The Lancet Series on Work and Health1, 2, 3 recognises that changes in the world of work are causing new occupational hazards to physical and mental health and increasing health inequalities within and between countries. These changes have profound implications for official workers’ health data and monitoring systems, which have become a global health priority as the world seeks to reach the Sustainable Development Goals (SDGs).4, 5 These monitoring systems are public goods that provide international organisations, governments, and communities the evidence base for policy and practice that ensures health for all workers. We argue that these monitoring systems must respond to changing working environments by expanding capture of workers’ rights, working conditions, and health inequalities. We outline normative data and monitoring products to reach this systemic shift and provide the public health vision for this new direction. | | No worker should die or get ill because of their work, or be left behind in occupational health protection and promotion. All workers are entitled to the human rights to: health;6 a clean, healthy, and sustainable environment; and a safe and healthy working environment.7 However, WHO and the International Labour Organization (ILO) estimate that annually 2 million deaths and 90 million disability-adjusted life-years are attributable to selected occupational risk factors.8 Recognition is growing that improving workers’ health and health equity requires action on the social and environmental determinants of health. Examples include strengthened evidence on the effects of the emerging psychosocial hazard of long working hours on cardiovascular disease,9 and the environmental and climate crises strengthening attention to workers’ environmental and climatic hazards (eg, air pollution and heat exposures). Occupational health policy increasingly comprises health equity analysis and targets. The WHO/ILO joint estimates show geographical and socioeconomic health inequalities—an increased number of deaths is noted among workers in Africa, South-East Asia, and the Western Pacific, and among men and people aged 55 years or older.8 People working in the informal economy, and migrant, outdoor, and front-line workers are often especially disadvantaged. Health-care workers, despite working in a sector that aims to restore, protect, and promote health, often face hazardous working conditions and are exposed to pathogens (eg, SARS-CoV-2), violence, and long working hours, among others. Ongoing changes in working environments (eg, globalisation, automation, digitisation, new pandemics, environmental pollution, and climate change) exacerbate these inequalities. Ultimately, unhealthy working conditions act as barriers for realising workers’ rights to health, population health, and health equity, and threaten the goal of achieving the SDGs globally.

The COVID-19 pandemic has highlighted the importance of Public Health interventions for global social and economic development. Still, the community's well-being depends on each individual's health. In addition to pandemics, health conditions can be altered by chronic degenerative diseases, aging, disabilities, and work. Personal behaviors such as poor nutrition, lack of physical activity, tobacco use, excessive alcohol consumption, and drug use can also affect health and safety at work. In the last twenty years, we have witnessed rapid changes in the nature of work, workplace and workforce. In parallel, there is increasing attention to fatigue, psychosocial risks and the achievement of decent, sustainable and healthy work as societal goals. Consequently, in 2011, NIOSH developed Total Worker Health®, a holistic approach to worker well-being to help improve worker health and safety. More recently, in Italy, the Ministry of Health has provided for the preparation of projects according to the "Total Worker Health (TWH)" approach in the National Prevention Plan for the five years 2020-2025. As indicated by the Ministry, the strategic role of the occupational physician is fundamental, being the only figure of occupational safety and health professionals able to integrate the health and safety of workers with their well-being to reach the Total Worker Health.

Cellulose nanocrystals (CNC), also known as nanowhiskers, have recently gained much attention due to their biodegradable nature, advantageous chemical and mechanical properties, economic value and renewability thus making them attractive for a wide range of applications. However, before these materials can be considered for potential uses, investigation of their toxicity is prudent. Although CNC exposures are associated with pulmonary inflammation and damage as well as oxidative stress responses and genotoxicity in vivo, studies evaluating cell transformation or tumorigenic potential of CNC's were not previously conducted. In this study, we aimed to assess the neoplastic-like transformation potential of two forms of CNC derived from wood (powder and gel) in human pulmonary epithelial cells (BEAS-2B) in comparison to fibrous tremolite (TF), known to induce lung cancer. Short-term exposure to CNC or TF induced intracellular ROS increase and DNA damage while long-term exposure resulted in neoplastic-like transformation demonstrated by increased cell proliferation, anchorage-independent growth, migration and invasion. The increased proliferative responses were also in-agreement with observed levels of pro-inflammatory cytokines. Based on the hierarchical clustering analysis (HCA) of the inflammatory cytokine responses, CNC powder was segregated from the control and CNC-gel samples. This suggests that CNC may have the ability to influence neoplastic-like transformation events in pulmonary epithelial cells and that such effects are dependent on the type/form of CNC. Further studies focusing on determining and understanding molecular mechanisms underlying potential CNC cell transformation events and their likelihood to induce tumorigenic effects in vivo are highly warranted.

