Good afternoon, everybody, and welcome to the session, the Global UN Workforce, a Road to Post-Pandemic Recovery and Resilience. The session will be presented by a team of international occupational health and safety specialists, and I will start our story with a brief introduction about UN Health Intelligence and about the project that we were working on for the last ten years. My name is Jasminka Goldoni-Lestadius. I am a senior occupational health specialist in the World Bank. So talking about the United Nations or what are United Nations, so this is an international organization founded after the Second World War with the main goal to maintain peace and security and achieve cooperation among its 193-member state. This is official chart that is created 70 years after establishment of the UN system, showing its structure. I have no intention to go into any details of it, but yes, thank you for the smile, but I just have it as a very good illustration of the magnitude and complexity of the UN system. It has more than hundreds of various organizations, agencies, specialized agencies, programs, and it employs hundreds of thousands of people around the globe. So from occupational health, what is, or medicine, what are the challenges with such a workforce? It is, of course, clearly very difficult to maintain its health and safety and productivity at work. So a UN workforce is a mobile workforce. It's a mobile target. It moves around. It is multinational. It is away from its social and cultural roots. It faces a lot of language and cultural barriers, and it's moving around. And for many, it is the truth that they have limited access to adequate healthcare. Even for workforce that is in developed countries, they are typically out of the loop of national healthcare system. So even they have a problem with access to appropriate healthcare. From OEM point of view, there is a chronic lack of trained OEM specialists in the system, fully trained specialists, although a lot of, or most of UN physicians, they practice occupational medicine. They have typically multiple multidisciplinary roles in a non-medical setting, which by itself is very difficult. And then they have to deal with a range of healthcare system and medical insurance plans. But I would say that the biggest challenge of all is lack of data about their workforce. You can't treat something you don't know. So they have health data, but they are not standardized, not centralized. They have records in multiple languages, sometimes even handwritten. They have the information that is often incomplete. And when we talk about the data on medical risks and lifestyle, they don't have such data at all. So to somehow standardize the OEM practice across the UN system, UN medical directors approved the Occupational Safety and Health Framework as a sort of guidelines for all UN organizations to establish their occupational health and safety policy committees, risk registers, and also monitoring and evaluation frameworks. Not all organizations have done that, but this is established in 2015 exactly in order to somehow standardize and ensure at least minimal level of occupational health and safety services across the system. Just to remind everyone this very simplified graph, how management system in any area, including occupational health and safety, looks like. So you have this risk assessment phase, which then leads to planning, to acting, to monitoring and improving the system. So looking at the portion of assessment, risk assessment, this is exactly what is missing, what was missing for all these years. And this is how UN Health Intelligence actually grew and how it became interagency working group for data management, analysis and visualization. Ten years ago, UN Health Intelligence created the first holistic and comprehensive survey to assess health risks of UN population. And after that, there were about seven more organizations adopting the same survey and comparing their results, benchmarking results and creating maps of high health risks for UN population. However, then pandemic happened and the pandemic changed the world. So anything that we knew in occupational medicine and whatever we practice, it's time to reconsider, to restart it based on a new baseline that we noticed among workforce in the UN and generally. So we used the same survey that was implemented before, that was capturing all possible health risks, mental, physical health and others. And we added a part of pandemic impact on workforce, measuring how many people had COVID, how severe it was, how they were treated, did they have access to vaccination, did they vaccinate and so on. So the baseline survey was extended into more comprehensive survey that captured impact of pandemic as well. Those of you who were attending previous session on survey in the bank, for you, this slide might look familiar. And yes, it is familiar because it is exactly the same as the one we use for the bank because we use the same survey. It was, again, comprehensive and holistic survey that asked everything from general information, employment, work patterns, perception of health, physical, mental health, office setup, doctor's visit, preventative screening, sick leave, vaccines and biometrics and most important plans regarding your health. What we added to this previous core question is COVID pandemic experience. So the survey was launched in June 2021. It was launched in four languages, English, French, Spanish and Arabic across the UN system. In the beginning, just several agencies joined the survey, however, they quickly recognized the strategic value of data they can get for their organization, both actually at the level of their agencies, but also for the UN as a whole. So the data collected, they informed future occupation health and safety strategy, guide policies and measures that improve staff health, provide adequate resources if you want to build business case for any kind of new program or extension on old program, you need data. So this is exactly what was advantage of this UN-wide survey. The same benefits were also for the UN as a whole, especially at the time when UN mental health strategy is created and also OSH occupation health and safety framework. There is also task force on future work. So all these networks and programs could be informed and were informed by the survey results. There were two pathways to conduct this assessment. One through agency-owned survey tools. It is actually what happened in the bank. It went through its own survey tool and the bank produced its own report. But there was another pathway that was massively used and extremely efficient in this project, and this is platform that was provided by UK agency. We have director here who will explain the properties and features of his platform. So using the same platform, survey was launched to 23 agencies. They all got their reports based on output from the survey tool. And there was also a report, aggregated report with all data together. So my colleagues will talk more about that, but just to say here that we collected more than 16 million data points and when you have such incredible amount of data, the question comes up, so how will you use it? How will you prioritize? You cannot do everything at once. What we noticed was general deterioration of physical and mental health in our workforce and you have to have some process to decide where will you start. We had ideation process among agencies that conducted the survey. We asked about what projects based on the survey results you think would be the most feasible and important for your organizations. So we got the list ideation after ideation process and then we went through Delphi consensus process. And out of all these topics, we voted actually for the most first priority, medium and lower priority projects and topics that we will explore further. The first on the top is mental health, before and after all this health risk that we were measuring, we were comparing before pandemic and after year of pandemic and future work. We asked people when they are ready to come back to work, to travel, what kind of work they prefer, so we received a lot of information that will be implemented in the future. What is staff telling us? This was from qualitative data. On the top of obviously rather large survey, staff still took time to tell us their stories. So we went through it and we certainly will have to work more on this part, but because it was told in four languages, as I