Upload
suki
View
72
Download
0
Tags:
Embed Size (px)
DESCRIPTION
Initiative Partners in Occupational & Environmental Health Vision for Training of OEH Hygienists, Nurses, Doctors in Asia-Pacific Hong Kong 28-29 October 2013. Thomas H Gassert, MD, MSc Harvard University School of Public Health University of Massachusetts Medical School. Overview. - PowerPoint PPT Presentation
Citation preview
InitiativePartners in Occupational & Environmental Health
Vision for Training of
OEH Hygienists, Nurses, Doctors in Asia-Pacific
Hong Kong28-29 October 2013
Thomas H Gassert, MD, MScHarvard University School of Public Health
University of Massachusetts Medical School
Vision of Partners in OEH Asia-Pacific 2
Overview• Why we are here• Legal Basis – O&E Health is a global
– Human Right guaranteed by law– State and Employer Obligation
• Burden of Occupational Disease (injuries & illnesses by country)
• Capacity: now and future (country needs assessments)
• Resources to identify:– Medical training capabilities (local, regional, international) – National regulatory and accreditation standards– Local and international labour and NGO guidance– Financial
• Challenge: tasks, goals and timelines• Organization: name, mission, base, website, collaboration
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 3
Why this meeting?• Other meetings, but what has been the practical outcome?• Other organizations (ICOH, AAOH, SPH, etc.)• Nothing unified or labour driven (but we are!)• Very little capacity building (little clinical substance)• Little regulatory movement; few dedicated resources• Our emphasis is preventive medicine and health protection
– Primary, Secondary, Tertiary Prevention• OEH is needed for climate change, and clean water, air, soil• OEH means economic gain for all• We have strengths and a vision, a good base, and need a system that
works to achieve OEH for all
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 4
Preventive Medicine & Health
Occupational & Environmental Health (OEH) is part of a specialty called Preventive Medicine
Three levels of prevention in OEH:1. Primary: prevent or control hazards at source
• Hierarchy of controls (Occupational / Industrial Hygienist)• Wellness – health promotion with health protection (nurse, doctor)
2. Secondary: detect early disease risk by medical surveillance, health monitoring (doctors, nurses)
3. Tertiary: prompt medical care to prevent complications of death, disability, job loss (doctors, nurses)
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 5
Define “Asia” – per U.N. nation listings• There are a total of 193 U.N. member nations (2013)• Asia list: Afghanistan (west) to Pacific islands (east)
– Including Oceania (Australia, New Zealand, Pacific isles)• Does not at this time list:
– Western Asian nations of the Middle East– Other “…stans” of Central Asia:
• Kazakhstan• Kyrgyzstan• Tajikistan• Uzbekistan
– Siberia (Russian Federation)– Guam (a U.S. territory)
• Taiwan (ROC) membership was replaced by China (PRC)• North (PDRK) and South (ROK) Korea are both members28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 6
Legal Basis: Human Rights
• Entitlements because of being human, extends naturally to workers• Form: political, social and material claims• Guarantee protection of basic freedoms and dignity• Origin: to protect against abuse by those with power• Political rights extend to socio-economic realm• Implies a party with duty to impart/honor those rights:
– Governments– Employers, including Trans-National Corporations– Inter-Government Agencies– Banks and Aid Agencies
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 7
Governments and Human Rights
• Nation States are obligated (must…)• Protect (disability, pregnancy, gender, ethnicity,
minorities, children)• Take active steps (budget, services, infrastructure)• Educate about Human Rights• Improve rights (progressive realization)• No constraint by int’l lenders (e.g., IMF, ADB)
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 8
Health & Human Rights
• Global (all workers, citizens, environment)– Double standards or constraints are forbidden
• Rights as Enforceable Laws• Tied to Standards of Ethics• Dimensions of Gov’t and Corporate obligations:– Respect– Protect– Fulfill– Promote
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 9
Brief History – Health and H.R.• ILO estab. 1919, first addressed global right to healthy work conditions• Franklin Roosevelt’s Four Freedoms speech 1941 proclaimed freedom from want,
taken up by• UN Conference on International Organization, San Francisco, 1945• Article 55 of UN Charter 1945 and WHO 1946
– “universal respect for and observance of human rights”• Articles 57 and 62 of UN Charter
– “health” is the responsibility of the UN Economic and Social Council (ECOSOC)• Universal Declaration of Human Rights (UDHR) 1948
– Affirmed in Article 25(1) that “everyone has the right to a standard of living adequate for the health of himself and his family, including food, clothing, housing and medical care, and necessary social services.”
