«UNITED NATIONS AD HOC INTER-AGENCY TASK FORCE ON TOBACCO CONTROL REPORT OF THE SIXTH SESSION GENEVA, SWITZERLAND 30 NOVEMBER - 1 DECEMBER 2005 1. ...»
The focus of our efforts needs to be on preventing healthy workers from becoming ill.
The goal of SOLVE is integration of the psychosocial issues of stress, alcohol and drugs, violence, HIV-AIDS and tobacco into a comprehensive organizational policy and development of action based on the policy. Part of the process of getting management to buy into the program is expressing the costs of psychosocial problems in terms they can understand. As an example on an exercise used in the SOLVE course for managing directors, Drs. Gold and Caborn presented a sample enterprise of 100 workers, in which 10 drink regularly, 30 smoke and 10 have been victims of psychological or physical violence. According to the scientific literature: people addicted to alcohol take 7 times the sick leave as others; smokers take an average of 3 additional sick leave days per year;
victims of physical or psychological violence take an average of 7 additional sick days per year. The sample enterprise of 100 workers would need full time replacement workers to make up for the absenteeism caused by these three psychosocial issues.
In a one-hour course for workers, workers’ representatives and supervisors, SOLVE demonstrates how multiple psychosocial problems can impact the worker at work, during leisure activities and at home. It can familiarise workers with corporate policy. It uses exercises, group discussion and individual action planning to achieve its objective.
MicroSOLVE presents an action-based follow-up to SOLVE, targeted at workers and
supervisors, and each addresses one psychosocial issue, broken down into modules on:
recognising, dealing with and preventing the problem.
The participant from FAO pointed out that the source of tobacco and other psychosocial problems may not be confined to the workplace. The ILO responded that this is correct and that SOLVE aims to look at the individual trough an ecological model, taking into account home, work, the social environment, the family and the community. The aim of the program is not to eliminate all problems for workers, but to help them to develop the skills needed to cope with them. If one can change behaviors in the workplace, one might be able to change behaviors at home.
The participant representing the EC questioned whether there was a regulatory mechanism within the ILO. David Gold responded that there is no regulation specific to tobacco, but that the issue falls under Convention 155, to the extent that occupational safety and health are affected. The EC would like to see the ILO take a firmer stance, and suggested that the Task Force put in a recommendation for a non-binding code of practice on smoke in the workplace, possibly referring to the WHO FCTC, which is binding, as the principal guiding mechanism. The WHO conceded that it too found it odd that the ILO had never passed a resolution on the issue, and suspects that it has something to do with the ILO's tripartite governance structure. Representatives from the ILO emphasized the ILO has a tripartite structure and a democratic process of social dialogue reflecting the views of governments, employers’ and workers’ organizations. They reminded the group that progress on ETS in Ireland was made taking the occupational safety and health perspective. Nonetheless, given increasing awareness about the costs of SHS, and given that some unions are beginning to spearhead developments in ETS, the time might be right to develop such a code of practice.
Tobacco smoking, health and work (Ms Evelyn Kortum)
A presentation by Ms Kortum, Occupational and environmental Health Programme (PHE/SDE), cast the ETS problem, an occupational hazard in and of itself, in the light of its interactions with other workplace exposures. ETS can result in increased risk of coronary heart disease, lung cancer, asthma and low birth weight. The combination of smoking and airborne particulates can double the rate of COPD & pulmonary fibrosis, the combination of smoking and asbestos exposure can increase the rate of lung cancer over 20 times. Certain workplace factors, such as occupational status, sector or industry, and occupational strains and hazards, may influence smoking prevalence and the success of cessation programmes. On the one hand, Occupational Health and Safety strategies aim at minimizing workers’ exposure to job-related risks (chemical, biological, physical and/or psychosocial). Measures taken are usually situated at managerial level rather than individual worker actions. Health Promotion, on the other hand, aims at reducing riskrelated behaviours such as the use of tobacco. In this approach the individual behaviours are targeted. The worksite provides an important setting for educational efforts to reach large numbers of workers not accessible through other channels. Despite the differences of these two approaches, they clearly share the common goal of promoting worker health.
