Good afternoon, everybody, and thank you for visiting our session today, the Global UN Workforce Achieving Data-Driven, Forward-Looking and Sustainable Occupational Health and Well-Being Strategies. So this session is prepared by the UN Health Intelligence Team from the World Bank Group, Washington, D.C., International Atomic Energy Agency, Vienna, Austria, World Food Program, Rome, Italy, World Intellectual Property Organization, Geneva, Switzerland, and Agenda Consulting from Oxford, U.K. So presenters today, I am Dr. Jasmina Goldoni-Lestadius, I'm Senior Occupational Health Specialist in the World Bank and Chair of UN Health Intelligence Group. We have Dr. Matthias Lademann, he's a Chief Medical Officer in Atomic Energy Agency, Vienna, Austria. And we have Roger Perry, he's Director and Founder of Agenda Consulting from U.K. Authors have nothing, no conflict of interest to disclose. So this is a simplified version of our workplace. We are here working for the UN system. It is an extremely complex system of agencies and programs with different missions, with workforces of different sizes, in different locations all over the planet. But we do have something in common, and this is UN workforce, and these are challenges of OEM practice in the global environment. UN workforce is very specific to that almost level that we consider it as a distinct multinational population. UN workers work and live in the harshest and most difficult places on earth. They are multinational, they are typically away from their social and cultural roots. There are language barriers, cultural barriers, they are always on move, we are dealing definitely with the moving target, and they have limited access to adequate medical services. OEM practice in the UN is not much easier, not less challenging. We do have lack of trained OEM specialists. We have physicians who have multidisciplinary roles in non-medical settings, very difficult environments, a range of different health care systems, medical insurance plans. And then what is very challenging definitely is lack of health data. They are not standardized, they are not centralized, they are in multiple languages, they are often incomplete, and data on medical risks and lifestyle do not exist at all. When we say that we work for UN, many perceive us working in comfortable offices in this shiny headquarters building. This is WHO building in Geneva, WFP in Rome, this is UN Secretariat in New York, this is World Bank in Washington, D.C. However, reality is quite different, and most of our workforce lives in very remote, difficult places. These are my photographs from a mission to South Ethiopia, where I learned that many definitions from textbooks are different in reality. So road safety, workplace safety, oh my God, okay, workplace offices, shopping malls, ergonomics, airports in the sand, gyms in the sand. So how to secure our workforce, how to provide standards that would go from this to this and cover all workforce wherever they are. So the UN developed Occupational Safety and Health Framework, and recommendations for phased implementation of it in the whole UN system, in all agencies. So this Occupational Safety and Health Framework is in reality actually OEM management system. So as all other management system, it starts with assessment, with risk assessment. So considering all what they described before, the only actually way we could assess risk, health risk, and safety risk in our global workforce was a survey. And these are actually chapters of our comprehensive holistic surveys that covers physical and mental health, but also information about employment, work patterns. Since we conducted surveys during pandemic, it also had questions about COVID pandemic experience, about offices set up, doctors' visas, preventive screening, sick leave vaccines, blood pressure and lab results, and very important plans regarding your health. So we implemented such a survey across the UN system. The survey was built by UN Health Intelligence Group. This is a working group of UN Medical Director for interagency data management, analysis, and visualizations. So our main motto here was one survey, one analytics, and one strategy. In so fragmented system, it was important, we thought, to have the same survey tool and collect the same type of data to be able to compare them, to find the best practices, to recognize hotspots of health risk globally. So this idea started 10 years ago. It started slowly because we were struggling with finding survey tools, with finding right methodology. However, then in 2021, there was a game changer. We found a partner who was providing survey on the same platform for all interested agencies. So here is our colleague, Roger Perry, who will explain how our idea turned into reality. Thank you. Thank you very much, Jasminka. Nice to be with you all. So a few principles in terms of the approach for the survey. The first was to have a common survey for all agencies. And that has a lot of benefits, not least agencies being able to compare their results with others. So that sense of, well, when you have different agencies doing different things, then it's very hard to really compare and to get the insight. So the key principles, one survey, comprehensive survey with some branching in the usual way. Some questions, you get a follow-up question if you answer A and maybe a skip if you answer B, those sorts of things. So ability to delve in. So that's a key approach. Demographic questions, increasingly important, I think, probably for all of us in terms of surveys, being able to break the results down. We had a strong set of what we called core demographics. The agency, your age, gender, marital status, length of service, staff