The Occupational Health Needs Of Workers: The Need for a New International Apprach

Workers themselves rarely distinguish between occupational and nonoccupational illness, although they are acutely aware that much of their physical wellbeing stems from bad working conditions (Shukla, 1991: 597-603). In India, a study was carried out among tannery workers. The tanneries were stratified on the basis of the tanning process (chrome, vegetable, or mixed) and hide processing capacity (large, medium, or small). The medical profile of the study population was divided between occupational and nonoccupational morbidity. However, many kinds of morbidity existing in the study population tended to be more embraceable in the WHO concept of 'work-related' disease, rather than the narrower concept of 'occupational' disease (Jeyaratnam, 1992). The former concept suggests that the causes are multifactorial and may be work-related, but not necessarily directly. For example, diseases such as tuberculosis or asthma may be aggravated, accelerated, or exacerbated by workplace exposures or conditions. The occupational and environmental health problems of workers, particularly in the informal sector, present a challenge to health and labor ministries to develop a new approach. The model in the North of moving occupational health from the health ministry to the labor ministry is inappropriate in a situation where most workers are unorganized, are women and children whose health needs cannot be separated into 'home' and 'work,' and where industrial processes may affect not only workers' health, but also that of the population living nearby. This is illustrated by the following evidence. Before this can be achieved, however, health authorities need to be more aware of the health conditions of workers. District health systems need to be strengthened and reoriented toward health promotion, prevention, and protection. Attention is needed to ensure that the integration of occupational health with PHC goes beyond the establishment of another separate, vertical technical program (Macdonald, 1993). For example, health promotion aims to work with people in the 'settings' of their everyday life, focusing on building up 'healthy workplaces' or 'healthy neighborhoods,' rather than focusing on people at risk from specific conditions or already in contact with the health services (Ashton and Seymour, 1988). Establishing local information systems can promote links between environmental/occupational health data and health conditions; local resource centers have proved to be import