GeoHealth Hub Planning Grant
As part of our U.S. National Institute of Health Fogarty International Center GeoHealth Hub planning grant, CWEND organized a Workshop to examine and prioritize the Occupational and Environmental Health (OEH) research needs of healthcare and informal sector workers (our target population).
Our goal was to identify existing research gaps and to guide the process of developing a research agenda for our GeoHealth Hub. Sixty six invited persons participated in the Workshop, representing key OEH government organizations, healthcare organizations, academic institutions and organizations involved in activities to promote health and well-being among informal sector workers.
We produced a workshop report, and four background papers on occupational safety and health (OSH) in Thailand for each of the target sectors: 1) current policies and regulations covering informal sector workers in Thailand; 2) gaps and recommendations for Thai agricultural worker OSH with a focus on pesticides; 3) a systematic review of research and gaps in OSH for health care workers in Thailand; 4) gaps and recommendations for Thai home-based worker OSH. For links to these publications see our Outreach Section.
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Agricultural workers in Southeast Asia (SE Asia ) use increasing amounts of pesticides.
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Workshop to identify gaps in research for the development of occupational and environmental health policies.
In 2012, the International Labor Organization (ILO) reported that there were approximately 1.3 billion agricultural workers worldwide. Almost 60% of these agricultural workers were in developing countries, with a great majority found in the Asia-Pacific region. In Thailand, agricultural work is an economic foundation of the nation and rural areas are home to more than 70% of the population. Among the working population, 42% work in agriculture (16.7 million), with 93% of these agricultural workers in the informal sector and 44% female.
Little is known about the accident and injury rates or the chronic disease experience of agricultural workers in Thailand or other Southeast Asian countries. Likewise, few studies have described the ergonomic risks of agricultural work. In addition, demand for higher agricultural yields has contributed to the continuing annual increase in pesticide imports throughout Southeast Asia, with pesticide poisonings common throughout the region.
CWEND GeoHealth Hub projects in this sector include:
Our Fogarty R21 project on Brain Disorders in the Developing World. Pregnant women were recruited as subjects from partner hospitals in three provinces in Thailand to investigate whether in-utero organophosphate pesticide exposure, as measured by urinary metabolites, along with mild to moderate iodine insufficiency produced synergistic effects on neonatal neurodevelopment, as measured by the Brazelton Newborn Behavioral Assessment Survey (BNBAS) in newborns and by EEG/ERP (Electroencephalogram/Event Related Potential) testing in 4 month old babies. See Outreach Section for publications.
Our GeoHealth Hub planning grant collected health questionnaires from over 1100 health care workers (patient care and non-patient care) and over 630 informal sector workers (agriculture, salt farm, bird cage makers, stone sculptors, and rubber tappers) at our 5 partner sites. For access to questionnaires see our Outreach Section. During our GEOHealth Network meetingthe questionnaire results were presented and reviewed with our partners and used to develop the proposed surveillance and hazard assessment follow-up. Manuscripts reporting these results are in preparation.
Informal Sector Workers
Informal sector workers are those not recognized or protected under the legal and regulatory frameworks of national governments. Without legal protections or access to social social supports, workplace safety is often lacking, contracts and benefits usually do not exist, working time is long, income low and skills development possibilities scarce. In Thailand the informal sector accounts for about 63% of the working populationa and workplace accident rates are ten times higher than for formal sector workers.
Common groups of informal sector workers include: 1) industrial home work in labor-intensive industries like footwear, electronics, garment production and cigarette rolling, 2) crafts production workers such as basket-weavers, bird cage makers, pottery makers, stone sculptors, and ornaments makers; 3) people who make and sell food on the street or in small stores; 4) personal service workers like maids, child care providers, masseuses, beauticians, barbers; 5) agricultural workers working on family farms.
Each of these groups face a wide range of occupational hazards. In our outreach section we provide information on our research in these areas.
Health Care Workers
As a result of their labor, healthcare workers are exposed to significant health risks including exposures to infectious diseases, musculoskeletal strain, latex products, workplace stress, violence, and hazardous substances.
Healthcare workers are also on the forefront of emerging disease outbreaks and are called upon to provide services under difficult situations, including man-made conflicts and natural disasters.
In Thailand there are about 300,000 employees who work in the health care industry, with about 75% providing direct patient care. The remainder work in maintenance and housekeeping, food services, laboratories or laundry services. Health care workers experience about 19% of all reported work-related illnesses in Thailand.
In our CWEND GeoHealth Hub workshop report (see Outreach Section) we identified several gaps in research and polices for the protection of health care workers including:
Lack of research to confirm the relationship between occupational exposures and health risks and outcomes
Lack of standard criteria for prevention and control measures for healthcare workers during disease outbreaks
Insufficient knowledge about occupational health risk and safety among healthcare workers
Lack of epidemiologic research on non-direct care workers in the healthcare sector
In addition to the occupational safety and health (OSH) concerns regarding agriculture, the diverse ecosystems found in Southeast Asia are under threat from unsustainable development, especially from the move toward intense industrial agriculture and aquaculture expansion and increasing industrialization and urbanization. With climate change, sea level rise is projected to bring devastating floods to Southeast Asia. Rice culture especially relies on large quantities of water, and at present urban centers and the rapidly emerging industrial sector are all competing for water. Water conservation and water quality maintenance are key concerns at present and for the future. Thus, the areas of Agricultural Health and the overlap with Environmental Sustainability will provide many opportunities for research to policy initiatives in the future
Other ongoing concerns in Southeast Asia include widespread air pollution from mobile sources, power plants and industrial sites. CWEND partners have been active in research that documents exposures and examines the health impacts of air pollution. See the Outreach Section for publications in this area.