type, staff categories, whether recruited internationally or nationally, duty station, so where the individual member of staff is based, whether it's a headquarters or field, and then which country, so one can drill down. And then also, for each agency, we allowed them to have up to three of their own demographics to reflect their own situation and to be able to drill down further as they wished. Ran the survey in those languages and using a platform called Reflections, which is owned by my company, Agenda, well-established platform that we've used many, many times. So that's a little bit about how the survey was set up. I wanted to talk about information security and data privacy because it's just increasingly important for all of us, the whole area of cyber. I think the first thing to recognize is this is very highly sensitive data. People are being asked to share information. They may well not necessarily tell many other people, perhaps anybody. And so it then becomes essential to have the right context, the policies, and setup to enable staff to feel comfortable in doing so. And a key, the second box there, all questions were optional. This one here, absolutely key part of the approach. If people wanted to skip a question, that was absolutely fine, move on. Not force anybody to answer a question they didn't feel comfortable to answer. We're a UK-based agency, as Jasmine mentioned. We're subject, therefore, to UK law around the handling of personal information. When we were part of the European Union, this was called the General Data Protection Regulations, and though we have left the European Union, the UK government has continued with the same approach. And therefore, as an agency operating and gathering and processing that data, we have to, we're obligated to set out our policies, and in particular, what our policies are for survey respondents, anybody taking our survey. And we are explicit about our privacy policy with all our survey respondents, and tell them who we are, how they can contact us, why we're processing their data, and the context for that. And we're also reminding them of their rights, because they do have rights. People who take surveys have the right to see the information you hold about them. That's a fundamental right, and they also have a right to be forgotten. And the way we interpret that is that if they write to us, we say, I'd like my data to be removed. We don't. We remove all the demographic, all the data associated with their record, so that we have, we very rarely get such requests. But that's part of the environment and the policy that we operate in. Another aspect is this final box here. We provide agencies with access to data, but we have very strong controls, so that one agency can only look at their data and keep that fairly tight. So a little bit there about security. And in terms of the deliverables, three main areas. Obviously able to look at the overall results, if you like, the descriptive statistics for the sample overall. In 2022, that was 17,000 respondents from 13 agencies. The 2022 survey followed the 2021 survey, so we were able to undertake a comparison. And Jasmine could be sharing a comparison, sort of summary comparison between the two years later in this presentation. So big picture. Access to all the agencies to our portal to be able to access their data, analyze it through a range of different reports, agency report to look at an individual agency's results in comparison with the whole sample, again, as I said, sorry, the benefits of keeping a common questionnaire, being able to drill into those results by demographic group to see it by gender, by length of service, and so forth. To analyze open question responses, there were about five to six open questions, open text, free text questions to be able to drill into those. Obviously for every agency to be able to see the breakdown of their respondents, to be able to think through the extent to which they were reasonably representative, analyzed by demographic, and then for those who wish to also provide a file of their results. Another key aspect here is what we call the rule of 10. So as part of the platform setup, it enables agencies to drill down into their results, but as soon as they get below that number of 10 responses, then they get no data. So you're keeping it well away from any individual data and protecting staff's confidentiality. I'm going to pass now to Matthias, who's going to talk to us about the IAEA. Thanks for handing this over to me. I'm very happy that we're able to present some of this data because the journey was quite long. The United Nations sounds like it's united, but if you see the first slide, to get them united to do a survey like this is not so easy. We started in 2015, and that's why my slide has a comparator in the last column to 2015 data. It was the same survey, 90% the same questions, with three agencies out of the whole UN system. Then the momentum took on in 2021. We had over 20 agencies taking part in that. That's how this whole developed. When we communicated this survey and what you can do with it, we had a lot of other agencies under the UN umbrella to join us with this common set of data. We had the platform where we could adapt to a certain point each individual agency with the demographics and additional questions, especially now focusing also on the pandemic and the mental health impact. We had a momentum to come together. The other was, of course, the financing always. Once we had sorted that out, we had them come all on board. I have put here an example from the data set and the reporting on the slide, and you see how the comparator is to the whole sample in the middle column on the right here, and how that