mentioned, so there is a lot of work. We didn't finish all analytics. We did quantitative data, but qualitative data still waiting for us. Domestic abuse came up as extremely much more prevalent than we thought. And then preventive care neglected and ergonomics and pain management, they came in this list only seven, but in individual agencies, they were higher. So I mentioned already this network that will use the data further, but I would like my colleague to continue the stories in more detail. So Dr. Matthias Lademann from Vienna, Austria, will talk first about challenges of contractual process among multiple agencies when they want to get together and share health information. It is recorded after my introduction. After that, Roger Parry, Director of Agenda Consulting from Oxford in the UK, will talk about features of platform that was used for survey administration and reporting. Sophia Voldemicael from the World Bank Group, Washington, DC, will talk about communication strategies because, as you can imagine, it's not very easy to inspire so many organizations to do the same survey. And then finally, Dr. Gloria Dalforno from Geneva, Switzerland, she will talk about results and our plans what to do with this goldmine of data. So thank you very much, and if we can get recording from Dr. Lademann, please. Hello, everybody, I'm Matthias Lademann, Medical Director of the VIC Medical Service located at the Vienna International Center in Austria, and we're serving about 4,500 staff, which are coming from four different major UN organizations, including the International Atomic Energy Agency, the United Nations Industrial Development Organization, UNIDO, and also the UN office in Vienna. In 2021, five years after initial survey efforts, several agencies decided to do a follow-up of the same survey, but left some room for adjustment for specific questions, including mental health and related to the ongoing pandemic. We tried to combine efforts and resources and decided to conduct the survey this time together. Once we started planning and advertising our intent, more agencies within the UN umbrella saw the opportunity and decided to join. In the end, we had 23 UN agencies taking part. The wish to participate was especially high in the last weeks before the start of the survey, which led to some agencies having a one-week or slightly delayed start after it was officially launched. This was due to last-minute adjustments to their specific organizational questions in the demographic sections where they need to do some changes. The IEA, the International Atomic Energy Agency, and three other major organizations did launch a survey at the same time on the 23rd of June 2021. We were very happy to have this broad participation, as only a few UN organizations had individual experiences more than five years ago when they conducted the first UN staff and health and wellness survey for the first time. At that time, each of the organizations used a different survey platform or application and, in addition, had their own provider of the analytics and also the reporting. Overall benchmarking and data sharing was quite difficult. Based on this experience, we wanted to improve our efforts and use the same platform together with the same platform provider, where we had an initial reporting the same way and also findings were kind of comparable. Also, we wanted to have the pooled data and specific analytics and evidence-based recommendations coming from one academic institution in the end. We saw the need to follow up on our previous survey, but also the opportunity to ask COVID-19 related questions, including also mental health aspects. Therefore, a certain fraction of the survey questions were smartly customized to the current needs and the big plus was the sharing of the costs of the platform together among all participating agencies. This was especially helpful in order to get smaller agencies with no or very limited resources attracted to participate, as they would otherwise never be able to conduct and finance such a big survey on their own account. This time, they also could benefit from the data-driven, evidence-based health and safety recommendations in the end and strategies arising from the larger pool of data being analyzed. The main challenge was to find the agency which was going to enter into the contractual agreement with the survey platform provider. This sounds easier than it was finally done, as the UN having a vision of serving as one is facing some hard reality check when it comes to funding and committing money. Once the leading agency was willing to commit to the obligation with the platform provider and was identified, then the challenges did step up to another level with internal scrutinization of the legal department, IT security, data protection officer and procurement sections. So quite complex but manageable. The model was designed that the costs were covered by one agency and later recovered from participating agencies with the UN to UN agency contribution agreement based on the final number of participating entities. The benefits of the approach were having a secure partnership with the platform provider and clear communication with participants from the UN agency side as well. Let me hand over to hear the experience from the provider side now and thank you for your attention. Good afternoon, everybody. Nice to be with you. My name is Roger Parry. I'm Director of Agenda Consulting with the aforementioned platform provider. I've been called many things, not often a platform provider, but there we go. Let me just talk a little bit about who we are. We are a research consultancy. We work exclusively in the non-profit sort of vertical market segment. So that includes UN agencies, other international organizations, international NGOs globally and because we're based in UK, we also work with a number of UK non-profits. So that's our world in terms of clients. In terms of our offer and surveys, we work a lot in engagement surveys, so the classic engagement survey that your HR colleagues will be commissioning on regular basis, management leadership and communications and so forth. Health and well-being, we're beginning to develop our experience here. Diversity and inclusion, obviously a massive important factor for organizations in thinking about how their experience for people, all their people are in an organization and respectful workplace picking up the whole sort of me too area of abuse, discrimination, harassment, sexual harassment, and so forth. So we have a fairly broad offer in terms of our approach to the employee experience. Obviously, you're just going to be drilling down a little bit into this particular project. We're based in UK, as has been mentioned. Okay, so a little bit about our platform. We have our own platform, which we've developed over the years to support our survey work. A range of different question types, different scales, single-choice questions, multi-choice choose-from-a-list, conditional questions so that you can branch. For those who answer one question, they may get follow-up questions. Those who answer differently, they don't get the follow-up questions and so forth. Open questions, we were talking about that earlier in the earlier session, really, really powerful listening to, usually good to answer a few open questions to hear what your people think about the particular questions you're interested in and really root the survey results in that. Demographic questions, by which we mean a range of different things. It can be both organizational demographics, which department are you in, which team are you in, how long have you been here, are you senior, middle, junior, what's your role? And then also those personal demographics, gender, ethnicity, disability. We have a very powerful and comprehensive approach to demographics and very much encourage our clients to break those results down so you can see how survey results are similar or different and start beginning to explore those differences. We work internationally, so we run surveys in many, many languages, and our platform has that. We have a couple of approaches around password access. It sounds a little bit technical, but sometimes one really needs to know who the individual respondent is, and you capture their email address, and then you can attach a whole bunch of other data to that, maybe loaded from your people databases. Sometimes you absolutely don't want to do that. This project was the latter