مصاحبه دكتر ايوانف در بازديد از توانمندي هاي حوزه بهداشت حرفه‌ای

Interview by:

Dr Ivan D. Ivanov, Team Leader, Global Occupational Health Programme, Department for Public Health, Environmental and Social Determinants of Health (PHE), World Health Organization, Headquarters, Geneva

 Dr. Ivanov:   Iran has long tradition in delivering some essential interventions for workers ‘ health

Lead sentence: very strong point of the Iranian primary care system is the complete health coverage of defined communities with preventive and clinical services delivered by primary care teams, including general practitioners, occupational and environmental health technicians and community health workers. 

1. Please explain for us your view points on the status of occupational health in Iran in compare with other EMRO member states and developed countries

During my mission to Iran 1-6 February 2014 I had opportunities to visit different primary care facilities to study their role in protecting the health of workers. The country seems to have long tradition in delivering some essential interventions for workers ‘ health such as workplace visits and recommendations for improvement, health education and medical surveillance of high risks workers and diagnosis of occupational and work-related diseases and injuries. These interventions also appear to be very effective - about half of the workplace visits result in implementing the recommended improvements and the other half of the cases would require a second visit.  A very strong point of the Iranian primary care system is the complete health coverage of defined communities with preventive and clinical services delivered by primary care teams, including general practitioners, occupational and environmental health technicians and community health workers.  This allows primary care to intervene on the root causes of diseases by addressing social and environmental determinants of health in the community.

The main features of health systems are routed in traditions and social-economic context so it is difficult to compare directly across countries. In many developed countries primary care is centered on clinical services provided by physicians in liberal practice. It is difficult to integrate prevention in such services. Other countries, such as  Brazil, Thailand, Sri Lanka and Iran, where primary care is comprehensive and community based, where people live and work, were very successful in providing preventive health services to all. Some countries, Finland, for example, rely on specialized occupational health services for their workers. Such services are funded primarily by the enterprises and provide high quality preventive and curative care to workers. There are current efforts to ensure that this model of service delivery can also contribute to equity in access to health services for people outside the workforce.

2. How do evaluate the role of occupational health in Universal health coverage?

Universal health coverage means that all people, and particularly the disadvantaged groups, should have access to the needed preventive, curative and rehabilitative health services of sufficient quality without experiencing financial difficulties with catastrophic health expenditures.  There are three dimensions of health coverage: (1)  the proportion of costs for health services covered by public funds; (2) the breath of interventions and services provided; (3) the population groups having access to these interventions and financial protection. 

First, in occupational health, the principle is that workers should not have to pay for anything that is needed to protect their health from health and safety risk resulting from their work. The employer, or the person who makes profit of using this work should cover all costs for protection against occupational health and safety risks.  In most countries there are insurance schemes to cover the financial compensation to victims of occupational diseases and accidents. However, only 30% of workers worldwide, mostly in big enterprises in the formal sector are covered with such insurance. Extending  coverage to other workers, as well providing preventive medical examinations, personal protective equipment and diagnosis of occupational diseases and injuries at no cost for the worker are some of the measures to strengthen  the financial dimension of universal health coverage. 

Second, we should bear in mind that one third of patients visiting primary care providers for treatment think that their health problem is related to work and expect the health provider to address this concern. , Only few countries provide training of students in medicine, nursing and allied health and continuous medical education in the area of occupational health. This is the reason that the question “what do you work” is rarely addressed in a typical patient visit in primary care

Third, health coverage should extend to specific disadvantaged population groups. While workers in big enterprises have occupational health services, including prevention of occupational risks, wellness programmes and curative care, most workers in the informal sector, agriculture, small enterprises, migrants do not have access to the most essential preventive, curative and rehabilitative health services.

About 4% of the annual gross domestic product in the world is lost because of occupational and work-related diseases and injuries. So, there is a strong economic arguments for investing in providing health services to workers. WHO studies  in countries  demonstrate that  the most essential package of health services to protect workers’ health costs between 14 and 83 PPP$ per worker when integrated in primary health care. Occupational health programmes bring prevention and social justice to the work towards universal health coverage. In addition, occupational health programmes have the capacity to mobilize resources from the private sector, enterprises and other economic sectors to provide additional health coverage for their workers and this relief the financial burden on the public health system.

3. What is the importance and impact of "International Consultation on health workers" in promoting the health of workers in Iran and throughout the World?

In order to monitor progress on universal health coverage we need international indicators. This is one of the objectives of the international consultation – to develop a core set of indicators to measure health coverage of workers in a systematic way. Another objective of the consultation is to decide what national and international actions are needed for scaling up coverage with the most essential interventions, such as advise for improving working conditions, health surveillance and diagnosis and reporting of occupational diseases. We expect that participating country experts will bring home not only indicators and recommendations for action but also ideas from other countries about practical implementation.  

4. considering that the World Day for Safety and Health at work is commemorated in 28 April, what is the importance of event and what is its impact on workers` health?

For WHO, the World Day for Safety and Health at Work is an opportunity to urge global community to pay more attention to the health of workers and its social and environmental determinants.  This year we will urge countries on 28 of April to extend health coverage to all workers, in particular in the informal sector. The World Health Assembly, the annual meeting of the ministers of health of the 194 Member States of WHO declared in 2007 that “that the health of workers is an essential prerequisite for productivity and economic development.” We hope that this year the World Day for Safety and Health at Work would build a momentum in countries to work towards universal coverage of workers with essential interventions and basic health services for prevention and control of occupational and work-related activities. This requires strong linkages between health systems, labour protection and employment policies and involvement of employers, trade unions, local communities and primary care providers.