We will cover broad topics and integrate them into a cohesive view for the future of action. Most slides will offer more information than this time slot allows, but you will need the key details. There is enough here to cover at least a semester course, and you will have access to the slides for deeper exploration of the topics and embedded links. So, sit back and relax. Among the most hardest of jobs is to be a nurse, and among the hardest of jobs is to be a good teacher. This quote from Antoine de Saint-Exupéry, as for the future, it is not a question of foreseeing it, but of making it possible. So I will be talking to you about positive things in the future. So why this talk? It's the intent to provide vision, inspiration, and hope for the future, particularly for children, our future workers. Three of the four current global occupational environmental disasters will be addressed, the fourth one being war, which I will only touch on briefly. To solve one, we need to work on all four. These include the global burden of occupational disease and death, climate change, pandemics, and wars and conflicts. We must expand our scope beyond the workplace. We have the ability, but do we have the will? Let's consider a global vision, framework, and roadmap. The example of Ukraine is before us these days and is heartbreaking. According to the government ministry, 139 instances of environmental war crimes have been referred to the International Criminal Court, the Hague, in the Netherlands. Ecosystem and biodiversity have been devastated in the Ukraine. A third of protected waters and lands are now occupied by the Russian army, and risk of poor regulation is there in oil deposits and facilities, coal mines and nuclear facilities. And more than 1,500 Russian missiles have been fired in these locations, and more than 5,000 military equipment destroyed, littering the land. The Ukraine Climate Network is now pushing for the UN at the Stockholm Plus 50 meeting in June 2022 to end expansion of fossil fuel production. So this may be the silver lining of the war in Europe, a move toward renewable energy sources. All of you are familiar with this dynamic cycle by teamwork of the levels of prevention and best practice through universal basic occupational health coverage. So this is the formulation for our roadmap that I will discuss later in the talk. We're familiar with primary prevention, such as control hierarchy and banding, exposure risk assessment, disaster management, and the secondary level with surveillance and biological monitoring, education, communication. And then, of course, tertiary diagnostic, telling the story of the injured or ill worker, rooted in cause, built with trust, compensation, and safe return to work. There are both the internal team on the environmental and medical sides, as you can see here, hygiene, safety, risk management, the OSH committee with 50% worker representation, and also the medical side with nursing physicians and rehab therapists. The external team players are also vitally important. The professional training institutions, centers of excellence, the OSH regulators and inspectors, free trade unions, NGO support groups, the media, so important, worker comp lawyers, and hygiene specialist consultants. The goal here is universal occupational health coverage through utilization or rollout of basic occupational health services. And this is in line with the United Nations Sustainable Development Goal number three on universal health coverage. So starting at primary prevention, there are clearly pressures on safety, hygiene, as well as on occupational nursing and medicine, as we are here, and we need to get in on the design and redesign engineering and built business at this end. So all these decisions tend to be made before work processes get going, the workers are in place, and we have our safety staff to do primary prevention. But real primary prevention should include action at all stages, including informing design and engineering. Who are the populations at risk? To give us some global perspective, we can see on the right that China and India, the United States and Indonesia are the largest four countries population wise. And if you look at the global breakdown of population, a quarter of the world's people are children under the age of 15, and seniors are representative of the top 10%, whereas all those in between 60 to 70%, depending upon country, represent the working class or the work of able persons. As for climate, 33 countries are deemed to be at extremely high risk. It includes India and collectively, they only emit 9% of global carbon dioxide. The 10 highest greenhouse gas emitters account for 70% of CO2 release by rank, with China being first and the United States second, India third, even though it's one of the most vulnerable countries. At this chart here on the left, you can see where we are in 2021-22, right here, at about 8 billion total global population, with projected population by the end of the century at 2100 to be closer to 11 billion people, and perhaps leveling off at about that time. Some other projections are lower, WHO is a little bit lower than 11 billion, but you can see here the growth is going to be predominantly in Africa and Asia, up until the end of the century. Here you can see comparison of the world, in terms of the blue are children and the black are seniors, and you can see that most of the seniors are in North America and Europe, proportionally, compared to children, whereas in places like Africa, 40% of the population are children. Nearly half of the 8 billion global population are working, of whom two-thirds are vulnerable, with few or no protections or occupational health services. The vulnerable include women, often poor and illiterate, children even aged 5 to 17-year-old at 125 million, 73 million into 3D, dirty, dangerous, devastating jobs, 1 million in prostitution or slavery, but this is decreasing with ILO Convention 182, issued in 2000, with regard to child labor. Migrants are 258 million, and half of them are workers, and of those, half are economic and half are bonded workers, and nearly half of them are female. So let's take a look at climate as the second major disaster after war. Climate change is the most dangerous, now at permanent overall elevation of 1.2 degrees Celsius temperature above the 1750 pre-industrial baseline, and it is accelerating very rapidly. So who cares, and who must act for climate, future, and planetary health? All people. All life systems are targeted. 