The Right Question for Health&Safety:‘Why has it changed?’ rather than ‘How can it be changed?’

백 도명서울대 보건대학원

우리나라 산재발생의 변화

1964

1965

1966

1967

1968

1969

1970

1971

1972

1973

1974

1975

1976

1977

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

0

12

34

56

78

910

111213

14

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

Occupational Injury Rate and Death Rate

Occupational Injury Rate Occupational Death Rate Health Insurance Coverage Proportion of Disabled

1964

1965

1966

1967

1968

1969

1970

1971

1972

1973

1974

1975

1976

1977

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

0

12

34

56

78

910

111213

14

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

Occupational Injury Rate and Death Rate

Occupational Injury Rate Occupational Death Rate Health Insurance Coverage Proportion of Disabled

1964

1965

1966

1967

1968

1969

1970

1971

1972

1973

1974

1975

1976

1977

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

8,000,000

9,000,000

10,000,000

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

The Number and Proportion Covered by Industrial Accident Compensation Program

Number of Insured Proportion of Insured among Economically Active Population

1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 20000.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

Industry Profile over Years

Agriculture Manufacturing

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

0

100

200

300

400

500

600

0

5

10

15

20

25

30

35

40

45

General Population Mortality and Industrial Accident Mortality

General Population Mortality Industrial Accident Mortality

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

11.0%

12.0%

Occupational Death Rate and Its Proportion over Total Death Rate among General Population

Proportion over Total Death Rate

1964

1965

1966

1967

1968

1969

1970

1971

1972

1973

1974

1975

1976

1977

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

0

12

34

56

78

910

1112

1314

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1Occupational Injury Rate and Death Rate

Occupational Injury Rate Occupational Death Rate Health Insurance Coverage

Dilution of Risk

Transfer of Risk

Transform of Risk

우리나라 직업병의 규모

남성 여성 전체 남성 여성 전체급성질환 만성질환

0

5

10

15

20

25

30

위중도로 본 직업관련성 질환의 비중

활동제한 침상와병 활동감소

(%)

Total Prevalence Prevalence of Work-related

Diseases

Proportion of Work-relatedness

Total Prevalence Prevalence of Work-related

Diseases

Proportion of Work-relatedness

Acute Diseases Chronic Dieseases

0

10

20

30

40

50

60

70

The Prevalence of Diseases and the Proportion of Work-relatedness

Self-Recognized Physician Diagnosed Hospital Treated

(%)

왜 산업안전보건이 변화하는가 ?A Descriptive Model

Asbestos Mining and Import, Korea

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

0

20000

40000

60000

80000

100000

120000

Mining Import

Phases of Change

EXPAN-SION

FALLPLATEAU

Key EventsAsbestos Consumption in Korea and Japan

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

Import to Japan Mining in Korea

Industrial Safety and Health Act of Japan, 1972

Industrial Safety and

Health Act of Korea, 1981

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

ton

Year

Asbestos imports to Japan and Korea

Import to J apan Import to Korea

352,316

79,46344,146

320,393

Asbestos imports to Japan and Korea

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

Year

ton

Import to J apan Import to Korea

352,316(1974)

79,463(2001)

44,146(1939)

320,393(1988)

First Mesothelioma Case in J apan (1978)First Mesothelioma Case in Korea (1994)

Second Mesothelioma Case in J apan (1984)

