"How does a company ensure workers within its supply chain enjoy adequate safety protection within the workplace, when it sources from supplier companies in countries with little or no safety protection, either because the law is inadequate or the law in not enforced?"

The dilemma for responsible business is how to address weak occupational health and safety (OHS) practices in its supply chain given the variety of complex circumstances wherein health and safety at work can be compromised. The dilemma not only arises in the short-term, in respect to the prevention of accidents at work, but in the long-term, in relation to diseases and injuries that can have lifelong effects on employee wellbeing and livelihoods.

Often responsible companies find themselves in situations where they face challenges in enforcing defined OHS standards amongst their suppliers, especially in countries where the health and safety regulatory framework is weak or where laws are poorly enforced and monitored. This gives rise to a number of concerns in relation to how suppliers, especially the smaller ones in developing countries that have limited resources, put in systems and procedures that will comply with developed countries' health and safety practices. This is a particular concern if suppliers do not have the resources to upgrade health and safety systems.

There are many situations that education and awareness-raising – rather than investment per se – assists in the implementation of safer practices. However, in other cases companies must invest in good OHS practices, which may result in an increased cost of production for goods, making these suppliers less competitive. That said, health and safety lapses can result in business discontinuity and costlier production; so savings in the short term often lead to higher costs longer term.

There is a higher risk of abuses and violations relating to the enforcement of health and safety standards occurring in countries where:

• Monitoring and implementation of internationally recognised workplace safety standards for companies with obscure supply chains is made challenging due to the inability to trace the sources of some products. For example, this may concern minerals, which may be traded through unregistered intermediaries, or apparel supply chains which may involve large amounts of sub-contracted home working
• Multinational Companies (MNCs) source from countries in which there is inadequate legal protection around occupational health and safety, both in terms of the quality of legislation and enforcement. These are also the countries where the workforce is either poorly educated and/or has received inadequate workplace health and safety training

Poor occupational health and safety standards, in addition to increasing costs and reducing productivity, can potentially expose MNCs to allegations of complicity. Poor standards can also give rise to civil law suits or highly publicised NGO campaigns against the company where accidents and injuries within the supply chain expose inadequate safety standards.

In such situations, how can MNCs ensure that their suppliers – and particularly small and medium-sized suppliers – address health and safety responsibly? Further, how can these suppliers, go beyond compliance with local national law to provide a level of protection to their workers that is aligned with the MNC's standards and/or international standards?

Defining health and safety

The International Labour Organization (ILO) states that occupational health and safety "encompasses the social, mental and physical well-being of workers."

Also, the World Health Organization (WHO) has summarised the various definitions of occupational health and safety (OHS) and characterises OHS practice as an activity that:

• Protects and promotes the health of workers by preventing and controlling diseases and accidents and by eliminating occupational factors and conditions hazardous to health and safety at work
• Develops and promotes healthy and safe work, work environments and work organisations
• Enhances the physical, mental and social well-being of workers and supports the maintenance and development of working capacity, as well as professional and social development at work
• Enables workers to conduct socially and economically productive lives, while contributing positively to sustainable development

In 2015, the ILO estimated that approximately 6,300 people die each day and 860,000 people are injured or become unwell due to occupational accidents or diseases. In 2012, the ILO estimated that approximately 4% of the world's gross domestic product is lost through the cost of injury, death and disease through absence from work, sickness treatment and disability and survivor benefits.

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Health and safety risks in the supply chain

Within their own operations, MNCs often have health and safety policies in place, ensuring safe workplaces and compliance with national law. However, third party suppliers may not have as stringent health and safety measures, resulting in unsafe workplaces and a higher rate of accidents. As a result, MNCs may be perceived to be complicit in health and safety violations of third-party suppliers and/or may suffer reputational damage by association.

Health and safety risks at work include, but are not necessarily limited to injuries caused by fire, workplace accidents and injuries due to dust, noise, toxic fumes, asbestos inhalation and radiation, and also stress and tiredness due to overwork.

MNCs are more likely to find lax health and safety procedures and practices in countries characterised by the following:

Lack of labour laws and their enforcement

Many countries at the national level have not ratified or implemented international conventions or introduced national legislation that would allow the government to regulate OHS in sectors or areas of risk. This creates a culture of impunity and a business environment that does not value workplace health and safety, making it difficult for responsible business to introduce improved procedures and policies.

If the country has laws on OHS they are often general and do not provide enough protection for workers, both in lower and higher risk industries. In some countries, labour laws do not enact specific provisions about the rights and responsibilities of workers or employees. Further, in many countries, the lack of laws and regulations controlling sectors, such as mining and construction, leave workers more vulnerable to unsafe working conditions without recourse to protect themselves.

Where there are adequate rules and regulations, a country may lack the resources, in money or manpower, to ensure that regulations are complied with and may fail to bring prosecutions or other sanctions against violations of OHS regulations in force.

However, in some instances, corruption and lack of adequate training for labour inspectors or other OHS officials contributes to lax regulatory enforcement. In a large country such as Brazil, for example, it is difficult for national and local governments to recruit an adequate number of labour inspectors to cover all industries and sectors as the country is vast.

Lapses in upholding standards in OHS may not only be due to the lack of law and policies, but employers not sufficiently understanding these laws. This can result in the company not implementing policies that comply with laws. Lack of compliance can also be due to a lack of education and a poor commitment to training in relation to laws and internal policies, both by the responsible labour ministries and within companies.

High levels of corruption

In countries where labour inspectors/enforcement officers are poorly compensated corruption could be an impediment on the enforcement of OHS standards. These inspectors/officers are more likely to accept bribes from employers breaching labour standards, including working hours. This is particularly of concern where corrupt inspectors are not held accountable for their actions by the responsible authorities and therefore act with impunity.

Large informal economy

Poor enforcement of health and safety standards can be common in countries with a large population of informal workers operating outside the formal business environment. Informal workplaces are not subject to inspections or are not held accountable for standards being met. Informal workers are not protected by the law, therefore their rights to a healthy and safe working environment are neither protected nor enforced. This means workers are particularly vulnerable in supply chains that stretch in lower tiers into the informal sector, or that rely on services from the informal sector, for example transportation and communications, home working etc.

Sectors that require higher health and safety standards

There are some sectors and industries that by their very nature are more hazardous than others. These include industries where people have to work underground, work at dangerous heights, operate heavy machinery or equipment, handle dangerous machinery and equipment, or work with sharp instruments or toxic substances.Compliance with international OHS standards call for national frameworks to be tailored to address the specific risks of each of these unique hazardous conditions.

