Global occupational health

Globally, an estimated 2.3 million workers die every year from occupational accidents and work-related diseases; this equates to 6300 deaths daily [1]. In addition, over 300 million workers have non-fatal occupational accidents resulting in disability and time off work; 2.3 million work-related deaths per year outnumber deaths due to tuberculosis (TB), AIDS and road accidents. The burden is particularly heavy in low- and middle-income countries, where manufacturing is mostly concentrated and health and safety law and its application is often not so well implemented [1]. Workers in Europe, North America and Australasia are fortunate; there is well-developed legislation and there are systems in place to manage occupational health and safety hazards; in the last 40 years, the numbers of deaths caused by fatal injuries in the UK has markedly decreased by 86% since the introduction of the Health and Safety at Work Act 1974 [2]. However, deaths from occupational illness have increased, mainly due to the historical exposure to asbestos and its long latent period. Even in high-income countries when controls are relaxed, occupational diseases which were thought to be of historical interest can return [3], and where exposures have not been well controlled, the working population can develop a significantly increased incidence of disease. This has been seen in the gold miners working in southern Africa where some estimates are up to 500000 workers affected by silicosis [4]. There have been large scandals where perceived poor treatment of workers has reflected poorly on manufacturers and even on national governments [5,6]. Companies are now much more sensitive to these issues and more aware that they have to provide good and safe working conditions. However, in the developing world, many workers still have significant occupational exposures; they work in the artisanal or informal sectors where there is no corporate governance, and state governance is not well developed. There is also a shortage of occupational health and safety professionals to help implement safe systems of work.