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  African Newsletter Volume 23, number 1, April 2013 ON OCCUPATIONAL HEALTH AND SAFETY Health promotion at work   Contents 3 Editorial  Social determinants of health, and the workplace Sir Michael Marmot, Peter Goldblatt UCL Articles4 Visible workplace health promotion in Botswana  Sinah Yamogetswe Seoke BOSWANA 7 Health promotion at workplaces in anzania  Vera Ngowi ANZANIA 9 Occupational health nursing practice in the private sector in South Africa  Louwna Pretorius SOUH AFRICA 13 Occupational health and safety in the informal sector – an observational report  G.J. Sekobe, N.M. Mogane, M.G.I. Ntlailane, K.A. Renton, M.J. Manga- nyi, G.E. Mizan, C.D. Vuma, . Madzivhandila, S.A. Maloisane, K.C. Lekgetho SOUH AFRICA 16 How can we support young immigrants’ health and work ability at workplaces?  Merja urpeinen, Anne Salmi, Jaana Laitinen FINLAND 18 Networking emphasized in Dresden  Suvi Lehtinen 19 Occupational safety and health (OSH) training at ARLAC  Mary Muchengeti ARLAC / ZIMBABWE 21 Health aspects of child labour in the crushing of granites in central Benin  A.P. Ayélo, B. Aguêmon, A. Santos, F. Gounongbé, L. Fourn, B. Fayomi BENIN African Newsletter ON OCCUPAIONAL HEALH AND SAFEY Volume 23, number 1, April 2013 Health promotion at work  Published by Finnish Institute of Occupational Health opeliuksenkatu 41 a A FI-00250 Helsinki, Finland Editor in Chief  Suvi Lehtinen Editor Marianne Joronen Linguistic Editors Alice LehtinenDelingua Oy Layout Kirjapaino Uusimaa, StudioTe Editorial Board is listed (as of January 2013) on the back page. A list of contact persons in Africa is also on the back page.Tis publication enjoys copyright under Protocol 2 of the Universal Copyright Convention. Nevertheless, short excerpts of articles may be reproduced without authorization, on condition that source is indicated. For rights of reproduction or translation, application should be made to the Finnish Institute of Occupational Health, International Affairs, opeliuksenkatu 41 a A, FI-00250 Helsinki, Finland.Te African Newsletter on Occupational Health and Safety homepage address is: http://www.ttl.fi/AfricanNewsletter Te next issue of the African Newsletter will come out at the end of August 2013 . Te theme of the issue 2/2013 is Prevention culture.African Newsletter is financially supported by the Finnish Institute of Occupational Health, the World Health Organization, WHO, and the International Labour Office. Photographs of the cover page: © International Labour Organization / M. Crozet © Finnish Institute of Occupational Health, 2013Printed publication: ISSN 0788-4877On-line publication: ISSN 1239-4386Te responsibility for opinions expressed in signed articles, studies and other contributions rests solely with their authors, and publication does not constitute an endorsement by the International Labour Offi-ce, World Health Organization or the Finnish Institute of Occupational Health of the opinions expressed in it.  Editorial Afr Newslett on Occup Health and Safety 2013;23:3 • 3 Social determinants of health, and the workplace “Te poor health of the poor, the social gradient in health within countries, and the marked health inequities between countries are caused by the unequal dist-ribution of power, income, goods, and services, globally and nationally, the conse-quent unfairness in the immediate, visible circumstances of people’s lives – their access to health care, schools, and education, their conditions of work and lei-sure, their homes, communities, towns, or cities – and their chances of leading a  flourishing life. Tis unequal distribution of health-damaging experiences is not in any sense a ‘natural’ phenomenon but is the result of a toxic combination of  poor social policies and programmes, unfair economic arrangements, and bad  politics. ogether, the structural determinants and conditions of daily life consti-tute the social determinants of health and are responsible for a major part of health inequities between and within countries.”  WHO Commission on Social Determinants of Health – final report  F  or many years, the social, political and economic situation in much of Africa provided little reassurance that the health inequities between the continent and the rest of the world, as well as those within and between countries, would im-prove. But there are signs, over the last decade, of progress in all these dimensions of inequity. Much will need to be done, by countries, communities and civil society within Africa and by the international com-munity at large, to ensure that sustainable reductions in inequities are ac-hieved, that the benefits of economic growth are experienced by all, and that public health lessons are learnt both from Africa’s own experiences and from the impact of rapid economic growth elsewhere in the world. According to the 2012 World Health Statistics, in 13 countries in Afri-ca life expectancy at birth in 2009 was 50 years or less – all in sub-Saharan Africa – while it was over 70 in five countries on the African Mediterranean coast. A massive health divide. Nonetheless this represents a major impro-vement compared to the position in 2000, when the life expectancy figure was below 50 in 22 countries across the continent. As a result, the range between countries was four years less in 2009 than in 2000, and average life expectancy for the WHO Afro Region rose by four years – a bigger increase than in any other region. Te rate of GDP growth in Asia has been high throughout this period, and it has been increasing steadily, from an initially low level, in much of the African continent. As a result, the average growth rate in Africa is pre-dicted to overtake that