19 of the 20 warmest years since 2000, and 2021 was the warmest yet, and may take centuries to reverse. Teens and young adults care a lot, and many are terrified. It falls largely on us, who hold the power of science and influence, and on them, the millennials and Gen Z age group, to make the difference. As the Swedish child activist Greta Thunberg said a couple of years ago to the adults of the world, the eyes of all future generations are on you. So without getting into too much of the detail on the problem, just note some of the terminology. Greenhouse gases are heat trapping and uniform in air globally. They include carbon dioxide, methane, which is about 25 times worse than carbon dioxide, but has a shorter life in the atmosphere, nitrous oxides, and fluorinated gases. They remain in the atmosphere, globally thickening the Earth's blanket. And since the 1750 advent of industrial revolution, main sources include cement, metals processing, such as iron and steel, chemicals, coal mining, natural gas, petroleum, and landfills, particularly for methane release, fossil fuel energy use, and air conditioning. And the goals are reduction of greenhouse gases through energy efficiency and conservation, fuel switching to renewables, carbon capture and sequestration, land use and management changes. As you look at these charts, the top left shows you the trend in CO2 emissions over many, many thousands of years, until we get to 1950 here, and we can see this huge escalation up to 2014 here. And then now, as of last summer, the carbon dioxide average was 417 ppm, whereas in 1950 it was fairly stable at 300 parts per million, as it had been for many millennia before. Here you can see the CO2 emitting parts of the world – this is total for the world – at over 30 billion metric tons of CO2. And here you see the various participants, China being the biggest, along with the United States and the European Union. These are projections out to the year 2100, with the goal of getting back to below a total 1.5 degrees Celsius elevation. 2030 is pivotal for greenhouse gas mitigation to 50% of 2015, according to the Paris Accord, and achieving UN Sustainable Development Goals, pandemic prevention, and the evolution of universal occupational health coverage. So in 2020, we had a plus 1.2 degrees Celsius warming. For 2030, the goal is to cut gases by 50%. However, right now we're way behind with only 7% reduction since the 2015 Paris Accord. In 2050, the goal is net zero. That means keeping us at 1.5 degrees Celsius and no higher for the rest of the century. The cost benefits are significant. You can see here by 2050 a total cost of $8 trillion. Climate impacts are projected to cost roughly that, whereas a $26 trillion benefit by the end of this decade, 2030, if we take action. So we also expect 65 million new, good, low-paying jobs by 2030. These are adapted from the World Resources Institute and other resources, such as Visuality and Grantham Research Institute. Have a look at some of these websites. They're absolutely fascinating. For the COP26 in Glasgow last November on climate change, the graph emphasizes where we need to steer, to act, and to commit to get to 1.5 Celsius net zero in 2050 globally. The link in the second bullet describes the huge difference between 1.5 and 2.0 temperature rise in terms of impact. And what I'm talking about is the second line here. If you take a look at this webpage, it will show you what the difference is between these two half a degree global scenarios. It's vastly different in terms of what we may be seeing, in terms of fires, hydrologic events, heat waves, storms, et cetera. The G20 nations, which does include Russia, account for 80 percent of greenhouse gas emissions. And of the 193 United Nations members, 192 have made nationally determined contributions, NCDs, with current pledges for 2030 to result in a total increase in temperature of 2.7 degrees Celsius by 2100. We need to keep that to 1.5 ideally, but we may be stuck at about 2 if we're lucky and move very quickly. The net zero emissions goal no later than 2050 is what we're aiming for. By net zero, we mean 1.5. Failure to meet these goals will be catastrophic for life and life cycles. And one good thing coming out of COP26 was that the U.S. and the EU led the global methane pledge to reduce 30 percent to 30 percent by 2030. You can see some of the data on that. And yes, there has been progress on climate, as you can see here in this New York Times article. This graph shows in the 70 years since the founding of modern China are the six worst emitters, with the G20 members responsible for 80 percent. It's imperative that all G26 nations commit to having greenhouse gases by 2030 and to net zero by 2050. At the COP26 November 2021 meeting, it was agreed on these issues for forest and land use. The pledges include the Democratic Republic of Congo, Indonesia, and Brazil. These three countries alone represent 90 percent of global forests. The huge effort by the U.S. and EU on methane, although strategically absent on the methane pledge, was China, Russia, India, and Australia, who are big methane producers. But if we can reduce by 30 percent methane, switching all global transport to zero-tech electric – that means cars, trucks, ships, and planes – we can see a benefit of 0.2 to 0.3 degrees Celsius temporized by 2050, making 1.5 possibly more achievable. So the focus right now is on methane because it is one of the worst greenhouse gases, but its lifespan in the atmosphere is far less than carbon dioxide. Notably absent from the methane agreement was South Asia, including