category. We're asking extremely personal health data, and there's absolutely no way we want any individual name associated with that. Range of different situations, laptops, PCs, phones, all the rest of it. I'll talk a little bit more about response tracking in a moment. And confidentiality, which is one of those absolutely classic things that comes up every survey you run, everybody's always going to say, well, how does confidentiality, all these questions you're asking, they're going to know it's me, right? So our approach is always to agree a particular number of maybe five, seven, or ten. In this project it was ten, and we say, look, you don't get the ability to run any reports of any data less than the minimum threshold. In terms of reporting, which is really so crucial, and I think in the sort of broad tech revolution in which surveys have been going in the last four or five years, it's the reporting, the outputs, which is where it's coming. So we are passionate about being really careful about data and contextualizing that data. So we like to present results back. How do they compare with the overall results? How do they compare with last time? How do they compare with external benchmarking? So you're making sense of data, not just saying, well, 69 percent think X. Okay, well, kind of, so what? Is that high? Is that low? Will you only know if it's gone up from 54 last time? Oh, wow, quite a big change, or whatever. So we're passionate about contextualizing survey results. We have a platform which has a wide range of reports. I won't go through them all, but to drill down, giving people, a range of people, access to the portal. And dashboards are also part of the platform coming through in the next couple of months, and action planning as well. IT security is always, as probably has been mentioned before, all organizations are wanting to take that really seriously. It's particularly strong in Europe with what's called GDPR, General Data Protection Regulation, which is a requirement, actually, for any organization gathering data from people within the EU. And whilst we've had the wonders of Brexit in UK, from a data protection perspective, there's no change. So we are completely compliant, and we see that as a global standard, which I think many other countries will be moving towards over time. So yeah, strong data security and protection. Okay, so what about this particular approach? I think the most powerful kind of word on this slide is the second one, run one overall survey. We have run lots of surveys in lots of different situations, and there are so many benefits of running one survey and involving a range of organizations. First, you get more data. You get big data sets, and for those of us who love stats, when you get big data sets, then you get your confidence intervals start working, and you can start seeing what's significant or what isn't, 95% or whatever threshold you wish to look at. You can then drill down and say, well, are men experiencing it the same way as women, and what about for different ethnicities? The breakdowns start becoming meaningful and insightful. You also begin to get benchmarking. As Matthias was mentioning in the previous, if everybody's doing different things, using different questions, it doesn't add up, and how do we compare? Well, our question was different from your question. If everybody's using the same survey questions, then you get that benchmarking, and then you get that result of, well, our agency is 69, everybody else is at 84 or whatever. Let's look at the difference and start thinking about some of those points. Also, it's just cost-effective, actually. There are massive economies of scale in surveys if you run them at scale. That's a key point. This was a brute of a survey. Jasmin Cohen and her team concocted over 200 questions, a range of different response scales. I had to be extremely nice to my colleagues who were actually delighted to be a part of this, but it was a big survey, so lots of data. We ran it in English, French, Spanish, and Arabic to reflect what people would feel comfortable in in the agencies who were taking part. A core set of demographics. I was encouraging you all in the direction of demographics, so both gender, age, ethnicity, and so forth, and then also the organizational demographics as well, length of service, grade, seniority, and so forth. But also, crucially, point three, we enabled every agency to choose its own demographics, too, in addition, so that they could break their results down. The UN Secretariat who took part, who have a number of peacekeeping missions, for example, were able to break their results down into about 20 to 30 different units so they could see how those differences played out. Those were obviously going to be agency-specific, so that could add a bit more value. On timescales for all agencies, what happened is we became victims of our own success, really, in terms of the promotion. You've already heard about the 23 agencies. They were all joining. A number were joining at the end, so could we have an extra week, please? I think it ended up as about eight weeks of fieldwork, and then setting up the reports has been mentioned. The promotion was really, really successful. A particular colleague led on that. The model was, for each agency who wanted to participate, they needed to appoint a focal point who would then promote the survey within their organization. And then, you think you've seen the slide, there's 23 agencies who all took part. This is just a little bit about the response rate. I mean, firstly, actually, we used a tracker report, so every day, actually, we ran a report just setting out how the response was going by agency, so everybody could kind of see where they were doing. So, I think that was quite powerful. Overall, 19,000 responses, 15 million data points, so it was big. That was, I think the 23 agencies was massively successful. I'd say the overall response rate, 12%, was disappointing, but probably inevitable, given the process that we had, which was that quite a lot of agencies were joining fairly close to the deadline. And I think that's something that, collectively, we can work. I think the bank talking about, in the previous session, around about 35, was it 35 to 40%? 32%, I think is a better number to go for. I mean, engagement survey response rates tend to be in the sort of 70 to 80% generally. It's hard to get response rates at that level when you're doing focused surveys, which probably don't get the organizational buy-in and impetus that the company or the organization's engagement survey was. So, I think aim for something like 30. We had three, we had seven agencies who got over 30%, and two who got over 50%. The leading agency, their director general said, I did the survey, and I want everybody else to do it. So, guess what? When top management starts saying those sorts of things, people do the survey. Leadership counts. So, but there was obviously a long tail as well, and some would have just, this would have perhaps just been a starting point for them. We've started the survey. Okay, we didn't get a great response rate, but we'll engage this and think about how we can improve it next time. And then, finally, just some outputs. Gloria's going to talk in a moment about the outputs, but these are just some of the health risk. It was a model with 50 in health risks, with some of the graphical outputs just to begin to sort of help organizations and agencies just see where they sat in relation to the overall sample. I'll stop there. Thank you for listening. Over to you, Gloria. Oh, Sophia. Sorry, it's Sophia next, not Gloria. Thank you. So, we'll be talking about how, among 23 organizations, a UN organization, we were able actually to collaborate and work together. You've seen this slide many times, just to emphasize that it's not easy to gather 23 agencies. And the way we did it is really to think about how do we build relationships and how do we communicate the value of the survey. So, in terms of relationship building, it's really meeting people where they are, having representatives who can communicate with the different organizations, calling for participation, doing countless presentations on the objectives and the scope of work that the survey was trying to do, and together defining and articulating a common outcome that is of value to all of us. And also, really hearing from each other and trying to find solutions. For example, some agencies had difficulty with