is then also compared in the answers to the 2015 sample data. You see there's a clear negative development. The red means difference plus more, but in the negative area, and the green is more than five percentage difference in the positive area. We asked, in general, how satisfied are you with your work-related life and how are you with your non-work-related life? And then the sources of my stress are as follows, and these are examples of these 160 questions we had in the whole survey. Not all of them were to be answered, but some opened up then when you answered one. We were kind of analyzing these data in more depth when we did select 10 fields or 10 questions to dig a bit deeper with regression analysis to find a relationship. One area we focused especially in the mental health area is physical health and mental health, and that's where we find also some correlations, associations more. But we also found that different demographic groups had a different response to the same area. And in the green little squares, you see the more positive responses who did well in this, and these are the ones who did not so well with these key findings in the mental health and the physical health. Not going to the very detail here, it just gives an idea how then can you maybe look even deeper in your subsections of your demographic groups or employee groups to target your interventions a bit more detailed or different to that section than to the other, which is an immense effort, of course, but just showing you what's possible from the data set. For us, it led to certain recommendations. Especially in the mental health field, we realized already years ago in the UN that we have a problem like anybody else, I guess, too, WHO prediction of mental health at work is increasing over the next decades. And we also saw our sick leave data coming up with a big proportion of the sick leaves taken on with mental health group or diagnosis out of the mental health group field. So we've developed a mental health strategy in the United Nations, a UN system-wide strategy with a five-year roadmap in 2018. Now these recommendations are actually matching very well with the mental health strategy we had in 2018 already developed. We see that our data kind of incorporates or moves forward doing more in this field. And we're very happy also that WHO-ILO in 2022, last year, came out with the Mental Health at Work Guidelines, which is an immense or great document, I believe, because it has really done evidence-based literature review, expert panels, and then combined this into recommendations, which is pointing in the same direction again. So one more evidence base to include in your argumentation also to convince your higher management, the leadership, in implementing and doing something for mental health at the workplace. We actually do this self-reported data. We validate this data with our internal staff counseling clinical psychologist usage data, who also reports statistical data anonymized about usage and reasons for usage. And we see a clear validation of this self-reported data and the area where we need to do something with the actual data reported or gathered from on the grounds in the agency. And it all points to this area where the unhealthy environment is created that you have to intervene and do something more in this area. And this leads me to the McKinsey study, which you may have heard of, where the toxic workplace area has to be addressed. And if you only do all the other things around it, but don't address the toxic workplace area, your interventions will not lead to anything, which we are happy because we are trying to address this much and more now that we have the staff counselors' data also and are able to convince our management to do more in this area. So with these four, five pillars here, the counseling data and the evidence-based data, we have a pretty good business case to really move forward in this area. What we also have in this previously mentioned UN system-wide mental health strategy is certain scorecards where we are scoring from a certain way of assessing where you stand. And we have to report this. We're all reporting this this year to a higher body in the UN. And then you can actually report approaching standards, meeting standards, exceeding standards. And these standards are defined in this implementation scorecards, which is another tool we use to actually convince the higher management organizations or each individual organization about where they stand and what more is to do. So we were happy to get data, first of all, because the UN never had data before 2015 to this extent. We're creating more data. And in this line of what you don't measure, you can't manage, we actually want to move forward with just regular surveys to create more data, but also more evidence-based recommendations out of it, which can be system-wide, depending on the region and the organization, of course, implemented and be used. And we speak a unified language. Thanks. I hand over to you. Thank you, Matthias. So International Atomic Energy Agency was a leading agency of the first round of the survey in 2021. In the second round in 2022, the leading agency was a World Food Program. Our colleagues from World Food Program couldn't attend this time, so they asked me to give you just some highlights of their results. WFP is a very decentralized organization. It has about 24,000 staff, employees, and only 10% of them are in Rome at headquarters. The rest are in remote duty station, more than 1,000 remote duty station across the world. They achieved incredible result in the survey. So first highlight is their response rate, which was 47% in only three weeks. The survey went out in four