India, China, and Russia. The U.S. EPA is now proposing a new Clean Air Act to reduce methane by 70 percent. This schema shows the health effects of climate change, basically related to temperature rise, sea level rise, and hydrologic extremes – drought to floods. There's also a new OSHA heat standard proposal, which will be vitally important for workers in the United States who work outdoors in the environment, such as construction, mining, and agriculture. Here you can see a video of BBC of what we can expect life would be like living at 50 degrees Celsius. Recently, in August of 2021, UNICEF produced what it calls the Children's Climate Risk Index, stating that climate crisis is a child rights crisis, and launching this risk index with mapping of key climate impacts. Half of all 2 billion children live at extremely high risk, and where children are exposed, so are workers and elders. You can see on this schema the various types of maps that they've been generating. They include heat waves, cyclones, riverine floods, coastal floods, water scarcity, vector-borne diseases, air pollution, and lead pollution. So what can we say about hope? Well, mental health is another major health effect of climate and coping with climate anxiety and climate denial. So as a matter of survival, we need to think beyond the eco-apocalypse and nurture our visions for a post-fossil fuel future. Here you can see quite a good book, two of them actually, that I came across in the last year, published in this one in 2020 by a professor of environmental studies who realized that her students were quite anxious about the future. And she did tremendous research, and this was published by University of California Press. Highly recommend it. And, you know, we will get nowhere if we do not first imagine the future we hope to live in and start to work together, even in small groups, because it's difficult to work alone. This particular book on the right I highly recommend for those who are more scientifically oriented and who are physicians, especially our specialty. It was co-edited by Sam Myers from our Department of Environmental Health at the Harvard School of Public Health, and by Howie Frumkin, who was the former dean and specialist in occupational environmental medicine at the University of Washington School of Public Health. There are many contributing editors that get through the whole orientation on climate, and then they get to all the solutions. It's very comprehensive and an excellent read. I also recommend this IASS on planetary health, reimagining human health and the Anthropocene as a way to reorient our future and shed our anxiety. So let's get into some of the specifics about the future of rescuing the climate. Say, for example, in terms of transport, light vehicles emit 6% of CO2 globally, and the automakers are racing to catch up. Everybody knows Tesla, General Motors, all electric by 2035, Mercedes, all electric by 2030. The EU and U.S., California, Massachusetts are banning sales of new cars with internal combustion engines after 2035, and Biden is pressing automakers for 50% electric vehicles by 2030. And China controls about 80% of lithium battery supply chains. So right now, particularly with the ports closed with the pandemic there, we are seeing a problem with supply chains, and we are moving toward better batteries that are, for example, chlorine-based and eventually hydrogen fuel cells, which emit water only. This industry in hydrogen fuel is taking off quite rapidly these days, and we can also see that there are industrial partners from other countries that are building battery factories in the United States, such as Korea's LG Chem and Korea's SK Innovation. We need to build charging infrastructures and modernize the electric grid globally. And indeed, in October 2021, the International Aviation Transport Administration, representing global airlines, is committed to net zero by 2050, so we'll start seeing electric aircraft. What about construction, which is booming? Cement consumption is second only to water consumption in terms of raw materials, and cement contributes 8% of CO2 emissions, about half from the fuel to make it, and half from off-gassing. About 98% is Portland clinker, but there are substitute fuels for clinker and CO2 safe alternatives to both. And in fact, a method of actually turning in carbon dioxide from Portland clinker back into its substrate and capturing it. So carbon capture and storage are huge paths forward and I'll talk more about that. By 2030, $90 trillion worth will be invested in new infrastructure, mostly in developing countries. So we need to look at alternatives in the way we produce cement and the substitutes for them. How about agriculture and food? Well, agriculture is a major source of greenhouse gases, nitrous oxides, carbon dioxide, and methane, combining plants and animals and machine equipment. However, there are ways to sequester carbon in the soil and farming is becoming very smart with the advent of 5G broadband sensors, artificial intelligence, robots, drones, solar and wind energy. You can see many, many companies are investing in the agriculture sector. I encourage you to take some time to explore some of these fascinating new developments. And food itself, we talk about what is the carbon footprint of various types of animals and plants? Well, you can see beef, lamb, mutton, cheese, dairy, even dark chocolate and coffee and shrimps, palm oil, all of these pork are major high footprint. Low footprint include nuts, fruits, vegetables, and legumes. And these should be a major portion of our diets going forward. So what's on the company's food menu? Think about it. How about energy sources and smart buildings? Well, solar systems are best on and off grid. They're cheaper than coal and gas. 95% are silicon, but there's new 3D printing bypasses, which bypasses wafer production, which itself is energy intensive. And there's new hybrid or tandem systems for photovoltaic cells using a material called perovskite, which combines other minerals to enhance the