the timeline, so working with them, or they may have had questions from their staff representatives, their HR. So, we were working together really to help each other out in finding common solutions from our own learned lessons. And second is creating effective communication channels. And the next slide, I'll talk a little bit more about that, but it's with who? It's with Agenda Consulting, and you heard from Roger already, from UN Medical Directors, which sponsors the UN Health Intelligence Group, as well as the UN staff. And with that, we appointed, or focal points were appointed for each of the UN agencies. And formalizing agreements, you heard from Dr. Matias earlier, who talked about some agreements that we all had to sign up in. And also, how are we going to share the data? How are we going to analyze it? So, it's working together. So, all of these three elements really provided the framework for us to be able to network effectively. So, in terms of communication, I said with who, and how we did it is with focused meetings, countless meetings. Yes, Mika can attest to that. And having effective, with Agenda Consulting, who was the provider of the analytics tool, as well as the analysis itself. And working with different stakeholders to really understand, or to really relay the objectives of the survey. And the focal points who are representatives of each agency, they, in turn, were responsible for communicating with their own medical director, their staff. And finally, we also established a common folder, I should say, so that each agency can, instead of recreating their own material, can use material that was already created by another agency, for example, presentations that they could use to present to their own staff and their own directors. And we also collaborated to have a common place where we had frequently asked questions, so all the focal points could go there and get the resources they need. And finally, I know that, yes, Mika has already touched upon the Delphi process. In this context, it's really how we built consensus, and this is one example. And the goal was to create a list of feasible initiatives that each agency could take. And we had a round of two questionnaires, first the same questionnaire, where each agency was asked to rate from low to high which of the topics they wanted to analyze first, depending on what they were able to do. And again, the question was recirculated, and we refined it through the individual responses through the second survey, and we reached consensus. So this is an example of how, with 23 organizations, we were actually able to build consensus and be effective. And the results, these are the results of the Delphi survey on the right. As you can see, that mental health came up at the top for all of the agencies. And the benefits of collaborating, Roger already talked about that. But sharing resources, 23 agencies had to develop their own communication material and surveys and their own staff, you can imagine. So it's really helpful to work together in terms of saving time, money, and having a data collection that is systematic, holistic, global, and cost-effective. And as we said, the same survey in order to benchmark and compare. So that's it for me. Thank you. I'll pass on to Gloria. Take this one. Good afternoon. I take this. I'm sorry, I apologize, but hyperactivity runs high in my family, so I need to move around a little bit. Not the attention part, unfortunately. In any case, my name is Gloria Del Forno. I come from Geneva, so I might be sundowning a little bit at this time. So forgive me if something is not absolutely perfect coming up. I'll put my first slide, let's see. Is it going on? Nope. This one? That one. Okay, sorry. So I come from Geneva, I'm one of the medical directors of the UN, and I will be presenting now the results, because up to now we've been hearing about how we've done it, and I will be telling you a little bit of what we've found so far. Obviously, as you've heard, it's 19,000 participants. How many million data points? Huge. So obviously, we haven't analyzed absolutely everything, but I will give you some of the things we've found thus far. There's plenty of things to do, and we'll need plenty of time to analyze every detail. But one first thing we did was health risk stratification. We'll start with this. I highly recommend that book that I have there myself, that Jasminka recommended, it's a little bit old, it's 2009, from Dr. D. Eddington from University of Michigan. But this is sort of a system that looks at 15 risk factors, very common. So some are like blood pressure, cholesterol levels, you name it, but some are like perception of health, self-perception of health. Some are, I have a hard time reading them all, but in the handouts you will be seeing some, but in any case, stress is one there and so on. So basically, the idea in this type of method is that if you have one to two risks of this list, you're considered a low-risk individual. If you have three to five, you're medium risk. If you have more than five, you're a high-risk individual. And this is on the basis of planning, basically, healthcare at a national level as well, if you want, for industries, for companies, to see how you can do to try and prevent things, especially to get worse. And actually, the theory behind this is that if you prevent things already from getting worse, from the risk level you have, you're going to achieve a lot, rather than waiting until someone gets sick and treating. So this is one of the methods. So what we found in our population is that 57% of our UN staff fall into the medium to high-risk categories, which is actually higher than what Dr. Enten reports in some of his analysis. So we are at a high-risk population. There are a number of reasons. We can touch on some of them. The highest negative health indicators, in our case in particular here, were diet, physical activity, body mass index, stress, sick leave uptake, a number of days of sick leave that are taken, seatbelts use, now I'll touch base on that one, and smoking. Now seatbelt sounds a little bit odd, but you have to think about the fact that it's a big workforce. Many of our staff live in countries where traffic is horrible, or they have a situation where the roads are impossible, and not wearing a seatbelt may mean the difference between life and death. And we have a huge problem in the UN, so seatbelts, for us, it's a big deal. So in any case, the next thing we looked at are working patterns. Working patterns were particularly important at this time, because obviously this is the first time in our history, even in the history of the UN, that we have many, many people teleworking, working remotely. This is a new paradigm completely, and so we had to look at what happens with that. So we asked, now remember that some of this data in general, this is something that goes back to last summer. So we've had, in the meantime, two more waves of COVID, but this is sort of a picture of what we saw after the very first, very large COVID waves. So the majority of people reported being quite productive in teleworking. Now the average is 58, but this ranges tremendously. In some, for example, HQ-based agencies, they reported almost 100% productivity, sometimes more when teleworking, in others, a lot less. But you have to keep in mind, again, that the difference is between someone sitting, for example, in Geneva or in New York, in a beautiful office, or a beautiful home with light, a beautiful desk, and all the equipment you need, and someone in a compound in South Sudan, for example. So there's quite a difference in our workforce, and that's why some of these things come out in general, though. They work pretty well from home, and this is a good lesson for the future, as well, for companies in general, I would say. 17% said they would rather not go back at all, ever, to the office, which is almost one in five, so it's pretty high. Life balance prior to COVID, most people were satisfied and we say 68% and this is why I'm telling you, because 43% reported the deterioration of their work-life balance during the pandemic, so pandemic really affected the life and work and the balance of the two for all of our, for most of our workforce, almost half. So the commonest negative behaviors that were reported. Now a lot of people say that UN staff do nothing or that we tend not to work much, well okay, look at this data, you know, we have this bad reputation for some reason, I don't