• UN Commission on Human Rights 2002– Appointed a Special Rapporteur on the right of everyone to the highest attainable
standard of physical and mental health
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 10
Basis of Legal Right to Health• United Nations Declaration of Human Rights (all members obliged)• WHO uses a voluntary policy approach (e.g., Covenants)
– If adopted or ratified, have legally binding authority• ILO uses a treaty approach (Conventions, Protocols, Recommendations)
– Legally binding– Tripartite basis (Employee, Employer, Government)– Applies to ALL workers irrespective of age, gender, nationality, migration status
• ILO Conventions for worker health rights (key ones):– No. 155 – Occupational Safety & Health (1981)– No. 161 – Occupational Health Services (1985)– No. 169 – Indigenous & Tribal Peoples (1989)
• Equal but culturally sensitive health care and protection
• ILO Convention re Child Labour– No. 182 – Child Labour
• Article 3(d) – deems children’s health as an essential criterion for the definition of the term “worst forms of child labour.”
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 11
U.N. International CovenantsCivil & Political Rights
(ICCPR)
• To organize independently
• To bargain collectively• To information
– Hazard Communication– Community Right-To-Know– Investigation and Surveillance
Economic, Social & Cultural Rights(ICESCR)
• To safe living and working environment
• To health protection and services
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 12
UN ICESCR 1966 (in force 1976)• Article 12
– 1. “The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.”
– 2. “The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for:• (a) The provision for the reduction of the stillbirth-rate and of infant
mortality and for the healthy development of the child; • (b) The improvement of all aspects of environmental and industrial hygiene; • (c) The prevention, treatment and control of epidemic, endemic
occupational and other diseases; • (d) The creation of conditions which would assure to all medical service and
medical attention in the event of sickness.”
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 13
Dimensions of Right to Health
• CESCR (Committee on ESC Rights) in 2000– General Comment 14 details dimensions– Freedoms dimension: • To make decisions about one’s own health data• To make decisions about sexual and reproductive care• From being subject to non-consensual treatment
– Entitlements dimension:• To a system of health care protection, including
emergency care• To underlying determinants of health
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 14
Health Determinants
• Referenced in CESCR General Comment 14 (2000)
• Underlying determinants of health:– Adequate sanitation– Safe and potable water– Adequate food and shelter– Safe and healthy work conditions– Healthy environment
• If not met, right to health cannot be protected
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 15
CESCR Definition
• CESCR General Comment 14 on definition of “right to health” in ICESCR:– Restricts “right to health” to a right to enjoy a variety of
facilities, goods, services and conditions needed to realize the right to health
– Contains both freedoms and entitlements– Contains four elements (AAAQ):
• Availability• Accessibility• Acceptability• Quality
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 16
CESCR Definition (cont.)
• CESCR General Comment 14 (continued) on the “right to health” states it requires of health facilities and practitioners that they must:– Respect medical ethics– Be culturally appropriate– Be gender sensitive– Offer health education of high quality
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 17
State Obligations
• ICECSR Article 2(1)– Progressive realization
• States must show how they progressed in realization of rights protections between two reporting phases (4 yrs)
• A clear and immediate legal obligation• If no progress, or worse, State must explain
– Resource availability• Not a carte blanche for States to do what they please• Must take reasonable and targeted steps toward goals• Poorer States, if unable, must request help• Richer States must provide help