energy absorption of the solar panel. Wind power also is major on and offshore and water power wherever water moves. So geothermal flow, fall, and waves are all sources of water power. There is the Zero Emission Homes Act, which is you can read about it rewiringamerica.org and you can see the photovoltaic power role for current science. These apps and Wi-Fi enabled smart homes are the wave of the future. And many states now are moving toward requiring LED lighting only, getting rid of incandescent, halogen, fluorescent. And there are infrared panels for hot water demands and also heat pump systems, which are much more highly efficient. So you can see the schematic of the home with solar power, with heat pump, with maybe a battery or interchange with the local energy supplier, as well as a battery or a car charge port. Okay. You know, even here in Mongolia, you can see the Mongolian Gur and the nomadic herdsmen. They have a windmill and they have a solar panel. And so they have a computer and a TV set inside their Gur. Some systems are evolving with wind. So the standard wind turbine or windmill produces about 80 gigawatt hours of energy. They tend to be moored to the seafloor. They can only go about 30 kilometers off offshore because of the way they're anchored. And there are fires in about one in 2000 of the big systems. You can see the nacelle is caught fire here and here. And those are difficult to replace, expensive. But there is this new wind catching system, which is, you can see, taller than the Eiffel Tower, produces five times as much power. It's a lot of small windmills in a trellis. And its anchoring system allows it to be dragged way out to sea, far further than 30 kilometers, and also towed back to shore for servicing. And it meets the 2030 SDGs 7, 9, 12, 13, and 14. The other half of the equation is carbon capture, sequestration, and solar reflectance. Here you see orbiting solar panels that follow the sun between the earth and they mirror some of the sunlight back as active sunshades. And over here, you can see wrapping of glaciers. That's actually happening in Europe now. And you can see other ways of pumping CO2 to the ground and to the deep ocean. And also changing activities with agriculture, such as no more tilling. We don't need to till the fields. We can use cover crops and replace nitrogen fertilizers. Other methods of direct carbon capture and developing green carbon dioxide and green hydrogen are really fascinating. I encourage you to read about it. Capture and sequestration to the earth as stone. Here you can see this system has now been developed by a company called Climeworks, and you can watch the video. They've developed a huge plant in Iceland that's operational now. And basically what it does is it sucks carbon dioxide out of the air onto filters. The filters are then mixed with water and the solubilized carbon dioxide concentrate is then pumped with water back down into the basalt level of the earth's crust where it fixes to basalt porous rock. And it forms carbonate, which will sequester virtually permanently that CO2. So there's a lot of push to get these systems developed and operational around the world to actually draw down carbon dioxide from the air. And other ways is to produce carbon neutral hydrocarbon fuels through these methods here. There's also a cementless concrete and green hydrogen, which is produced by electrolysis of water using electricity from renewable energy sources only for the electrolysis process. So actually you can combine water-based wind capture system with an electrolysis component that actually generates and stores hydrogen, which then can be extracted and taken off for fuel use on land. The future of cooling systems, trucks and petrochemicals, there's a lot to it. By 2050, 4 billion people will need air conditioning at home to avoid health risks, such as heat stroke, which will mean 10 air conditioning units every second until 2050, and will produce a tripling of energy demand. So buildings contribute about 20% of all greenhouse gases and HVAC consumes half of building electricity. It's the single largest opportunity for reducing building emissions and costs. That is HVAC modification. And there are excellent, there are excellent new startups, many using artificial intelligence, including for example, DeepMind was able to reduce Google's massive data center overall energy consumption by 40%. So more efficient ACs cut in half CO2 emissions from space cooling. And there's also ice power for large building and many other systems. And you can see these links down here from the IEA, these reports on cooling trucks and petrochemicals. I encourage you to read them, including examples here of electric heat systems. Also coming out are, for individuals are actually Occupational Environmental Health sensor systems to help us with our epidemiologics study of what is the burden of disease and exposure. So specific external exposures like a sleep, physical activity, smoking, alcohol, diet and physical chemicals, such as, you know, noise and air pollution, various types of chemicals. And we call these exposome sensors to pick up with high chemical resolution or spatial temporal resolution, the various types of exposures to individuals or groups of individuals, say in a factory. Yes, carbon climate intelligence and artificial intelligence. We are heralding the dawn of these competencies. And I strongly recommend that you read about these so that you understand what is going to be essentially running everything. So employers and governments are making climate strategic priority because of adverse weather and events that wreak havoc on core operations by disrupting supply chains, forcing mass evacuations due to wildfires and flooding of their facilities near coast, halting outdoor activity to extreme heat, making certain regions less habitable and raising costs of insurance and aid. So there are many startups applying AI to tackle climate change. You can read about them in Forbes in June, 2021. And recently the International Panel on Climate Change