The widespread industrial application of nanotechnology has increased the number of workers exposed to engineered nanomaterials (ENMs), but it is not clear to what extent prevention guidance is practiced. Our aim was to explore the extent that companies manufacturing and/or using ENMs apply risk assessment and management measures. Thirty-four companies were surveyed with an international 35-item questionnaire investigating company and workforce features, types of ENM handled, and risk evaluation and preventive measures adopted. Among participating companies, 62% had a maximum of 10 employees. Metal-based nanomaterials were most frequently identified (73%). Environmental monitoring was performed by 41% of the companies, while engineering exposure controls were approximately reported by 50%. Information and training programs were indicated by 85% of the sample, only 9% performed specific health surveillance for ENM workers. Personal protective equipment primarily included gloves (100%) and eye/face protection (94%). This small-scale assessment can contribute to the limited amount of published literature on the topic. Future investigations should include a greater number of companies to better represent ENM workplaces and a direct access to industrial settings to collect information on site. Finally, deeper attention should be paid to define standardized frameworks for ENM risk assessment that may guide nano-specific preventive actions.

Objectives The widespread application of nano-enabled products and the increasing likelihood for workplace exposures make understanding engineered nanomaterial (ENM) effects in exposed workers a public and occupational health priority. The aim of this study was to report on the current state of knowledge on possible adverse effects induced by ENM in humans to determine the toxicological profile of each type of ENM and potential biomarkers for early detection of such effects in workers. Methods A systematic review of human studies and epidemiological investigations of exposed workers relative to the possible adverse effects for the most widely used ENM was performed through searches of major scientific databases including Web of Science, Scopus, and PubMed. Results Twenty-seven studies were identified. Most of the epidemiological investigations were cross-sectional. The review found limited evidence of adverse effects in workers exposed to the most commonly used ENM. However, some biological alterations are suggestive for possible adverse impacts. The primary targets of some ENM exposures were the respiratory and cardiovascular systems. Changes in biomarker levels compared with controls were also observed; however, limited exposure data and the relatively short period since the first exposure may have influenced the incidence of adverse effects found in epidemiological studies. Conclusions There is a need for longitudinal epidemiologic investigations with clear exposure characterizations for various ENM to discover potential adverse health effects and identify possible indicators of early biological alterations. In this state of uncertainty, precautionary controls for each ENM are warranted while further study of potential health effects continues.

As the number of nanomaterial workers increases, there is need to consider whether biomonitoring of exposure should be used as a routine risk management tool. Currently no biomonitoring of nanomaterials is mandated by authoritative or regulatory agencies. However, there is a growing knowledge base to support such biomonitoring, but further research is needed, as are investigations of priorities for biomonitoring. That research is focused on validation of biomarkers of exposure and effect. Additionally, there is the possibility of using biomarkers of effect as indicators of early adverse effects in biomonitoring of nanomaterial workers. However, these biomarkers of effect are generally nonspecific. These biomarkers also need validation before they should be used. Overall biomonitoring of nanomaterial workers can be an important supplement to the exposure and risk assessment and risk management practices, although additional research is needed.