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 18
ICESCR-12: Respect, Protect, Fulfill• ICESCR Article 12 obligations, three levels:– Respect (not interfere with) right to health– Protect (e.g., by legislation, access) right to health
• Make sure medicines, facilities are regulated for access• Ensure practitioners meet appropriate standards of education, skills, and
ethical codes of conduct– Fulfill right to health
• Give sufficient recognition in political and legal systems• Adopt national health policy with detailed plans• Provide adequate health care facilities, vaccines• Formulate, implement and review periodically a coherent national policy
to minimize risk of occupational accidents and diseases [CESCR 2000 General Comment 14, para 36]
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 19
State Obligations for O&E HealthProvision Respect Protect Fulfill PromotePromote Safe Healthy O/E Conditions
Labor and Community Rights
OESH Regs; Refusal Right; Inspect
O/E Health Services; BioMonitor; Child services
Educate, hearings, RTK, Risk Com
Improve O/E Protections
Multivalent Inspectorate
OESH Regs update and enforce
IH training, engineering, env impact
Community RTK, Hazcom
Treat and Control O/E Disease
Compensation Prevent employers from blocking
Health maintenance
Education & care for workers & communities
Apply Scientific Progress
Evidence-based; Limit vested interests
Oppose trade agreements that limit access to safer technologies
Prevention research
Share research findings, provide support to implement
Adapted from London L, IJOEH 2011;17:80-92
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 20
ICESCR
• Art 7: just, safe, healthy work conditions• Art 12: improve all aspects of environment
and industrial hygiene• Art 12: prevent, treat, control occup disease• Art 15: benefit from scientific progress• Many other global and regional rights
conventions re OE health
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 21
ICESCR
• Right to health care:– “…not only…timely and appropriate but also…
the underlying determinants of health”– Food, nutrition, sanitation, water, shelter and…– “healthy occupational conditions, and access to
health related education and information”– “…benefits of scientific progress…”– Ensure the “diffusion of science”
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 22
ICESCR Parties & Signatories
Dark green: signed and ratified Light green: signed but not ratified Grey: neither signed nor ratified** in Asia: Brunei, Malaysia, Myanmar, Taiwan, some Pacific isles
161 parties, 70 signatories (there are a total of 193 U.N. member nations)
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 23
U.N. Declaration of Human Rights
• All 193 member states are subject to the terms of the UNDHR
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 24
Ratification of ILO OSH ConventionsConvention Number, Name, Year of Adoption No. of Countries* (update)
45 Underground work (women) 1935 97
115 Radiation protection 1960 47
119 Guarding of machinery 1963 50
139 Occupational cancer 1974 35
148 Working env. (air pollution, noise and vibration) 1977 41155 Occupational safety and health 1981
42 (60, 8 in A-P)161 Occupational health services 1985
22 (31, none in A-P)167 Safety and health in construction 1988
17 (24, 2 in A-P)170 Chemicals 1990
11174 Prevention of major industrial accidents 1993 9176 Safety and health in mines 1995
20 (28, 1 in A-P)184 Safety and health in agriculture 2001 4
(15, 2 in A-P)P155 Protocol and 194-Rec to C155 2002
n.r. (9, none in A-P)187 Promotional Framework for OSH Convention 2006 n.r. (25, 4 in
A-P)*—number of countries (out of 193 members) that ratified the convention as of 2006Source: http://www.ciop.pl/18286 Table A (JOSE, 2006, Vol. 12, No. 3, 255–266)
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 25
ILO C155 OSH (1981)
• To establish a national OSH policy and program• Asia-Pacific signatories (8 of 60 total):
1. Australia2. China (PRC), incl. Hong Kong (2007) and Macau (1999)3. Fiji4. Kazakhstan5. Mongolia6. New Zealand7. Tajikistan8. Viet Nam
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 26
ILO P155 Protocol (2002) to C155
• Establish periodic OSH program reviews, record and report occupational diseases, etc.
