Good afternoon, everyone, and welcome to the session Global OEM for the UN Workforce, Mission Possible. My name is Jasmika Goldoni-Lestadius. I'm Senior Occupational Health Specialist in the World Bank Group in Washington, D.C. I'm also a founder and chair of UN Health Intelligence Working Group. With me today is Dr. Matthias Lademann. He is a Medical Director of UN International Atomic Energy Agency in Vienna, Austria. He's a co-chair of UN Health Intelligence. And we are speaking here also on behalf of our colleagues who could not make it today to Orlando. Thank you. And this is Dr. Gloria Dal Forno from UN Office Geneva, Switzerland. She is their Medical Director, and she's also chair of UN Medical Directors. Sofia Voldemikel from World Bank Group Headquarters in Washington, D.C. Mariana Igelnik, she's a Chief Counselor in UN World Intellectual Property Organization in Geneva, Switzerland, and our colleagues, Roger Perry and Aidan Steed, who are from Agenda Consulting in Oxford, U.K. We have no conflict of interest to declare. So something short about UN Health Intelligence. So this is a working group of UN Medical Directors for interagency data management, analysis, and visualization. We are known for our motto, one survey, one analytics, one strategy. Looks very simple, sounds simple, but considering the complexity of the UN system, which consists of more than 100 agencies, organizations, and programs, and considering a large footprint of it, we have staff all over this planet. So this is not such a simple goal, but mission is possible, as the title says. So our basis is for Occupational Health and Safety Management System, is spelled out in Occupational Safety and Health Framework, issued in the UN system in 2015, and slowly started to implement soon after. So we are assessing health and safety risks at three dimensions, three levels. One is population health management, so we assess health and safety risk of our population, and then also workplace and general environment. The survey we created, and which will be the topic of today's discussion, is addressing health and safety risks of population, but has elements also of risk in workplaces and in general environment. So this is a short history, a timeline of our development and implementation of the survey. So we started in 2013, and in a period of six years, seven agencies took the survey, World Food Program, Agency for Refugees, IMF and World Bank Group, IAEA, IOM, this is Organization for Migration, WHO, and IMF actually took the survey twice. So this is a long period of time. We were taking the same survey, but in different time intervals, and that was a long journey to figure out which survey tool would best serve us. So you see here from Survey Monkey, which was revolutionary in 2013, but then others came in. So we were using CVENT, WHO were using their internal tool. So there was wandering there, although from all the survey tools, as you know, you can explore data in Excel and analyze, but it was still a lot of work to figure out what works best. And then we had different partners for data analysis, starting from Catholic University of Rome, because the first organization that took the survey was in Rome. Then we tried with Yale University, with George Washington University, John Hopkins University. So there was a long journey to figure out what works best for us. In 2021, it was a big, it was a game changer for us. We found a partner who offered a platform for the survey that could be used by any number of agencies, by any number of respondents. So in 2022, 23 UN agencies took the same survey at the same time, not this six-year interval in between, thanks to this, thanks to Agenda Consulting Oxford in their reflection platform. The survey was offered in four languages and collected, I will tell you, amounts of data, millions of data points. At the same time, World Bank also took the survey using Qualtrics tool. There is here a problem that there are agencies that have just one tool approved by their ITS, so this is why we couldn't participate in common platform. In 2022, 13 agencies took the survey, in 2023, 18 agencies, and again, IMF and World Bank Group on their own survey platforms. How much data we collected, as you can see, in six first years, we collected 7 million data points, but then year by year, this number was much bigger. So just in 2021 alone, 22 million data points, then 13 million, and then 19 million in 2023. We conducted more than 60 surveys, collected 87,000 responses so far, and over 61 million data points. So huge database for the UN workforce. This new approach, this common survey platform came with many features that were very useful for us. So, first of all, the same survey could be conducted, it is for as many agencies as wish to participate. So there was no limit in size, English, French, and Spanish and Arabic were offered, versions of the survey were offered. It was a great collaboration between UN organizations because this was not required by any rules or laws to conduct the survey. So it was voluntarily, agencies were participating on voluntary basis, and then this translation, for example, was done pro bono by World Intellectual Property Organization. It was done in four days. It was really amazing effort from all involved parties. In this common platform, agencies are allowed to customize questions on demographics because we all have different levels of appointments, different types of appointments, different presence in the field. So there are agencies that have more than 1,000 country offices around the world. There are agencies that have just basically people at one headquarter. So that part of the survey was modified, and then later on, we modified also the part about utilization of services that were offered by specific agencies. Other than that, the core survey questions were the same over the years. Also we collectively each year were reviewing whether there is anything new going on in the world that we need to include in the survey questions. So during the pandemic, there was the whole paragraph on questions about the pandemic, about vaccination, about generally long COVID, everything. So once the COVID was over, then we removed most of these questions, but then focused on coming back to the offices, reestablishing mission travel. So there is a part of the survey where we take into account