Nanotechnology has the potential to make a beneficial impact on several agricultural, forestry, and environmental challenges, such as urbanization, energy constraints, and sustainable use of resources. However, new environmental and human health hazards may emerge from nano-enhanced applications. This raises concerns for agricultural workers who may become primarily exposed to such xenobiotics during their job tasks. The aim of this review is to discuss promising solutions that nanotechnology may provide in agricultural activities, with a specific focus on critical aspects, challenging issues, and research needs for occupational risk assessment and management in this emerging field. Eco-toxicological aspects were not the focus of the review. Nano-fertilizers, (nano-sized nutrients, nano-coated fertilizers, or engineered metal-oxide or carbon-based nanomaterials per se), and nano-pesticides, (nano-formulations of traditional active ingredients or inorganic nanomaterials), may provide a targeted/controlled release of agrochemicals, aimed to obtain their fullest biological efficacy without over-dosage. Nano-sensors and nano-remediation methods may detect and remove environmental contaminants. However, limited knowledge concerning nanomaterial biosafety, adverse effects, fate, and acquired biological reactivity once dispersed into the environment, requires further scientific efforts to assess possible nano-agricultural risks. In this perspective, toxicological research should be aimed to define nanomaterial hazards and levels of exposure along the life-cycle of nano-enabled products, and to assess those physico-chemical features affecting nanomaterial toxicity, possible interactions with agro-system co-formulants, and stressors. Overall, this review highlights the importance to define adequate risk management strategies for workers, occupational safety practices and policies, as well as to develop a responsible regulatory consensus on nanotechnology in agriculture.

Nanocellulose (NC) is emerging as a highly promising nanomaterial for a wide range of applications. Moreover, many types of NC are produced, each exhibiting a slightly different shape, size, and chemistry. The main objective of this study was to compare cytotoxic effects of cellulose nanocrystals (CNC) and nanofibrillated cellulose (NCF). The human lung epithelial cells (A549) were exposed for 24 h and 72 h to five different NC particles to determine how variations in properties contribute to cellular outcomes, including cytotoxicity, oxidative stress, and cytokine secretion. Our results showed that NCF were more toxic compared to CNC particles with respect to cytotoxicity and oxidative stress responses. However, exposure to CNC caused an inflammatory response with significantly elevated inflammatory cytokines/chemokines compared to NCF. Interestingly, cellulose staining indicated that CNC particles, but not NCF, were taken up by the cells. Furthermore, clustering analysis of the inflammatory cytokines revealed a similarity of NCF to the carbon nanofibers response and CNC to the chitin, a known immune modulator and innate cell activator. Taken together, the present study has revealed distinct differences between fibrillar and crystalline nanocellulose and demonstrated that physicochemical properties of NC are critical in determining their toxicity.

Responsible development of any technology, including nanotechnology, requires protecting workers, the first people to be exposed to the products of the technology. In the case of nanotechnology, this is difficult to achieve because in spite of early evidence raising health and safety concerns, there are uncertainties about hazards and risks. The global response to these concerns has been the issuance by authoritative agencies of precautionary guidance to strictly control exposures to engineered nanomaterials (ENMs). This commentary summarizes discussions at the "Symposium on the Health Protection of Nanomaterial Workers" held in Rome (25 and 26 February 2015). There scientists and practitioners from 11 countries took stock of what is known about hazards and risks resulting from exposure to ENMs, confirmed that uncertainties still exist, and deliberated on what it would take to conduct a global assessment of how well workers are being protected from potentially harmful exposures.

Rapid advances and applications in nanotechnology are expected to result in increasing occupational exposure to nano-sized materials whose health impacts are still not completely understood. Scientific efforts are required to identify hazards from nanomaterials and define risks and precautionary management strategies for exposed workers. In this scenario, the definition of susceptible populations, which may be at increased risk of adverse effects may be important for risk assessment and management. The aim of this review is to critically examine available literature to provide a comprehensive overview on susceptibility aspects potentially affecting heterogeneous responses to nanomaterials workplace exposure. Genetic, genotoxic and epigenetic alterations induced by nanomaterials in experimental studies were assessed with respect to their possible function as determinants of susceptibility. Additionally, the role of host factors, i.e. age, gender, and pathological conditions, potentially affecting nanomaterial toxicokinetic and health impacts, were also analysed. Overall, this review provides useful information to obtain insights into the nanomaterial mode of action in order to identify potentially sensitive, specific susceptibility biomarkers to be validated in occupational settings and addressed in risk assessment processes. The findings of this review are also important to guide future research into a deeper characterization of nanomaterial susceptibility in order to define adequate risk communication strategies. Ultimately, identification and use of susceptibility factors in workplace settings has both scientific and ethical issues that need addressing.