languages, so that certainly helped. But it was incredible, because typically big organizations, organization of that size, reach about 30%, 35% response rate. Small agencies were reaching all the way to 50%, but 47% for so decentralized organization was really exceptional. And we will certainly learn from their methods of communication how to, in the future, improve our response rate. In addition to typical kind of channel of communication, like emails and newsletters and announcement, they were using two methods that were very efficient. One was messaging from their leadership, senior leadership. So at the beginning of each year, each week of this communication campaign, one of their leaders would give a short kind of video saying that basically, so here is the survey, here's the opportunity to say what we would like to have in the next three years. All our programs will be based on the survey results. So if you don't say what you need, there will be no such program that will meet your needs. So this was very efficient. We were watching daily response rate in WFP. So typically after such messages, about 10,000 or even more responses would come in into one evening. So this was one method that was very efficient. The other method was daily following response rate and actually targeted messages to places, country offices or regions, which were behind in their responses. They would get that targeting message, your response rate is not moving up as the one in your neighborhood. So that was almost competition between country offices and region who will reach higher response rate. This was extremely efficient. Of course, it required additional effort to every day look into response rate by demographics and then really sending these targeted messages, but it definitely worked extremely well. And this is something that we will be implementing in the future. Regarding responses, they were analyzed in many ways. These are really just highlights and sorted in two, so to call back it, one is respondents' lands. These were actually, these were results from staff comments and they are self-reported numbers showing that the most prominent were issues that they recognized was and reported back was body pain discomfort in the past six months. Even 55% of respondents responded that because most of people work from home in offices that with no regulation, no ergonomic setup. So that was one of the findings that was very important for introducing programs. Stress affecting health was another high proportion of responses. Also disturbed sleep, gaining weight and low physical activity. From medical service lens and perspective, very concerning was how many people responded that they have no primary care physicians, so almost half of that didn't have. To say that in some areas of the world, concept of primary care is not very well developed, but still it was a very high percentage, much higher than in the rest of the UN. And consequently, a lot of people didn't know their basic biometric measures and lab results. Another concerning finding here was low compliance with cancer screening, which in post-pandemic world, we noticed that there were more medical evacuations for cancer in later stages. So certainly also one indirect effect of pandemic. Of course, there are not only challenges, wherever you have challenges, you have opportunities. So good news here is that 80% or 85% actually of respondents plan to improve their health and they listed exactly which kind of programs they would be interested in from increased physical activity and improved diet, lose weight, to programs to improve mental health management. From WFP medical service, of course, they will increase campaigns for cancer screening and general preventive screening, including Know Your Numbers campaigns and vaccination also related to return to mission travel. To come back to big picture, so in years 2021 and 2022, more than 30 UN agencies took the survey. We collected over 35,000 responses and more than 28 million data points. So here you can see sorted agencies without identifying them by response rate in 2021 and 2022. You see small agencies are around 50% response rate, much lower typically in big agencies, even 10%, 11%. And then in the second round, this high percentage of WFP right there. So how do we use this data? We compare data between whole samples between agencies and then for same agencies that were repeating survey several times. Just to say that among participating agencies, we had leading agencies in the UN system like World Health Organization, ILO, World Food Program, of course, and others. We had also agencies that were not conducting survey on the same, this same platform because of IT security and data privacy policies. So World Bank, for example, had the survey outside of this platform. And then also this upcoming survey in 2023, World Bank again and IMF will have a separate survey, but most agencies are on the platform. So we were summing up all these results when we compared the samples and organizations. What was very useful in this, of course, there are a lot of data and it's difficult to summarize them and compare them. So we like to use some sort of indexes that are combination of multiple, multiple numbers and indicators. And one of them was health risk stratification index, which was including 15 high health risk factors listed here, I will not read through that. But the point is that if the person would have zero to two risk factors, it would be low risk level, medium risk level, three to four and five or more high, high risk factor. So this was very, very good methodology. It was developed and published a lot in the past 10 years, developed by the Eddington. And we were using it, for