• Asia-Pacific Signatories (1 of 9 globally):1. Australia
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 27
ILO C161 Occ Health Services (1985)
• Establish OSH program services for/at enterprise levels
• Asia-Pacific Signatories (None of 31 globally)– None
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 28
Agriculture, Construction, Mines
• ILO C184 Agriculture 2001 (2 of 15 globally):– Fiji– Kyrgyzstan
• ILO C167 Construction 1988 (2 of 24 globally):– China (PRC)– Kazakhstan
• ILO C176 Mining 1995 (1 of 28 globally):– Philippines
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 29
Cancer and Chemicals
• ILO C139 Occ. Cancer 1974 (3 of 39 globally)– Afghanistan– Japan– Korea (ROK)
• ILO C___ Chemicals 1990 (2 of 17 globally)– China– Korea (ROC)
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 30
Global Burden of Occupational and Environmental Death and Disease
• 300,000 work injury deaths per year• 2 million work illness deaths per year• Environmental disaster M+M unknown• 10-20% workers have access to OH services• 10% developing nations have OSH laws• Globalization and Free Trade Agreements have
protected some, but marginalized many
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 31
Migrant Labour
• “Regular vs. Irregular”• Both formal and informal sectors• Most jobs are low-skilled, labour-intensive• “3-D Jobs” – dirty, degrading, dangerous • Often: mining, textiles, agriculture, construction,
heavy manufacturing, sweat shops, sex work• In Europe: migrants have 2-times rate of
occupational injuries (Bollini, 1995)
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 32
Migrant Labour Health Rights• Rights endorsed in U.N. 1985 “Health Rights of Individuals Who Are Not
Nationals of the Country in Which They Live” - Article 8(1)(c) right to health protection and medical care
• Right to access health care and preventive public health services • Cannot be returned home without treatment of an active medical condition• ILO Conventions apply to migrant workers, including work hour limits,
maternity, paid holidays• “Non-discriminatory principle” – regardless of state status (including
undocumented workers), employment establishes between migrant and employer a series of economic and social rights (including health protection and medical care for work injuries)
• Rights include: prohibition of forced labour, freedom of association and right to organize and join union, right to adequate working conditions including OSH
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 33
Obstacles to OEH Rights and Protections
• Deregulation • Promotion of labour flexibility (anti-union, migrant)• Shift to informal sector employment• Outsourced production (SEZs, FTZs, EPZs)• Export of hazardous technologies and materials• Double standards, both national and TNCs• Government collusion and competition• Trade agreements that obstruct or inhibit rights
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 34
ILO C187 Promotional Framework for OSH (2006)
• Requires gov’ts to develop national policy, laws, programs with enterprise and labour representation (tripartite) per Article 4 of C155
• Asia-Pacific Signatories (4 of 25 globally)1. Japan2. Korea (ROK)3. Malaysia4. Singapore
Also, Russia, if one considers Siberia is part of Asia
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 35
Asia-Global OEH Activity• ILO technical training efforts• OEH (medical and hygiene) courses by western Universities • Mount Sinai Hospital (New York City)
– 1-week OEH training in Bangkok, April 2013• ~ 50 regional participants• Bhutan, Brunei, Cambodia, Indonesia, Laos, Nepal, Sri Lanka, Thailand, Viet
Nam– Discussions with Myanmar Minister of Health
• Finnish Institute of Occupational Health– Asia-Pacific Newsletter (quarterly; nation profiles)
• Triennial Asia Conference Occupational Health (AAOH) since 1956• NGOs – ANROEV (and GOSH); AMRC; Solidarity Center; Hesperian
Foundation; others
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 36
Taiwan OH Services• Problem: under-reporting of occupational injury and disease (OD)• Response: government founded and financed the Network of Occupational Diseases and Injuries
Service (NODIS) for occupational disease and injury services and established a new Internet-based reporting system
• NODIS comprised of: the Center for Occupational Disease and Injury Services and their local network hospitals
• Objectives: (1) Analyze possible influence of NODIS on compensable OD; (2) Describe distribution of OD across occupations and industries (2005-2010)
• Methods: Analyzed two datasets: (1) NODIS reporting dataset for demographics, OD distribution and time trends, and OD annual incidence; and (2) National Labor Insurance (NLI) scheme dataset of compensated OD for annual incidence
• Results: After NODIS was established, both the reported (NODIS) and compensable (NLI) OD incidences increased 1.2 and 2.0 fold from 2007 to 2010, respectively; the most frequently reported OD (2008 to 2010) were carpal tunnel syndrome, lumbar disc disorder, upper limb musculoskeletal disorders, and contact dermatitis
• Conclusions: NODIS system succeeded in providing more occupational health services, providing more workers with compensation for OD, and reducing under-reporting of OD
Chu PC, et al. The impact of occupational health service network and reporting system in Taiwan. Int J Occ Env Health, 2013; 19(4): 352-362
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 37
OE Medical & Hygiene Training in Asia
• Few for Occ Hygiene and Clinical Medicine– OEM Residencies; Occ Hygiene Master/Doctorate– Continuing Professional Education– OEM for Primary Care Doctors (none?)
• Many turn out researcher MD/PhD• Mostly MPH degrees (not clinical; few OEH)• Training in OEM– Japan, Korea (ROK), Taiwan (ROC), Hong Kong, China (PRC),
Singapore (other-?), – Australia (Monash Univ.)
