initiative partners in occupational & environmental health vision for training of oeh hygienists,...

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 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-THGVision of Partners in OEH Asia-Pacific2

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-THGVision of Partners in OEH Asia-Pacific3

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-THGVision of Partners in OEH Asia-Pacific4

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 members 28 Oct 2013 HK-THGVision of Partners in OEH Asia-Pacific5

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-THGVision of Partners in OEH Asia-Pacific6

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 intl lenders (e.g., IMF, ADB) 28 Oct 2013 HK-THGVision of Partners in OEH Asia-Pacific7

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 Govt and Corporate obligations: Respect Protect Fulfill Promote 28 Oct 2013 HK-THGVision of Partners in OEH Asia-Pacific8

Brief History Health and H.R. ILO estab. 1919, first addressed global right to healthy work conditions Franklin Roosevelts 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-THGVision of Partners in OEH Asia-Pacific9

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 childrens health as an essential criterion for the definition of the term worst forms of child labour. 28 Oct 2013 HK-THGVision of Partners in OEH Asia-Pacific10

U.N. International Covenants Civil & 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-THGVision of Partners in OEH Asia-Pacific11

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-THGVision of Partners in OEH Asia-Pacific12

Dimensions of Right to Health CESCR (Committee on ESC Rights) in 2000 General Comment 14 details dimensions Freedoms dimension: To make decisions about ones 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-THGVision of Partners in OEH Asia-Pacific13

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-THGVision of Partners in OEH Asia-Pacific14

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-THGVision of Partners in OEH Asia-Pacific15

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-THGVision of Partners in OEH Asia-Pacific16

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-THGVision of Partners in OEH Asia-Pacific17

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-THGVision of Partners in OEH Asia-Pacific18

State Obligations for O&E Health ProvisionRespectProtectFulfillPromote Promote 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 CompensationPrevent 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-THGVision of Partners in OEH Asia-Pacific19

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-THGVision of Partners in OEH Asia-Pacific20

ICESCR Right to health care: not onlytimely and appropriate but alsothe 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-THGVision of Partners in OEH Asia-Pacific21

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-THGVision of Partners in OEH Asia-Pacific22

U.N. Declaration of Human Rights All 193 member states are subject to the terms of the UNDHR 28 Oct 2013 HK-THGVision of Partners in OEH Asia-Pacific23

Ratification of ILO OSH Conventions Convention Number, Name, Year of AdoptionNo. 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 41 155 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 11 174 Prevention of major industrial accidents 1993 9 176 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 2002n.r. (9, none in A-P) 187 Promotional Framework for OSH Convention 2006n.r. (25, 4 in A-P) *number of countries (out of 193 members) that ratified the convention as of 2006 Source: http://www.ciop.pl/18286 Table A (JOSE, 2006, Vol. 12, No. 3, 255266)http://www.ciop.pl/18286 28 Oct 2013 HK-THGVision of Partners in OEH Asia-Pacific24

ILO C155 OSH (1981) To establish a national OSH policy and program Asia-Pacific signatories (8 of 60 total): 1.Australia 2.China (PRC), incl. Hong Kong (2007) and Macau (1999) 3.Fiji 4.Kazakhstan 5.Mongolia 6.New Zealand 7.Tajikistan 8.Viet Nam 28 Oct 2013 HK-THGVision of Partners in OEH Asia-Pacific25

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-THGVision of Partners in OEH Asia-Pacific26

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-THGVision of Partners in OEH Asia-Pacific27

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-THGVision of Partners in OEH Asia-Pacific28

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-THGVision of Partners in OEH Asia-Pacific29

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-THGVision of Partners in OEH Asia-Pacific30

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-THGVision of Partners in OEH Asia-Pacific31

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-THGVision of Partners in OEH Asia-Pacific32

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-THGVision of Partners in OEH Asia-Pacific33

ILO C187 Promotional Framework for OSH (2006) Requires govts 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.Japan 2.Korea (ROK) 3.Malaysia 4.Singapore Also, Russia, if one considers Siberia is part of Asia 28 Oct 2013 HK-THGVision of Partners in OEH Asia-Pacific34

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-THGVision of Partners in OEH Asia-Pacific35

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-THGVision of Partners in OEH Asia-Pacific36

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-THGVision of Partners in OEH Asia-Pacific37

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-THGVision of Partners in OEH Asia-Pacific38

National OEH Associations in Asia Few Philippines College of Occupational Medicine Offers a diploma course 28 Oct 2013 HK-THGVision of Partners in OEH Asia-Pacific39

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-THGVision of Partners in OEH Asia-Pacific40

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 countrys 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-THGVision of Partners in OEH Asia-Pacific41

Each Nation Need Determinants 1.Burden of occupational disease (injury, illness) 2.Labour force (by industry - union, gender, age) 3.Laws on OSH and environmental protection 4.Government agencies and institutes for OEH 5.Emergency preparedness and response for OEH 6.Public health, medical, laboratory services 7.OEH training programs (hygienists, nurses, doctors) 8.OEH support organizations (unions, NGOs, etc.) 9.Funding sources for OEH capacity building 10.Existing international partnerships (medical, NGO, etc.) 11.OEH links to community primary health care 12.Priority needs and vision 28 Oct 2013 HK-THGVision of Partners in OEH Asia-Pacific42

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-THGVision of Partners in OEH Asia-Pacific43

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-THGVision of Partners in OEH Asia-Pacific44

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-THGVision of Partners in OEH Asia-Pacific45

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-THGVision of Partners in OEH Asia-Pacific46

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-THGVision of Partners in OEH Asia-Pacific47

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-THGVision of Partners in OEH Asia-Pacific48

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-THGVision of Partners in OEH Asia-Pacific49

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-THGVision of Partners in OEH Asia-Pacific50

NextGenU.org Erica Frank, MD, MPH Founder and President, NextGenU.org Professor and Canada Research Chair, UBC

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 delivered through information communication technologies is highlighted as a solution. 28 Oct 2013 HK-THGVision of Partners in OEH Asia-Pacific52

4 Freedoms Cost Barriers Ads Carbon 4 Freedoms Cost Barriers Ads Carbon 28 Oct 2013 HK-THGVision of Partners in OEH Asia-Pacific53

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 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-THGVision of Partners in OEH Asia-Pacific54

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 Courses 28 Oct 2013 HK-THGVision of Partners in OEH Asia-Pacific55

Courses Launched Since April 2013 Climate Change and Health Emergency Medicine Environmental Health Climate Change and Health Emergency Medicine Environmental Health 28 Oct 2013 HK-THGVision of Partners in OEH Asia-Pacific56

Registrants in 94 Countries 28 Oct 2013 HK-THGVision of Partners in OEH Asia-Pacific57

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, 2013 28 Oct 2013 HK-THGVision of Partners in OEH Asia-Pacific58

Introduction to Emergency Medicine Course in Partnership with 28 Oct 2013 HK-THGVision of Partners in OEH Asia-Pacific59

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-THGVision of Partners in OEH Asia-Pacific60

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-THGVision of Partners in OEH Asia-Pacific61

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 Dahl Partners in Health (www.pih.org) 28 Oct 2013 HK-THGVision of Partners in OEH Asia-Pacific62

initiative partners in occupational & environmental health vision for training of oeh hygienists,...

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