example, here is one type of implementation of it. This is a staff health risk profiles in 2021, comparisons between organization. So you have a UN wide health profile with less than half of people in low risk categories and 18% in high risk categories. But when you go by organization, these risk profiles are different. And in this case, I picked three organizations that are in different levels of centralization. So UN1 is rather decentralized organization by UN3 organization is mostly situated at headquarters. And you can see that this organization has the highest proportion of respondents in low risk category because all these other challenges that I was listing before in the field were not present. So we also compared health risk profiles of whole sample in 2022 versus 2021 and learned that actually in, well, we cannot call it post pandemic period in 2022, but it was a period in the pandemic when it was much better controlled than in 2021. And people started to come back to work and missions. And it actually, we noticed that the risk profile was improved in 2022. The proportion of high health risk category was significantly lower in 2022 than 2021. Here are comparisons in these findings showing in green box improved health risk factors, the same in gray box and worse in this kind of, I don't know how to call it, maybe orange box. So what became worse, of course, there was prevalence of COVID that was higher in 2022 than 2021. There was high alcohol consumption self-reported and a higher proportion of people who had no primary care provider, probably also because during pandemic, people were not searching for primary care provider, but a lot of factors were improved from work-life balance, less overtime, shorter sick leave during COVID because it became less severe, more fully recovered, vaccinated, better mental health, better physical health, more physical activities, less smoking, less stress, satisfaction with work was improved, less working in pain and discomfort, people were coming back to regular offices. And in developing countries, we noticed that this home offices were far worse from ergonomic point of view than regular offices. So this also improved by greater return to work. And then more people plan to improve health in 2022. This will be my last slide to invitation actually for discussion and based on what we learned through this survey campaign so far, there is in case you plan to kind of implement the same methodology, develop the same type of survey that you want to repeat over time or compare with others. So this is a huge opportunity and to build a big common data pools with data that are holistic, that are global. This is very cost effective, also data gathering. I mean, all organization, 30 organization were using exactly the same survey. Just imagine that they were developing their own surveys 30 times and these surveys would not be the same and each organization would have to pay for another survey tool. And at the end, they would not be able to compare anything with anything. So this is extremely cost effective, not only data gathering, but when it comes to analytics, the same thing. It was very useful when we started to use the same platform that we could do the survey in the same timeframe because before in the beginning, when we were kind of going randomly as our agencies would approve the survey, then we would go for it. And then we had a spread of like few years and it was difficult although the survey was the same to compare the data. This problem is now solved with having the survey rounds every time on the same platform and we plan to do it also annually so we will get a good going in this term. Benchmarking for best practices, no need to even mention this benefit where you are comparing data. You can see agencies that are dealing better with certain occupational medicine problems. For example, in the first round pre-pandemic survey, we noticed that one of agencies had extremely low rate of smoking amongst survey respondents, big difference. So then we can go and check what they're doing, what kind of programs they have that they are so efficient. So for benchmarking for best practices, this is extremely a useful tool. In global organization mapping hotspots with highest health risk for shared intervention, this is big benefit because you can, for example, health risk stratification, you can on the map of the world actually see in which areas you have the highest proportion of population in high health risk. You can look which risk they are and actually establish programs that are very targeted and could be done with shared resources because they equally affect population of different UN organization. Also after pandemic, this survey will help us to understand prevalence of long COVID and treatment needs in future. For addressing this problem, we will create also evidence-based programs for hybrid work based on staff's comments and suggestions and then build data culture in our respective organization, which is really a problem. I think we all face this, that this health and wellness, it's a lot of stories and words, but they are often not supported with the data. And I think that during pandemic, this was our big display of how important it is to collect data and to plan your protective measures based on data. So we are kind of trying to keep this momentum going and this habit to look into data before building the program. But yeah, these are all good things. There were also a few lessons learned and things that you need to be aware of if you kind of venture to the same journey. First, it is to understand constraint of survey fatigue. I think that this is a big problem since electronic surveys were introduced. All of a sudden