Industries with high levels of risk exposure include:

Mining

Natural resource extraction industries such as mining, oil extraction, and forestry each have specific OHS issues. Miners for example, are particularly at risk from lack of oxygen when mining in low depths, exposure to other gases such as methane or carbon monoxide or from underground explosions causing injury or trapping the miners.

Further, mine structures can collapse through explosions and fire caused by a build-up of methane. Sometimes flooding can occur. Specific hazards vary according to the minerals being mined and the structure of the mine that is operated. In some mines, workers often use equipment and machinery that expose the workers to dust, noise and ergonomic hazards. Long hours of work present a hazard in and of itself as the practice increases the fatigue, which in turn increases the risk of an accident involving other hazards inherent in mining.

A lack of washing facilities can also exacerbate skin conditions that have been brought on by the chemicals and gases in the air as workers are not able to clean themselves after each shift.

The failure to create a culture of safety may also increase the number of accidents involving transportation within a mine site. For example, machinery left on mine roads or poor visibility due to dust or landscaping leaves workers exposed to traffic accidents.

Oil and gas

In the oil industry, the maintenance, construction and installation of oil platforms/structures and oil wells can be hazardous due to the machinery used, risks associated with precarious working arrangements and also the risks of falls from a height. Other hazards include working under high stress situations, respiratory tract diseases resulting from exposure to "harsh climates, infections and parasitic diseases."

Forestry

The ILO reports that forestry presents different challenges according to the type of forest and timber felling sites and processing facilities. In a 1997 ILO article entitled, "No more ‘Hang ups' and ‘Widow-makers'", it was found that, in general forest workers are required to handle heavy loads risking musculoskeletal disorders. The equipment used to log trees can also be hazardous, for example chainsaws that may cause injury or hearing impairment.

Agriculture

The agricultural sector, employing half of the world's workforce and prevalent in most developing countries, is another dangerous occupation.

According to a 2005 ILO release, the use of pesticides causes some 70,000 poisoning deaths each year, and at least seven million cases of acute and long term non-fatal illnesses.

The ILO in the Code of Practice in Safety and Health in Agriculture lists the following most frequent hazards including:

• Machinery: tractors, trucks and harvesters, cutting and piercing tools
• Hazardous chemicals: pesticides, fertilisers, antibiotics and other veterinarian products
• Toxic or allergenic agents: plants, flowers, dusts, animal waste, gloves (chrome), oils
• Carcinogenic substances or agents: certain pesticides, such as arsenicals and phenoxy-acetic herbicides, UV radiations
• Transmissible animal diseases: brucellosis, bovine tuberculosis, hydatid disease, tularaemia, rabies, Lyme disease, tinea, listerioses
• Other infectious and parasitic diseases: leishmaniasis, bilharziasis, facioliasis, malaria, tetanus, mycosis
• Confined spaces, such as silos, pits, cellars and tanks
• Noise and vibration
• Ergonomic hazards: use of inadequate equipment and tools, unnatural body position or prolonged static postures, carrying of heavy loads, repetitive work, excessive long hours
• Extreme temperatures due to weather conditions
• Contact with wild and poisonous animals: insects, spiders, scorpions, snakes, certain wild mammals

Construction

The ILO and the FAO state that construction is one on the three most dangerous sectors alongside agriculture and mining. According to ILO estimates from 2015, each year at least 108, 000 fatal accidents occur on construction sites around the world. Data from industrialised countries shows that the risk associated with construction work are 3 to 6 times greater than in non-industrialised countries.

The industry is still largely labour-intensive and has a tradition of employing migrant labour from lower-wage economies, with often precarious terms of employment. Many different parties are involved – employers, contractors, workers, architects, designers, clients, equipment suppliers and others – and demands from all these different parties can induce stress in the worker and may increase the prevalence of psychosocial problems.

In addition the ILO reports:

• One in six fatal accidents at work occur on a construction site
• In industrialised countries, as many as 25-40% of work-related deaths occur on construction sites, even though the sector employs only 6-10% of the workforce
• In some countries, it is estimated that 30% of construction workers suffer from back pains or other musculoskeletal disorders
• The global number of accidents and diseases in the construction industry is difficult to quantify, as statistical information is not available for many countries. But, 2015 ILO global estimates on work-related fatalities revealed that the construction industry recorded some 108, 000 fatalities out of a world total of 2.3 million.

The construction industry poses inherent health and safety risks throughout the world. The UK HSE, for example, states in a 2014/2015 report that the construction industry is one of the UK's most dangerous industries and that the most common causes of fatalities between 2010 and 2015 were:

• Falling from a height (97 cases)

• Being trapped by something collapsing (28 cases)
• Being struck by an object (21 cases)
• Being struck by a moving vehicle (21 cases)
• Contact with electricity (16 cases)
• Other (34 cases)

Building materials and equipment used in construction poses a risk to workers. In addition, employees may also be exposed to silica, dust, solvents and potentially asbestos as by-products if working in an older building. Working at great height increases the risk of falling. Proper preventative equipment such as steel capped boots and safety helmets must be worn to protect from falling objects. Manual handling such as lifting building blocks can cause back strain and other forms of muscle injury. There are risks of hazards on a building site, including the likelihood of electric shocks and fires.

Since construction is an activity that is relevant to all sectors, it is important for responsible businesses to consider construction-related health and safety risk exposures across their value chain.

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Real-world examples

Miners trapped in San José copper and gold mine

The collapse of the San José copper and gold mine near Copiapó, Chile, on 5 August 2010, which left 33 miners trapped underground for more than two months, occurred due to lax health and safety standards by San Esteban Mining Company and governmental agencies. The owners of the mine neglected to reinforce galleries and create a second emergency exit shaft.

Three workers had been killed at the mine in the last six years and dozens have been injured in accidents. Although the owners had been forced to suspend operations more than once for these “flagrant safety violations”, they were allowed to reopen the mine shortly after each accident. The state supervisory agency failed to close the mine down permanently.

In response to the San José mine collapse, the Piñera government formed an expert advisory commission tasked with reviewing and reforming the country's health and safety laws and enforcement procedures. The president has pledged to triple the budget for the government agency charged with supervising standards at mines. He has also dismissed senior officials at the safety regulator for the mining sector.

The government has also promised to double the number of mine inspectors with a view to ensuring that Chile's mines are inspected every eight months. Prior to the accident, the state body that oversees the mining sector, the National Geology and Mining Service (Sernageomin), was staffed by only 18 inspectors who were responsible for monitoring an industry that employed some 175,000 workers.