think it's well deserved. Most of our staff, 77 to 84% were checking their emails before, 30 minutes before going to bed or within 30 minutes before waking up. It's like huge, I mean it's like first thing in your life is just look at your emails. Pretty bad, right? I mean, I consider it bad. Video conferences, calls, use of mobile to track businesses, it went up to 72%. Most of our staff were using all the instruments they had available, mostly their mobile, to work outside working hours and in general, 41% of our working force worked at least six to ten hours more per week than their scheduled hours. So, you know, a huge amount of overwork. COVID experience. Now again, this is a picture at the end of August, essentially. At that time, the incidence of COVID had been 16%. If we looked at the data now, I'm sure that we would have many, many, many more cases, especially after Omicron. In any case, some other things are staying pretty much similar to what we observe as physicians within the UN system. Symptomatic and mild were the majority of cases, although we had a 3% that were severe. I don't remember the actual number of deaths, but there were lots of deaths within the UN system. We even had one in Geneva in my organization. Not fully recovered, 26%. Now this 26% is very similar in a way, when you look at data on long COVID, about one-fourth of cases of COVID do not fully recover. And we saw the same thing, essentially. Time to fully recover. Most people recovered relatively fast. Obviously, we're talking before Omicron here. Omicron was milder. It's been also going faster for most cases. But the first variants, they would take at least a week or so. But we had 25% that took even more than seven months to recover, if they recovered. The other 26% did not. And they're still suffering from the consequences. Now at that time, we had 62% of the workforce fully vaccinated, which was pretty good if you consider that we're talking about all over the world. So this is also thankful to the program that in the UN was put through for staff in the field in countries where vaccines were not available. So it was really a major effort. And unfortunately, of the non-vaccinated, the other 40%, though, there was a good percentage that said they would not vaccinate it even if they had it available. So there was, at that time, a lot of resistance. Now, things will probably be a little bit different now. In any case, long COVID symptoms. So here I put it because we have so many with these problems. One-fourth of our workforce that had COVID, which is now much higher than that 60%. Fatigue and weakness, general fatigue, muscle weakness, and so almost half, more than half, so 51%. This other big one is mental fogginess. It's usually described as mental fogginess, the difficulty to concentrate. Just before leaving, I met one of the directors of my organization. He was saying, you know what? I just, and the person had it at the beginning. So we're talking about two years in after he had COVID. I sit down, two minutes after I'm trying to do something, I just have to get up. I can't concentrate. I cannot do my work. So that's a very big problem. More than one-third of the staff that had COVID. Anxiety has become very prevalent. It's very prevalent in this population. Change in taste or smell, this was mostly for the first variants. With Omicron, we have seen very little of that, I must say. But during the survey, one-third of the people had experienced that. A lot of people couldn't sleep and have continued and continue seeing clinically not to sleep now. So one of the things there, persistent pains, discomfort, 21% of the long COVID cases, and 20% of depression, new depression. So we're talking about someone who technically shouldn't have had it before. Now, this is the perception of the health risks. Now, we're sort of representing it through the lens of the view of the staff member versus the view of the physician. So essentially, 38% thought that their physical health in general, we're not talking about people who had COVID, we're talking about the entire population here. So by at that time, you know, the vast majority had not had COVID. So 38% felt that their physical health had gotten worse. 45% that their mental health gotten worse. So COVID had impacted them very heavily. Stress affecting health, 60% practically of our staff. Domestic abuse, this was a surprise in a way. Almost one-fifth of people reported having suffered domestic abuse at one point or another in their life. And actually, if I remember the number correctly, it was about 50 that had some sort of abuse during COVID, during the pandemic, while probably at home with maybe a partner that was either getting violent or verbally abusive or so on. So certainly, the pandemic probably didn't help that. Also, people reported sitting more than 10 hours per day working, 12%. Sleep, as I showed you also before, was really affected. They reported 44% of people sleeping less than six hours. Less physical activity, mostly people sitting at home, not being able to do to the gym, doing other things, sometimes simply commuting to work. Smoking, some people started smoking and some smoked more, and that's 39%. So smoke got worse with COVID. One of the main reasons quoted was boredom, stress, and that applies also to the gain weight that we saw in almost half of the people. One thing that is really shocking, underlined in that, is 70% working with pain. Now, you look at the percentage, it's like, well, 70% is high, yes. But if you think of the numbers, we're talking about something like 13,000 people that were working with some pain. Mostly it was neck, back, and shoulder pain. And there was also a big number of people that were experiencing pain and discomfort in the eyes by being on the computer for a long time. And this is much more than before COVID. So this is a change. Now, from a doctor's standpoint, the UN doctors is looking at the patients. What we see is that 19% of people don't know anything about their blood pressure. 34%, no idea where their sugar levels are. Cholesterol, also 36%. More than one-third have no primary care doctor at all. So if they have a problem, they don't know where to go. 43% don't have any sort of physical exam. Fortunately, some agencies still do the exams, especially in the fields, but we cannot provide it for everybody. And in any case, it depends very much on the duty station. There are places where doctors are simply not there, not available. And also kind of disquieting was this don't want. So 53%, as I told you before, didn't want to get vaccinated against COVID, even if they could. And 51% wouldn't vaccinate against the flu. Now, in terms of the prevailing diagnosis, in terms of health indicators, back pain and mental conditions were the two big ones. So back pain, as you can see up there, I cannot see the percentage from up here. What is it, 30? Yeah. In any case, back pain, the green is nothing. So those are the good ones. Then we have back pain, 30%. Then we put together the mental health conditions. Obviously, here they were divided, but we put here anxiety, depression, burnout, and so on. So mental health conditions were the two big ones. And again, the other things I mentioned before. So these were the main that we found. Now, mental health, since has a very big impact, I wanted to say a few things about it. First of all, as I said before, 45%, almost half of the staff thought that they had deterioration of the mental health just simply due to the pandemic and the working conditions and so on. 30% were feeling anxious or depressed. Stress affecting health, 58%. This is a big one. We'll talk a little bit more about it. Worse sleep, medication for stress or to relax. 14% were taking medications and 55% started during the pandemic to take something. I think anxiolytics, benzodiazepines, you name it. As I said, smoking increased and hazardous drinking patterns actually thought 16% more, which is less than I thought we would find as a matter of fact. One other big thing we found, because we looked at stigma. Obviously, if you want to act and do something about mental health, stigma is so relevant. It's relevant because people do not report their mental health issues or they feel very ashamed to talk about it. They don't want to discuss it with colleagues. Managers don't want to hear about it, don't want to know anything about it. And that is a big problem, not just for us, but certainly in the UN, we found it. And we found that 24% of people reported not having or having been discriminated. So one fourth of people have been discriminated because of some mental health issues. They know someone, almost half, that has been discriminated. So a colleague that because of that had problems. But that 11% were people that said that they would never want to work with someone with mental health conditions. Now, that tells you what stigma means. 