Occupational safety and health in Europe - state and trends 2023 
European Agency for Safety and Health at Work – EU-OSHA 81 
A fundamental element of these disease statistics are the DALYs (DALY = lost life years due to disability 
or in other words: One DALY is one lost year of healthy life ).207 These DALYs are a combined value 
of the mortality rate YLL (Years of Life Lost due to premature mortality) and the YLD (Years Lived with 
Disability). DALYs are regarded as a comprehensive and comparable method to measure the health of 
a population.208 
Based on this framework, the Institute for Health Metrics and Evaluation (IHME) provides interactive 
statistical data of the trends and status of risk factors and outcomes (Death and DALYs). These data 
are constantly updated and visualised; the risk factors are: environmental risk, occupational risks (e.g. 
occupational ergonomic factors), behavioural risks (e.g. dietary) and metabolic risks (e.g. high systolic 
blood pressure).209 
 
4.2.2 Attributable fractions, risk pairs and burden of disease 
As mentioned, for the majority of diseases the working conditions are one of several influence 
factors in combination with other factors like private life, social and medical system, genetics, 
environment and so on.  The exact impact of this factor, that is, the fraction of disease generating or 
intensifying impact attributable to work , is the subject of numerous studies in occupational 
epidemiology.210  
The overall relation between work and illnesses is moving towards a less unambiguous picture 
compared to occupational diseases, where a strong relation between a single (over-)exposure and a 
specific illness existed. These were mostly high exposure levels that could not be found outside 
workplaces. Obviously, many such high exposures still exist and are important for prevention and 
compensation. However, many exposures at work approximate to other non- work exposures, like 
permanent sedentary work. This makes it more difficult to separate unambiguously the impact of work.  
Science, in particular occupational epidemiology, and institutions like the ILO and WHO studies have 
engaged to identify the approximate impact of work for diseases, the attributable fraction of work.  
For example, the WHO summarised their estimates in the year 2017: 
‘Certain occupational risks, such as injuries, noise, carcinogenic agents, airborne particles and 
ergonomic risks account for a substantial part of the burden of chronic diseases: 37% of all cases of 
back pain, 16% of hearing loss, 13% of chronic obstructive pulmonary disease, 11% of asthma, 8% of 
injuries, 9% of lung cancer, 2% of leukaemia and 8% of depression.’211 
One major difficulty surely is the reliable description of exposures at work. Workers might have had 
several occupations during their working life, or changed work tasks in the same occupation due 
to organisational and technological developments, and they might also have changed the specialisation 
in this occupation; also the level of prevention measures differs between sectors and count ries. Of 
course, all this influences the exposure patterns. 
EU-OSHA applied in its study on ‘Costs and benefits’ estimates, attributable fractions (AF) based on the 
evaluation of literature and statistics. The AF vary between 1% for all respiratory diseases, 3.2% for 
neoplasm and 12.4% for circulatory diseases up to more than 90% for mesothelioma and 100% for 
pneumoconiosis.212 For mental diseases the estimated AF is 17.4 % for males and 20.7 for females.213 
There are very clear connections between specific lung diseases (e.g. pneumoconiosis) and work 
because such exposures are often restricted to workplaces, as outside work ther e is practically no 
exposure; many of these diseases are recognised as occupational diseases. Much less clear are the 
attributions of work to cardiovascular, mental, other respiratory diseases like asthma or COPD, and 
digestive diseases.