what is going on in the world to collect the data in real time. We are getting out of this platform, we are getting reports. Each agency has their own report about findings of their part of the survey, and it's always compared with the rest of the sample. And it is also compared if the agency is repeating survey in intervals of two years, let's say, then it's also comparison with the previous results. So it is very useful, and it is also, everything is developing as the time goes. So in addition to relatively static reports that I described, there were also dashboard introduced in 2023 for interactive presentation of data. So Dr. Lademan will talk about that soon. So we are now having annual surveys and agencies, they join in intervals they are good for them. So some agencies go every year, some every second, some every third year. So this is the content of the survey. It is a comprehensive survey and holistic survey. So we are trying to get as much data as possible at once to avoid survey fatigue, to avoid multiple surveys, so mental health, physical health, COVID, work from home, ergonomics. I mean, there are all these surveys circulating around, and staff is forced to each time respond to the same demographic questions, and typically nothing happens after such surveys anyway because they are too focused to one topic. So this causes survey fatigue, and finally no one gets enough data for whatever they want to know. So we think that having one survey comprehensive every two years or every three, or for small agencies even on an annual basis, it's a much better approach. So we collect data, general information, employment, work patterns. In the last survey, we had information on COVID because we wanted to understand how, what is prevalence and how this will affect our services. A perception of health as predictor of participation in the preventive programs. We have physical health risk, mental health risk, office setup, ergonomics that became very important during home-based work, but then also upon return to offices. We collect data about doctor's visits, preventive screening, sick leave, vaccines, blood pressure, and lab results, and a plan regarding staff's health. In the core questions, we were using validated survey tools listed here. We were also customizing some questions to match our population and our presence in the field. Another standard, let's say, survey is health risk stratification and 15 high health risk factors. This is a methodology that is first described by and developed by Dr. Eddington in Zero Trend book. It was published in detail, but then it was published in many other manuscripts and it was used very often for health risk stratification of population network. So, we had all these 15 risk factors in the survey, and people who had 0 to 2 health, high health risk factors were sorted as low risk, low risk, and then 3 to 4 medium risk, and high risk, 5 or more high risk factors. So, we are able to stratify our population by risk, which then help us in prioritization of our services. Also, of course, for any risk level, for any kind of population, we can see which factors are most prevalent, again, to direct our programs. This is how the risk profiling looks in the few agencies. So, first you have UN wide graphs that show that 43% are in low risk category and 18% in high, but then there are different results from different agencies, basically showing that more decentralized organization have higher proportion of staff in high health risk. So, and then those who are very focused and at headquarters, they have better health risk profiling than other. We are marking agencies and UN 1, 2, 3, we don't want to put the names of agencies and create some competition or kind of image risks or whatever. So, we know the codes, but just for kind of presentation purposes, this is how we do it. And now my colleague, Dr. Lademan, will continue. Yes, just to add the slide before, that each agency who takes part only sees their own data. The other agencies are not able to access that data from the other agencies, but all see the whole sample data. So, that's a comparator then for everybody. And if they want to disclose or share, this is on consent of that individual organization. So, here you see the last year's survey. You see all the participating agencies on the blue, on the left side of the slide, but the yellow highlighted areas are showing you the ones of the new introduced modular topics we were asking in last year's questionnaire. And also the last one, awareness of experience of service provided, should be actually yellow because it was a new feature where each agency could actually add their own services they provide to find out if their staff actually is aware of that or is used of these services. And they may differ from organization to organization. Here is also the latest feature, and we're happy to have it on interactive dashboards. And I'll show you some samples of that in the next slides. But here, all these different areas can be stratified or like asked for, filtered with this demographic, for example, which is demographic data you put in as the agency. And each agency has also their own demographic data availability to enter there, up to 10 different fields, because you may imagine that you have a field-based organization, which is much more interested in what happens in different locations of the world, whereas the headquarter agency has more and more interest maybe in gender, age, grade classifications. That this is also not so easy to agree upon, exemplified by maybe a few agencies, for example, did not want to put the question about ethnicity in there, which could be highly debatable among how you look at this. So for some agency, they didn't even ask that question because they didn't want to raise a discussion. Here you see one of the sample reports. The red one has the negative responses, and the green ones are the positive ones, or the good responses, if you want. On the right side, the columns show the whole UN sample data as a comparator, and then you see the negative results for the individual agency. And if you had taken this survey several times, you could see like 2021 data is the same column and see already if there would be a trend or a certain difference in the numbers be visible. So if you do it several times, and that's a future vision, you can actually do a