emphasized six steps in their March report, switch on renewable energy, make buildings more efficient, turn cities clean and green, use electrical vehicles, bicycles and walkways, sink carbon back into the ground and extract it from the air and protect forests, invest in a fairer world. So that's it on climate for you to think about. Let's move on to the next disaster, which is pandemics. And these typically are created or accelerated by humans. And COVID-19 has shown we have an amazing capacity for rapid solutions when life threatened. So it can be at work or outside of work and the exposure risk means that it's related to closeness to infected humans and or animals such as zoonotic sources. And we can see an example of all kinds of pandemics that have occurred over time, some in our lifetime and even vector-borne diseases such as yellow fever, plague, malaria, chikungunya are known occupational diseases as well as pandemic such as the SARS-2, which we're dealing with now. One thing that the WHO and the CDC were not clear about was that the SARS-2 virus for COVID-19 was a droplet nuclei transmitted viral particle. It is actually, we found by combining engineering science on aerosols together with the old public health model on pathogen transmission, that became quite clear in the summer of 2020 that we were dealing with an airborne viral particle transmission that less than five microns diameter which can easily get into the lower reaches of the lung. So it is, SARS-2 is a beta coronavirus and it's a cousin to SARS-1 in 2003 and MERS, the Middle East respiratory virus and the unique thing about SARS-2 is a large proportion, 30 to 50% were actually asymptomatic cases were barely symptomatic, very unusual and it helped the spread of the virus. And as it mutated, the virulence, both the virulence and the transmissibility increased. We developed a system of variants of concern from the wild virus from Wuhan to the Alpha and UK Delta from India and others emerging until now the Omicron which is predominant in the United States. And for epidemiology, we looked at the reproductive rate, the R naught with, if you have one person, how many people are they likely to infect on average? So with the Wuhan native variant, it was two to three people, whereas transmission with Delta, one person was infecting five to nine on average and with Omicron, it was even worse. So if you're unvaccinated, we know that increases the risk of new mutations and increased transmissibility. The Delta viral shedding was 1200 times that of the ancestral wild variant shedding from the nasopharynx. So you can see here at this chart on the right-hand side, the values of R naught or reproducibility. Way down at the bottom is MERS. You can see that it was very hard for that virus to transmit for some reason. There's a feature of it and here you can see SARS-1 and then COVID-19 ancestral strain. So initially we thought we needed about 65% of the population having herd immunity, that's the HIT. However, when we got to the Alpha variant and then the Delta variant, you can see with the R naught increasing, we really needed to get up to above 90% of the entire population immunized. Well, with vaccine deniers and fearful people, the vaccine, we still are not at 90% where we need to be for herd immunity, even with the Delta variant here, certainly with the Omicron variant. Only about 67% of the entire US population has been immunized. It is an occupational disease and very high liability and loss risk, especially for hospitalization death or long COVID syndrome. For employers, we know about, obviously these longer bars are those in healthcare work and first responders. And as of December, a year ago, we already had over close to 3,000 healthcare worker deaths. And as of May, a year ago, it was upwards of 3,600 deaths among healthcare workers. But other high risk jobs included construction, mining, public transport, retail sales, hospitality, food processing, farm worker and domestic work. So there are two legal categories that we know about. One is the presumption laws in some states, for example, California, where if you're healthcare personnel or first responder, it's presumption that if you get C-19 infected, that it is work related. Whereas for all other industrial or other types of workers, it may be burden of proof in toxic torts. So schematically here, we can see healthy lung versus COVID-19 lung. Here's the healthy lung and the COVID-19 lung. And here you can see a COVID positive person who's not vaccinated and a COVID positive person who was vaccinated. So there is a difference in the severity. Here you can see that we have an occupational COVID-19 pandemic as well as a public health crisis, but how different is it from, for example, pneumoconiosis, such as chronic silicosis and of course, climate. So pandemic exposure risk management is multi-layered approach. We all know this following the science and presumed airborne transmission, the hierarchy of controls from our industrial hygiene side to work ventilation and air supplies, housekeeping and face masks and respirators, public health prevention controls of hand hygiene, general masking, testing, quarantine, isolation and vaccination with herd immunity goal. It was big arguments, as you know, between rapid antigen tests versus the standard high-end laboratory and AAT or PCR testing. This proved out in the public health sense that rapid antigen testing was extremely vital, particularly when we got large numbers of people infected and large numbers of people needing to go back to work. So this is the CDC antigen test algorithm. If you have symptoms or symptoms or no symptoms, how do you go through and when do you get a PCR test and when do you not need one? So it's extremely useful. And the only difference right now is of course, a lot of people are not reporting their positive tests and they're not as sick. So it's harder to follow the test positivity rate in local communities reliably. But here you can see the difference between RNA copies being picked up way after infectivity has