Year : 2006 | Volume
: 10 | Issue : 2 | Page : 85--86
Community-based occupational/environmental health studies: The challenges and the dilemmas
Rajan R Patil
United Nations Development Programme, Orissa, India
Rajan R Patil
United Nations Development Programme (UNDP), UN House-II, 256, Forest Park, Bhubaneshwar, Orissa - 751 009
Occupational/environmental health studies present phenomenal operational challenges to execute as per protocols due to their peculiarities and idiosyncrasies. Unlike in infectious diseases, where there is genuine desire for disease eradication by the affected communities, in environmental/occupational health studies, the dynamics are totally different, with vested interest groups working hard to maintain status quo. There are dimensions of economic dependence, politics, fear, suspicion, pressure tactics, intense lobbying, etc, that make community-based studies related to occupational/environmental health aspects very difficult. It«SQ»s not that the communities affected due to occupation/environment are not concerned about their health, but their participation is very tentative in nature; in the face of slightest risk, they would rather want to play it safe and withdraw, for their economics is at stake-not to forget vested interest groups who could go to any extent to sabotage any good work in favor of affected communities.
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Patil RR. Community-based occupational/environmental health studies: The challenges and the dilemmas.Indian J Occup Environ Med 2006;10:85-86
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Patil RR. Community-based occupational/environmental health studies: The challenges and the dilemmas. Indian J Occup Environ Med [serial online] 2006 [cited 2020 Feb 16 ];10:85-86
Available from: http://www.ijoem.com/text.asp?2006/10/2/85/27307
The environmental/occupational health researchers often find themselves in many unenviable situations. It is well documented that this is a branch of science that confronts open and direct industry pressures that favor the reporting of negative studies and the suppression of study results antithetical to the interests of industry. The challenges and the dilemmas involved with conducting community-based studies on working population are illustrated below.
Queer situation arising vis-à-vis child workers
In occupational health studies, when child labor is involved, the problems begin with the gatekeepers (literally and symbolically) who refuse to acknowledge existence of children working in their units; when pointed to children in the units, the gatekeepers say they are present as offspring of adult laborers working in the units.
Since approaching the child laborer at their workplace is impossible, an alternative is to approach them at the residence. Studying minors would necessarily require parents' involvement for informed consent. Very often, there would be reluctance on the part of parents due to intimidation they receive from employers to not allow their children to participate/cooperate in studies. Fear associated with participation in studies, largely stems from the insecurity arising out of possible action against the unit owners for employing child laborers and consequent unemployment for their children. Ultimately, participation in studies or investigation is considered to be harmful to their self-interest.
Even if children and parents are taken into confidence, employers of child labor can be very spiteful, spreading rumors and misinformation campaign - for example, blood is being drawn in large quantities; organs like kidney, eyes, etc, are being taken away after the child is sedated by biscuits.
Sampling issues in occupational health studies
In the light of the given scenario, there is bound to be difficulty in recruiting workers as study subjects chosen by random sampling, as illustrated below:
1. Insisting on strict random sample would require continuing the study only with the workers from the sampling frame willing to participate in the study by giving informed consent. It would invariably mean falling way short of required sample size due to fear and insecurity among the study subjects.
2. Insisting on predetermined sample size would warrant recruiting additional workers who satisfy the inclusion criteria and are willing to participate in the study by giving voluntary informed consent. That would necessarily mean:
a) Change in the sampling frame in the middle of the study because of the necessity of freshly recruiting additional workers as sample to make up for the deficiency due to attrition, but the danger is replay of same situation, e.g, refusal, nonparticipation, attrition.
b) The other alternative is to carry on with a mixed study group with sampled and voluntary study subjects participating in the study by giving informed consent. This option would help in completing the study with the required sample size amenable to statistical inference. The validity of the information due in such samples will be questioned.
Implications in exercising the above options
The first option of persisting with random selection of subjects and going ahead with inadequate sample size would certainly bring in Type-II error due to huge attrition and the conclusions will lack the required precision due to lack of statistical significance within the generally acceptable confidence interval.
Exercising the second option would yield good number of study subjects but would necessitate some mid-study maneuvers in reaching the required sample size, defeating the very purpose underlying sampling principles.
The middle path in occupational health studies
Getting out of catch-22 situations is always associated with dilemmas and one is invariably left with choosing between the devil and the deep sea. In community-based occupational/environmental studies, one is very often forced to continue with the mix of sampled and volunteer study subjects.
Many of the occupational/environmental health studies are and will have to be completely done on a convenient/grab sample.
Data collection in charged atmosphere
Conducting occupational health studies on politically sensitive subjects - for example, farmers' deaths, nuclear radiation, etc. - is particularly challenging given its political overtones. Some very common issues that arise are:
1. Validity of interview
The moment investigators visit an affected victim's house, neighbors and elders gather at the victim's house, replying as proxies; and they very often come out with liberal prompting in response to the questions meant for the family members.
2. Gender bias in reporting
Female family members often have accurate information of the early poisoning cases (in case of pesticide poisoning) and would have information of the patient's condition from the moment the patient is brought from the field. But it is difficult to interview them as they are overwhelmed with grief and are often seen wailing and crying. Also, sometimes male members of the family prevent them from being interviewed. The information given by male family members is generally incomplete as generally, they would be busy arranging for ambulance/transport for the patient to be taken to the hospital and hence miss out on early information of poisoning, while their information at later stages of the patient's condition is very accurate.
3. Compensation issue
Compensation is always an issue in occupational health problems. Any effort to study health consequences is mistaken to be an activity of record collection for compensation; as a result, dramatized versions are given to make a stronger case to qualify for eligibility criteria - for example, quoting of income much lower than actual or complaining of subjective health problems.
4. Ethics vs. principles: Conflict of interest vis-à-vis compensation
Sometimes, a researcher is caught in a peculiar situation, especially when conducting studies involving child laborers. One of the standard ethical practices is to compensate any working individual for a day's wage loss to, him/her arising due to participation in the study. Child labor activists question the ethics of following this practice with respect to occupational health studies involving minors. Their argument is that children below 14 years should be in the school and not be working. If due to participation in the study, if children are required to miss a day's work, it is in the interest of the children to be away from the hazardous work, at least for a day. In such a situation, child activists find it against their conviction and principles to pay for the day's wage as compensation. Questions are raised on whether or not the act of paying day's wage as compensation in itself would signify being insensitive to the social issue. Worse, it is misinterpreted as tacit support and lending legitimacy to the children working as laborers.
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