In a world of finite resources and ecosystem capacity, the prevailing model of economic growth, founded on ever-increasing consumption of resources and emission pollutants, cannot be sustained any longer. In this context, the "green economy" concept has offered the opportunity to change the way that society manages the interaction of the environmental and economic domains. To enable society to build and sustain a green economy, the associated concept of "green nanotechnology" aims to exploit nano-innovations in materials science and engineering to generate products and processes that are energy efficient as well as economically and environmentally sustainable. These applications are expected to impact a large range of economic sectors, such as energy production and storage, clean up-technologies, as well as construction and related infrastructure industries. These solutions may offer the opportunities to reduce pressure on raw materials trading on renewable energy, to improve power delivery systems to be more reliable, efficient and safe as well as to use unconventional water sources or nano-enabled construction products therefore providing better ecosystem and livelihood conditions.However, the benefits of incorporating nanomaterials in green products and processes may bring challenges with them for environmental, health and safety risks, ethical and social issues, as well as uncertainty concerning market and consumer acceptance. Therefore, our aim is to examine the relationships among guiding principles for a green economy and opportunities for introducing nano-applications in this field as well as to critically analyze their practical challenges, especially related to the impact that they may have on the health and safety of workers involved in this innovative sector. These are principally due to the not fully known nanomaterial hazardous properties, as well as to the difficulties in characterizing exposure and defining emerging risks for the workforce. Interestingly, this review proposes action strategies for the assessment, management and communication of risks aimed to precautionary adopt preventive measures including formation and training of employees, collective and personal protective equipment, health surveillance programs to protect the health and safety of nano-workers. It finally underlines the importance that occupational health considerations will have on achieving an effectively sustainable development of nanotechnology.

Recent advances in nanotechnology have induced a widespread production and application of nanomaterials. As a consequence, an increasing number of workers are expected to undergo exposure to these xenobiotics, while the possible hazards to their health remain not being completely understood. In this context, biological monitoring may play a key role not only to identify potential hazards from and to evaluate occupational exposure to nanomaterials, but also to detect their early biological effects to better assess and manage risks of exposure in respect of the health of workers. Therefore, the aim of this review is to provide a critical evaluation of potential biomarkers of nanomaterial exposure and effect investigated in human and animal studies. Concerning exposure biomarkers, internal dose of metallic or metal oxide nanoparticle exposure may be assessed measuring the elemental metallic content in blood or urine or other biological materials, whereas specific molecules may be carefully evaluated in target tissues as possible biomarkers of biologically effective dose. Oxidative stress biomarkers, such as 8-hydroxy-deoxy-guanosine, genotoxicity biomarkers, and inflammatory response indicators may also be useful, although not specific, as biomarkers of nanomaterial early adverse health effects. Finally, potential biomarkers from “omic” technologies appear to be quite innovative and greatly relevant, although mechanistic, ethical, and practical issues should all be resolved before their routine application in occupational settings could be implemented. Although all these findings are interesting, they point out the need for further research to identify and possibly validate sensitive and specific biomarkers of exposure and effect, suitable for future use in occupational biomonitoring programs. A valuable contribution may derive from the studies investigating the biological behavior of nanomaterials and the factors influencing their toxicokinetics and reactivity. In this context, the application of the most recent advances in analytical chemistry and biochemistry to the biological monitoring of nanomaterial exposure may be also useful to detect and define patterns and mechanisms of early nanospecific biochemical alterations.

Nanotechnology is a system of innovative methods for controlling and manipulating matter at the near-atomic scale to produce engineered materials, structures, and devices. Engineered nanoparticles are generally considered to be a class or subset of nanomaterials with at least one dimension, that is, approximately 1 to 100 nanometers. The specific attractive properties of nanomaterials have led to their widespread application in many sectors, such as medicine, consumer products, energy, materials, and manufacturing. However, the limited but positive knowledge regarding engineered nanoparticle toxicological profiles, the potential greater biological reactivity due to the high-surface area-size ratio, and the increased likelihood of human exposure has raised several concerns about the potential adverse health effects for general and occupational exposed population. Additionally, there is a continuing interest in incidental nanoparticle exposure, not intentionally produced by anthropogenic sources, namely, processes involving combustion, welding, or diesel engines. The main scope of this special issue is to contribute original in vitro and in vivo research articles as well as review articles that seek to define the nanomaterial interactions with biological systems that could be relevant in understanding the implications of nanoparticle exposure for the workers’ health. We have invited colleagues from worldwide who have been exploring their research in this field.