ended by PCR tests. Whereas in this red curve, the antigen tests basically picks up only when you're shedding live virus. So even though there's slightly less sensitive and specific actions, quite specific, it still has tremendous utility. These are some of the great things we've learned with this pandemic. And here you can see wastewater as a signal. Here in the Boston, greater Boston area, you can see the South and the North districts by green and yellow. And then what follows in the blue are the actual human infection rates by about a week to 10 days later. And here you can see the same schema with the spike in viral copies per mils of sewage and the dark blue line. And then a week later, you can see in Delgar here, the infection rate peaks. Another fascinating development and will help us in the future, if we can get people to accept vaccines is the mRNA. You can see they were produced within a year, including clinical trials, which really helped us with COVID-19. Whereas you can see other diseases, common infectious diseases, we still don't have a vaccine for some of them. Although malaria was just announced recently that there's a new malaria vaccine. And here you can see variation in vaccine uptake. This is from June of 2021. Also over a six month period, this study from the VA system, looked at the three major vaccines available in the United States. You can see that the mRNA had more durability over time in terms of keeping antibody load elevated. Whereas the J and J dropped down rather dramatically. And you can see from March to September of 2021, the percent of measurable antibody was down to 13%. Whereas with the initial shot, it was 86%. These are fully vaccinated, okay? So you can see the dropdown here. So this became the basis for developing a booster to add on an mRNA booster to add on to any one of the three vaccines. There's work been going on over the last year on a pan coronavirus vaccine. Another fabulous innovation. The technology is there. They're in, I think they're now in third-level clinical trials with a pan-coronavaccine that is common to all betavax coronaviruses with a potential prevention of new coronavirus pandemics, as well as even the common coronaviruses responsible for common cold seasonally. And these are the mechanisms of these. This company, for example, VBI Vaccines in Cambridge, Mass., has a synthetic virus-like particle, and the results are coming in gradually. We expect that maybe by the end of this year, it's possible to have a pan-coronavirus vaccine that covers SARS-2, SARS-1, MERS, any new coronavirus pandemic virus, new variants of SARS-2, as well as common cold coronaviruses. So I encourage you to look at these links here. And then, of course, big debate over voluntary versus required or mandated vaccines. There are options for employers to protect workers who are not subject to the OSHA ETS, which now has been blocked by the Supreme Court, but it may be reinstituted for federal workers. But the voluntary attestation versus a required attestation, these are pretty weak. We did try them in a couple of companies that I work with. Required proof of vaccination by all with an option to be tested once or twice weekly – that's the OSHA emergency standard – and then the required proof by all with the EEOC exceptions. Also, masking and vaccination reporting requirements. The big problem is fraud in faking CDC vaccine cards. This is a federal felony, and the approach to this is to use carrots and sticks. People are confused about HIPAA. There's no issue with HIPAA in terms of reporting vaccine status to employers. They have a right to know. And to support mandates and mask requirements where the science recommends that it's important. Now on to the global burden of occupational disease and death, as another disaster of the four. And the data do not yet account for climate change or pandemics or the undocumented occupational diseases and deaths, except for some estimates. And we are expecting more robust and true data with better AI solutions, and AI still needs human oversight and interpretation. So we have to plug in the truth – good data, not junk science and dishonest reporting. And then with the use of blockchain, we can make sure that the data, once verifiable, cannot be manipulated. So a lot of big computing power to help us drive down occupational disease and death globally. Just a couple of facts I'll mention here. Every 15 seconds, a worker dies and 160 workers suffer a work-related injury globally. A single work injury, an illness, or death can throw a family into abject poverty and homelessness. And 70 percent of the global workforce live in low- and middle-income countries, very vulnerable, 2 billion informal workers to things like climate and disease from work. The mitigating occupational disease and death will help mitigate climate change, and mitigating climate change will build better infrastructure, create many new jobs, reduce occupational disease and death, and improve life and planetary health. These are just some aggregate statistics on work-related mortality, and you can see that it's very high in terms of diseases in some areas of the world. This is a breakdown of Africa and the Americas and Europe, Southeast South Asia, and the Western Pacific region of Asia. I would draw your attention to the occupational injuries, and then some of the other non-communicable diseases. In terms of epidemiology, we look at the trends using death rates as well as dailies, which are the disability-adjusted life year, expressed as the number of years lost due to ill health and disability or early death. And these numbers, the percent change total over time has actually been improving globally for deaths, and the percent change also for dailies has been improving, but we've got a lot more work to do. These are various regions of the world across the bottom here with the global situation in the center, and the global proportion of all cause dailies attributable to behavioral, environmental, and occupational and metabolic risk factors, and their overlaps by