trend and correlate this or associate it with interventions you may have done or changes at the workplace. One of the interactive filters we have is also looking for the more qualitative answers, and here this is the answers for counseling or mental health services utilization and considering this utilization. And you see that only a fraction of them had utilized this. A higher proportion has not considered using it. But there was an area where the respondents could answer other. And you have the option then to filter the open questions, which a lot of times gives you much more insight about what's really happening, with keywords. And here you put the keyword waiting in there, and you can filter all the open questions who include kind of this keyword. It's very helpful if you have a list of open answers, and then you see only the answers related to this keyword. So you can actually have a good search function to group certain open comments and then have an idea what is, why are people saying others or why are they saying no, for example, because only certain questions are being then offered as a follow-up questions if a respondent said no or yes. One of the other areas I showed before, which was new, was work with disability overall. And that is especially in light that the UN is also implementing now or using, introducing a framework for disability inclusion, which is long overdue, I think. It's a personal comment. But we're actually going there to implement this in the next years. And for that, the question was, how big is the problem? And nobody really had the answer. So one of the first steps we wanted to get to is to ask this question in the survey, self-reported of course, but at least you have some idea where you stand and where the areas are to look especially and what to expect in the future also, because it may have cost implications also when you introduce a policy for disability inclusion. So you see here that from the survey respondents, 2023, you have this average of 4.6% people who said they work with disability. It could be a lot of range, and I show you the ranges. Type of disabilities I mentioned is mental health. One is a big percentage. You had actually the option to have several answers in this question. But you see mobility and another condition of illness, which we don't know at this point. So we have to do this further analysis ongoing at this to find out what's behind this. As this is a new question, we are trying to decipher some of the data in a better analytic way. But you see also vision and hearing is one of the areas where persons are saying that they are working with disabilities. Now the thing is that, is it a disability which is visible or not visible? That is also what we wanted to hear, because that is what the workplace in real life, what you experience a lot of time. And the visible impairments or disabilities are easier to accommodate. The invisibles you would like to accommodate, but sometimes you don't know of, or persons won't come forward to do this. And that's what you see in this slide. You have the disabilities group here, visible of 26% of that, but you see a high proportion is invisible. And when you ask would you consider it to be temporary permanent, you see a large proportion is a permanent disability. So the work life will be, they will have it through the work life. And it's important, I think, that also a workplace accommodation may be possible for these persons. Now, when you said, then, is there a need for work accommodation, you see that what 1 3rd, 1 3rd, 1 3rd said, yes, no, and I'm not sure, which is also an interesting answer. And did you disclose a need for accommodation at work? Only a smaller fraction, like 27%, were saying yes. That's also, I think, reflecting reality. A lot of times, at least in our daily work, where we staff with a disability, especially also mental health disabilities, are afraid to disclose this because of different reasons. Are your accommodating needs being met? And you see it there. You see a match. And we assume right now that the ones who disclose their disability, and most of the time it may have been the physical one, that also most of them have been accommodated. But that's an assumption. I can't make a direct correlation between these questions at this point. But how are your accommodation met? And physical, with the time or work accommodations, and why were your accommodations not met at work? And that's where it's going to become a bit more interesting. I don't want to disclose because of regular effect on my career. And that's one of the biggest reasons why people don't disclose their disability. And quite a significant fraction also is mental health disabilities of that. And that's where it kind of matches, or it's like a discrepancy between our efforts to reduce stigma of mental health at work versus this fear still to disclose, or to be coming forward even, even disclosing it to the occupational physician as a first step because they're afraid that even that information is not safe. So there's a lot more work to do from these data we see. And there's a lot more awareness to be raised and accommodation to be looked for, and first also in the mental health field to reduce the stigma. When we look at mental health section, which was also included in asking more questions, which has actually grown bigger over the time because mental health at work is also in the UN since several years a main topic. We have put a mental health strategy at the UN workplace in place in several years. 