in Asia during the current decade; the Arab spring has swept through North Africa; and many of the wars in the south have come to an end. Tese are all signs of hope – but we still have a long way to go to reach the conditions needed to achieve health equity in Africa. Some key indicators continue to place the WHO Afro Region in a poor position, as regards drinking water quality, sanitation, universal health service coverage, rates of mortality, malaria, B and HIV/AIDS. All of these have a greater im-pact on people and communities further down the social gradient and on countries poorly equipped to carry the burden or address the root causes.For the future, a real concern must be the increase in non-communica-ble diseases (NCD) and their social distribution. Te WHO African Region already has the highest NCD mortality rates in the world, particularly from CVD, and the highest prevalence of raised blood pressure in adults. As we have already seen in some countries in Africa, as economic well-being im-proves and Western diets and smoking habits spread, so these behaviours cease to be those of the elite only, and spread to those who are less educa-ted – creating new social gradients. In conquering communicable diseases we need to ensure that we also address the social conditions that give rise to these and to NCDs. Work is a big part of this. Work provides income, a purpose in life, self-esteem, social relations – but it can also be degrading, dehumanizing, dangerous, and damaging to health in various ways. Addres- sing social determinants of health will entail, among other things, addres-sing the crucial role of work in damaging or enhancing health.Professor Sir Michael Marmot  Professor Peter Goldblatt UCL Institute of Health Equitym.marmot@ucl.ac.uk  Michael MarmotPeter Goldblatt   4  • Afr Newslett on Occup Health and Safety 2013;23:4–6 Introduction According to the Bangkok Charter, “Health promotion is the process o enabling people to increase control over their health and its determinants, and thereby improve their health. It is a core unction o public health and contributes to the work o tackling communicable and non-commu-nicable diseases and other threats to health (1).” Te main elements in health promotion to be noted are to enable in-dividuals to be responsible or their own health and also the creation o an atmosphere that enables people to be contin-uously active participants in health promotion initiatives in every setting o their everyday lie in order to curb ill-health and ensure quality o lie. Te WHO recognizes that the workplace “offers an ideal setting and inrastructure to sup-port the promotion o health (2).” Promoting health in the workplace is reported to ben-efit enterprises in the orm o lower illness-related cost and an increase in productivity (3). Any intervention in the workplace that promises the prevention o ill-health is con-sequently providing occupational health and saety (OH&S) that will see an improvement in the well-being o the work-orce thereby leading to a reduction in occupational diseas-es, accidents, and injuries. Te objective o OH&S is to en-sure that workplaces are sae to operate in, that operations do not impact negatively on the health o workers, and sae-ty awareness amongst personnel is increased (4). Conse-quently, OH&S initiatives lead to promoting the preserva-tion o health in the workplace. Te concept of workplace health promotion has been incorporated into Occupational Safety and Health Manage-ment Systems (OSH MS). A typical OSH MS includes em-powering employees so that they take responsibility for their safety and health, not only their own, but also that of their fellow workers. Tis is in accordance with the Ottawa Char-ter (5) which states that health promotion supports indi- viduals’ development through the provision of information and education relating to health. “By so doing, it increas-es the options available to people to exercise more control over their own health and over their environments, and to make choices conducive to health (5).” One of the main ele-ments of OSH MS is training and the continuous provision of information to the workforce so that they understand the health and safety risks of their workplace [6]. According to Visible workplace health promotion in Botswana the World Bank (6), having an appropriate OSH MS in the workplace can improve staff performance and availability for work, help in recruiting and retaining key skills and ex-pertise, and reduce workers’ compensation insurance costs and medical expenditures (6).” In this sense, health promo-tion (in terms of OH&S) is an investment in the workforce, their employability and potential productivity. In the recent years, the application o systems models in OH&S, now reerred to as the OSH Management Systems (OSH MS) approach has gained the attention o enterpris-es, governments and international organizations as a prom-ising strategy to harmonize OH&S and business require-ments, and to ensure more effective participation o work-ers in implementing preventive measures (7). In the imple-mentation o OSH MS, all the workplace elements to assess hazards and risks are considered; commitments are made at all levels o the organization; management and workers are involved in the process at their level o responsibility (4). According to Robson et al. (8), there are studies that have shown that a more developed OSH MS is correlated with lower injury rate; thereby ensuring improved well-being in the workplace. Background Te 2012 Global Competitiveness Report revealed that Bot-swana has improved its competitiveness ranking rom po-sition 80 to 79 out o 144 countries (9). Te country was praised or having achieved the astest levels o