11% of our staff don't want anything to do with someone who has mental health issues. Mind you, that most of these mental health issues in our case, we're not talking about someone who is actively psychotic. We're talking about people who have anxiety, depression, or things of this sort, obviously. Otherwise, they wouldn't be functional and working in the first place. But this tells you so much about stigma. Counseling. We do have a counseling system within the UN system, but it's not used as much as it could. It's not really to treat, but it's mostly to help diagnose and direct people to get assistance. But most people prefer not to go to the organization's counselors. Some of that is understood, because you don't want to really go and tell at work what are your mental health problems, or your depression, your anxiety, your obsessions, whatever. But the system is there, so it could at least be a start. Stress. I wanted to talk about stress briefly, because stress has been a very big one. By the way, in whichever model you look at, even the health certification models, stress is one of the most dangerous things that you get, that has the greatest impact on health. So as I said before, 49% reported negative effect on their family. 50% they had overall stressful life. And this is the most interesting of all. What are the top stressors? Now, I'm just putting here the top stressors. There were, I don't remember how many, but a whole bunch. We had like three pages of options for stressors to choose from, and were not just related to work. They were related to everything. They were related to personal issues, health issues, economic difficulties, housing, you name it. But if you look at the first ones, working hours, high workload, the first one of all, 38%. Lack of time for personal activities because of work, 30%. Lack of resources to complete the assigned tasks, 28%. Unclear work priorities, unrealistic deadlines. So managerial issues here. Lack of control over the decisions. Insufficient support for managers, 15%. Office set up, we'll talk a little bit more about that on ergonomics. That last one I put in, caring for ill dependents, 12%. I put it there because that is the first one that appears, and it's actually not in that order. Imagine how stressful it is to care for a new parent or child. And that comes only at that point, much later than the other stressors. Which means in our workforce, at least, the vast majority of stress is generated by work, working conditions, HR issues, contracts, job security, things of this sort. So very, very big problems, which also means there's a lot that can be done to improve it. But our management doesn't really like to hear that too much, I'm sure. So where do they need more support from? Not surprisingly, 50% of people want it from their managers. Their managers are those that could change their life. And in the UN, we have a mental health strategy, implementation board strategy that is looking at all these aspects. And managers keep coming out as the cause very often, and also the possible solution of a lot of stressors and mental health problems in our staff. Then, obviously, support from family and friends, from colleagues at work. It's a big one, too. So we're talking about 37, 38%, 36, 38%. Can't see that far. But that's also a big source of support needed. So this is what people would like, not what they get. What they really, really would like, especially their manager, to be there for them, or at least not to kill them at work, or just treat them poorly, or whatever happens. So domestic abuse, as I said, was another surprise we found. 19% experienced domestic abuse while being in the UN already. And 22% worsening during COVID. And 81% of these said, obviously, that this abuse affected them physically or mentally, as you could probably imagine. It's logic. But this is, again, 20% of the workforce. So out of 20,000 people, say, would mean 4,000 people abused at some point. So we're still talking about huge numbers. Now, ergonomics has come up as well. Obviously, people having to all of a sudden go to work at home on their kitchen chair, or kitchen table, or with a laptop this small, and doing things that needed a big screen, or so on, have had problems. 30% rate their home office setup as poor. But 13% also rate their office setup as poor. But again, it's a very varied workforce. We have people who really don't have chairs even in the office, in their offices, in some duty stations that are really underserved or poorly set up. Now, what would they like to work better from home? Half would like a better chair. 40% would like either a better desk, better IT equipment, more space, privacy. Obviously, when it's home, there's not much you can do to change the lighting, the space, and so on, because that's the house. But when it comes to things like chairs, and desks, and IT equipment, probably there's a lot that can be done. Also, many people are not too happy about what happens at work. Now, this is comparative data of before and after for one of the agencies. As we said, as you heard before, only some of the agencies that were in this survey had had the same survey before. The majority was the first time, so we didn't have any benchmarking data to compare. But one big agency for which we had data, we could look at before and after COVID. What happened? So, perception of poor mental health went up 270% compared to the previous perception. Of poor physical health, 151%. I'm sorry, alcohol abuse, 98%. BMI, usually increase in BMI, 38%. Inactivity, 44%. Like, poor lack of exercise. And cholesterol, blood pressure, glucose, actually 40%, but not as much as you might have expected. So, this is... And they didn't know it, these guys. The other ones didn't. So, we don't know what is the truth behind this. Now, Sophia mentioned the open-ended questions. Obviously, these are just initial things that came out. Reason being that we have, as I said, 23 agencies, we have many, many open-ended answers. And so, we have to sort of sit there, read through them, put them together, try to make them into blocks of types of responses. The few things that we have noticed in the open-ended questions. So, staff are asked, tell us what you think of. And they come up with an answer, but being an open-ended question, we cannot just quickly count them. Basically, we saw that most people were happy to have a teleworking option. Not necessarily to telework all the time, but the teleworking option being there was really something that most people really enjoyed. But this came at a big price. So, the productivity remained quite high in general, but there were blurred lines between life at home and at work. So, while you're at work at some point, you just close everything, you go home, and even if you still have something to do, you've done, you just forget it, or you take one hour to go for lunch. When you work, work, work, at home, it's just, everything sort of blends into the same thing. Also, increased expectation to be online all the time, to the point that they're looking into, in the UN system, they're looking at a way to limit that, because managers started expecting you to be available at all times of the day and night, essentially. And so, people were receiving emails, were receiving messages, and so on. I showed you the numbers of how much more people work outside of the working hours, but it was also that expectations were increased, which is pretty bad. So now they're looking at ways to limit that. One other thing that we found is that younger colleagues were more affected by all this in general. Younger colleagues had felt more isolated and lonely than older colleagues, maybe because they're more likely to be single, maybe because they've been in the duty station or their place shorter, don't have as many friends, or they need more social engagement. But in general, they had more feelings of isolation, loneliness, more stress and anxiety, more mental health symptoms, more physical pain symptoms, and they were less likely to have a primary care physician. These are the younger