2018, that was introduced. And it was a system-wide mental health strategy where all agencies came together, which was really also unique. One UN is not really one UN when you start doing something, but it comes one UN when you make a lot of effort and the benefits are being seen after five years because for the five-year roadmap was finished. This last year has just been extended for another three years. By the time in three years, the UN hopes, the UN family hopes that it has been established as a mental health at work with several factors improving the workplace from different angles that it will be taking on on its own and doesn't need a framework pushing it anymore. But here you see all the questions being introduced into the questionnaire, which is quite long. And we have to say that this questionnaire is a long questionnaire. And that's why we want it to be holistic, but also probably we'll only do this every two years instead of every year. But doing it together, that's what the big positive factor is in this approach. When the, we're very happy that the questionnaire per se and the data gatherings leading or putting this survey also and this concept of data-driven decision-making in the UN, also that is something which is a relatively new concept. And that's why a lot of times we realized there is not very much data in certain areas and we haven't done this systematically in the past. So the mental health strategy I mentioned before has actually came forward with a so-called implementation scorecard, one of the most successful tools in the UN, I would say, where agencies have a certain set of check marks and score systems from low, medium and maximum implementation steps they can do in integrating mental health at work and supporting staff with mental health at work. And in these mental health and these implementation scorecards, actually the UN High Survey, this tool we are presenting right now, has been incorporated as one of the data-driven tools to be used to get data about what's happening at your workplace. And that's one of the success stories where a tool we started slow and focus on more speed and gravity actually has been recognized and been now linked with other policies and strategies. And we hope that this will lead to kind of a solid base for the future in this step forward with the survey. Now I'm handing over of the other areas to Jasminka again. Thank you. We are trying to keep you awake and keep your attention after lunch break. So we are alternating here. So another area that was really impressive when we looked at the results was ergonomics. So we asked our respondents whether they felt discomfort or pain in the past six months at their workplaces. And 73% said yes. This was a stunning result. We got the same actually result for home-based work during pandemic. So just from this UN sample, more than 9,000 people said that they work in pain in the last six months. So how about that? That was really something that clearly we needed to address. It is also interesting how in this surveys the results are very consistent. So we had 73% in the whole sample of 18 agencies, but 75% in the agencies that took survey differently. So out of 23,000 responses, that's a permanent finding, 73, over 70% of people working in pain. So we went into details of this, of course, and we were asking about location and severity of pain, which you see results for 2023. That the worst was neck, shoulder, and upper back pain. And then lower back pain, headache, pain in leg and knees, eyes, hand, wrist, arms. So all very significant findings there. We've also comparing all sample results from 2023 with sample from 2022. And all this actually collocation of pain, that it all got worse. So this return to work, return to travel had an additional effect on staff. And we clearly understood that standard approach, that ergonomist come to your office and set it all up for you. But then what you're doing when you work from home, when you travel, when you're in hotel, when you're in hotel lobby, meeting room, people work from everywhere. So clearly this standard approach was not enough, considering especially the size of the problem. So we developed multifaceted global ergo program, ergonomic program, and as ergonomics for everyone, and trying to address all levels of prevention, actually starting from learning all stuff about ergonomic principles, also having a team of skilled ergonomists who would help staff we have for all staff software that is providing basic principles of ergonomics. So those who want after this kind of learning experience still ergonomic assessment, there are skilled ergonomists, they are also in different parts of the world so they can address locally problems in ergonomics, but we also have a very strong virtual program in ergonomics for individual and group ergonomic assessment. We also developing network of ergonomic champions, so staff that showed interest in ergonomics and gets a higher level of knowledge than all other staff so they can intervene with simple problems for their colleagues if there is above that, again, ergonomists come in. So we also understood that not everybody has the same type of problems with ergonomics setup of workstations, so we are developing also specialized ergonomic solutions for various categories, subcategories of staff. So for staff with disability, we have accommodation process that includes advice from ergonomists. We also developed program for professional drivers. This is typically, this category of staff is completely neglected. We have hundreds of drivers all over the planet and so we introduced program for ergonomic program for them because sometimes we would have even medical evacuation for back pain or something. Nobody ever shows drivers was the proper position of car or steering wheel, how to exit the car. We have also drivers of armored vehicles, so which is another set of ergonomic challenges. So there is a program for them and we are also developing program for aging workforce. So in short, we want to have ergonomics for everyone and working from everywhere. So what about the second decade? So one decade is over, we summarized what we got, we have all these results, we are still working on analyzing them. So what challenges we predict for the second decade of global OEM? We are having a summit of participating agencies, UN agencies in this survey and this whole project coming up in Washington DC right after this conference. We have two days meeting of representatives of UN agencies, medical directors, counselors, Asia specialists to talk how we are going forward, how to straighten data analytics and visualization capacity, how to validate the survey tool. As I mentioned, the survey tool was developed from validated surveys in the beginning, then we were adding different specific areas. We are kind of in this process of 10 years, it happened that sometimes we were not consistent in scales or some questions were maybe not worthy the best. So we want to do a validation of the survey tool, data governance framework, we have our practices but we want to define it better in this world of IT security and data privacy breaches, we want to have a solid framework for