they were all over the place. There were so many surveys, people cannot stand seeing survey. And this is problem because a lot of these surveys, even in the same organizations, they're very fragmented. You have survey about that survey, about, I don't know, mental health survey, about how happy you are, this and that. people keep feeling the same demographic data and all these questions and nothing happens. Why nothing happens? Because you cannot compare even within the same organization results of this kind of surveys because each time there is a different subgroup of respondents, so you don't know what you're doing. So it is much better to have one holistic, comprehensive survey in intervals of two to three years and at once collect all the data and explore all associations and work. This is also an indirect way actually to address survey fatigue. We learn also that we have to sensitize senior management for support. I think this is for occupational medicine practice in principle so that we alone in corporations cannot do much. We have to work with all stakeholders to move the needle. We cannot just issue order, hey, just do this program. It is not working like that. Everybody has to sit around the same table, facilities, HR, even legal. If you have fitness center, if you have cafeteria, these programs have to be justified based on evidence and then planned properly, monitored properly. Otherwise, a physician, him or herself cannot do much alone. Share resources and services, this is part of the same message, communication campaign in the organization. Again, you have to have buy-in. Create data governance framework, that's very important as we discussed before, these are sensitive data and it is important to properly implement policies on data, privacy, on IT security. So to access the data, very important. So to have the set of rules to understand who is doing what, who has access to what, it is very important in this environment and generally whenever you work with data related to people. Develop internal capacity for analytics and data visualization would be ideal if you can do that. We are trying to go this route because having outside partners and each time educate them what it means, what you want to achieve, what's objective, it is much better to have somebody internally and to look into data in real time whenever you need to do something with them. Strong commitment and adequate resources are required for positive impact, so it should be recognized in the organization that there is a priority, so this is part of building data culture to really ensure that you have resources and time to devote to data analytics and to implementation of recommendation based on them. And I don't know the time, yes, it is good timing, so I will finish our part with this and invite you to ask for questions and we'll be happy to discuss it. Thank you. May I? Yes, please go ahead. Is it on? Hi, I'm Kaoru from Tokyo, Japan. In your slide, I think it was page 17, the one with the two circles, it talks about the medical service lens, does that mean those medical professionals of your employees did not know the blood pressure, like 23%? This is just sorted actually for us to explain better interventions after. This is all based on the same results. So as a respondent's lens, these are issues that are recognized by staff as important to them. They would report they don't sleep, they gain weight, they are not active, and we agree with that, it's all important. But they will never say, well, I'm concerned because I don't know my blood pressure. So that's what we see. They don't know blood pressure, they don't know glucose level, we get it from the same survey, but this is on our list to address. It is not something, when you look at the next slide, for example, plans to improve your health, nobody says, I want to know what's my blood pressure. People want to exercise, they want to lose weight, they want to eat healthy, they are worried about their mental health, but then comes this cholesterol, blood pressure is somewhere low because it is easier to achieve that than to change behavior in terms of health risks. Oh, okay. So the one on the right, the circle, means medical assessors did not think employees knew blood pressure? Yes, because people were saying that they never did colonoscopy, they were in this age bracket for colonoscopy, they were saying that they never did a breast cancer screening or whatever mammogram. So this is what we, out of the survey, we recognized as a risk, so, and something that we need to address. Oh, okay. Yeah. Yeah, the right side is just what medical service saw on the data. Yes. They are, okay. Okay, thank you. Yeah, thank you. Okay, I have one more question to Matthews. You mentioned about the WHO, the ILO's guideline that just came out. So it really emphasized on the evidence of a manager's training, yeah, on the stress. So have you and the UN done the training for managers and how is it going and yeah. Actually, thank you for this question because it's actually close to my heart because that's the area where we actually were lacking in the past and the mental, UN system wide mental health strategy, which came out in 2018 was a five year roadmap, stigma reduction, but also training of managers has come a long way and actually did do workshops, webinars for managers offered it actually open to not only UN, like New York based UN, but also other agencies to take part, but each individual agency also in addition developed training for managers. Okay. Oh, I see. And in addition, there's also a toolbox, like a, not a scorecard, it's a different, like a pocket card or like a guideline paper or information sheet, which especially is developed for