Occupational safety and health in Europe - state and trends 2023 
European Agency for Safety and Health at Work – EU-OSHA 86 
ICOH used for its estimates more risk factors, different disease categories and different values of 
AF. This methodology results in significantly higher figures for CVD and other diseases.  
The same applies for DALYs; WHO/ILO estimates sum up to approximately 63% of the ICOH values. 
The main difference is due to the approximately 2.3 million DALYs that ICOH calculated for other work-
related diseases. WHO/ILO applied strict methodological criteria and consequently excluded quite a 
large number of studies as a base for their estimates. They write: 
‘Third, it must be noted that not all occupational risk factors and attributable burdens of disease have  
yet been quantified. The production of estimates for some pairs was not possible in this estimation cycle, 
such as: occupational exposure to biological risk factors and infectious diseases; occupational exposure 
to psycho-social risk factors and mental health outcomes; and occupational exposure to ambient air 
pollution and its various health outcomes. Further, while there are established methods for estimating 
the burdens of silicosis, asbestosis, coal worker’s pneumoconiosis and unspecified pneumoconiosis 
attributable to occupational exposure to dusts and fibers, WHO and the ILO are currently reviewing 
these methods and the available bodies of evidence (10); these pairs were therefore not included in this 
estimation cycle. While this means that the work -related burden of disease is almost certainly higher 
than the current estimate of selected pairs, the addition of such pairs in future will broaden the scope 
of these estimates and capture the work-related burden of disease more comprehensively.’224 
All estimates depend on good monitoring capacities of the health system but also on reliable quantitative 
overviews of exposure situations at workplaces. In research and monitoring of occupational cancer 
some quantitative overviews on such exposures have been established (see for example, CAREX 
Finland, its follow-up projects, e.g. in Canada, and the many approaches for exposure assessments).225 
One of the reasons for the establishment of a clear relation between long working hours and stroke is 
the comparatively excellent data situation concerning working hours and long working hours in 
combination with administrative health data about stroke.  
 
4.2.3 Examples of specific prevalence estimates  
The methodologies to estimate the burden of diseases have been developed over the past 30 years. In 
the coming years we can expect that research will contribute to more precise estimates of the work-
related share of the burden of the diseases.  
Very probably mental health and biological agents will be fully incorporated in such estimates , 
and research will contribute to better explanations, for example, of the work-related prevalence of MSDs. 
Two groups of diseases examples —  mental health and musculoskeletal diseases — are briefly 
presented in this chapter.  
The first ‘Global Burden of Disease’ study  (1996, the study was the breakthrough for the concept of 
DALYs) is quite astonishing. Already then, the authors complained that the ‘burden of psychiatric 
conditions has been heavily underestimated ’. In their estimation of the globally leading causes of 
disability they put four psychiatric conditions under the first 10: 
• Unipolar major depression – 10.7% (of all causes) 
• Bipolar disorders – 3.0% (of all causes) 
• Schizophrenia – 2.6% (of all causes) 
• Obsessive-compulsive disorders – 2.2% (of all causes) 
 
The data of the first overview (based on data from 1990) were updated in 2019 and show an even worse 
picture:  
‘From 1990 to 2019, the global number of DALYs due to mental disorders increased from 80.8 million 
to 125.3 million, …. Age -standardised DALY rates remained largely consistent between 1990