that. We will continue with annual surveys and we of course working hard on data integration in UN OEM strategies. So this is the flyer for our summit and our goals and objectives, I will not read them all. Just to mention that we are very excited for the first opportunity for many people to meet each other in person, to discuss, to interactively find solutions for our common problems that are coming up from this common huge database that we collected so far. So we will make some sort of plan for the next decade of surveys. Also in the summit is included some learning program, it is implementation of artificial intelligence and machine learning in analysis of health data. This is coming, this is future, we want to be prepared and especially because we have in our hands so much data, we want to explore how we can dice and slice this data to serve all our purposes. And then we will also learn about data literacy for leaders, clear communication of data because this is very important part. We realize we have a lot of findings, a lot of recommendation, but if you don't clearly communicate this to senior management, to your other stakeholders in the organization, it is kind of lost, boring stuff. You have to put it into action. So this is how our discussion will be going on. I said that one of challenges that we will try to address next year by the next year survey round is validation of the survey tool. We are finding academia partners to do that, to check item validity, construct validity, internal consistency and scale. We realize some questions have five point clicker scale, some four, we have to smoothen it up. And also we are planning to introduce psychosocial risk assessment tool into the whole survey because it turned out that psychosocial factors are very much contributed to stress and mental health issues in our populations. So this is going to be a big project with the final goal to have a very good solid validated survey tool that will be some sort of also puzzle, meaning that it will have pieces, all these elements that we were talking about, some like ergonomics, like domestic abuse, like work with disability. We want to be able to take out these pieces out of big survey together with demographics. And if we want to implement it more often after let's say introduction of some programs, we can use them, but they are still remain comparable with the main survey and included in this big survey campaigns that would go every two or three years. So we are very excited about this project and expect a big benefits of that. Matthias again. Yeah, just to keep your attention, three more slides, then we are done. This modular way of doing this, we think could be a really good way to move forward, especially for agencies who may just have a particular aspect they want to do a survey about, but not to lose kind of the validity in a way that it is still comparison when you ask a bigger question there that you can actually compare results. And that's our challenge because sometimes you lose validity when you do only components of a certain survey part. That is a future where we're trying to do this modular fashion moving forward. The big thing was also the data governance. As I said before, each agency is holding their own data and only sees their own data. But in the end, we actually want to share data and sharing and also analytics of the data and open data for research or for doing further publications somewhere where it may be of use or interest. So we had to come up with a set of rule and guidelines. We haven't put this in a policy or like a document yet because that's the harder part to put this in writing and to make a legal document out of this. But these are the guiding principles we have put forward so far when we interact with each agencies. And we use a bit the EU data privacy and ITS rules applied in our data collection already, but the agencies own their own data. On the common survey platform, each participation agency has access to its data and the whole pool. The data sets to be anonymized in benchmarking studies. Data origin sources should be acknowledged if applications to be shared. So the idea is to share, but then to acknowledge also where the data come from, which in the past, from some experience, we know that can be a contentious discussion, which we wanted to avoid. And it's better to have this laid out beforehand. Now, what's the benefit of the whole thing we're presenting is that especially with so many agencies, some are actually have more funds available than others. Smaller agencies are tight with their budgets, but all agencies are getting tight with their budget now, but to have a standardized approach together to offer something where you don't have to duplicate your work. Do you have a good way to measure trends over time, but also with these highly international, multinational workforce, all locations to have some baseline or background, be able to stratify this also with field-based organizations who have a different spectrum of delivering the service versus headquarter-based ones, but they're still overlapping a certain part of issues and problems we all have in either workforce where you are. Benchmarking, yes, that would best practices that would leading into occupation of the safety and standardization and standards at one point, which the UN doesn't really have. We align our standards to either OSHA or European standards or UK standards, depending where your agency in this UN family is located and which framework they use. So it's kind of still diverse in standards. We wanna move forward with having a unified way of looking at this, and of course, building sustainable evidence-based strategies in these data, which we gather more and more self-reported, and that's one of the limitations, of course, but some agencies also go and validate internally the data with staff counselors' data, for example, what happens really in the agency. Staff counselors are kind of the sensor of psychosocial aspects at the workplace, and if that data matches, for example, with some of the mental health data we have self-reported, you have a higher sense of validating your results or being more sure that your results are reflecting what you report, and also over time, if there is no big variation, it gives you also a validation sense, which is important for the higher-level management to