The global health threat of climate change

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Climate change is the biggest global health threat of the 21st century. Effects of climate change on health will affect most populations in the next decades and put the lives and wellbeing of billions of people at increased risk. During this century, earth's average surface temperature rises are likely to exceed the safe threshold of 2°C above preindustrial average temperature. Rises will be greater at higher latitudes, with medium-risk scenarios predicting 2-3°C rises by 2090 and 4-5°C rises in northern Canada, Greenland, and Siberia. With this current situation, the whole of U.K. population is at risk considering the changing patterns of disease, water and food insecurity, vulnerable shelter and human settlements, extreme climatic events, and population growth and migration. Although vector-borne diseases will expand their reach and death tolls, especially among elderly people, will increase because of heat waves, the indirect effects of climate change on water, food security, and extreme climatic events are likely to have the biggest effect on global health (Prof A. Costello FRCPCH, S Ball BSc, C Patterson LLB).

Aside from the bigger picture of climate change we still need to consider the leading global risk for mortality, Hypertension is responsible for 12.8% (7.5 million) of total deaths worldwide, according to a new report issued by the WHO. The report also identified hypertension as responsible for 3.8% of years of life lost due to premature death plus years of healthy life lost due to illness and disability (known as disability-adjusted life years) (Colin Mathers, PhD, coordinator for mortality and burden of disease at the WHO). Majority of the U.K. population is exposed to a total of 8 risk factors (hypertension, alcohol use, tobacco use, high body mass index, high cholesterol, high blood glucose, low fruit and vegetable intake, and physical inactivity) account for 61% of loss of healthy life years from cardiovascular diseases, and 61% of cardiovascular deaths. The same risk factors account for more than three fourths of deaths from ischemic and hypertensive heart disease.

The Shift of affairs from national level to global status is influencing health challenges. On top of domestic problems, all countries must now deal with the international treat of transferring health risk. These new challenges are demanding forms of international cooperation, which, if developed, may also help to reconcile general national self-interest with international mutual interest.

Economic globalization has been the fundamental driving force behind the overall process of globalization over the last two decades. It has been characterized both by a dramatic growth in the volume of cross-border flows and by major changes in their nature. International trade has grown at an accelerating pace - nearly 8.6% per year (Bull World Health Organ vol.79 no.9 Genebra 2001).

We cannot underestimate the implications of these changes for health. In addition to their own domestic problems, all countries must now deal with the international transfer of risks. The most obvious case of the blurring of health frontiers is the transmission of communicable diseases. Again, this is not a new phenomenon per se. The first documented case of a transnational epidemic was the Athenian plague of 430 b.c.7 The Black Death of 1347, which killed one-third of the European population, was the direct result of international trade. In the sixteenth century the conquest of the mighty Aztec and Inca empires was an early example of involuntary microbiological warfare through the introduction of smallpox. More recently, the global spread of the influenza pandemic of the early twentieth century accounted for far more casualties than did WorldWar I.

What is new is the scale of what has been called "microbial traffic." The explosive

increase of world travel produces thousands of potentially infectious contacts daily, and jet planes have made even the longest intercontinental flights briefer than the incubation period of any human infectious disease. Thus, a Peruvian outbreak of cholera turned into a continental epidemic in a matter of days in the early 1990s. Drug-resistant strains of tuberculosis have traveled from detention centers in Russia to Paris in just a few hours. Likewise, the Asian "tiger mosquito," a potential vector for dengue fever virus, was introduced into the United States in the 1980s in a shipment of used rubber tires imported from northern Asia.

These are all examples of what is called "our new biocultural era, generated by radical changes in our environment and lifestyles" according to "Man and Microbes" author Arno Karlen. Indeed, to make matters more complex, it is not only people, microbes, and material goods that travel from one country to another; it is also ideas and lifestyles. Smoking provides a clear example. Whenever a legal or regulatory battle against the tobacco companies is won in a State, everyone rejoices for the public but trembles for the consequences in other countries, because those very victories give those same companies the incentive to look for new markets with less stringent regulations. Already about four million people die from smoking-related causes every year. By 2020 that number will grow to ten million, making tobacco the leading killer worldwide.