Asbestos Mining and Import, Korea

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

0

20000

40000

60000

80000

100000

120000

Mining Import

Phases of Change

EXPAN-SION

FALLPLATEAU

Industrial Safety and Health Act of Korea, 1981

First Mesothe-lioma Case in Korea, 1994

Expansion Phase

ShrinkagePhase

PlateauPhase

Source

Expo-sure

Effect

Ac-tion

Repercussions

Foreign Investment

AdministrativeRegulation Asbestos

Ban

Source, Exposure, Effect, and Action (SEEA) Model of Asbestos Industry

왜 산업안전보건이 변화하는가 ?A Theoretical Model

Data → Information → Knowledge → Wis-dom

Utility Validity Predictabil-ity

Collected Tested Accepted

Data X X X

Information O X X

Knowledge O O X

Wisdom O O O

Risk Assessment and Management

Utility ValidityPre-

dicta-bility

Risk Approach

Collected Tested Ac-cepted

Data X X X Assessment Superficial

Informa-tion O X X Technical

Knowledge O O X Institu-tional

Wisdom O O O Manage-ment Cultural

Agents and ProgramsUtility Valid-

ityPre-

dicta-bility

Agent Program

Col-lected Tested Ac-

cepted

Data X X X Bureaucrat Superficial

Informa-tion O X X Professional Measure-

ment

Knowledge O O X Managers/Labors

Manage-ment

Wisdom O O O Victims Movement

Agenda Setting for Problem SolvingUtility Validity Predicta-

bilityRequire-ments

Collected Tested Accepted

Data X X X

Information O X X Graveness

Knowledge O O X Solvability

Wisdom O O O Responsibility

H&S Problem Solving Phase1st 2nd 3rd Require-

ments

Input Process Output

Data X X X

InformationKnowl-edge

TransferX X Graveness

Knowledge O Social Capital X Solvability

Wisdom O O Cultural Bias Responsibility

H&S Problem Solving Phase1st 2nd 3rd

Industry Phase Exposure Phase Effect Phase

Input Dominant Process Domi-nant

Output Domi-nant

Information Uncurbed and Expansion

Knowledge Control and Plateau

Wisdom Feed-back and Decline

H&S Problem Solving Phase - Who1st 2nd 3rd

Input Process Output

Data Bureaucrat

Information Employer Professional

Knowledge Labor Union NGO

Wisdom Victim

H&S Problem Solving Phase - Why1st 2nd 3rd

Input Process Output

Data

Information Politics based

Knowledge Economy based

Wisdom Health based

H&S Problem Solving Phase - What1st 2nd 3rd

Input Process Output

Data

Information Technical

Knowledge Management

Wisdom Culture

H&S Problem Solving Phase - How1st 2nd 3rd

Input Process Output

Data

Information Code-based

Knowledge Performance-based

Wisdom System-based

Industry, Exposure, Effect and Action Model for H&S Problem

1st 2nd 3rd

Input Process Output

Information Industry

Knowledge Exposure

Wisdom Effect

Action Action Action

Action Stakeholders

Process

Output

Input

Vic-tims

Politi-cians

Profession-als

IEEA MODEL 의 검증

Analysis of National H&S Program• Focus on Input-Output-Outcome linkage→ Exp Assmnt, Dis Assmnt, and H&S Solution

ver-sus

• Focus on whether H&S status is dif -ferent by the membership history of the country

• Membership– EU15+ : 15+Swiss+Norway– EU+12 : new 10+Bulgaria+Romania– Non-EU and Others

• Status of I-P-O, scope, and content of the H&S Program

Analysis of National H&S Program

Questionnaire Survey• National Focal Points and CCs• 20 countries had answered• Because of the nature of the questions,

not all countries could have provided rele-vant information

• The current results are still provisional, and need to be confirmed by the providers

• The survey is still open, and will continue to receive responses from other countries

Analysis of Data• Noise Assessment Coverage No of workers assessed for noise exposure = -------------------------------------------------- No of employees in 1st & 2ndary industries• NIHL Detection Rate No of NIHL Cases per year = -------------------------------------------------- No of employees in 1st & 2ndary industries• Accident Report Coverage No of workers for accident rate denomina-tor = -------------------------------------------------- No of economically active employees

Noise Assessment, Overexposure, and Hearing Loss

0.0%

50.0%

100.0%

150.0%

200.0%

250.0%

EU

15+

EU

15+

EU

15+

EU

15+

EU

15+

EU

15+

EU

15+

EU

+12

EU

+12

EU

+12

EU

+12

EU

+12

EU

+12

Non

EU

Non

EU

Non

EU

Non

EU

Non

EU

ETC

ETC

BelgiumFranceAustriaPortugalGreeceSwissNorwayPolandCzechSlovakEstoniaRomaniaBulgariaUkraineCroatiaRussiaArmeniaTurkeyIsrael USA

Exp

Ass

essm

ent C

over

age

0.1

1.0

10.0

100.0

1000.0

10000.0

100000.0

Hea

ring

Loss

Det

ectio

n R

ate

N_Ass_rate N_Overexp_pcnt N_Diag_rate

Croatia, even with ac-tive high level of noise assessment, low rate of detection of hearing loss

Israel, with lot of hearing loss cases, still high proportion of overexposed

Noise and Hearing Loss• As noise assessment coverage ↑ → No of Noise Induced Hearing Loss ↑• No of Noise Induced Hearing Loss ↑ → Proportion of Noise Overexposure ↓• EU15+ countries tend to have more