convince, because that's one of the questions that come up, or we see, at least, this is self-reported. What does it mean, and how sure are you that this is reflecting in my agency, in our agency, what you say, which is then linking to communicating the survey. One of the challenges we had in previous years was better collaboration communication, doing combined survey tooling, the survey tool, but also sharing openly our communication templates, our way we did roll out the survey to staff, which was successful and which helped, and so other smaller agencies didn't have to put this effort in developing all this, was a big help in moving forward. We see still that the overall response rate could be better, but in some agencies we had, in the field-based agency, we had a response rate of 50%, which is quite significant for a large survey, we think, and we want to, of course, build on that experience if we can repeat this and get a better response rate overall. I think that's concluding our talk. Here's a team, again, I have to say, Dr. Yasmin Karagodouni is staying there on the first place because she was initiating this project from the very beginning and was a driving force behind all this. And we're very happy that we are there where we are now. So thanks for listening to us. Any questions? So we have 15 minutes left, and we hope, actually, that our presentation helped those of you who work with global organizations. But also, there are a lot of US-based organizations. They have multiple locations in different states. So there is always this problem, how to learn about your workforce, how to establish contact with your people who can then report what their needs are. So I hope that this inspired you, and we are very happy to respond to your questions. Thank you. Thank you for sharing your experience. Now I know why the talk is called Mission Impossible. With all these data points, it really is awesome efforts. So I just had a couple of really quick questions. So number one, did you manage to do the social determinants of health, or was this an issue to look at that within employee population? Because you were about discrimination or identification of the data. And then the other question was about mental health, because you started the program really early on. So I'm curious what happened to the collective mental health of the population after COVID, if you're able to share anything or any insights. So social determinants of health, I have to say that we didn't address it directly in the survey. We can, through analysis of data, there are so much data. So you can look at various locations. You can look at various grades of staff and do some comparison. We didn't have a chance to go so deep into this area. But we have this UN Mental Health and Wellbeing Strategy. They have their tools. And they would probably respond to you with some sort of concrete data. Regarding, what was the second question? I can answer this. Yes, please. Regarding COVID, how it influenced mental health. Actually, yes. And overall, we see an increase. I was citing one of the results here. 30% feel their mental health is worse than it was prior to the outbreak of COVID. So it's very similar to what we see in other. I mean, the outside world is also the inside world, obviously. We have a unique workplace with multinationalities in there. So there's maybe nuances there. But we're not that much different from the outside world, outside the UN world. But yes, it has affected, from the data that we have, the mental health of staff. We have a lot of data. So one hour is just really, we are scratching the surface. Questions on mental health are really comprehensive. There are a lot of them that are related, both to work life and to overall life. So we do have a lot of data on that. But generally, during pandemic 2021 and 2020, two surveys show a really deterioration of both mental and physical health in almost all aspects. There were some positive stories. It is a long survey. So we collect a lot of numbers. But we also have, at the end of the survey, open-ended questions. And within the survey, a few times, we ask people to share their story, in case we didn't really put in all boxes whatever is happening. So we learned a lot about mental health from these stories during pandemic, how there was a large proportion of people who had negative experience in terms of loneliness, in terms of fears, and generally, lack of control of their work, and stuff like that. But surprisingly, there was also a significant portion of people who did have very positive experience from working from home, being with their family during the day, being with their children, active with their schooling. There were those who said, oh, I did my master's thesis through pandemic. Pregnant women loved this, because they didn't have to commute. They were not seeing. So there is a mixed picture, but overall, it was really a bad effect. And we don't see much of improvement in 2023 survey. Somewhat, but not really. If you, maybe I can just ask quickly, answer quickly, the top three sources of work-related stress, not going beyond your question there, are actually high workload demands, the few resources to complete assigned tasks, and lack of time for family friends. That is kind of the key, if you ask for what's the reason. Yes, and this is also what point us to the fact that health services or medical services alone cannot address such type of problems. So we need to work really within organization. All stakeholders have their role in improving health and safety, because this is basically on HR side. People come to counseling or to medical services when they break down, but prevention of that is actually organization of work, it's management, it's using talent properly, and so on. We have the whole list of these predictors that people will burn out or end up with mental health problems, but it's not medical. Yeah, it's coming to you. It's a number of people who have a mental health condition and the ones who seek treatment and the ones who don't seek treatment, but treatment would be available, I mean, counseling would be available. That's a lot more we have to do to make this more aware and to reduce the stigma of getting this. 25% is the average. Yeah. In organizations, it's usually 3%. Oh, I agree. 