3
If its not counted it didnt happen! David H Wegman, 1 Christer Hogstedt 2 In this information age we are increasingly dependent on having adequate and timely data appropriate to inform decisions and action. In fact, there is good reason to worry about the old adage that if it is not counted it didnt happen. This concern has prompted focus on the need to mod- ernise occupational health surveillance. 14 Fundamental to effective occupational health surveillance and priorities for pre- vention are an effective characterisation of the hazards faced by the full population of workers and trends over time in prevalence of those hazards. The best recognised effort in this regard is the European Foundations European Working Conditions Survey (EWCS) recently com- pleting its fth iteration. 5 This has proved an invaluable resource for the European Union nationsneed to understand the dis- tribution of risks among the workforce in member countries. The ndings and trends provide the European Union as well as member nations an invaluable foundation for planning prevention efforts. Ongoing analyses and publications using this resource also provide opportunities for members to learn from one another about successful efforts to improve and maintain worker health and safety. To our knowledge a report presented in this issue is the rst time another multi- national setting has been the subject of such a survey. The report, by Benavides et al, 6 presents the structure and overall ndings from the First Central American Survey of Working Conditions and Health Effects. Creating such a resource is a remarkable achievement, especially given the absence of funding from government entities, in contrast to the EWCS (operat- ing for over 20 years with EU funding) and the several Swedish surveys described below (operating for 2040 years with Swedish government funding). These investigators have implemented a sam- pling structure along with survey ques- tions on ergonomic and hygiene items that were designed based on the EWCS. They have, however, expanded on the EWCS survey components to gather details on health, safety and psychosocial items, mental health and injury using other established survey instruments. A particularly important target of this new multinational survey is a focus on the informal as well as the formal workforce. In their ndings the investigators note that the informal workforce is growing and that an estimated 74% of the work- force is not covered by social security. Information on this major component of the workforce is invaluable for assessing work-related health risks and to track these over time. The long-running El Programa Salud, Trabajo y Ambiente (SALTRA) programme in Central America 7 played an important role in making possible this long-term col- laboration and training for data collection in the region. The rst survey has been funded with support from the Organizacion Iberoamericana de Seguridad Social and the Fogarty International Center. It is imperative that this pro- gramme now be stabilised with ongoing funding so that the long-term survival and progress of the survey and its products can be assured. We encourage the International Labour Organization, the Pan American Health Organization and the Central American Integration System (Sistema de la Integración Centroamericana) to work with the investigators to develop a sustain- able and productive programme that paral- lels the EUs commitment to the European Foundation for the EWCS. This survey presents the structure and overall ndings from the The First Central American Survey of Working Conditions and Health Effects. The team of investigators clearly has a plan to offer this survey as a resource, like the EWCS, that can be regularly used to track trends in topic areas already surveyed and also to permit additions as the work setting and work practices change over time. The European Foundation scientists have chosen the repeated cross-sectional survey as their standard in the ve quinquennial EWCS surveys to date. We encourage the Central American team to consider the added value of using a panel design to follow selected subpopulations where lon- gitudinal data on the same population will enhance understanding of trends in work in the future. Such a design has proven most fruitful in Swedish surveys that have been carried out for the past 2040 years. 810 The investigators are to be congratu- lated for the development and execution of this important survey. We expect that this report is just the rst in a series of publications that will provide greater detail on the characteristics and differ- ences in the occupational health of the workforce in these six countries. The nd- ings should prove invaluable in efforts to improve working and health conditions as the region seeks to expand integration efforts. The high quality of the survey design, based on well-validated survey instruments used in other regions, has the added value of providing a library of data that can be used for badly needed research on prevention and health promotion in the region. We expect the database to be accessed enthusiastically by masters and doctoral students of public and occupa- tional health from across the region. Contributors DHW prepared the rst draft of the commentary. CH provided signicant revisions and additions. The effort was equally shared. Provenance and peer review Commissioned; internally peer reviewed. To cite Wegman DH, Hogstedt C. Occup Environ Med Published Online First: [ please include Day Month Year] doi:10.1136/oemed-2014-102223 Received 27 March 2014 Accepted 20 April 2014 http://dx.doi.org/10.1136/oemed-2013-101908 Occup Environ Med 2014;0:12. doi:10.1136/oemed-2014-102223 REFERENCES 1 IOM (Institute of Medicine) and National Research Council. Evaluating occupational health and safety research programs: framework and next steps. Washington, DC: The National Academies Press, 2009. 2 Strengthening of Health Surveillance of Working Populations: The Use of International Statistical Classication of Diseases (ICD-10) in Occupational Health. Geneva 810 July 1998. WHO/OCH/98.1. 3 Markowitz SB. Occupational Disease Surveillance and Reporting Systems, Chap 32 Record Systems and Surveillance in ILO Encyclopedia of Occupational Safety and Health. http://ilocis.org/documents/ chpt32e.htm (accessed Mar 2014). 4 Stellman SD, Wegman DH. Occupational Hazard Surveillance, in Chap 32: Record Systems and Surveillance in ILO Encyclopedia of Occupational Safety and Health. http://ilocis.org/documents/ chpt32e.htm (accessed Mar 2014). 5 http://eurofound.europa.eu/working/surveys/ (accessed Mar 2014). 6 Benavides EG, Wesseling C, Delclos GL, et al. Working conditions and health in Central America: a survey of 12,024 workers in six countries Occup 1 Department of Work Environment, University of Massachusetts Lowell, 1 University Avenue, Lowell, Massachusetts, USA; 2 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden Correspondence to Dr David H Wegman, Department of Work Environment, University of Massachusetts Lowell, 1 University Avenue, Lowell, MA 01854, USA; [email protected] Wegman DH, et al. Occup Environ Med Month 2014 Vol 0 No 0 1 Commentary OEM Online First, published on May 9, 2014 as 10.1136/oemed-2014-102223 Copyright Article author (or their employer) 2014. 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Page 1: If it's not counted it didn't happen!