Despite the propagation of government initiatives that have been announced since the San José accident, the absence of a pledge by the Chilean government to ratify the ILO Convention on Safety and Health in Mines (No. 176) remains conspicuous. Upon ratification of this convention, signatory states are obliged to legislate and enforce regulations on safety in mines, such as those governing the provision of two emergency escape shafts. While this would have significant cost implications for businesses, some stakeholders – including trade unions and NGOs – consider that the unwillingness to accept such additional costs may lead to the neglect of miners' safety.

Bangladesh textile factory fire kills more than 120 and injures 200

On 24 November 2012, 117 workers were killed and more than 200 injured when the Tazreen Fashions garment factory caught fire. At the time of the fire more than 1,150 people were working inside the factory. According to reports, the fire broke out in an open-air area of the factory on the ground floor where fabric was being stored illegally. It is alleged that workers were told to ignore the fire alarm by management and continue working, corridors were blocked with highly flammable fabric and fire escapes were locked. In addition, due to a lack of external fire escapes it is reported that numerous workers died after jumping from the building to escape the fire.

In September 2015, the factory owner, his wife and 11 others were charged with causing death by negligence. The factory's managing director and its chair were accused of breaching building regulations, including those relating to the unsafe conditions of the stairwells. MNCs reported to source clothing from this factory included Walmart, C&A and Enyce. The BBC reported that "Lax safety standards and poor wiring causes several fatal factory fires every year in Bangladesh." In April 2005 for example, the Spectrum factory in Bangladesh collapsed due to a fire, killing 64 workers and injuring 84. Meanwhile, the Clean Clothes Campaign reports that "at least 172 workers were killed" between 2005 and 2010.

Rana Plaza factory collapse in Bangladesh

On 24 April 2013, the Rana Plaza factory collapsed in the Savar Upazila, Dhaka, Bangladesh, killing 1,134 people and injuring approximately 2,515. The factory collapse highlighted the poor working conditions in Bangladesh's garment industry.

It is alleged that the upper four floors of the complex had been built without a permit and the building was not designed to house factories with heavy machinery. The day before the disaster took place, it was reported that cracks had appeared in the buildings walls and the building was evacuated. However, the following day the factory owner, Mohammad Sohel Rana, told workers to return to work, and managers at another factory within the complex, Ether Tex, threatened to withhold workers' pay for a month if they refused to come to work. On the morning of the 24 April there was a power cut and diesel generators housed on the top floor were started up sending powerful vibrations throughout the building and triggering the collapse.

A number of global brands are reported to have had orders with one of the five garment factories located in Rana Plaza when the incident took place including Walmart, Mango, Inditex, Matalan, Benetton and The Children's Place.

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Legal risks

Most countries have legislation providing for OHS protections. If a company is found to have breached any legislation surrounding limitations on health and safety then it could face penalties. Penalties could include fines, remediation, and restitution for employees or compensation. These cases are often not reported as they are minor offences with minor penalties.

However, there are examples of cases where companies have had to pay damages and face reputational impacts due to not upholding health and safety standards.

Mankayi v AngloGold Ashanti Ltd: In this case, Thembekile Mankayi, a South African gold miner sued his former employer AngloGold Ashanti (‘AngloGold') after developing the lung disease silicosis while working for the mines. He claimed that AngloGold failed in its duty of care to make the workplace safe and healthy for its employees: both under statute and at common law. Mankayi made a claim for delictual damages: this type of damages extends beyond non-financial loss to include injured feelings.

Mankayi had received compensation through what is called the Occupational Diseases in Mines and Works Act ("ODIMWA") (No. 78 of 1973). This Act does not preclude a worker from claiming under common law. However, s35 of the Compensation for Occupational Injuries and Diseases Act ("COIDA") (No. 130 of 1993) does preclude employees from initiating negligent actions at common law (to receive delictual damages). AngloGold argued that the preclusion under s35 of COIDA also precludes employees seeking compensation under ODIMWA.

The court found that because ODIMWA's compensation is materially different to COIDA, it was an earlier specialised act. Therefore, because s35 only mentions the COIDA and no other Act, the court found that those seeking common law claims with compensation claims under ODIMWA could do so.

Unfortunately, Manyeki died days before the High Court judgement. He made a claim for ZAR2.6 million (around US$390,000) in compensatory damages, which now can be pursued in the appropriate court.

Not only has this case clearly resulted in high legal costs for the company it gas also resulted in negative publicity. The case has been pending since October 2006 and has made its way through the entire court system. It has also paved the way for other miners in similar circumstances to claim damages.

Operational risks and risks to business continuity

Poor health and safety practices and unsafe workplaces increase the risk of accidents in workplaces, resulting in interruptions at work, work stoppages or employee shortages.

There are direct and indirect risks for companies:

Direct risks include:

• The loss of essential staff
• Business disruption due to accidents
• Damage to products or machinery and equipment
• Increased insurance premiums
• The costs of improving workplace systems

Indirect risks include:

• Decrease in job satisfaction and morale
• An increase in absenteeism
• The need, at times, to train a replacement employee while a worker is sick or injured
• Loss of reputation within a supply chain

Reputational risks

MNCs could face reputational risks that may affect sales and revenue. For example, the Clean Clothes Campaign is currently running a campaign to stop the sand blasting of denim for fashionable effects called "Stop the Killer Jeans!" Sandblasting is used to wear down denim to make it look used, a fashionable effect. In one form of sandblasting, where sand containing silica is used, workers may be exposed to breathing this in if workers are not wearing protective equipment and there is no proper ventilation. In the long term, this could result in the workers developing silicosis – a deadly lung disease. The campaign is targeting such brands as Benetton, Diesel, Dolce & Gabbana, New Yorker, Orsay, Replay and Versace.

The campaign has been largely successful, as some jeans manufacturers have dropped the use of sandblasting. The government of Turkey has banned sandblasting when the materials used contain silica. These actions came after around 600 sandblast workers had been diagnosed with silicosis over the past decade. Some jeans manufacturers that have since banned the sandblasting process include New Look, Marks & Spencer, H&M and Levi's.

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The UN ‘Protect, Respect and Remedy' Framework for Business and Human Rights provides guidance on how to protect individuals and communities from corporate related human rights harm.

The framework is comprised of three key principles:

• Protect: The state duty to protect against human rights abuses by third parties, including business;
• Respect: The corporate responsibility to respect human rights; and
• Remedy: Greater access by victims to effective remedy, both judicial and non-judicial.