5% of that, so 25%. I would say 25, 30 is average, but then you have agencies, as Dr. Leidemann said, who organize very good communication campaign. They achieved over 40%, almost 50% of our program, for example, was leader in communication campaign. You have to, for three weeks of survey, it's about three months of working on all communication channel, on agreeing on content of messages, who will say what. It's very important to have senior management involved. It has to be launched from the top, otherwise, people don't care. There are a lot of lessons learned and not to keep. Please, go ahead. Thank you. I really applaud your efforts to make sure that all international organization now are working together. We need that on many levels, and I assume you've been working with employees or workers in formal sector. Now, is any effort in the future to try to look at the informal sector workers? Because some countries, especially in Global South, by like 75% of the workers in the formal sector. Yeah, we didn't come to that. We still work on inclusion of all UN agencies, which is a high goal. We don't have means that I'm aware of that we could definitely see the need. Retired workers, you mean? Retirees? No, informal sector workers. Who don't have employment. The people who sell bananas on the street of Lagos, or, you know, Costa Rica. That's exactly the problem, how to even reach all of them, and who would take responsibility for their health. Yeah, we are not there yet. No, I mean, no. I mean, the answer would be right now is not. I can't really tell you their intentions to do this, because I can't really talk for the organizations will do in the future. But we hope, and that's where we're going with population health, with this idea that what we do at the workplace will actually transcend also at the family at home, and also then improve health knowledge first, and then hopefully, ultimately, health, yeah, health care. Now, that is an affordability or accessibility that we probably won't have any influence on. But first, knowledge and awareness, and I think that's a key. And that's where we hope it spills over. Workplace, eight hours, you have the exposure of staff, and you can inform them about something which they take home, at least for their family. Thank you. Keep up the good work. Thank you. Thank you. Hey, good afternoon. Thank you, Dr. Listeriaz and Dr. Letterman for your great presentation. It's really neat to see how you guys have moved occupational health from a very reactive, sort of tertiary prevention kind of response into truly primary prevention and proactive. I just had a quick question or two about, you mentioned dashboard and reporting, and I was curious, your dashboard, if it was like an off-the-shelf product, or if you built it from the ground up, and then following that, this dashboard, how do you take that and then communicate those results to leadership? Does leadership have access to this dashboard? Is it part of meetings, in what way? And if not yet, how would you envision this dashboard being used to provide that information and support for leadership decision-making? So, yeah, I mean, first, maybe I start on this. We both have the answer to this, but yeah, this dashboard, what you see, what you presented here was from Agenda Consulting, their platform, who developed this dashboard on their own. I can get you in contact with Agenda, or you can contact them also, if this was their own development, or if they maybe put somebody on co-work with them, which I don't know right now. This is dashboard accessible to all participating agencies, and the focal point in there, we haven't opened the dashboards to the managers. It's a good point. This may be, if we have enough interest, let me phrase it this way, of, let's say, HR personnel or decision-makers in this field to, in our agency, to have access to this, we probably would consider doing this, but we haven't done it before. Yes, and another, we have another dashboard that we developed. In the World Bank, we have dashboard developed from, originally from the survey tool, which is a Qualtrics platform, and some of these platforms are very well-developed, so they do have this feature where you have to define filters that you want to use, and then you produce these dashboards, and they are extremely useful because when you talk with certain, for various reasons, within the organization, of course, for prioritization of interventions, but also when our colleagues are going for mission in different parts of the world, they can check by country or by region what are the main issues in all these elements that we were explaining here. So, it is really a tool that help us to communicate with targeted, in a targeted way with certain population, not only by location, but many other things. For example, by age, we realize that young people in our organizations are much bigger, have much bigger problems than older people because they have absolutely no idea about their health risks, they don't have a physician, primary care physician, they report the most pain, they are mental health, they report they are the worst. So, sometimes through this kind of filtering through various factors, you discover unexpected objects of your interventions. And then from survey tool also, I mean, it is this platform are very powerful now, so we can do also qualitative data analytics from a quality platform, even sentiment analysis. So, it's not just kind of keyword home-based work and then you have 5,000 people who mentioned home-based work. So, is it good? Is it bad? Is it neutral? What do they say? So, there is this kind of sentiment analysis that you can say, well, okay, for 50% of people that was really bad, but for 30 it was good, for 20 it was neutral. So, to do that all, however, you have to have internal source in terms of, you have to have people who are skilled to use these tools, who will be able to interpret health, to interpret data, to visualize that, very important. To do it in Tableau, to have your map, to have your rate points where the problems pop out depends what you are researching. So, big move forward. Thank you so much for that. Just to add to this, we found out the interns in our organization, for example, have one of the biggest problems, which we're kind of overseeing for quite a while. Yeah. It's very interesting. Thank you. I'm curious about the slide you showed where some of the UN agencies were, shall