If it’s not counted it didn’t happen!David H Wegman,1 Christer Hogstedt2

In this information age we are increasinglydependent on having adequate and timelydata appropriate to inform decisions andaction. In fact, there is good reason toworry about the old adage that “if it is notcounted it didn’t happen”. This concernhas prompted focus on the need to mod-ernise occupational health surveillance.1–4

Fundamental to effective occupationalhealth surveillance and priorities for pre-vention are an effective characterisation ofthe hazards faced by the full population ofworkers and trends over time in prevalenceof those hazards. The best recognisedeffort in this regard is the EuropeanFoundation’s European WorkingConditions Survey (EWCS) recently com-pleting its fifth iteration.5 This has provedan invaluable resource for the EuropeanUnion nations’ need to understand the dis-tribution of risks among the workforce inmember countries. The findings and trendsprovide the European Union as well asmember nations an invaluable foundationfor planning prevention efforts. Ongoinganalyses and publications using thisresource also provide opportunities formembers to learn from one another aboutsuccessful efforts to improve and maintainworker health and safety.

To our knowledge a report presented inthis issue is the first time another multi-national setting has been the subject ofsuch a survey. The report, by Benavideset al,6 presents the structure and overallfindings from the First Central AmericanSurvey of Working Conditions and HealthEffects. Creating such a resource is aremarkable achievement, especially giventhe absence of funding from governmententities, in contrast to the EWCS (operat-ing for over 20 years with EU funding)and the several Swedish surveys describedbelow (operating for 20–40 years withSwedish government funding). Theseinvestigators have implemented a sam-pling structure along with survey ques-tions on ergonomic and hygiene itemsthat were designed based on the EWCS.

They have, however, expanded on theEWCS survey components to gatherdetails on health, safety and psychosocialitems, mental health and injury usingother established survey instruments. Aparticularly important target of this newmultinational survey is a focus on theinformal as well as the formal workforce.In their findings the investigators notethat the informal workforce is growingand that an estimated 74% of the work-force is not covered by social security.Information on this major component ofthe workforce is invaluable for assessingwork-related health risks and to trackthese over time.The long-running El Programa Salud,

Trabajo y Ambiente (SALTRA) programmein Central America7 played an importantrole in making possible this long-term col-laboration and training for data collectionin the region. The first survey has beenfunded with support from theOrganizacion Iberoamericana de SeguridadSocial and the Fogarty InternationalCenter. It is imperative that this pro-gramme now be stabilised with ongoingfunding so that the long-term survival andprogress of the survey and its products canbe assured. We encourage the InternationalLabour Organization, the Pan AmericanHealth Organization and the CentralAmerican Integration System (Sistema dela Integración Centroamericana) to workwith the investigators to develop a sustain-able and productive programme that paral-lels the EU’s commitment to the EuropeanFoundation for the EWCS.This survey presents the structure and

overall findings from the ‘The FirstCentral American Survey of WorkingConditions and Health Effects’. The teamof investigators clearly has a plan to offerthis survey as a resource, like the EWCS,that can be regularly used to track trendsin topic areas already surveyed and also topermit additions as the work setting andwork practices change over time. TheEuropean Foundation scientists havechosen the repeated cross-sectional surveyas their standard in the five quinquennialEWCS surveys to date. We encourage theCentral American team to consider theadded value of using a panel design tofollow selected subpopulations where lon-gitudinal data on the same population willenhance understanding of trends in workin the future. Such a design has proven

most fruitful in Swedish surveys that havebeen carried out for the past 20–40 years.8–10