The framework states that in addition to complying with national laws businesses have a responsibility, in the context of the countries where they operate, to respect human rights through their own business activities and through their relationships with third parties – such as business partners and entities in their supply chains. To meet this responsibility, the framework notes that businesses should engage in human rights due diligence and specifies the main components of the process:

Policies: Including a human rights policy containing broad commitments, supported by more detailed guidance in specific functional areas

Impact assessment: Including assessments that explicitly reference internationally recognised human rights and are used by companies to avoid potential negative human rights impacts on an ongoing basis

Integration: Including the embedding of respect for human rights throughout a company

Tracking performance: Including regular updates of human rights impact and performance

The Guiding Principles for the Implementation of the UN "Protect, Respect and Remedy" Framework aim to provide "concrete and practical recommendations" about how businesses can operationalise their responsibility to respect human rights. According to the Guiding Principles, the responsibility to respect human rights requires responsible companies to:

• Implement a human rights policy
• Apply human rights due diligence
• Provide for remediation

The UNGPs apply to all States and to all business enterprises, both transnational and others, regardless of their size, sector, location, ownership and structure.

The UNGPs have experienced widespread uptake and support from both the public and private sectors, and numerous companies have publicly stated their commitment to the Guiding Principles. The UN Guiding Principles Reporting Framework is also used by companies to report on how they respect human rights.

Companies can seek specific guidance on this and other issues relating to international labour standards from the ILO Helpdesk. This aims to help company managers and workers understand the ILO approach to socially responsible labour practices and to assist in the development of good industrial relations.

Specific actions that responsible business might take include:

1. Adopting a forward-looking human rights compliance policy with procedures to match

It is a basic requirement that a company operating in emerging economies should develop and implement human rights policies and procedures (this should be throughout its subsidiaries) that encourage managers and suppliers to take a socially responsible approach to health and safety.

Specific actions may include:

Policy

• Compliance with national laws concerning health and safety, such as the provision of protective clothing and equipment, ensuring machinery is in good working condition and regulating temperature and ventilation. Where local laws differ from company policy, the higher standard should prevail. Company policy on health and safety should be guided by ILO Conventions on health and safety (see examples below)
• If there are no national health and safety laws or if laws are weak or poorly enforced, the company policy should commit to international standards, ILO Convention No. 155, on Occupational Safety and Health, ILO Recommendation No. 164, on Occupational Safety and Health and ILO Convention No. 174, on the Prevention of Major Industrial Accidents
• Committing to voluntary international health and safety guidelines including OHSAS18001 and complementary standards including the International Organization for Standardization's 14000 and 14001. The Occupational Health and Safety Assessment Series assist organizations in managing health and safety risks in their operations. Companies that have adopted the OHSAS standard include Coca-Cola, Lexmark and IBM
• Ensuring that company health and safety policies are tailored to the particular risks in the industry or sector
• A grievance mechanism, in line with the Ruggie Framework, which allows employees to raise issues in relation to health and safety
• Supplier contracts with the MNC must require compliance with the MNC's social policy, as well as to maintain a grievance process to address claims in relation to health and safety. For example, Rio Tinto's Health, Safety, Environment and Quality (HSEQ) management system standard requires that "principal contractors, suppliers and others with whom it has a substantial involvement" must comply with this standard

Procedure

• Implement a health and safety programme to ensure the realisation of the policy by having a comprehensive management system in place. GE, for example, has a comprehensive Environmental, Health and Safety (EHS) management system that focuses on four key building blocks. These building blocks include (1) operational responsibility and accountability relating to EHS performance, (2) programmes that are applicable to the company's global operations, (3) effective training and the tools and (4) metrics. For more information see, Overview of EHS Policy, Team & Program
• Undertake due diligence. This may be particularly beneficial to companies in high risk industries, such as the mining and manufacturing sectors
• Monitor the prevalence of accidents and ill-health within an industry and the social and economic context in order to gauge underlying risks of the workplace and how health and safety issues apply to particular industries and workplaces
• Effectively communicate any health and safety policy, associated guidance and procedures to personnel and, if relevant, to suppliers, subcontractors and business partners
• Provide employees with regular training and awareness building to sensitise them to the risk of accidents and the related dangers of working long hours without breaks. This should also foster awareness and shared responsibility and accountability in relation to health and safety practices
• Continually review and improve health and safety policies and procedures to ensure that they are in-line with best practice and to train managers accordingly. Dow monitors health and safety policies through its Environment, Health and Safety Committee. The committee's functions include the review of health and safety policies and the management of health and safety practices. The committee reports back to the company's board of directors so it is able to fulfil its responsibilities in respect to the environmental health and safety policy
• Implementation of grievance procedures for both employees and for suppliers. They can be internal or they could be at the industry-level (e.g. ombudsperson)

2. OHS safety training for suppliers and company personnel on health and safety limitations

Training is a key component of responsible approaches to preventing weaknesses and gaps in health and safety mechanisms in the workplace. Company managers and suppliers can benefit from ongoing training in the following areas:

• Understanding the relevant health and safety laws within the country
• Understanding and implementing company policy on health and safety
• Establishing a different set of health and safety procedures for young workers. Most workers under 18 are potentially more prone to accidents or disease than adults
• Understanding the issues and risks for a company with respect to poor health and safety policies and procedures

The ILO provides guidance on health and safety on certain issues and sectors, including agriculture, HIV/AIDS, child labour and construction. The training materials provide useful information on hazard, risk and prevention which contributes the establishing an effective health and safety culture.

3. Employee participation in health and safety practices and procedures

Employee's taking an active part in health and safety practices and procedures – this can be encouraged throughout the supply chain. Workers will then be empowered to actively take care of their own workspace and look out for potential hazards. Incentives – for example, a cash incentive for remaining accident free for a certain time period, the company hosting a dinner in celebration of accidents not resulting in deaths – can also be provided, but should not be used to deter workers from reporting injuries.

This could also include employers becoming more healthy, which would inturn decrease the rate of sick days in the long-term. Companies could encourage employees, for example, to undertake certain activities through providing them with access to sports facilities. In 2009, BASF launched a health promotion campaign which encourages employees to improve their health through increased physical activity. MNCs could also provide nutritious food that is cheaper than other food (thereby incentivising employees to choose the cheaper, more nutritious option).

Employees working on a daily basis have a much better understanding as to the health and safety risks of their working environment and therefore their suggestions should be taken seriously.