region, okay? The ACOEM with its Corporate Health Achievement Award has been studied over time, and in this publication, for example, you can see that over roughly 13 years, among the Standard & Poor's 500 top companies, those who met very robust CHA criteria for occupational health and safety programs had between a three and four times return on investment for their investments in safety and health. So these are the numbers. This is the benefit. More newly reported is the Integrated Health and Safety Index as a guide concept for investors and employers, measures the business value of OSH programs, and it is based on the Dow Jones Sustainability Index measuring results across economic, environmental, and social dimensions. Please read about this. The ACOEM with partner social organizations in occupational health and other countries, predominantly Europe, joined together over the last nearly 10 years to form the International Occupational Medicine Society Collaborative, which includes societies from close to 50, you know, close to 45 countries and a total of 50 societies, advocates for education in OEH and for policies globally. And they've produced a nice toolkit, which I strongly recommend that you share with your colleagues abroad, and work on developing national medicine, nursing, hygiene, safety societies to become spearhead experts to educate, guide, and advise policymakers, lawyers, legislators, governments. So the last point here is what is our framework and roadmap for universal occupational and environmental health coverage through basic occupational health services? The first DOOHC initiative was in 2018 in the western Pacific region of the World Health Organization. You can see on the map here, it's the blue countries, 37 total countries. There are 21 Pacific island countries and territories included in WEPRO. And so we convened a meeting at the Seoul National University in preventive medicine, and nine of the most populous WEPRO member states came and joined us in Seoul, and we developed a regional report as well as individual country profiles to serve as a baseline for intervention with special attention to the most vulnerable workers, including informal sector and migrant workers. And the roadmap action plans has been developed with six strategic lanes and pillars, and this model can be adapted to any country in the world, although it is being produced in the western Pacific region for their member states. We hope to have it brought to the Global Center in Geneva and rolled out to all regions of the world. But you can see it covers these inputs, so governance, regulation, enforcement, infrastructure, and service, human resources, training, education, information, registration, financing. And then with health services and through employers and workers, the outcomes are all very good, these here in the orange. So I will leave it for you to look at these more closely. We do use this standard model, so if we have public health expenditure, what is it going to do? Well, this is a model for universal health care coverage, universal health coverage, which is Sustainable Development Goal Number 3 of the 17 UN SDGs for the year 2030. And what we did in Seoul, Korea, in naming universal occupational health coverage, utilizing basic occupational health services, we can add these components in red, in the white boxes, to expand out universal health coverage to include occupational health. And we actually defined what is universal occupational health coverage in March of 2018. It's an integral part of UHC that provides access for all workers to essential occupational health services as part of health protection promotion, prevention management, work-related injuries and diseases, and overexposure to hazards without financial hardship to them and their families. And it blends SDGs 1 on poverty, 8 on decent work, 13 on climate with SDG 3, which is universal health coverage, and includes the following dimensions for all workers. So health protection and workability, productivity, the fundamental mechanism provided through basic occupational health services, along with rehabilitation and social service protections, such as workers' comp and disability, and the cost coverage for occupational health to assure no financial hardship and coverage for wage loss. So what is BOHS? I'll leave this to you to read, but you can imagine as occupational health providers, it's the basic services, including hygiene, safety, and nursing, not just medical. So it's primary, secondary, and tertiary prevention, scientifically sound and socially acceptable and integrated with local primary care services. And hopefully the development of specialized centers of excellence within various world regions and nations. Here's a schematic, stage one, basic occupational health services, with the goal toward universal health coverage in occupational health services. So UOHC, this is the highest level, this would be the United States and Western Europe. And here you can see some emerging industrial countries, and we've got to get the basics to the most vulnerable down here and then build on it. So in summary, use and adapt globally, it's founded in law, it's sustainable, direly needed, six-pillar framework with timelines, six-pillar framework with timelines, and these SDG goals are predominant. You know, generating a national profile at baseline as a reference, which can be used to demonstrate your achievements as you intervene and develop your programs. Adoption of the ILO conventions, particularly the ones on occupational safety and health, and for specific industries, including industrial accidents, child labor, and so on. And what are the permanent goals? Progressive realization and capacity building with no one left behind. Each nation self-sufficient with basic occupational health services, and each nation incorporates OH at both workplaces and community primary care and public health levels. It's mobile, it's outpatient, team approach, and linked communication, 5G broadband and expert support, and bans asbestos, tobacco, and