The investigators are to be congratu-lated for the development and executionof this important survey. We expect thatthis report is just the first in a series ofpublications that will provide greaterdetail on the characteristics and differ-ences in the occupational health of theworkforce in these six countries. The find-ings should prove invaluable in efforts toimprove working and health conditions asthe region seeks to expand integrationefforts. The high quality of the surveydesign, based on well-validated surveyinstruments used in other regions, has theadded value of providing a library of datathat can be used for badly needed researchon prevention and health promotion inthe region. We expect the database to beaccessed enthusiastically by masters anddoctoral students of public and occupa-tional health from across the region.

Contributors DHW prepared the first draft of thecommentary. CH provided significant revisions andadditions. The effort was equally shared.

Provenance and peer review Commissioned;internally peer reviewed.

To cite Wegman DH, Hogstedt C. Occup Environ MedPublished Online First: [please include Day Month Year]doi:10.1136/oemed-2014-102223

Received 27 March 2014Accepted 20 April 2014

▸ http://dx.doi.org/10.1136/oemed-2013-101908

Occup Environ Med 2014;0:1–2.doi:10.1136/oemed-2014-102223

REFERENCES1 IOM (Institute of Medicine) and National Research

Council. Evaluating occupational health and safetyresearch programs: framework and next steps.Washington, DC: The National Academies Press,2009.

2 Strengthening of Health Surveillance of WorkingPopulations: The Use of International StatisticalClassification of Diseases (ICD-10) in OccupationalHealth. Geneva 8–10 July 1998. WHO/OCH/98.1.

3 Markowitz SB. Occupational Disease Surveillance andReporting Systems, Chap 32 Record Systems andSurveillance in ILO Encyclopedia of OccupationalSafety and Health. http://ilocis.org/documents/chpt32e.htm (accessed Mar 2014).

4 Stellman SD, Wegman DH. Occupational HazardSurveillance, in Chap 32: Record Systems andSurveillance in ILO Encyclopedia of OccupationalSafety and Health. http://ilocis.org/documents/chpt32e.htm (accessed Mar 2014).

5 http://eurofound.europa.eu/working/surveys/ (accessedMar 2014).

6 Benavides EG, Wesseling C, Delclos GL, et al.Working conditions and health in Central America:a survey of 12,024 workers in six countries Occup

1Department of Work Environment, University ofMassachusetts Lowell, 1 University Avenue, Lowell,Massachusetts, USA; 2Institute of EnvironmentalMedicine, Karolinska Institutet, Stockholm, Sweden

Correspondence to Dr David H Wegman,Department of Work Environment, University ofMassachusetts Lowell, 1 University Avenue, Lowell,MA 01854, USA; [email protected]

Wegman DH, et al. Occup Environ Med Month 2014 Vol 0 No 0 1

Commentary OEM Online First, published on May 9, 2014 as 10.1136/oemed-2014-102223

Copyright Article author (or their employer) 2014. Produced by BMJ Publishing Group Ltd under licence.

group.bmj.com on June 7, 2014 - Published by oem.bmj.comDownloaded from

Page 2: If it's not counted it didn't happen!

Environ Med. Published Online first: 20 Mar 2014.doi: 10.1136/oemed-2013-101908.

7 Wesseling C, Aragón A, Elgstrand K, et al. SALTRA:a regional program for workers’ health andsustainable development in Central America. Int JOccup Environ Health 2011;17:223–9.

8 Vogel J. Strategies and traditions in Swedish socialreporting: a 30-year experience. Social IndicatorsResearch, 2002;58:89–112.

9 The Swedish Level-of-Living Survey (LNU) http://www.sofi.su.se/english/2.17851/research/three-research-departments/lnu-level-of-living (accessed March 2014).

10 Swedish Work Environment Authority. WorkEnvironment Survey 2011. Stockholm 2012. http://www.av.se/dokument/statistik/officiell_stat/arbmil2011.PDF (accessed March 2014).

2 Wegman DH, et al. Occup Environ Med Month 2014 Vol 0 No 0

Commentary

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doi: 10.1136/oemed-2014-102223 published online May 9, 2014Occup Environ Med

 David H Wegman and Christer Hogstedt If it's not counted it didn't happen!

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