managers and how they can cope with mental health of their staff, but also themselves. And all that came a long way. So we are, we are doing, we're walking what we're talking. Oh, okay. Okay. Thank you. Yeah. Thank you. Thank you. I just wanted to piggyback on what she just said. Cause I think that it's, can you, we're in my company, we're doing something as well, but not only with managers, but also with people that many like peer support, I guess you could say. So I was just wondering, what are you looking at in terms of training for the managers in terms of being able to, to provide support to their staff? Like what, because there's different, like there's mental health first staters training. Is that one of the things that you're looking at, or are you looking at something different? The key issue for us was first information because on awareness, a lot of times managers came to a medic service or a staff counselor, I'm talking all about the experience in the international atomic energy agency, but also UN wide, but getting the questions, what do I do? How can I talk to this person? Well, how can I identify? Or I think they have a problem, but I don't dare to even address it. So that was one of the help we're trying to get in the awareness sessions. And in addition, in this awareness sessions, which were run initially together with medical service and staff counselor and HR, like, like three people on board or three parts of this on board. We also addressed behavior, how to talk and will not to talk. And that was the most sensitive issue to really put in this training because there were initially some resistance to be too blunt. But we managed to do this. And I think it's a, it's an eye opener based on the response we were able to show how special behavior impacts staff or special behavior of staff impacts a manager. So my second question, which was the original, because I thought it was really interesting what she was saying is getting people to fill out surveys can be very challenging as you talked about initially. And I found the fact that in the decentralized organizations, such as the one that you presented, the 27% response rate was exceptional. Like you said, I just wanted to know, what did you do to help? Because if we get 50, 20% is like, we're like, yay, success, let alone more than double that. So I was, especially for something as sensitive as this, some people are like, I don't want to talk about it. And there's even cultural considerations for people who don't want to even acknowledge that it's an issue. So I was just curious, what did you do? Well, WFP prepared the communication strategy prior to the survey and plan all the steps, what kind of communication with staff they will do. So I think one, this was one reason for success that people knew what was coming. And it was very clearly stated what the objectives of survey are. It was important that it was anonymous. So it was also stated that it's not possible to recognize anyone. It was, it helped, it was in four languages, I said. But I think really, the most powerful were messages from their executive director and highest managers in the organization, and this daily following on response rate. So people noticed, so it's not something that it doesn't matter, it's launched once and nobody knows whether I will respond or not. But they were aware that there was really, it was important enough to be followed daily. I think also culture in WFP is special, but that this one cannot imitate. But this, what I wanted also to say, we are sharing all the materials. So we saw what material WFP developed. And these videos were shared with the whole UN Health Intelligence. So this is, we are not sharing all the survey, but all this campaign promotion material. These videos were extremely powerful. I mean, this is really senior management showing care for its population and saying it very clearly. This was very impressive. I think that we should all follow the same model in the future. Maybe it will not work the same way. But they got to this 47% in three weeks. Their response curve was like that. Typically, it's kind of hills. You have the big peak in the launch of the survey, and then each reminder, it's a little bit peak, and this is how this response rate curve goes. Their curve went like that. They would easily exceed 50% if they would want to extend. But they just gave it three weeks, and that was it. Very impressive. Just to add to this, we did this from the grounds up more. We did reach a 33% participation rate, and we were happy. At that time, we were leader of the pack, and we thought, well, it's great. What we did, we did like a know your numbers campaign. We actually did like a reach out in like three days. We were headquarter-based, we could do this. We actually did have stands where we were testing like cholesterol levels, and did like show that we're doing something, and at the same time, we promoted the survey. We got quite a good response rate at that time, but we didn't have the leadership message. Now, we're kind of looking at WFP and thinking, wow, there's really an added value if we get repeated message or leadership showing there's value in responding. And that's where there's a key difference between what we did, yes, had some impact, but having the higher level adding to this gives you more response rate. That's what I interpreted. Yes, another trick. We are sharing these tricks regularly in our group. But what we did in the bank also when we had in 2021 survey campaign, it went relatively well, but we were still not happy. And then last three days of survey campaigns, we got support from IT and communication. So each time when you would log on on internet, there was a little pop-up