colleagues. Some other things that came out, again, request to managers. They come up again, the managers. Improve the task distribution and the expectation. Lower the expectations and distribute work better. Use more motivation versus control instead of just imposing things. Building trust with the staff. The ergonomics was, again, these are the open-ended questions. It came out, again, as needs to do something about this. Then now there's some suggestion. Gyms, availability for physical activity at work, and so on. Mental health support programs, they were being requested a lot, although they're not being used as much as they could, the ones that we have. But it's very uneven across the UN system, because you have to imagine some agencies, for example, mine, their coverage for mental health issues goes $9,000 a year. So you can basically have plenty of access to psychiatrists, psychologists, and so on. And there are some agencies that have $800 per year, or even less. Some don't even have mental health coverage. So it varies a lot. So now we're trying to harmonize this. But this data is extremely important for us to understand how important it is to harmonize. And again, preventative health programs, things like mammograms, colonoscopies, and things like that. Some agencies do wonderful. They have this program. Some others don't. And so this needs to also be improved. I think I'm almost done. Recommendations. This is just a few things thrown there, because there are lots of things that we have to think about. So I don't want to be, I don't mean to be exhaustive in the least way possible. Certainly what comes out is that we need to have a multidisciplinary approach. It's not just medical. It's just not counseling. It's not just ergonomics. It's everything. Big HR issues that, as we have seen, in terms of contracts, working patterns, and so on, they need to really be addressed. We need training for managers, particularly in mental health. Managers need to learn. Soft skills need to recognize mental health issues with their staff. Need to be supportive. Need to know what to do. Need not to cause problems. Need to learn not to cause problems. And again, psychological first aid to be available for everybody. And there were other suggestions, like platforms to increase social connectivity between young people, and so on, and more engagement with the UN Domestic Abuse Task Force. But these, again, I say, are just a few things. But from what you've seen, there are lots of other things that could be coming out that we have to still work around. I think Jasminka is going to close for us. So we turn this off. Thank you. Thank you very much to our presenters and colleagues. These are just now final, few final thoughts before we open the question session. First of all, what we all forgot to say is that we decided to have annual surveys on the same platform, so that agency can decide which interval they want to use, whether they want to join every year, every second, every third year. In May each year, we are launching the survey and waiting for agencies to join. Second, what we also all forgot to say, well, it is a long survey, but it is a smart survey. So it depends how you answer some questions, you skip huge parts. For example, if you didn't have COVID, you are free of 25 questions. If you, I don't know, didn't experience domestic abuse, the same thing. So it is, we don't want to discourage you. I think that it's still for user, on the user side, it's not so complicated to complete the survey despite its length. So a few final thoughts, why we told you this story. We think that we are not that much different as you. We think that your population is also global and multicultural, even if you have just organization in the US, not to mention, if you have also global workforce, we are actually the same there. So new challenges for OEM are the same also for all of us. We need to redefine some of our targets and definitions. For example, workers, they are diverse, global, mobile, everywhere. And also definition, part-time workers, are they workers? They are. So workplaces everywhere. We said that in the, for example, in the bank, we have 250 country offices. It turned out into 30,000 home offices. People work from everywhere they can, including Starbucks, including everything. So what are our standards for such workplaces? We don't have them. Who is responsible for any kind of injuries at home when people work? We don't know. So we have to really rethink our practices. General environment, constantly something happening. We have to be ready, including emerging new technologies and hazard. We have to learn all the time. Things are changing, especially in IT technology. Lake of OEM specialist, our chronic problem that is becoming bigger and bigger as needs are growing. And then research lagging behind technology innovation, behind everything. We experienced this during pandemic, that you finally, at this time, you almost don't know where to look for really good studies. Opportunities are to strengthen communication channels, to exchange knowledge, as we are doing finally in this conference. Spreading best practices, involvement, education, not only in terms of education of occupational medicine physician, but the education of our staff. They will have to rely more than ever on themselves, especially in this home-based work model. And then strong advocacy for OEM. Again, the pandemic did well in that sense that we became more visible. So in the future work, we have to continue our leading role. So thank you very much. And let's hear questions from you. If you can come, Sophia, please, to help me. Oh my God, with this chat. There is a lot. Oh my God, a lot of text online. Yes, please go ahead. I want to salute you. An absolutely excellent, oh, okay. Rick Albon, CMO, Optima Health. I just want to salute you. That's an amazing survey that you've done. It must have been like herding cats. So it's, now you've got a huge amount of data. And so sort of, and you've got the health indicators, you've done the Delphi, so you know what your priorities are. So my two questions are, well, you sort of answered one that you're going to be doing the survey every year. That was sort of my next question, but more specific than that, are you also going to repeat the Erdington risk rates, the high, medium, low each time? Yes, this, sorry. And then sort of the follow-up to that, if not before that, is the so what question. So you've got lots of data, you know where you're, you've identified where your risks lie. So what are you planning to do with that so that that survey each year gets better and better? Yes, thank you very much for this. Yes, the main thing is to repeat the same core questions so that you can follow up whether you improved, whether you had any impact of your intervention. So we have the core questions always the same as we did in the baseline in 2014 or 13, but we also want this survey to reflect the current situation. So on the top of this base of these core questions, we are adding a component of this, what is kind of happening right now. So you asked about Erdington factors. Absolutely, this is an excellent model to follow up whether your profile, risk profile of population improved or got worse. It's really a quick way to get a global picture, and especially you can then do it by location, you can do it by any target population. You can look whether you managed to reduce this high health risks and whether you managed to improve your health profile or at least keep it same. Because as we know, to stay same, it is already improvement, right? So yes, absolutely. Only this portion of pandemic, we will repeat that part, but we will maybe add this year, maybe only one question about perception of risk from armed conflicts, something like that to reflect the current time. But also what we have on this customization part, there are agencies that have very specific health risks they can add. They should not change question, but they can add, for example, Atomic Agency, Energy Agency, they can add, there are a few questions about exposure to radiation for their inspectors. So this is something that is super relevant for them, but not for others. So there is this kind of end of opportunity also to adjust some parts of the survey to your organization. But formulation of question basis is always the same. Thank you. Yes. Thank you. I'm Phil Harbor, Arizona. This was an excellent presentation. My question relates to how the