1.2) 40 years ago, activities in international health were the domain of The World Helath organization (WHO), governments (based on bilateral agreements), and non-governmental organisations. This has changed. Today, new players (such as the World Bank and, increasingly, the World Trade Organisation) have an influence on international health. As globalisation of trade and markets takes hold, new coalitions and alliances are forming to examine and deal with the direct and indirect consequences on health. A new cooperation in international health, voicing concerns about rising potential inequalities in health, both within and between countries is on the scene (G.Walt. Globalisation of international health The Lancet)

Health systems around the world are facing similar challenges; many of them, as we just discussed, are related to globalization. Developed countries are witnessing problems of cost explosion, irrational use of technologies, and consumer satisfaction. Developing nations are dealing with problems of access to care, quality of services, and unregulated growth of the private sector. The communication revolution provides the opportunity to exchange information about the challenges facing national health systems and about the initiatives to deal with them. In addition to that, there are international private sectors that are willing offers assistance to health organizations globally, Utilizing there experiences and advancements. To be informative, such exchange should be based on sound evidence about alternatives, so that we may build a solid knowledge base of what really works that may be transferred across countries when it is culturally, politically, and financially reasonable. This obviously implies a strong international influence on health care.

1.3) European Countries had joined together in an effort to better the standards of health practices on workplaces. An example of this is the European Network for Workplace Health Promotion (ENWHP). Since it was established in 1996, this has been the vision of the European Union. The Network was founded when the European Union adopted the Programme of Action on "Health Promotion, Education, Information and Training" to improve public health standards in Europe in which workplaces were accorded a special role. Health promotion for employees has after all verifiable effects and serves the common interest as well as promoting social and economic prosperity. Since it was established, the ENWHP has grown steadily with a current 31 members from national safety and health and public health organizations from the EU Member States, Switzerland and countries of the European Economic Area.

Over these years the EU has made quite an impact: successfully formulating a general definition for workplace health promotion (WHP) in Europe; developing standardised criteria for good quality WHP and publishing reports with models of good practice from a wide range of industrial sectors. The ENWHP has also developed a European toolbox of successful practices and identified strategies to help keep workers longer in employment. In addition, national networks were established by the Network in recent years on national level to disseminate information on WHP to a wider audience. However, to turn our vision into reality there still remains much to be done. A large number of companies and organisations still need to be convinced that WHP is a worthwhile investment. We are confident that by working together on our new initiatives, including our campaign to promote healthier lifestyles at work, we will continue to be successful over the coming years (European Network for Workplace Health Promotion).

Workplace health promotion (WHP) is not just theoretical. It is taking place in enterprises and organisations with practical programmes running on-site. But, if the WHP measures are to bring real and long term improvements for the employees and to become a model for success, their quality must be guaranteed.

The European Union membership on such organization is clearly giving a big impact on each of its countries' industries. Workplaces in most of the EU members are now being complaisant to the standards that are being established.

References

1. McMichael AJ, Beaglehole R. The changing global context of public health. Lancet, 2000, 356: 577-582.

2. Yach D, Bettcher D. The globalization of public health, I: threats and opportunities. American Journal of Public Health, 1998, 88: 735-738.

3. Yach D, Bettcher D. The globalization of public health, II: the convergence of self-interest and altruism. American Journal of Public Health, 1998, 88: 738-741.

4. Lee K. Globalization and the need for a strong public health response. European Journal of Public Health, 1999, 9: 249-250.

5. Globalisation of international health The Lancet, Volume 351, Issue 9100, Pages 434-437 G.Walt

6. Dr. Maria Dolores Solé, Dr. Karl Kuhn Chairpersons of the ENWHP

2.1) Costs of benefits for environmental awareness in a health care perspective will depends on the size, sector, structure, market, culture and the regulatory context. Norms and values have implications on research, how you view the relationship between environment, Health care and Profitability. Legislation is the main influencing factor for companies to do environmental changes.

Adopting an environmental awareness policy may have several items to consider:

Perspectives on regulation

International policy and voluntary initiatives

Strategies and the environment

Environmental Management Systems and Standards

Environmental Reporting

Environmental Management Accounting

There are three perspectives to consider in strategic environmental policy:

External influences (Industry structure, market, environmental risks, regulatory influences, customers, NGOs)

Firm context (market strategy, internationalisation, organisation structure, environmental risks etc.)

Network (Dependency relationships with suppliers and customers and their environmental problems. A company with more control can have a more offensive environmental strategy)

There are three sets of issues to consider in strategic environmental policy:

Risk (higher for multinational companies)

Supply chain management

Green capabilities

Regulating environmental awareness and policies may lead to the following:

Pollution haven (a country attracts investors thanks to lax or no regulation)

Flight (Investors leave a country because of strict regulation)

Innovation (Strict regulation forces companies to innovate)

Protectionism (Regulation to protect certain companies from competition)

Cooperation (companies cooperate with regulators)

In addition to all implication is the accounting aspect. Environmental management accounting plays a key role in establishing and adopting an environmental awareness policy. Here are four different definitions to environmental costs:

The costs of business impacts on the environment and society for which firms are not legally accountable (also called externalities or external costs)

The financial burden for firms as a consequence of environmental regulation

The costs of environmental measures

All costs that are relevant for environmental management

Cost calculation should also be used for the following reasons:

Internal communication

External communication

Policy formulation

Capital budgeting

Negotiations

Cost allocation

2.2) Based on the economics of adopting a policy of environmental awareness, in order to maintain the environment it should be managed accordingly. Part of the over all preparatory set up in adopting a policy is the Environmental Management System (EMS). An environmental management system will also include improvement cycles.

