO, FI, SG, EU-OSHA, ICOH estimate for U.K.: 18.3 * 109 USD in 2015

Country and disease specific data vs. EU data

Source: ILO/EU Cost

Estimates of Occupational

Accidents and Work-

related Diseases, 2015

Better estimates when data sources are reliable, example: Sweden

Poor work environment costs this much,percent of GDP

Can

cer

cau

ses

he

avy

loss

es

SwedenSource :

Arbetsmiljö Nov 2017

PL ES SE GR FI DE CH DK FR BE

Risk/outcome specific data vs. EU data and Trends

All Cancer Costs excluding intangibles by:

ILO, FI, SG, EU-OSHA, ICOH: 132.2 * 109 USD = 120.5 * 109 EUR

IHME-GBD2017 140.4 * 109 USD = 127.9 * 109 EUR

2098

And new ILO data released in 2017

106,307

Source new,

ILO:

goo.gl/hTZaW5

Source:

goo.gl/fuUXsl

Switzerland 1905

GBD/IHME

in 2017

Source new,

GBD/IHME:

goo.gl/isCng3

99,083

Norway 759

17

1481

849

1896

183

2326

1285

303

1163

12,623

18,180

1678

1860

13

968

18

11,057

23

510

710

110

80

23

3879

7874

2457

4498

10

1211

446

10,248

2201

14,082 19,232

Deaths at Work/All Estimated Global Mesothelioma Deaths (Annual N*), based on WHO data.

* Reported N in 59 countries, estimated M in 172 countries, Odgerel,Takahashi et al.

Asbestos related lung cancer and other asbestos related deaths (Takala et al,

Extrapolation method Reported Global Non-reported, adjusted Global

China/EU28

(1) Best estimate, asbestos consumption adjusted 15,011* 23,377

(2) Estimates based on asbestos use,

All GBD 2015 and best estimates

Work AFmeso.work = 94.9% Rushton et al., (2012)

32,373 (IHME) - 38,400 (new)

22,822 (IHME) - 36,400 (new)

China: 4,512 (GBD/IHME 2015 all)

EU28: 11,404 (GBD/IHME 2015 all)

(3) Reported/Estimated by continent, employment

and asbestos adjusted, other EU estimates, all

15,011 21,247- 23,377 EU: 8,363 Odgerel, Takahashi et al 2016 all

EU: 10,368 Takala 2015 all

Methods of estimated lung cancer deaths using

mesothelioma as a proxy for asbestos use

Lung cancer/

mesothelioma

rate

Asbestos related lung, other cancer (and other asbestosis) deaths

World China

McCormack, Peto et al. (2013) average estimate

using chrysotile, lung cancer, all , GBD 2015 Study

6.1 197,475

McCormack, Peto et al. (2013), low - high estimates,

lung cancer, all, GBD

2.0-10 64,746 – 323,730

GBD2016 based rate between (global asbestos-

related lung cancer, ovary and larynx cancers,

asbestosis),and mesothelioma death numbers at

work, GBD2016,

6.92 222,322work – 242,802work

based on GBD/IHME 2016work

Area Meso/ARLC/Ova/Lary/AsbestosisChina 2,178/17,971/270/198/323Earth 27,612/181,450/6022/3743/3495

Global asbestos deaths, work: 222,321 - 242,802 Mid-point 232,562

All asbestos exposed deaths, global: 243,223 - 265,645 Mid-point 254,434

www.mdpi.com/1660-4601/15/5/1000

Costs of asbestos-related disorders@work in EU28

Disability adjusted Life Years, DALY’s, for cancer and asbestosis caused by asbestos from http://vizhub.healthdata.org/gbd-compare/

1,443,544 years based on 87,955 deaths in EU28 in GBD estimate of 2017, includes mesothelioma, lung cancer, larynx and ovary cancers, and chronic respiratory diseases (asbestosis)TOTAL DALY : 1,443,554 years Employment: 227,000,000 employed persons, or person-years if no loss

Lost DALY’s of the total potential maximum years without any DALYs:1.443 540/227.0 = 0.636%

The GDP of EU28 was 18,750,052 million ( * 106 USD*)of which 0.636 % makes

119.235 * 109 USD, or 107.77 * 109 EUR or 97.5 * 109 GBP

Sources: GBD 2017 https://vizhub.healthdata.org/gbd-compare/ The Lancet 2018; 390: Global asbestos disaster Int. J. Environ. Res. Public Health 2018, 15(5),1000; https://doi.org/10.3390/ijerph15051000and Supplementary tables ZIP document from the website http://www.mdpi.com/1660-4601/15/5/1000

Trends in all asbestos deaths in U.K. 1990 -2017 Trends in all asbestos deaths in Sweden 1990 -2017

Trends in asbestos deaths of 50-69 years old in U.K.1990 -2017

Trends in asbestos deaths of 50-69 years old in Sweden1990 -2017

Source: https://vizhub.healthdata.org/gbd-compare/

Diseases,injuries and costs as such cannotbe eradicated, but we can eliminate

exposures leading to them. In particular, at places of work.

We need exposure information for all risks. Data by country, number of exposed, levelof exposure, CAREX, JEM matrix, digitally

assisted surveys of exposures…