data can be used and the associated analysis. All the data presented, which is of course a huge diverse data set, are presented and analyzed on the basis of the individual, what percentage of people have problem A or outcome B. Have you looked at data to see what are the determinants of these, whether it's which agency they work for, their job title, country or culture, or some mix thereof? And similarly, it seems like a great opportunity as you just answered the prior question of doing this periodically, where some agencies or some locales make changes to see if it's almost a pseudo-intervention study without doing an intervention study. And again, related to the pattern recognition for big things, this is all supervised learning where you specify your question in advance. With 15 million data points, have you looked for pattern recognition with neural networks or any other machine learning pattern recognition to look for things that wouldn't pop out of our heads? So it's a single question, but with three elements. It's not so simple to me, I have to say. I will try to respond, and then you will tell me whether I managed to do it. First of all, this is just really overview of the whole sample of data. Each agency got their own report and in comparison with the rest of agencies, so they already have their, straight from the survey tool, this is only descriptive statistics. So then it is in their hand. They get also their whole data set and they are free to analyze their data as much as they want. We did a lot of that in the bank, for example, together with John Hopkins University. So the data analysis is much more granular already and will be in the future. Of course, there is a reason why we asked all these questions about demographics, location, all these elements we can use to understand differences between staff in different location, different age categories and so on, and based on that, to create our interventions. Regarding following up, we are, in addition to health recertification, we are developing monitoring and evaluation framework where we will find the indicators that are easiest to follow and compare over time. So it is all, this job is not finished. We are still working on that, but yes, with all this, what you mentioned in mind, because it does matter, we want to understand which population to target with interventions. We, for example, didn't expect that young population in our workforce is really diverse in practically all outcomes that we measured. So we certainly, in our intervention, have to pay attention. One thing, of course, on location, but the other, on age, to make sure that these young people who maybe don't have physician or don't think that they are at risk, they don't pay attention to their health and actually have health risks that will develop over time into conditions. So that's what I can answer right now. Yeah, here is Dr. Davey. Thank you to the team for the presentations and for the perceptive questions. Just throwing in another area of utility of such service, of course, as occupational health professionals, we think immediately of how you can use the data for the benefit of your clients. But as a director of a health center, I've also got to manage my stakeholders and I've got to get a budget every year. And I cannot tell you how much having this data has helped that process. So being able to go to the board, present data, which there's some jaw-dropping moments when people say, wow, have we got that much of a health problem in our organization? It also helps when you can benchmark and show it's not just us. Because management at the top level, it can be a little resistant to news that could reflect badly on the image of an organization. You just have to accept that in managing upwards. And what we have found is that really, as bad as the data was for ourselves, I'm the World Bank Group part of that, the patterns were the same across the entire community. So being able to give the reassurance we're dealing with common problems that, in fact, working populations that are similar to ours all have. But two, wow, just that's how big it is. We have to invest in it. Without that data, we really wouldn't be where we are now in attracting those investments. Thank you very much. Just a comment, there is online a question about whether women are more affected. We did only partly analysis based on gender, I think, in the area of mental health. And yes, it is confirmed. And there is still a lot we can do about that. But what we noticed with our data is that a lot of interventions that would help staff are actually not in hands of physician. We deal with the result of stress, of not good management and so on. But really, in planning the work correctly in educational manager, it's more in domain of HR. In terms of ergonomics, it's in domain of facilities. So clearly, interventions based on the survey results have to be at the level of the whole organisation. It's not only on health and safety services or departments. Yes, please go ahead. Hi, I'm Dr. Ichikawa from Japan. I work for Quadrant Health Strategies. I'm epidemiologist. So since your title is Road to Resilience, I was just wondering if you found any piece of positives in some of the agencies that they're doing good through this time, which you can use as a good example to give clue for improving resilience. Thank you very much for this. Yes, so there are positives. We are typically presenting problems and issues. And I would say the most positive are actually stories from staff with their experience in home-based work. I can tell you that a huge amount of people don't really feel excited to ever come back. They call this pandemic blessing. They have time for their kids. They have time to walk their dogs. They have times to go to do their master degrees. It is amazing. That would be the whole topic, which is, in a way, uplifting how people are actually resilient and how they find silver lining in any situation. Of course, those who left, who were sick, who maybe lost family members and so on, that cannot, I mean, you cannot expect much of these positive comments. But in terms of people who were not directly affected but all of a sudden got this whole time at home, I could go forever with all kinds of example of what people experienced. We did analysis of qualitative data for the bank only at the beginning. We had only survey in English, so it was a little bit easier to analyze this. I mean, hundreds of pages of responses. After such a long questionnaire in the bank, out of 8,000 responders, almost 4,000 took time to write additional about their personal experience to write stories. So we did analysis, and it's still not finished, of qualitative data to include sentiment analysis to understand whether people are actually feeling positive, negative, neutral, or mixed based on their experience in pandemic. This is, again, the whole new topic. Some things came out very positive overall, some like flexibility, while workload came almost completely red because all this work started to creep into personalized weekends, evenings, especially for global organization in various time zones. All of a sudden, people are on the Zoom meetings day and night. So that was completely negative. More or less, everything was mixed. Productivity was mostly higher, and I'm talking now only about the bank, mostly higher at home-based, in home offices, but this depended on location, of course. So it was lower in fragile and violence country situation, and also in some of the regions where people don't have comfort of really houses and space to make office. Everybody was thinking, well, that would be maybe a few months away, so they improvised their working space, but after two years, they paid by pain and so on. So yeah, this is not finished work. This was just overall highlights for your interest. We cannot scroll all this online. It's frozen. There's a lot of, there are a lot of comments online, but we know who actually asked this question, and we will, over email, continue responding. But anyway, so thank you very much for your attention. Our time is over for today, but we can stay in touch. Our information is on platform, so please feel free to contact us anytime. Thank you. Thank you. Thank you. Thank you.

United Nations

workforce challenges

health and safety

standardized health data

UN medical directors

occupational health

COVID-19 impact

physical health

mental health

staff well-being

work-related stress

ergonomic issues