economic growth in the world, even outstripping China. Tis is large-ly attributed to the country’s well-known relatively good governance and institution o property rights, which has been reported to have given most o the population an in-terest in political stability (10). Botswana’s Gross Domestic Product (GDP) per capita impressively stands at US$9,481 (11). According to the Central Statistics Office (11), the composition o the GDP by sector stands at 1.8% or agri-culture, 59.5% or industry (including mining), and services at 35.2% (11). According to Botswana Vision 2016 (12), Botswa-na’s policy initiative, the government’s vision is to have a healthy, compassionate nation that is inormed and provid-ing a sustainable contribution to the country’s development. Health and well-being promotion is o paramount impor- Sinah Yamogetswe SeokeBOSWANA  Afr Newslett on Occup Health and Safety 2013;23:4–6 • 5 tance in achieving Botswana’s prosperity. An inormed nation is a critical element in health promotion since inormation empowers and enables individuals and communities to take control o their own health and determinants o health. Tis fits well with the WHO Bangkok Charter defi-nition o health promotion. Botswana has become more dependent on Small and Medium-sized Enterprises (SMEs) as its strategy to diversiy its eco-nomic growth and eradicate poverty. Te country has developed a national strate-gy or poverty reduction (13), which puts private sector development and trade ex-pansion at the centre o economic develop-ment. Te strategy includes strengthening private sector development with an added stimulus, particularly ocusing on SMEs and the inormal sector (13). With this na-tional plan, the country will experience an increase in the number o SMEs. SMEs are an intervention strategy on poverty eradication and need health promotion programmes as small-scale industries are prone to occupational hazards. Botswana will do its best to recognize that a healthy workorce is a key to overcoming poverty and increasing productivity Te increase in SMEs will heighten the difficulty in enorcing the current national prescriptive legislation statutes. At present, there is an acute shortage o OSH inspec-tors across the country. Currently, there is a significantly disproportionate ratio o inspectors to workplaces. It thereore be-comes important to have a mechanism in place that will ensure sel-monitoring o workplaces through OSH MS. Activities contributing to Health Promotion in Botswana In 2011, the Ministry o Labour and Home Affairs through its tripartite constituents signed the Botswana Decent Work Coun-try Programme 2011–2015 with one o its outcomes being “workers and enter-prises benefit rom improved saety and health condition at work (14).” Te activi-ties include the development o a national OSH policy and programme that will see, amongst other things, the revitalization o the CIS-national Occupational Saety and Health (OSH) inormation centre (14).Te Ministry o Health, with relevant stakeholders, has consistently over the years, implemented health promotional in-itiatives as ollows: • Smoking reduction and implementa-  tion o the obacco Act • Reduction in the use of alcohol and drugs • Mental health promotion• Promotion of sexual and reproductive health and HIV\AIDS prevention • Prevention of cancers • Promotion of physical activities for health. Workplace Wellness Programme: Im-plementation Guide has been developed by key stakeholders in the country that in-clude organizations and businesses, with the aim o promoting the health and well-being o employees, and the vision o see-ing “transormed, healthy and productive workorce (15).” Government departments and agencies, parastatals, and some pri- vate companies have developed activities, which have gradually become culture, and which include most commonly an annu-al wellness week across different govern-ment ministries and departmental weekly short session at a specific time in the week throughout the year or employees to gath-er or prayers, talks, discussions and ad-dress employee well-being issues. Work-place committees have been set up to or-ganize the ollowing: • Health screenings and well-being day/  week activities • Peer education and counselling• Talks covering dierent topics (such as stress management, personal finan- cial management, health topics).  Awareness on OSH Promotion Botswana has implemented several aware-ness campaigns that are continuously and gradually addressing the improvement in workplace health promotion. 1. World Day for Safety and Health at Work on 28 April Te ILO celebrates the annual World Day or Saety and Health at Work on 28 April to promote the prevention o occupation-al accidents and diseases globally. It is an awareness-raising campaign intended to ocus international and national attention on emerging trends in the field o occupa-tional health and saety. It encourages im-provement in working conditions and the environment. Te day has been observed since 2006 in Botswana. Participants in-clude government, utilities companies, pri- vate sector, workers’ organizations and em-ployers’ organizations. 2. Safety, Health and Environment (SHE) Awareness Saety, Health and Environment (SHE) is recognized as a airly new concept in Bot-swana, but an important concept that has potential to “promote efficiency and re-duce losses by continuously improving employee awareness o their health and saety to promote productivity (16).” Tis is a non-legislated concept that has been Te World Day for Safety and Health on 28th April has been celebrated since 2006 in Botswana. Photo: access by DOHS Public Relation Desk Officer, Mr Armstrong Dube.
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