Examples of employee participation could include:

• Employees' participation in the health and safety groups/committees within a company to make suggestions for steps to mitigate particular health and safety hazards in operations
• Rewarding workers on any health and safety improvements made that result in reduced injuries or incidents
• Empowering workers to make decisions on whether they should continue to work, if the work environment changes and becomes more dangerous
• Encouraging participation in sports, health and nutrition education

Please note that incentives and rewards have to be properly structured and provide concrete results. These incentives cannot indirectly punish workers for reporting an accident as these types of incentives imply that it is always the fault of the worker that he/she had an accident, instead of the fault of operational or strategic policies and practices.

4. Social auditing and monitoring

A company should consider including in its social audits monitoring its own operations as well as major suppliers' factories in countries where a high incidence of health and safety have been reported. Such monitoring or audits can be undertaken by the company or a third-party contracted by the company.

Audits could include:

• Interviewing management on policy and practices ensuring that health and safety policies and procedures are being honoured. The auditor should ascertain, for example, whether machinery is well maintained and up-to-date
• Interviewing employees on their health and safety practices – including what training they have received – preferably out of the work setting and anonymously so as to assuage any fears they may have over losing their jobs
• Inspecting the factory/workplace for any signs of workers appearing overly tired, fatigued or stressed
• Inspecting time-keeping records to ensure that workers' overtime hours are not excessive

Further, the implementation of health and safety measures shall be continuously monitored, evaluated.

It is imperative to uphold a continuous information disclosure process. Companies should continuously report back to their stakeholders about progress, consultation outcomes and issues addressed through grievance mechanisms.

5. Improving the productivity of business partners and suppliers through improved health and safety practices

A company can introduce methods to increase productivity. While commercial pressures will often mean buyers and employers will have to find a way to reduce non-labour costs to compensate for a reduction in health and safety, MNCs might be in a strong position to help their suppliers achieve such non-labour cost reductions.

This could be achieved through "capacity building" efforts such as:

• The promotion and/or financing of new technologies to improve health and safety
• The promotion of new production techniques that are safer
• Employee training on health and safety procedures and on how to use machinery and equipment
• Improved logistical coordination and planning to reduce the impact of production problems and disruptions

Nonetheless, MNCs will need to implement health and safety mechanisms to ensure the improvement employee health, which, in turn translates into lower costs incurred as a result of occupational accidents and disease.

A company is likely to see initial non-financial benefits almost immediately, such as employees taking fewer days' leave due to illness. Non-financial benefits in the long-term include increases in productivity and reductions in employee turnover due to greater work satisfaction. Financial benefits include cost savings in relation to reduced staff turnover (therefore the reduction of recruitment costs), improved worker/management relationships.

6. Multi-stakeholder engagement and programmes

Multi-stakeholder programmes can help companies to develop programmes to minimise the risk of unsafe health and safety practices throughout their supply chains. For instance, a coordinated effort amongst suppliers, business partners and other companies aimed at managing health and safety in the supply chain, through creating a "level playing field", may enhance the chances of making a positive impact on a supplier's working environment.

Such an effort could initially focus on contexts where there is a critical mass of buyers who have a long-term relationship with the supplier and are willing to ensure that health and safety policies and practices are properly implemented. This may be arranged through industry groups, multi-stakeholder initiatives such as the Ethical Trading Initiative and the Fairtrade Foundation.

Sedex, for example, provides a secure database for companies to store and share ethical data including self-assessment, audit reports and corrective action reports and status. Such information could be used by member companies to coordinate their efforts in the implementation of health and safety policies in supply chains.

7. Grievance mechanisms

Where businesses identify responsibility for adverse impacts, they should provide for, or cooperate in their remediation and offer routes to judicial or non-judicial grievance mechanisms. Businesses can provide for operational-level grievance mechanisms as recommended in the Draft Guiding Principles. Operational level grievance mechanisms are administered by companies alone or in collaboration with relevant stakeholders and are accessible directly to "individuals and communities who may be adversely impacted by a business enterprise".

Operational-level grievance mechanisms may help companies identify human rights impacts and grievances and make it possible to address such grievances and remediate human rights impacts at an early stage.

According to guidance from Harvard University, any grievance mechanisms should ideally be:

• Legitimate and trusted – and ideally be overseen by the company and its employee representatives
• Well-publicised and accessible
• Transparent in terms of process and outcomes – whilst allowing for confidentiality where necessary and desirable
• Based on engagement and dialogue between the relevant parties (where appropriate)
• Predictable in terms of process – including key steps and options within the process, timeframes and the monitoring of outcomes
• Fair and empowering – including the appropriate treatment of imbalances in power, knowledge and influence between protagonists
• A source of continuous improvement – including the achievement of learning on the basis of received complaints, the identification of systematic problems within the workplace and lessons learnt from the grievance process itself

Access to judicial and administrative grievance mechanisms available in the country should never be obstructed. Any mechanism should have processes in place to receive, record and address health and safety grievances by employees. A collaborative approach involving employees can facilitate the solution finding process. Any decision taken should be reported back to the employees or other stakeholders.

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Health and safety risks worldwide

Verisk Maplecroft's Occupational Health and Safety Risk Index details the prevalence of such risks for businesses worldwide. This Index assesses the risk to OHS using data on the number of accidents and fatalities in work-related accidents, absence from work and conventions ratified. The Health and Safety Risk Map reveals the level of risk to OHS in 198 countries. In accordance with the ILO's Occupational Health Safety Convention 1981, for the purpose of this Index, 'health', in relation to work, indicates not merely the absence of disease or infirmity, it also includes 'the physical and mental elements affecting health' which are directly related to safety and hygiene at work.

International legal instruments

The ILO has approximately 80 standards or codes of practice that address matters of OHS , both on a general level and in relation to particular sectors.

These include:

ILO Convention No. 155, on Occupational Safety and Health

This is a general convention on health and safety and covers "all branches of economic activity". However, a country can apply to opt out of the application of this Convention in respect to particular areas of economic activity due to the special nature of health and safety problems that may arise. This includes, for example, maritime shipping or fishing.

Each state party to this Convention must "formulate, implement and periodically review a coherent national policy" on OHS (Article 4). This process should involve consultation with representatives of both employer and employee organisations.

Under Article 5 of the Convention, the main issues to be addressed in the national policy include the safe design of workplaces, the capacity of workers to use tools and machinery, adequate health and safety training, cooperation and communication at all levels, and the protection of workers against inappropriate disciplinary action.

Further, under the Convention employers are required to ensure that workplaces are safe and that workers are provided with adequate clothing and protection (Article 16). The workplace must also be adequately equipped to deal with accidents (Article 18). In turn, workers are required to fully co-operate with the employer in respect to health and safety guidelines and regulations (Article 19).