controls infectious disease and pandemics, and integrates mental health. Lastly, where are we headed with our planet? Well, if we had paid attention to all of these things, we still have to have a basis for moving forward, and that framework is essentially an ethical and moral framework. So we must now commit to all nine, both the traditional ethical principles of autonomy, beneficence, non-malfeasance justice, but also for planetary health, we will have to add five more called intergenerational justice for future generations, there are children and grandchildren, and more than human rights, we have rights of life forms and eco cycles, not just people, and distributive justice, meaning equity, no one left behind, and the precautionary principle to risk mitigation, and the right to know and the right to act. This schema on the right is produced by a clever woman at Oxfam UK, and it basically shows are the safe and just space for humanity, its regenerative and distributive economy, here in the light green, and the borders, the social foundation, the fabric that we need is to avoid these shortfalls, and all these things that we need to sustain life, and out here is where we don't want to go, we overshoot, and we destroy basically the planet. So safe and just, life economics, limited operating space, between a social foundation and ecological ceiling, and you know, everybody focuses on GDP, but it's not a good measure, what we are now promoting is something called the happy planet index, which instead applies direct measures and physical constraints of a finite planet, such as average life satisfaction, life expectancy, and our ecological footprint. Consider what the country of, little tiny country of Bhutan has done in the Himalaya, they've done extraordinarily well with all of these things. So what policy options are there for planetary health? Well, direct regulation, bans and mandates, taxes and subsidies to optimize positive social outcomes, cap and trade with environmental permits, and also behavioral nudges. And for those of us in research, we're putting out new information, analyses, AI is going to drive us more and more, but it's very important that we consider what kind of research we're doing, are we just tinkering, or in terms of generalized knowledge and applications across the bottom, is it pure basic research like Niels Bohr, or is it pure applied research like Thomas Edison, or is it use inspired basic research like Louis Pasteur. And here you can expand it out into a cube model where in the finer grained and crossover collaborations with end users or beneficiaries in mind. So whatever you spend your research dollars on, make sure it has a really positive and speedy outcome that's reliable for beneficiaries. So our challenge is to lead and scale up radically times 10 or 100, as they say in high tech, become conversant and take action for the UN 2030 SDGs, which you can read here, there are 17 of them, collaborate through our networks, industrial hygiene and medical, we've listed a whole bunch of them here as well as through worker and government organizations, set up a global task force to inform practical solution, accelerate our training of trainers, and create a national profile for each country and a roadmap action plan with 2030 goals. Some reflections think of planet Earth as if it were a generous person, and the only home you know, and realized like any human, the Earth only has a limited capacity to survive abuse, nurture nature, as we would our children to thrive in harmony, find peace and joy, not what we're seeing in Ukraine, huge social economic benefits await. If we dedicate ourselves to work on planetary health, we are at the tipping point and have solutions. We'll use them now. No time left to lose. Are you ready for the great transition toward endangered species or planetary health? Lastly, I'll call your attention to the view of planet Earth here. Look how beautiful it is. Sort of shaped like a zero circle. Zero has Arabic origin. The words in Arabic is sifr or void, and that's what zero means. It's like a door or a room. It's a framed space in which we can live and thrive, but it's limited and can take only so much abuse. So our goal is planetary health, and our mission is no harmful emissions to the air, water, and soil, and to live with compassion, that Buddhist Sanskrit way of life. And how do we do it? We follow the UN 17 SDGs and UOHC for strategic transition to Vision Zero. Zero – Vision Zero is zero to negative greenhouse gases, zero work hazard exposures, leading to no burden of work disasters, deaths, diseases, and disabilities, zero pandemics, zero violence, wars, and nuclear weapons. So first, do no harm. And from the Bible, where there is no vision, the people perish. And I leave you with this Korean national flower, the mugunghwa blossom, which symbolizes great affection, but it also symbolizes liberation through hard work and resilience. And that's the encouragement, hard work and resilience, and we shall get there. Thank you very much. What follows are some resource slides. All right. Thank you, everyone, for coming this afternoon. Just a point of order, so folks know, it's about 12 minutes after four. If you intended to go to the 4.15 Future of Occupational Medicine lecture, I encourage you to move to the next room where that would be available. I'm trying to remember where that is. I think it's the Imperial Ballroom. Today's speaker is not available for Q&A, unfortunately. He was not able to join the audio portion of today's meeting. So thank you for coming to this particular presentation. Some folks have asked where are the slides and will they be made available? The answer to that is yes. Once we have slides from the speaker, we'll be happy to publish them and make them available for attendees. So thank you for coming. Thank you. Thank you. Thank you.

future of action

occupational disease

climate change

pandemics

wars and conflicts

occupational health

renewable energy sources

COVID-19 pandemic

vaccination

planetary health

global challenges