we say, sicker than others. And you said, well, we're gonna not tell you which are which. But I'm hoping you all are looking at, back to this person's question about social determinants, of what are those factors other than maybe proportion of interns? So maybe it's just that they all have a bunch of interns and are sicker than the rest. And I'm just wondering what your hypotheses are. And then afterwards, I'll come ask, how do we get access to these data for our graduate students who want to do thesis? There you go. There you go. Yes, we do have all the data. We do work with academia. John Hopkins is analyzing both the World Bank and IMF data in details and do regression analysis. This report's 100, 200 pages long. So we do have insight about the main risk factors and who is affected more, who is less. So in a very detailed scale, yes. And talking about students, sometimes, yeah, well, we can talk offline about that because we did have few time students who were helping with a little portion of data analysis for various purposes. We had University of Gothenburg from Sweden involved in that. And we have to be very careful with data privacy and IT security. There are limitations, and this is getting more and more strict over time. But yes, we are open for conversation. Yes. Can you share some of those risk factors for the agencies that were less healthy with us? Yeah, I mean, one that was caught to say that one of the causes that we feel like is knowledge about diet. If you have thought- Diet? Diet. Okay. Nutrition-wise, we have a, because of this multicultural national cultural background, you have different ideas about what good food is and what not. Fruit servings, you saw one of the question was, and these 15 risk factors, we had a serving of fruit was one of the ones. Body mass index was the second one. And I forgot the other one. So we think we have an idea, and we're putting some of our efforts in doing education and awareness, but then changing habit or changing this, what they do is the hardest part. We have a lot of risk factors from sleep and physical activities and reasons why people are active or not. We have, again, perception of mental health or physical health. So we have about 800 variables per person. This is why we get all this million data point, but it is a never ending job to analyze all this and for various purposes. So this is where we lack capacity to use fully this database that we have. Valid question. I mean, getting to the root cause, what we can really address. I think it's really, some of that is related to lifestyle behavior. Some of these risk factors we see. And even if some agencies didn't include ethnicity, I assume you know what nationality they were? We can look into all that factors, whatever we want to. You know the individuals like I'm Swiss, but I'm working in Honduras. Yeah. That kind of thing. Yes, yes. To a certain extent, yes. But if ethnicity is not being asked, then of course we don't know. So there are one or two agencies that didn't want to ask that question. Even nationality. Yeah, yeah, yeah. So it is, we have to be flexible. Sometimes you have to sacrifice a question or two in order for survey to be approved in the organization. It's not easy to get this kind of approval. So we try to accommodate as much as we can. Yeah, it was a decision making. Either we include the question and we don't do the survey, or we don't include the question, but we do the survey. So the answer was clear. Guess what we do, yeah. It's a beautiful data set. Thank you. It'll be interesting to keep reading what happens. Thank you. Yes, thank you. Sir, yeah, we have some more. Five seconds. Four seconds, three seconds. Yeah, go ahead, please. Following up on these two comments, and this was fabulous presentation. I'm the physician lead for toxic exposure screening in the VA, where we're screening all veterans for potential exposures to toxins. And so we think not only in terms of social determinants of health, but also physical environmental determinants of health. And so when we start talking about healthy, less healthy, have you taken into account or thinking about looking at physical determinants in these different, especially UN, it's international, that could be contributing, you know, air quality, water quality. Yes, we do ask about these all questions. And we asked about all these factors in work environment and in general environment for travelers. So out of that, we see what we can use. And then here, atomic agency, you added your part, if you want to say. Yeah, correct. We have a special surveillance group of radiation exposed workers group, the safeguards inspectors. But that's a specific part of the UN agency, which no other agency has. But yeah, physical determinants of health, we're also looking. I have to say, this is still work in progress, because occupation health and safety in the United Nations is a late starter. We are, I think, 2014, 2013 was the first time an occupation health and safety roadmap was developed based on internal joint inspection unit report. And that is because medical services was always reactive to you do sick leave approval. Each agency had their own medical service, and there was no unified approach. And slowly, this gets now into occupational health, now actually acknowledged as occupational health in the UN, which was a long time only led by individuals in each organization. Now, that is the occupational health safety framework now, which has been just approved to be implemented. Each UN agency has to have an occupational health and safety committee and a policy. We just arrived at this point. Now, the next one is standards and looking at these physical determinants and doing the same everywhere. In VA, we're using this notion of exposure-informed care, which means we always take into account the physical environment as well, and various exposures and potential impacts on health. Excellent. Thank you for the feedback. Thank you. So thank you all very much. Thank you for staying on. We are going to leave. Time is over. Thank you so much. Thank you.

UN Occupational Health and Safety Management System

Global OEM Initiative

UN Health Intelligence Working Group

Interagency data management

Population health management

Workplace safety

Data visualization

Mental health

COVID-19 impact

Artificial intelligence and machine learning