Only 64 member states have signed this convention. Notable omissions include the Philippines, Indonesia, Pakistan, Bangladesh, Iran, Egypt and India.

ILO Recommendation No. 164, on Occupational Safety and Health

The Recommendation gives further guidance to government on what it should integrate into the national policy plan. Such fields of action include (Chapter II), but are not limited to:

• The design, site, structural features, installation and maintenance etc. of workplaces
• Lighting, ventilation, order and cleanliness of workplaces
• Temperature and humidity and movement of air
• Use of machinery
• Maintenance, design, testing and inspection of machinery
• The prevention of workplace physical and mental stresses that may harm workers
• Radiation protection
• Prevention of hazards such as fire, noise, vibration, explosions etc.

It also provides more detail on how a national action plan should be created and implemented, how the government can implement the plan as well as what employers are required to undertake to verify they are complying with laws, regulations and standards.

ILO Convention No. 174, on the Prevention of Major Industrial Accidents

This Convention, ratified by only 18 countries, addresses how countries can take appropriate measures to prevent major accidents. This includes preventing the risks associated with major accidents occurring and minimising the effects of any accidents that actually occur.

The Convention includes provisions on the use of hazardous substances and applies to all "major hazards installations" (Article 1). It does not apply to nuclear and military installations, or transport outside the site of an installation (except when it is via pipeline).

A major hazard installation is defined as "one that produces, processes, handles, uses, disposes of or stores, either permanently or temporarily , one or more hazardous substances in quantities which exceed the threshold quantity" (Article 3).

This Convention also requires the country to periodically implement a national policy to ensure the prevention of major accidents (Article 5). The national authority is obliged, in cooperation with employee and employer representatives and other relevant stakeholders, to establish a system to identify hazardous installations (Article 5).

Employers are also given certain responsibilities under the Convention including identifying a major hazard installation and conducting safety reports (Articles 7, 10 and 12). Employees also have a duty to comply with practices and procedures that are aimed to prevent major accidents (Article 21).

Countries that have signed the treaty include Brazil, Russia and India, however no other N11 or BRICs country has done so.

Conventions covering the working environment

There are a number of conventions covering the working environment and the tools and substances used in these environments.

Up-to-date conventions include:

• ILO Convention No. 148, on the Working Environment (Air Pollution and Vibration) Convention ratified by 45 countries, including Brazil, Egypt and Russia
• ILO Convention No. 162, concerning Safety in the Use of Asbestos ratified by 35 countries, including South Korea and Brazil
• ILO Convention No. 170, concerning Safety in the use of Chemicals at Work ratified by 18 countries, including China, Brazil, South Korea and Mexico
• ILO Convention No. 115, concerning the Protection of Workers against Ionising Radiations ratified by 50 countries, including Brazil, Egypt, Mexico, Turkey and Russia

Conventions for sectors or industries

There are also conventions that cover particular sectors or industries and they include the following up to date Conventions:

• ILO Convention No. 152, concerning the Occupational Safety and Health (Dock Work) Convention ratified by 26 countries, including Turkey, Egypt, and Brazil
• ILO Convention No. 110, concerning Conditions of Employment of Plantation Workers ratified by 12 countries, including the Philippines, Mexico and Brazil
• ILO Convention No. 134, concerning the Prevention of Occupational Accidents of Seafarers ratified by 29 countries, including Turkey, Brazil, Egypt, Mexico, Nigeria and Russia
• ILO Convention No. 184, concerning Safety and Health in Agriculture ratified by 16 countries, none of which include the N11 and BRICs countries
• ILO Convention No. 176, concerning Safety and Health in Mines ratified by 30 countries, including Brazil and Philippines
• ILO Convention No. 167, concerning Safety and Health in Construction (1988) ratified by 29 countries including, China, Brazil, Mexico and Colombia

Health and safety and the impingement of rights

Unsafe and unhealthy workplaces can affect the following rights:

The right to a safe working environment (ICESCR, Article 7) (as well as ILO Conventions, including but not limited to, ILO Convention No. 152, on Occupational Safety and Health (1979), ILO Convention No. 155, on Occupational Safety and Health (1981), ILO Convention No. 161, on Occupational Health Services (1985), ILO Convention No 170, On Chemicals (1990) and ILO Convention No. 174, on the Prevention of Major Industrial Accidents Convention(1993): An unsafe working environment will have a direct effect on a worker's right to a healthy and safe workplace.

The right to enjoy just and favourable conditions of work (ICESCR, Article 7): Employees have a right to just and favourable working conditions, including healthy and safe working conditions, fair wages, equal remuneration for work of equal value, the right to rest, leisure, holidays and reasonable policies encompassing health and safety as part of the conditions of work.

The right to social security, including workplace insurance (ICESCR, Article 9): If there is an accident at work, an employee has the right to adequate social protection. Under the ICESCR this means that a worker should be entitled to all social security benefits including health care and sickness and protection if the person is injured or suffers an illness that is work related. Without this protection, injured employees that are unable to work again due to an injury suffered at work will not be able to support themselves, nor their family.

The right to health (ICESCR, Article 12): An unsafe and unhealthy working environment can impinge upon a worker's right to health. Working unprotected in hazardous conditions such as in a mine, could result in long-term physical injuries and illness including chronic pulmonary disease due to exposure to crystalline silica. Exposure to coal dust can give rise to pneumoconiosis as well as chronic pulmonary disease. An accident at work that results in a permanent physical disability, such as the loss of a limb, can also affect a person's ability to enjoy a home life to the full, or recreational activities.

The right to a family life (Article 10, ICESCR): An injury or illness arising from a person's employment may disrupt family activities and recreational activities undertaken with the family.

The range and scope of workplace injuries

The range and scope of health and safety issues is vast; however, some of the more important risks have been highlighted below, as many of these contribute to the significant numbers of occupational injuries, deaths and diseases suffered each year by workers.

Accidents

The most common types of health and safety incidents at work are accidents and injuries from work equipment. Correct and safe machine operation will depend upon adequate worker training, safeguards on the equipment, proper protective gear for the worker and ensuring that the equipment is well maintained and free from mechanical defects.

Accidents also occur where workplaces are inadequately maintained, there is an inadequate attention to spills and obstructions on the work floor, etc. Lack of first aid equipment and trained first aid personnel prevents health symptoms and injuries from being treated quickly which can prevent early recovery. Early reporting of symptoms and recognition of the seriousness of poorly maintained workplaces and first aid equipment will play a role in reducing the severity or deterioration of the injury.