An EMS is that part of the overall management system which includes the organisational structure, responsibilities, practices, procedures, processes and resources for determining and implementing the organisationa's overall aims and principles of action with respect to the environment. The actions to be should encompass the totality of organisational, administrative and policy provisions to be taken by a firm to control its environmental influence. The organization should be identifying environmental impacts and legal obligations, the development of a plan for management and improvement, the assignment of responsibilities and the monitoring of performance. According to Prof.dr. Ans Kolk of Amsterdam Business School "You should check and act".

The organization must also educate its stakeholders, influencing them to act in the maintenance process through "Sustainable development" and "Social responsibility" to maintain the goal in the environment. Every action will always be rooted back to the goal of sustainability through responsibility.

2.3) In order to measure workplace health and safety we need engage in several assessments first. Through Risk management we are able to assess the risk of a specific process involved in a workplace. Risk management is an ongoing process that should be undertaken now, if it has not been done before, When any new work is planned including laboratory/workshop/course work, When planning or making a significant change, After an incident, at regular intervals appropriate to the nature of the workplace and the hazards present and when legislative obligations including regulations change.

We also need to consider the Hazard of the specification versus the risk. A hazard is something with the potential to cause harm. This can include chemical substances, plant, live electricity, work process and/or other aspects of the work environment. Risk on the other hand is the likelihood that illness, injury or even death might result because of the hazard.

Here are the basic steps in indentifying:

Identifying the Hazard

Assess and prioritize Risk

Analysing the risk involves determination of the:

Consequences - outcome of an incident

Exposure - interaction with hazard

Probability - likelihood that consequences will occur once individual is exposed

In order to further assess risk and hazard in the workplace, you can also use a risk calculator. Here is how to use a Risk Score Calculator:

Estimate the Probability

Estimate the Exposure

Identify the Consequences

Determine the Risk

After the steps in identifying the risks and hazards of the work environment and the job itself, we need to assess the control measures that are established in the organization. The control measures should adequately control the risks; not create other risks and allow the staff to do their work without undue discomfort or distress. There will be a need to develop work procedures in relation to control measures, which may involve clearly defining responsibilities of management, supervisors and workers.

Most organization uses the Hierarchy of Control Measures: Eliminate the hazard is the first choice. The ideal solution is to get rid of the hazard completely. This is the most effective control measure and should always be considered first. If the hazard cannot be eliminated completely there are a number of control options that can be used to prevent or minimise exposure to the risk:

Substituting a less hazardous material, process or equipment;

Redesigning the equipment or work process;

Isolating the hazard through engineering - separating the worker from the hazard;

Administrative controls involve minimising exposure to a risk through the use of procedures or instruction. This could involve limiting the exposure time to a particular hazard such as noise or radiation;

Personal Protective Equipment (PPE) is used as a last resort when exposure to risk is not or cannot be minimised by other means. PPE is worn by people as a final barrier between themselves and the hazard. This measure does not control the hazard at the source but relies on behaviour modification for its success. The success of this control is dependent on the correct PPE being chosen, worn correctly, used correctly and maintained in good condition.

Administration and the use of personal protective equipment are the lowest priority on the list of controls. These controls should NOT be relied on as the primary means of risk control until the. All relevant persons must be knowledgeable about the control measures being implemented; in particular, the reasons for the changes. We need to check if adequate supervision to verify that the control measures are being implemented and used correctly. We also need to know if the measures are being monitored and reviewed.

Monitor:

Chosen control measures have been implemented, as planned?

Control measures are working and are adequate?

Did the implementation of the control measures create other hazards?

Review:

Has anything changed over time since the process was implemented?

Is the control of risks still adequate?

Was the risk management process conducted effectively?

References:

Risk Management Code of Practice 2007: Department of Employment, and Industrial Relations

Australian Standard AS/NZS 4360:2004 - Risk management

Workplace Health and Safety Act 1995

Workplace Health and Safety Regulations 2008

3.1) Protecting the health and safety of employees or members of the public who may be affected by your activities is an essential part of risk management and must be led by the board. Failure to include health and safety as a key business risk in board decisions can have catastrophic results. Many high-profile safety cases over the years have been rooted in failures of leadership. Health and safety law places duties on organisations and employers, and directors can be personally liable when these duties are breached: members of the board have both collective and individual responsibility for

health and safety.