saying, did you complete the survey? Here is the link. Here is the deadline. This, we collected hundreds and hundreds on this last three days with these pop-ups. And when we thought it was over, we got the most of what we could get. But pop-ups gave us to be over 30%, 33%, so which is a lot when it's rather decentralized as well. So we have shared the drive where we put all this stuff on it. So any new agencies that participate in the survey can benefit from this content of launch messages, content of reminders messages, posters. Everything is on one shared drive, and this way we are also very cost-efficient. Sorry, we are keeping you here with your question. Thank you. I really appreciate your presentation. I have some global, to use a coined phrase, questions, and then some more specific. To what role does the UN headquarters in New York oversee or have any role with respect to the various other UN agencies? When I looked at your organizational chart, it reminded me of trying to get through the Krebs cycle. All kidding aside, what do they do at the UN in New York? What type of medical services? You talked about shortage of OEM, but more importantly, and not to be critical, but obviously you are in an environment here of occupational physicians, I was struck by the lack of questions about work-related issues, such as dust exposure, metal exposure, you addressed a little bit of the ergonomics and so forth. And then the final comment, I don't want to take up the whole day here, but to what extent do you do research to either to identify problems or to evaluate the effectiveness of your interventions? So let me think if I can get this together. You only have 30 seconds. Oh, I'm putting up the threshold here. Yeah, tell us what the UN in New York does. What is their role and what kind of medical services does the UN facility in New York do? You can sing in duet and that. Well, let's say the UN in New York is actually kind of the, was kind of the leading figure because of the highest number of employees in the workforce. And they have a department of, it's called DMOS, like the medical service, which is under the operational support. And they actually were initiating the occupational health policy, which you saw at the, at one of the slides, where the whole momentum took place that in the UN we should do something more. And we have a medical directors, like medical directors from all the agencies meeting once a year, annual meeting, but also a group where we are all trying to unify our approaches with the medical like lead in New York. Um, but maybe 30 seconds to be very concrete, to be very concrete. This initiative is almost like a major corporation, an international corporation that has a headquarters and there's dotted line reporting to some, no, no, this initiative started actually from occupational medicine physicians without prior to any regulation from a UN secretary in New York. Um, so it was just a few of us who were, uh, who were aware of problems in our agencies that we didn't know any information about health risks of our people. If somebody would ask you how many people smoke or drink or whatever in the organization, we didn't know anything. So it started before that without obligation, um, in few agencies. And then it was getting momentum once when we started, what was the first survey, 2012. And this framework was established in 2015 while we already had seven organization just conducting the survey thinking it's important. So it's, it's, uh, not really formally requested. It was, it was led by need of us to, to build programs that are really meeting our needs, uh, needs of our workforce. So, uh, UN secretariat as an organization, they, uh, they joined, uh, 2021 survey round as everybody else as World Health Organization, ILO and other organizations. So, um, we joined actually UN medical directors. They played role before any, any regulatory, yeah, we played a role, but we were pushing kind of the occupation health and the UN system on the UN medical directors group. And of course, kind of New York as the biggest entity, uh, the secretariat as we call it with their own workforce, uh, was kind of guiding, uh, us all along. And we are, we're trying to identify, identify identical areas, uh, where we can all hook on to as a first step now as to lead and dust, uh, that may come, uh, we don't do research per se. That was the other quick question, answer to your question. And on the IA, we did enter a question regarding radiation exposure because we have occupation exposed working group, like our inspectors, uh, the safeguards inspectors, um, where we have our own monitoring program, surveillance program in-house. But in this survey, we also added a question, uh, kind of a validation question to what we see there. If there's any other anonymous report of an exposure. And for your safety questions, uh, in 2021, we were mostly working from home. We didn't include safety questions in that survey in the 2023, uh, this question will come back. They were in pre pandemic survey about concerns of people who, uh, who work and live in country offices, travelers, 70% of our populations are travelers in the bank, for example. So we have in the survey that concerns regarding security, safety in locations where they travel, we have about vaccination and malaria, prophylaxis, and so on. We have much more than we could show for this 60 minutes. So we do have, uh, data, uh, on many more factors. Well, thank you. I didn't want you to think you were under cross-examination. I was just curious. No, that's good exercise in thinking. Yeah. Thank you. Thank you. Well, all your questions answered. Okay. Great. Thank you.

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