Falls from hazardous heights are particularly common in the construction industry and for contractors, such as roofers. In most of these cases, this is due to the use of inadequate safety equipment, inadequate risk assessments and the failure to implement adequate risk mitigation mechanisms.

Exposure to hazards

Fire and explosions can be caused by a variety of reasons, including careless behaviour, improper storage and handling of volatile or flammable materials and lack of precautions for any pressure systems. They are particularly dangerous given the level of damage, loss of life and severe injury that can occur within moments. However, the effects of fire and explosions can be compounded by inadequate emergency planning and response, such as a lack of fire doors, blockage of emergency exits or lack of employee training for the event of a fire.

Musculoskeletal disorders

Musculoskeletal disorders result from a range of tasks in the workplace. Workers who lift heavy loads at work are prone to back strain, injury and other muscle damage if loads are too heavy or if the worker lifts or carries the load incorrectly. For example, nurses and care assistants who need to lift patients must have access to specialised equipment or be assisted by other members of staff to prevent back injuries or muscle injuries, as well as to safeguard the welfare of the patient.

Other types of injuries occur when there are repetitive movements in conjunction with inadequate breaks or safety management. For example, workers operating pneumatic drills - such as miners or construction workers - for long periods of time can suffer a debilitating disease known as ‘Vibration White Finger' or Raynauds Disease.

The UK Health and Safety Executive (HSE) in its guidance on hand-arm vibration at work has estimated that, in the UK, two million workers are exposed to hand-arm vibration. The guidance also states that exposure to hand-arm vibration occurs in many industries, particularly where the use of power tools is extensive, e.g. construction/demolition, mining, quarrying, forestry, shipbuilding/repair, motor vehicle manufacture and repair, foundries, public utilities (gas, electric, telecoms, water), railways and aircraft manufacture.

The HSE has also identified other risk factors such as:

• Bending and twisting repeating an action too frequently
• An uncomfortable working position
• Exerting too much force
• Working too long without breaks
• An adverse working environment (e.g. hot, cold)
• Psychosocial factors (e.g. high job demands, time pressures and lack of control), and
• Not receiving and acting upon reports of symptoms quick enough

Office workers are particularly prone to injuries from display screen equipment and the problems associated with the equipment include visual problems, eye strain and injuries, risks of injury to arms, wrists and elbows, and also mental stress.

The HSE, in its guidance on musculoskeletal disorders, explains that these disorders are preventable or can be minimised. However, they are found in every business sector and in the UK alone an estimated 9.4 million working days are lost annually due to work-related musculoskeletal disorders.

Hazardous substances

Typically, the types of disorders that can occur from exposure to hazardous substances include cancers, respiratory illnesses and skin diseases.

Asbestos

The ILO publication "Facts on Safety at Work" reports that asbestos is responsible for 100,000 occupational deaths per year. In the UK, it is estimated that 120,000 people may be victims of exposure to asbestos. Asbestos was widely used from the 1950s onwards and is present in many buildings and workplaces. Asbestos only becomes hazardous once fibres are exposed, which typically occurs only when surfaces are damaged. Asbestos fibres are easily breathable, without any warning that the fibres are present in the air. Once exposed, an individual does not suffer from the effects of the asbestos until many years after the initial exposure. The legacy of this lag time in asbestos related diseases and the continued presence of asbestos in many buildings mean that the risks from asbestos remain high.

Silica

Crystalline silica is found in concrete, masonry, sandstone, rock, paint and other abrasives. The cutting, breaking, crushing, drilling, grinding or abrasive blasting of these materials may produce fine silica dust. It can also be in soil, mortar, plaster, and shingles. Small pieces of silica dust get in the air and become trapped in the lungs. As the dust builds up in the lungs, fluid accumulates damaging the lungs, making it harder to breathe. At present, there is no cure for the disease silicosis, and deaths from silicosis can occur within only a few years after exposure. The workers particularly prone to silicosis are construction workers and workers, such as tile experts who may work in the same vicinity. In "Facts on Safety at Work" the ILO estimates that in Latin America, 37% of miners have some degree of the disease.

Radiation

Radiation exposure is one of the deadliest hazardous substances, in that exposure to radiation can cause numerous diseases and conditions, particularly cancer and genetic mutations in unborn children. The different types of radiation hazards are exposure to ionising radiation, radioactive materials, radon and ultra violet radiation. Most incidents of radiation exposure generally occur to individual workers; occasionally, however, communities have been affected by radiation leaks.

Chemicals

Chemicals, in the form of liquid, gas and solids are used extensively in the world. The widespread application and use of chemicals requires proper attention and training to using them properly, safely, with emphasis on adequate labelling and ensuring workers are fully informed of the risks and have proper protective equipment. For example, lack of worker knowledge may lead to the inadvertent mix of two chemicals producing a third more dangerous chemical.

Noise disorders

As part of the WHO's Environmental Burden of Disease Series, the publication "Occupational Noise" profiles the impact of noise on workers who are often exposed to noise levels above 85 decibels for more than eight hours a day which is potentially hazardous. Exposures can come from use of heavy machinery but also background sound in places like foundries, factories or paper mills. Hearing related disorders include deafness and tinnitus, which is described as a ‘ringing in the ears'. Such irreversible hearing impairments are easily preventable.

Communicable diseases caused by exposure to pathogens

HIV/AIDS and Tuberculosis (TB)

The ILO has developed a "Code of Practice on HIV/AIDS and the World of Work" in recognition of HIV/AIDS as a workplace issue. This is not only because it affects the workforce, but also because the workplace can play a vital role in limiting the spread and effects of the epidemic. For example, a top health and safety priority for health care workers is the prevention of exposure to HIV due to needle-stick injuries from contaminated needles.

The Code of Practice states that there should be no discrimination or stigmatisation of workers on the basis of real or perceived HIV status (Key principle 4.2). Promoting gender equality and empowering women is vital for the prevention of the spread of HIV infection and assists in enabling women living with HIV/AIDS to cope (Key principle 4.3). A healthy work environment that is adapted to the state of health and capabilities of workers (Key principle 4.4). HIV/AIDS screening should not be a requirement for either job applicants or employees (Key principle 4.6). Access to personal data relating to a worker's HIV status should be confidential and consistent with existing ILO codes of practice (Key principle 4.6).