By following this guidance, you will help your organisation find the best ways to lead and promote health and safety, and therefore meet its legal obligations.

The starting points are the following essential principles. These principles are intended to

underpin the actions in this guidance and so lead to good health and safety performance (The Health and Safety Executive (HSE) has further advice on leadership for small businesses and major hazard industries).

"An organisation will never be able to achieve the highest standards of health and safety management without the active involvement of directors. External stakeholders viewing the organisation will observe the lack of direction."( Health and safety leaders in the public and private sectors (HSE).)

Here are the responsibilities of an organization to its employees as the law stated:

provide a written health and safety policy (if they employ five or more people);

assess risks to employees, customers, partners and any other people who could be affected by their activities;

Arrange for the effective planning, organisation, control, monitoring and review of preventive and protective measures;

Ensure they have access to competent health and safety advice;

Consult employees about their risks at work and current preventive and protective measures.

Failure to comply with these requirements can have serious consequences - for both organizations and individuals. Sanctions include fines, imprisonment and disqualification.

For many organisations, health and safety is a corporate governance issue. The board should integrate health and safety into the main governance structures, including board sub-committees, such as risk, remuneration and audit. Guidance on the Corporate Governance requires companies to have robust systems of internal control, covering not just 'narrow' financial risks but also risks relating to the environment, business reputation and health and safety. The organisation will find itself facing service improvement targets. Using corporate and clinical guidance, it set about taking a 'whole systems' approach to managing corporate risk, giving one of its directors responsibility for the leadership of health and safety for the first time. Health and safety is also made a key item on the board agenda. This will result in a much better integrated health and safety management system that increases the opportunity to identify and manage all corporate risks, and a much more open culture, improving reporting and monitoring. The board actively promotes a culture that gives staff the confidence to report incidents.

Addressing health and safety should not only be seen as a regulatory burden. It offers significant opportunities. Benefits can include:

Reduced costs and reduced risks -employee absence and turnover rates are lower, accidents are fewer, the threat of legal action is lessened;

Improved standing among suppliers and partners;

A better reputation for corporate responsibility among investors, customers and communities;

Increased productivity - employees are healthier, happier and better motivated.

In addition, here's a list of responsibilities and actions that should be done and addressed regularly in the executive level of the organization:

Health and safety should appear regularly on the agenda for board meetings.

The chief executive must give the clearest visibility of leadership, but some boards find it useful to name one of their numbers as the health and safety 'champion'.

The presence on the board of a health and safety director can be a strong signal that the issue is being taken seriously and that its strategic importance is understood.

Setting targets helps define what the board is seeking to achieve.

A non-executive director can act as a scrutineer - ensuring the processes to support boards facing significant health and safety risks are robust.

3.2) While organizational interest in diversity continues to grow, many programs that support diversity initiatives are faltering. As a consequence, the valuing diversity movement now stands at an important crossroads. To say that today's choices and the actions taken will determine the ultimate success or failure of this vitally important initiative is no exaggeration (Marilyn Loden, IMPLEMENTING DIVERSITY).

Workplace diversity refers to the variety of differences between people in an organization. That sounds simple, but diversity encompasses race, gender, ethnic group, age, personality, cognitive style, tenure, organizational function, education, background and more. Diversity not only involves how people perceive themselves, but how they perceive others. Those perceptions affect their interactions. For a wide assortment of employees to function effectively in a healthcare organization, human resource professionals need to deal effectively with issues such as communication, adaptability and change. Diversity will increase significantly in the coming years. Successful organizations recognize the need for immediate action and are ready and willing to spend resources on managing diversity in the workplace now. Benefits of Workplace Diversity

An organization's success and competitiveness depends upon its ability to embrace diversity and realize the benefits. When organizations actively assess their handling of workplace diversity issues, develop and implement diversity plans, multiple benefits are reported such as: Increased adaptability.

Have a diversified organization has its own challenges which needs to be managed effectively. Implementation of diversity in the workplace policies - This can be the overriding challenge to all diversity advocates. Armed with the results of employee assessments and research data, they must build and implement a customized strategy to maximize the effects of diversity in the workplace for their particular organization.

Successful Management of Diversity in the Workplace - Diversity training alone is not sufficient for your organization's diversity management plan. A strategy must be created and implemented to create a culture of diversity that permeates every department and function of the organization (Greenberg, Josh "Diversity in the Workplace: Benefits, Challenges and Solutions).

Here are approaches to better manage diversity in a work place:

Assessment of diversity in the workplace

Development of diversity in the workplace plan

Implementation of diversity in the workplace plan

Foster an attitude of openness in your organization

Promote diversity in leadership positions

Utilize diversity training

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