Occupational Health
An Emerging Discipline in Developing Economics
Scott Barnhart
Matthew Keifer
Tanongsak YingratanasukAn expanding global economy is bringing rapid change to impoverished countries in Southeast Asia and Central America that have large populations and natural resources available for tapping. In the drive for economic development and obvious need to raise standards of living, limited resources have been available for occupational and environmental health. Fatalities from construction injuries are far more common than in the developed world; pesticide poisonings remain common; and provision of clean water and air are major challenges as these regions industrialize and the population concentrates in urban centers. Challenges on many fronts range from the problems brought on by rapid development in countries with few strong labor or environmental regulations to a call for global labor and environmental regulations to establish equitable and fair rules for competition and promotion of the environment and reasonable standards of living.
The International Scholars in Occupational and Environmental Health (ISEOH) program, a joint initiative of the University of Washington schools of Medicine and Public Health and Community Medicine, seeks to address these issues by promoting research and training in these disciplines in Southeast Asia and Central America. The program is funded for an initial five years by the Fogarty Center of the National Institutes of Health through support from the National Institute for Occupational Safety and Health and National Institute for Environmental Health Sciences. ISEOH promotes research and training through various mechanisms including short courses conducted in host countries, faculty exchanges, and research collaboration.
Among the program's guiding principles are a focus on primary and secondary prevention of relevant local problems, a multi-disciplinary approach to occupational safety and health problems, and participation by public and private sectors. In the first year we have primarily focused on conducting needs assessments in the target regions, holding two short courses, identifying candidates for masters programs, and supporting faculty exchanges.
Work in Thailand
The short course co-organized with the faculty of public health at Burapha University (BU) in Chon Buri, Thailand, illustrates the challenges and opportunities in these fields in the developing world. Beginning in the early 1970s and concurrent with its expanding industrialization, Thailand has enacted regulations and established government agencies aimed at improving workplace safety and preventing occupational diseases and injuries. Resources focused on these goals are increasing significantly, but still fall far short of needs. The country lacks depth of expertise in all components of occupational health including medicine, nursing, industrial hygiene, and toxicology.To help meet training needs, UW faculty conducted an "International Workshop on the Primary and Secondary Prevention of Occupational and Environmental Health Risks," from May 20-24, 1996. Participants were required to have a minimum of a baccalaureate degree, two years of practical experience, and a particular occupation or environmental health problem to present for discussion. Thirty-five participants included faculty from other universities in Thailand, the local and central public health agencies, and private companies.
The challenges of organizing the course included meeting the needs of a diverse group of occupational and environmental health professionals, using English as a second language, and, importantly, focusing the course sufficiently to give the participants an increased level of skills. To address these challenges we asked participants to identify key problems in their work so the course could be relevant to those problems. We used a problem-based learning approach that focused on developing problem-solving skills Course faculty were chosen to provide a range of expertise and included Drew Brodkin (occupational epidemiology), Janice Camp (industrial hygiene), Stanley Freeman (safety), Matthew Keifer (pesticide-related health problems), and Scott Barnhart (occupationally related respiratory diseases).
The five faculty members left Seattle with 13 boxes containing syllabi, a computer, printer, and overheads for last-minute changes. Fortunately, all arrived in Bangkok, and customs officers were sufficiently daunted by the number of boxes to admit us expeditiously Faculty from Burapha University escorted us the 60 miles south to Chon Bun.
The first day began with problem-based case studies that required participants to solve problems ranging from calculating exposure levels to analyzing medical surveillance data. Each case study was selected to communicate important information in the specific discipline and to give the participants essential skills to be used in applying the public health model. For that reason, as a group, the faculty emphasized skills such as use of epidemiologic data to identify problems.
Teams of UW and BU faculty led small group discussions. By far the most successful was a full-day program organized by Stanley Freeman in which students developed a safety program for a construction site. This well-organized session vertically integrated each component of a public health approach to construction safety while acknowledging many practical constraints.
At the close of the course, participants went through an exercise of designing a public health system for control of occupational and environmental health risks. The course evaluation, which included pre- and post-tests, showed that knowledge increased significantly. From this first step the faculty learned several lessons. While the course was a major success, it also likely covered too broad a range of topics for too diverse a group of professionals. Thus, we are considering focusing efforts on a narrower range of issues, perhaps the control of health problems caused by silica and pesticide exposures, to permit us to address our goal of using training and research to assist developing countries in implementing a public health approach to these specific problems.
A second phase of the training program brought Tanongsak Yingratanasuk, an instructor from the BU industrial hygiene program, to the University of Washington from September 1996 through January 1997 for coursework and research. While here he authored a paper on the occupational health system in Thailand to be published in a new journal of international occupational health. He recently returned to the UW to begin the M.S. program in industrial hygiene.
Other Initiatives
Program faculty conducted a short training course in Hanoi, Vietnam, in May 1997, and are developing a plan to collaborate on training and research in Central America. Realistically, a program such as ISEOH cannot address the myriad of occupational and environmental health problems in Central America and Southeast Asia, but it clearly can assist with targeted training and research and serve as a model for strategies to improve occupational and environmental health.While the limited resources now available through the Fogarty Center require us to focus on a relatively narrow range of the most important problems, the extremely wide scope of problems begs for additional work. How should lead contamination of the environment be addressed? What is the right approach to hazards such as the widespread use of synthetic multicomponent paints and polymers, which are potent sensitizers resulting in skin and respiratory disease? How do multinational corporations, labor unions, and governments address issues of labor and environmental standards? These issues are relevant to Washington State, with its extensive international trade, and to countries in Southeast Asia and Central America. Using the lessons learned in this project, we are exploring partnerships with business, labor, and government agencies to address these problems.
L to R: Dr Scott Barnhart and Dr Matthew Kiefer confer with
Tanongsak Yingratanasuk about his paper on the occupational health
system in Thailand.
Recommended Reading
Commission on Human Research For Development: Health Research: Essential Link to Equity in Development. New York: Oxford, 1990.
Kjellstron T, Rosenstock L: The role of environmental and occupational hazards in the adult health transition. World Health Stat Q 1990; 43:188-196.
Michaels D, Barrera C, Gacharna M: Economic development and occupational health in Latin America: New directions for public health. Am J Public Health 1985; 75:536-541
Authors
Scott Barnhart, M.D., is an associate professor of medicine and environmental health and directs the Occupational and Environmental Medicine Program at the University of Washington.
Matthew Keifer M.D., is an assistant professor of medicine and environmental health at the University of Washington and has conducted extensive research on the health effects of pesticides in Central America.
Tanongsak Yingratanasuk, M.PH., recently entered the masters program in industrial hygiene at the University of Washington. He is an instructor in industrial hygiene at Burapha University in Chon Buri, Thailand.
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Created: 4/8/98 Updated: 7/15/99