The ILO's 2010 report Recommendation concerning HIV and AIDS and the World of Work demonstrates how the effects of the HIV/AIDS epidemic are dramatically impacting the global workforce. The ILO's Code of Practice on HIV/AIDS and the World of Work reports that while all employers are suffering loss of competent workers with skills and experience, certain industries have more of their workforce affected by HIV/AIDS. Examples include the mining industry and the transport and logistics sector, where the long hours, separation from communities and required mobility of the workers lead to increased risk-taking activities in relation to sexual practices.

HIV/AIDS impacts the workplace in the following way:

• Lower labour productivity
• Higher employee benefit costs
• Higher labour turnover rates
• Loss of experience and vital skills, and
• Higher recruitment and training costs

The HIV/AIDS dilemma details the risks and issues, presenting examples of good business practice in preventing worker exposure to HIV/AIDS. Examples include the introduction of voluntary testing or engaging in ‘train-the trainer' programmes which help to facilitate HIV/AIDS education, awareness and preventative measures.

Tuberculosis (TB) is a bacterial disease which affects the lungs and is easily communicable. Workers that contract HIV/AIDS are prone to TB, as patients are most vulnerable to TB infection when immune systems are compromised. Maplecroft's Global Map of Tuberculosis gives more details on the risks and impacts that business suffers from having a TB affected workforce. For example, TB has a direct impact on the profitability of individual businesses by generating increased costs: direct costs (related to inefficiencies and treatment) and indirect costs (such as the replacement and retraining of workers). Moreover, where TB incidence rates are high, workplaces are often the sites where employees face increased risks of contracting TB, making it an occupational health hazard.

Other diseases

Poor-quality drinking water, poor sanitation, poor hygiene in the workplace and lack of OHS knowledge by employees also contribute to other illnesses affecting worker health. In addition, workers may also be exposed to infectious and parasitic diseases such as malaria, viral and bacterial diseases, schistosomiasis, tse-tse flies, zoonosis and severe acute respiratory syndrome (SARS).

The WHO publication "Global strategy on occupational health for all: The way to health at work" reports that Hepatitis B and Hepatitis C viruses (particularly among health care workers), as well as chronic parasitic diseases (particularly among agricultural and forestry workers) are the most common occupational diseases resulting from such exposures. The growing mobility of people from disease endemic areas to areas of low risk has increased the risk of the spread of the disease, particularly to health care personnel. Immunisations can be used to control some hazards such as Hepatitis A and B, while for some others careful personal and occupational hygiene and use of personal protective devices or immunoglobulin (Hepatitis C) may be the main preventive strategy. A new occupational health problem affecting health service workers and certain other groups is the re-emergence of traditional epidemics of communicable diseases such as TB in, for example, Eastern Europe.

Other risk factors

Stress

Although the word ‘stress' has been commonly adopted into everyday language and can be used indiscriminately to describe varying degrees of work pressures in modern working life, the effects of stress upon workers must not be underestimated and the symptoms of stress should be adequately recognised by an employer. The ILO report ‘What is workplace stress?' explains that the effects of stress cause "disorders that are responsible for the great majority of disease, death, disability and medical care use in most industrialised countries, ranging from chronic fatigue to depression, insomnia, anxiety, migraine, emotional upsets, allergies and abuse of tobacco and alcohol. Also, in the longer term, stress can contribute to hypertension, and as a consequence to the development of heart and cerebrovascular disease, as well as to peptic ulcers, inflammatory bowel diseases and musculoskeletal problems. It may also alter immune functions, which may in turn facilitate the development of cancer."

The ‘What is workplace stress?' publication reports that several recent studies have highlighted the links between work-related stress, violence at work, the abuse of drugs and alcohol and tobacco consumption. The publication suggests that stress at work contributes to negative emotions such as fear, helplessness and failure which may lead to behaviours such as drinking, using drugs and other harmful substances. This, in turn leads to other health issues.

The impacts of worker stress have a number of cost implications for employers, including absenteeism, higher medical costs and staff turnover, with the associated cost of recruiting and training new workers and reduced productivity and efficiency.

The following are recent estimates which relate to the cost of work-related stress:

• In 2012 15 million working days were lost due to stress-related disorders in the UK. Further, in 2013 the cost of work related stress amounted to £6.5 billion.
• In Australia in 2013, workplace stress cost the economy AU$14.8 billion a year and costing employers AU$10.11 billion per year. This does not include indirect costs such as the cost of re-hiring and re-skilling due to high staff turnover that is associated with stress.
• 550 million working days are lost each year due to absenteeism in the United States and over half of these absences are stress-related

Excessive working hours

Health and safety protocol is compromised by long working hours or continuous shifts without breaks. Long hours can lead to sleep deprivation affecting alertness, concentration and recognition of impending dangers. Other effects of long working hours include stress and musculoskeletal disorders. Longer working hours are particularly dangerous for example, for workers operating machinery. Productivity and effectiveness is particularly affected. For more information see the Working hours dilemma.

Gender-specific issues

According to World Health Organization's "Women and Health Report", globally, men and women suffer from OHS issues in different ways. Women are often in lower paying, unskilled work in the informal sector that provide little or no health benefits.

Traditionally in many countries, particularly developed countries, construction industry workers or ship workers are more likely to be men; however, women are the majority in places such as garment factories in many parts of the world, including Mexico, India, Bangladesh and China. In many sectors however, the Women and Health Report states that compared to men, women suffer more OHS incidents.

According to a 2011 WHO report entitled "Gender, Health and Work", there are a number of factors that could result in women being exposed to more injuries than men. These include a larger proportion of women working in a particular sector (e.g. domestic work, textile), women workers' not reporting an injury due to the informal nature of their work or the insecure nature of their work. It can also be because of inherent discrimination against women including sexual harassment at the workplace. Women are also less able to take the time they need to recover from injury, thereby exacerbating the symptoms and injuries suffered. For more information, see the WHO's report.

The ILO's "World Day for Safety and Health at Work 2005: A Background Paper" states:

"Regarding hazardous substances, the impact reveals that men are at particular risk. This can be explained by the distribution of hazardous jobs. More men work in jobs that expose them to accidents or hazards caused by substances that are carcinogenic or may cause circulatory and respiratory disease. Also, it appears that even in the same jobs, women tend to adopt more preventive and protective ways of carrying out work.

On the other hand, with large numbers of women working in agriculture in developing countries, they are particularly vulnerable to communicable diseases, such as work-related malaria, hepatitis, schistosomiasis (infection by a water-borne parasite) and other bacterial, viral and vector-borne diseases.

While men are more likely to be involved in fatal accidents and other work-related deaths, the everyday burden of muscular-skeletal disorders, stress, and violence hits women hard, but the outcome may often be long-term disabilities rather than death."

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