Their complementary functions in protecting and enhancing the health of workers provide an important opportunity for coordinated efforts. A comprehensive approach addresses several organizational levels, as well as multiple factors that influence worker health including efforts to reduce exposures to workplace hazards, modify job factors to support healthy outcomes, and promote health-enhancing behaviours, including nonsmoking..
The representative from PAHO pointed out that the evidence is now conclusive: asthma and low birthweight are indeed a consequence of tobacco use. She also highlighted the fact that blue collar workers may have higher smoking rates than others, but that cessation activities are equally successful, and that therefore it is more a consequence of the fact that blue collar workplaces may be the last to go smoke-free. She takes this to mean that cessation and smoke free initiatives must run in parallel.
The representative from FAO asserted that a complete intervention in the markets to ban smoking would be difficult, and questioned whether smokeless tobacco might not present an alternative. One participant cited a study by the IARC which shows that smokeless tobacco is still carcinogenic, and from experience in California, that it is inappropriate as a harm reduction strategy. She reminded the Task Force that California instituted farreaching smoking bans without offering such alternatives. The EC representative revealed that while some smokeless products have heretofore been banned in Europe, this partial ban will have to be lifted. Further, on other alternatives to smoking bans, the EC representative pointed out that the engineering required to provide sufficient ventilation to a smoked filled room in order to meet safety standards would imply such costs as to make it prohibitive. A WHO representative argued from a practical standpoint, that we simply do not have the standards by which to compare these products in a regulatory environment. He asserted that while the WHO is prepared to consider harm reduction strategies, it is wary of the path down which the tobacco industry is trying to lead it.
Productivity implications of smoking in the workplaces (Dr Ayda Yurekli)
Dr Ayda Yurekli, TFI, presented data on the cost of smoke in the workplace, both in terms of the cost of ETS for workers, as well as the cost for employers of having smokers on their payrolls. Her economic justification of smoke-free workplaces included the reduction of external costs to employers and non-smokers, as well the increase in health benefits through decreased prevalence and consumption as well as in non-monetary costs for smokers. External costs include absenteeism and smoking breaks, decreased productivity on the job, earlier retirement, higher health, life and fire insurance premiums, as well as increased maintenance and cleaning costs.
One study cited finds that quitting may increase absenteeism in the short run, but with time, will decrease to a rate somewhere between never smokers and continuing smokers.
She made particular note of the fact that smoking bans can have a strong impact on smoking prevalence and cigarette consumption. There is no evidence to suggest that bans on smoking in the workplace lead to increased consumption in the home. In fact, a study in the UK finds that a total public ban on smoking has resulted in a 22-37% increase in smoke-free homes between 1996 and 2003. There is also no evidence that sales or employment in restaurants, bars and hotels have suffered due to public smoking bans.
The representative from the World Bank cautioned against assuming that smoking bans cause job growth, in the absence of contextual data on general trends in employment and a discussion of confounding factors. UNICEF suggested there was a need for a good study comparing pre- and post-intervention periods, including for example, the interventions undertaken under SOLVE. What is the knowledge gain, and what is the increase in productivity?
6. Smoke free workplace in the UN - Case studies and impact WHO Smoke free policy and Kofi Annan's smoking ban in UN premises (Dr Yumiko Mochizuki) Dr Mochizuki provided an overview of the development of the smoke free policy at WHO. While smoking had been restricted to specific areas of the HQs since 1987, smoke free policies at WHO were intensified in 2000: smoking was only permitted in two designated outdoor areas. Opinion of the workers was very favorable. In a WHO survey, 95% of respondents from the WHO either completely or somewhat agreed with the WHO policy, whereas 47% and 70% of respondents at the ITU and ILO felt the same about their respective smoke-free policies. The percentage of smokers at WHO (21%) was somewhat lower than that of at the ITU or ILO (27% and 30% respectively). In all organizations, however, a plurality of respondents favored a total ban on smoking in
working areas. In a more recent survey of WHO employees, from 2005:
• 8.8% of respondents were smokers • 58.8% of smokers said they would like to quit within the next year, • 58.5% of smokers said they would like to receive help in-house, • 81.7% of respondents "strongly agreed" that WHO should ensure a smoke-free environment, • 67.7% of respondents felt that there should be more no-smoking signs around the WHO premises.