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 38
OH Nursing and Mid-Level Providers in Asia
• Training of certified occupational nurses (none?)• Training of mid-level providers (none?)– Nurse Practitioners (Master/Doctorate levels)– Physician Assistant (separate training)– Can act like MD, with MD oversight collaboration
• U.S. has OHN certification for RNs and NPs
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 39
National OEH Associations in Asia
• Few• Philippines College of Occupational Medicine– Offers a diploma course
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 40
Trade and OEH
• World Trade Organization (WTO)– 153 member nations– Diminish and regulate commerce barriers
• Regional– NAFTA, EC, MERCOSUR (4 So. Amer.), bilateral
• Trade rules restrict extent to which States can limit imports in order to protect public health, including OEH
• Implications often for medications (patent protection; generic drug compulsory licenses) and pharmaceutical industry practices
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 41
Needs Assessment and Tracking• Each nation baseline
– See next slide• OEH goal setting to affect real change
– Decrease occupational M&M (morbidity & mortality)– Decrease environmental degradation– Improve health and safety of work places and communities– Reverse man-made climate change
• What is your country’s situation?• What OEH strengths does your country have?• What are the OEH needs?• What OEH priorities does your country have?• What plan could help solve some of them?• What long-range OEH goals for your country?28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 42
Each Nation Need Determinants1. Burden of occupational disease (injury, illness)2. Labour force (by industry - union, gender, age)3. Laws on OSH and environmental protection4. Government agencies and institutes for OEH5. Emergency preparedness and response for OEH6. Public health, medical, laboratory services7. OEH training programs (hygienists, nurses, doctors)8. OEH support organizations (unions, NGOs, etc.)9. Funding sources for OEH capacity building10. Existing international partnerships (medical, NGO, etc.)11. OEH links to community primary health care12. Priority needs and vision
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 43
OEH Clinical Training Structures• Core specialty– Medical residency– Post-graduate degree or clinical fellowship
• Additional component to core training– OEM or OEHN curriculum added to basic medical or nursing
degree program• Certification or Diploma courses– Comprehensive vs. Hot Topic– OEM for primary care doctors and nurses
• Continuing education– Education credits for board certification maintenance
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 44
Occupational Hygiene Training
• Core degree program• Occ Hygiene and Safety Professional
certification or diploma courses• Continuing professional education needed to
maintain certification
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 45
Training Modes• Regional and International established programs• Standardization
– ACGME International (e.g., Ecuador)• Category 1 vs 2 level of continuing education credits• Internet learning (podcasts, curricula, videoconf)• Face-to-face• Field work and clinical work apprenticeships (these are essential!)• Work site visits• Occupational health clinical rotations• Goal: establish national capabilities after transfer of knowledge
and skills to local core teams of professionals; integrate with community primary health care
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 46
Training Topics – 1 • Lung disease
– Asthma – Pneumoconioses (Coal, Silica, Asbestos)– See handout examples of resources– Simple spirometry (diagnosis restrictive & obstructive OD)– ILO digital radiography for pneumoconioses
• Emergency/disaster preparedness and response• Conducting an occupational history and physical exam, lab testing,
diagnosis, treatment plan• Disability management and return-to-work• OH Nurse case management• Leadership skills for OH
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 47
Training Topics – 2 • Hazard identification, prevention and control:
– Physical (temperature, pressure, vibration, noise, repetitive strain, falls, struck by/against)
– Radiation (ionizing, non-ionizing– Chemicals, Gases, Metals Toxicology– Biological– Psychological & Social
• Epidemiology and biostatistics• Medical surveillance for the more hazardous jobs• Running an occupational health service• Substance abuse, workplace violence, wellness at work• Regulations, recordkeeping, reporting• Privacy protection
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 48
Training Topics – 3
• OSH for specific industries and/or jobs– Construction– Mining– Transport– Agriculture– Automobile– Electronics– Textiles, garments and shoes– Chemicals– Hospital and health care workers
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 49
Institutional Partners in North America
• US National Institutes of Occupational Safety and Health (NIOSH, International Support)
• American College of Occupational & Environmental Medicine (ACOEM, International Section)
• US Accreditation Committee for Graduate Medical Education (ACGME, International Standard Setting)
• Harvard University School of Public Health, Department of Environmental Health, Environmental & Occupational Medicine and Epidemiology Program
• Emory University, Mayo Clinic, Univ. of Washington, Stanford Univ., Univ. California San Francisco, MIT, etc.