Hearing Loss Cases and less Overex-posures than EU+12 countries

Russia, high screening level with limited detec-tion rate of pneumoco-niosis

Dust and Pneumoconiosis• Pneumoconiosis screening coverage

↑ → Detection rate of pneumoconio-sis ↑

• EU15+ countries are not that differ-ent from EU+12 countries in the screening coverage or detection rate of pneumoconiosis

Asbestos and Mesothelioma• Mesothelioma incidence ↑ →

Asbestosis detection rate ↑↑

• EU15+ countries tend to have more asbestosis cases detected while with lower incidences of mesothelioma than EU+12 countries

Accident Report Coverage and Fatal Accident Rate

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

EU15+ EU15+ EU15+ EU15+ EU15+ EU15+ EU15+ EU+12 EU+12 EU+12 EU+12 EU+12 EU+12 Non EU Non EU Non EU Non EU Non EU ETC ETC

Belgium France Austria Portugal Greece Swiss Norway Poland Czech Slovak Estonia RomaniaBulgaria Ukraine Croatia Russia Armenia Turkey Israel USA

Acc

iden

t Rep

ort C

over

age

0.000

0.500

1.000

1.500

2.000

2.500

Fata

l Acc

iden

t Rat

e

Fatal_Accd_Coverage Accd_Fatality(/10000)

Injury Reporting and Fa-tality

• The broader the segment from which accidents are reported, the lower the fatal accident rates

• EU15+ countries tend to have a broader accident reporting base and a lower fatal accident rate than EU+12 countries

Discussions (1)• The H&S problem solving cycle is

not Exp Ass → Exp Reduction → Dis Reduction, but Exp Ass → Dis Detection → Exp Reduction.

• Here the core ideas of problem solving strategy should lie with how to link exposure assessment with disease detection, and also how to link disease detection to source control.

• Many countries still show high exposure assessment coverage with no or minimal disease detections, and high disease detection rate with no source con-trols.

Discussions (2)• Differences in H&S among Euro member countries

could be identified as expected from membership history.

• Problems of H&S usually drive the program as in the case of high mesothelioma incidence that leads to even higher detection of asbestosis, but country dif -ferences could be identified.

• Comparatively higher problems should be stressed and concerns be raised for each country until the lowest possible examples can be obtained. We need collective and comparative social issue making.

Discussions (3)• Scope of the H&S program is important in that

the coverage determines the detection rate of NIHL and pneumoconiosis, and for accidents, it determines the over-all accident rates of the society.

• Target priority may be important, but general universal acknowledgement of H&S values by the society is more fundamental to the effec-tiveness of the program.

• Risk population is at risk, not because of high risk works, but because of acceptance of high risks for that particular working population.

• Minority populations including non-standard workers and illegal migrant workers should be given particular considerations in this issue of the H&S program scopes.

1975 1980 1985 1990 1995 2000 2005 20100

2

4

6

8

10

12

14

16

18

Germany (1993)

Belgium (1998)

Denmark (1986)

Spain (2002)

Finland (1992)France (1996)Italy (1992)

Norway (1981)

Switzerland (1989)

Mesothelioma Incidence (2000) and Year of Asbestos Ban in Europe

Mes

othe

liom

a In

cide

nce

(/M

illio

n)

WHAT SHOULD WE DO?

Conclusions• Europe still needs a lot of work to improve H&S at

work.– Some countries still need more coordinated inputs.– Many countries need effectiveness in the program to

harvest the first meaningful outcomes.– Some countries need activation of feed-back loops and

extension of the scope and coverage of the program to ever neglected areas to make the system alive.

– Information and evidence about the functioning of the program are not collected in most countries, and we need a really good information project.

• Here the evidence shows that input of the pro-gram itself can not solve the H&S problem unless it is linked to the output and then to the feed-back loop, and serious considerations and dis-cussions should be given to devising strategies to link input to output and output to feed-back for each country.

Recommendations• Look for strategy, first from the common sense• Goal setting: Not the best ever possible textbook solutions,

but the most practical alternatives from the neighboring countries– → Phased and feed-backed approach: every input should get a

feed-back by examining outcomes etc.• Faced with a quandary, inevitable conditions needs to be

reexamined, so that current results could be the cause of the current problem, vise versa.– → Social development including health and safety is the pre-

requisite of economic development, not the other way around.• Risk is there, not because of the risk itself, but because of

the conditions that make it risky. – → Socio-cultural bias against risk perception and management

is the real difference between different societies, and mechani-cal or managerial approaches should always be preceded by cultural approaches.