Since 1 December 2005, WHO applies a new rule for hiring smokers and tobacco users.
A candidate applying for a job at WHO is asked the following two questions "Do you smoke or use tobacco products?" and "If you currently smoke or use tobacco products, would you continue to do so if employed by WHO?". If the answer to both questions is "yes", the applicant will not be considered for selection. WHO sees its role as supporting cessation among its staff and prospective ones. In addition, WHO's Health and Medical Services provide support for cessation of tobacco use in the form of individual counseling, prescriptions for pharmaceutical therapy (including nicotine replacement products) and follow-up. WHO is at the forefront of the global campaign to curb the tobacco epidemic.
The Organization has a responsibility to ensure that this is reflected in all its work, including in its recruitment practices and in the image projected by the Organization and its staff members. In the case of tobacco, the importance for WHO not to be seen as "normalizing" tobacco use also warrants consideration in the Organization's recruitment policy.
In September 2003, Secretary-General Kofi Annan issued a bulletin asking diplomats and staffers to refrain from smoking inside New York City United Nations buildings “for the purpose of eliminating the risks associated with second-hand smoke for all those working on U.N. premises at headquarters.” Some diplomats reacted very strongly, pointing out that although the Secretary-General is the chief administrator at the U.N., the power to issue mandates comes from the members of the General Assembly. As a consequence, the policy can be applied only to staff and not the delegates. A letter jointly signed by WHO's DG Dr Lee and UNICEF's Executive Director Ms Ann Veneman was sent in November 2005 to SG Kofi Annan asking him to consider strengthening the enforcement of the tobacco free policy in the UN by implementing a ban of sales of tobacco products on UN premises and a complete smoking ban in all UN offices throughout the world.
Yomiko Mochizuki closed her presentation with a call for the creation of a common UN smoke free policy to be implemented in all UN premises at Headquarters but also at Regional Offices and Country Offices.
Smoke free policies of the other agencies
Participants each reported on the workplace smoking policy at their respective agencies and organizations. UNICEF, one of the early pioneers, initiated smoke free workplaces in UNICEF offices worldwide in the 1980s. The WCO has designated areas for smoking.
The WB, including its regional offices, is entirely smoke-free indoors. UNOG, where the final decision on such policies resides with the delegates, has been unable to institute a comprehensive smoking ban. The EC is smoke-free worldwide, and a mechanism exists for workers to report non-compliant seniors. The European Parliament, an exception, has designated areas for smoking. UNESCO also retains some designated smoking areas. The WHO, including EURO and PAHO regional offices, is entirely smoke-free indoors. HQ is moving towards extending the ban to the entire campus, including outdoors. Since 1997, the ILO has had designated areas for smokers, including in the cafeteria -restaurant workers are therefore still exposed to smoke. An ILO participant reminded the Task Force that budgetary constraints also influence the scope and implementation of smoking bans. In any case, insists the ILO, whatever measures are taken should be in consultation with staff groups. The FAO bans smoking in the workplace, but appears to have an implementation problem. Additionally, the representative pointed out that the duty-free tobacco was on sale in the building.
WHO emphasized that the decision on the new recruitment policy was made based on three factors 1) there is no safe way of using tobacco 2) WHO is at the forefront of tobacco control as a health organization and 3) WHO had to set an example in the nonnormalization of tobacco use.