• Next Generation University (Univ. of British Columbia)
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 50
Training Jump Start Proposal• New Generation University Preventive Occupational &
Environmental Medicine Program• Links existing top OEH training institutions with local and
regional participating OEH institutions in Asia-Pacific, or directly to students
• Raises financial support from donor agencies (WHO, ILO, Africa Fund, independent foundations, governments, private Individuals) to:– Pay trainers and their institutions– Pay cost of curriculum development and delivery– Pay stipends and expenses for trainees– Thus, trainees pay nothing and earn something (no debt)
28 Oct 2013 HK-THG
NextGenU.org
Erica Frank, MD, MPH Founder and President, NextGenU.org
Professor and Canada Research Chair, UBC
Vision of Partners in OEH Asia-Pacific 52
Health workers save lives, and WHO says the world needs 4.2 million more of them ...
Source: WHO, 2008, Scaling Up, Saving Lives
57 countries have crisis-level shortages of health workers.
Competency based education deliveredthrough information communication technologies is highlighted as a solution.
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 53
4 Freedoms– Cost– Barriers – Ads – Carbon
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 54
Founding Collaborators & Funders
• American College of Preventive Medicine • Annenberg Physician Training Program • Centers for Disease Control and Prevention in USA • NATO Science for Peace• University of British Columbia• World Bank • World Health Organization • World Medical Association • Grand Challenges Canada 28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 55
17 Ways NextGenU Differs from MOOCs* and Traditional Education
• Credit• Free • Financial sustainability• Higher level education• Best available resources • Coordinated curriculum • Competency-based foundation• Multiple languages• Extensive human interactions
• Interactive computerized learning• Extensive computer and human assessment• Open use • Customizable • Active educational partnerships • A new way to teach• Open research policy• Warm prestige
*MOOCs=Massive Open Online Courses28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 56
Courses Launched Since April 2013
Climate Change and Health Emergency Medicine
Environmental Health
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 57
Registrants in 94 Countries
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 58
First Results
• 1,530 course registrants (NextGenUsers) in 94 countries*• Pilot #1 – EM course in 2 US Medical Schools
– NextGenUsers and traditionally trained controls performed identically on the US national EM test
• Pilot #2 – EH course in Public Health program at Simon Fraser University– Test scores identical + course ratings higher for NextGenUsers
• Pilot #3 – Physical Activity Counseling course in Colombia – NextGenUsers learned >2x as much as controls and offered
positive qualitative feedback
*As of Oct 3, 201328 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 59
Introduction to Emergency Medicine Course in Partnership with
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 60
Summary• OEH is founded in law, economically sustainable, and direly needed• Each nation requires a needs assessment baseline• Each nation needs OEH team training, community based, linked to
labour, government and medical-legal experts• International partnerships must start with labour groups, NGOs, and
OEH friendly professionals and institutions in medicine and law to press for OEH capacities
• Permanent goals (progressive realization, capacity):– Each nation becomes self sufficient in OEH training, capacities– Each nation integrates OEH with primary health care and public health needs
at the local community and workplace level– Mobile, outpatient, team approach, linked communication and expert support
• Tasks at hand…. What are they?
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 61
Future• Future – Asia only or all developing world nations (Africa, Latin Am?)• Organization and partnerships?
– Name (reflect partnerships of all dedicated parties, nations?) • ? – Global Partners in Occupational & Environmental Health• ? – Partners in Occupational & Environmental Medicine (POEM)
– Mission (labour and NGO partners always at the table)– Objectives, Goals– Program(s)
• Short-term• Long-term
– Training (by whom?) – build partnerships• Institutional links (e.g., through NextGenU to WHO, ILO, leading Universities)• Labour and NGO links (e.g. Partners in Health, others)
– Communications (internet, website, other?)• Other projects?
– Each nation baseline needs assessment and alliance guided action plan; measure progress• Meet again? If yes, when and where?
28 Oct 2013 HK-THG
Vision of Partners in OEH Asia-Pacific 62
Vision, Love and Imagination
Primum non nocere (First, do no harm).Hippocrates
Where there is no vision, the people perish.Proverbs 29:18
We believe that love and imagination are potent weapons in the fight for the poor.
Ophelia DahlPartners in Health (www.pih.org)
28 Oct 2013 HK-THG