Chapter 2 Review of Literature Health problems of Industrial working women in Ernakulam District: An Economic Evaluation 23 The research in Occupational Health (OH) gained momentum since the last two decades. Much of the work has been done in the developed countries, and only a few studies have been conducted in developing countries like India. Out of them, some studies confine to certain area while, some others cover a particular aspect. Moreover, whatever studies have been conducted in this field are scattered and spread over given periods of time. An attempt has been made in this chapter to review the available literature relating to various aspects of the employed women’s health hazards. Review of literature helps to know the works that have taken place so far in the field concerned and the relevance of the present work. Review should motivate the view by stating that prior literature review justifies the study, puts it into context and also acquaints the researcher with the phenomenon under study. The literature study sensitized the researcher to the relevant content in the literature. After the research findings have been analyzed and interpreted, they can be related to the existing knowledge in the literature about the phenomenon under study (Talbot 1995; 430). Scientific technology and information is growing rapidly by the addition of new material every minute, on top of a great edifice already constructed by earlier researchers. Therefore, before beginning any new project or any new area to study, it is essential to find out the works already accomplished in the field and the present status of the study. A large number of studies were conducted on the health problems
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Chapter 2 Review of Literature
Health problems of Industrial working women in Ernakulam District: An Economic Evaluation 23
The research in Occupational Health (OH) gained momentum since the last
two decades. Much of the work has been done in the developed countries, and only a
few studies have been conducted in developing countries like India. Out of them,
some studies confine to certain area while, some others cover a particular aspect.
Moreover, whatever studies have been conducted in this field are scattered and spread
over given periods of time. An attempt has been made in this chapter to review the
available literature relating to various aspects of the employed women’s health
hazards. Review of literature helps to know the works that have taken place so far in
the field concerned and the relevance of the present work. Review should motivate the
view by stating that prior literature review justifies the study, puts it into context and
also acquaints the researcher with the phenomenon under study. The literature study
sensitized the researcher to the relevant content in the literature. After the research
findings have been analyzed and interpreted, they can be related to the existing
knowledge in the literature about the phenomenon under study (Talbot 1995; 430).
Scientific technology and information is growing rapidly by the addition of
new material every minute, on top of a great edifice already constructed by earlier
researchers. Therefore, before beginning any new project or any new area to study, it
is essential to find out the works already accomplished in the field and the present
status of the study. A large number of studies were conducted on the health problems
Chapter 2 Review of Literature
Health problems of Industrial working women in Ernakulam District: An Economic Evaluation 24
different industrial sectors. The overall review is made under the following three
heads, as 2.1, 2.2 and 2.3.The study on gender disparity in occupational health
discussed under the head 2.1, the work environment and occupational diseases among
the women workers are discussed under 2.2 and the cost of illness study of work
related diseases among the labour force is discussed under the head 2.3.
2.1 Gender Disparity in Occupational Health
Gender represents a set of complex relation and historically determined social
processes, modified by social responses from time to time (Ashokan and Ibrahim,
2008). In particular, gender differences and discrimination have become an issue of
concern in the provision and utilization of health care services. Formal and informal,
traditional, non-traditional, paid and unpaid work plays an important part in
determining women’s and men’s relative wealth, health, power and prestige. This
generates gender inequalities in the distribution of resources, benefits and
responsibilities. The workplace can be a setting where gender inequalities are both
manifested and sustained with consequent impacts on health.
All over the world, women and men suffer discomfort, disease, injuries and
death from their work. Male – female differences in education, socialization and
upbringing may lead to differences in the way workers manage their illness
(Alexanderson, 1998) their perception of risk (Gustafson, 1998) and the propensity to
take leave or to seek treatment (Alexander et al, 1994, 1996). These effects, coupled
with exposure differences and consequent differences in types of illness, may explain
why women’s work related sick leave lasts longer on the average than men’s (Islam et
al, 2001).
Relatively rigorous criteria were used for selecting component studies. Selected
occupational attributable risks identified by Nurminen and Kajalainen in 2001
included 18percent for asthma, 12percent for chronic obstructive pulmonary disease
and 17percent for cardio vascular diseases. It also calculated that 4percent (1800) of
all the deaths in 1996 were attributed to occupational factors. They estimated that the
number of occupational deaths was larger than those for suicide (1947) or diabetes
(593).However, two biases could have affected the findings. First is the criteria by
Chapter 2 Review of Literature
Health problems of Industrial working women in Ernakulam District: An Economic Evaluation 25
which occupational exposure were accepted as causes of diseases and second is the
dichotomous classification of exposures (present or absent), when for almost all
hazards, the risk may vary according to the intensity and duration of exposure.
The key findings of a report published by European Union-OSHA in 2003
addressing “Gender issues in safety and health at work” show the broad range of
specific points and topics that are linked to gender aspects in health at work. The work
was done by Kauppinen, Kumpulainen and Houtman in cooperation with other
European OSH experts. Musculoskeletal disorders are very commonly encountered in
certain occupational sectors that employ predominantly women/ eg, nursing, assembly
lines) and are considered to be one of the major causes of absenteeism and morbidity
among the female working population. Although this condition may manifest through
a variety of syndromes(lower back-pain, carpal tunnel syndrome, shoulder bursitis,
etc), it is well known that a number of factors related to activities in the workplace or
specific tasks, are highly associated with the development of musculoskeletal
disorders in different parts of the body.(Polyehronakis et al. 2008: 43)
In a 1989 study of a major Swedish industrial company Frankenhauser et al
recorded physiological and psychometric stress indicators in a group of employees at
middle management level who did work which could be considered as mentally
stressful. It appeared that the women took longer to recover after work than men. This
was interpreted as reflecting the difficulties of the women, due to home and family
commitments, in securing the necessary recovery time at the end of their working day.
Occupational Health is to assure as far as possible every working man and
women in the nations safe and healthy working conditions and to preserve our human
resources (OSHA, 1982). According to the findings of the study by the NIOH,
Ahmedabad, the main hazard in the beedi industry is tobacco dust, which was found to
cause, among others, burning of the eyes, conjuctivits, rhinitis, mucosal dryness,
occupational dermatitis, bronchitis and emohysema. (NIOH, 1994)
In less developed countries, there are numerous hazards and regulations may be
non-existent or ignored (Takaro et al, 1999). For example, in Maquiladoras industry in
Latin America, women are exposed to chemicals, ergonomic hazards, noise and stress
Chapter 2 Review of Literature
Health problems of Industrial working women in Ernakulam District: An Economic Evaluation 26
(Cedillo et al, 1997). In one study, 17percent of women had a cumulative trauma
disorder diagnosed on physical examination (Messarvy et al, 1997). Almost twice as
many women as men reported such disorders.
Investigation related to the gender differences in respiratory findings by
occupation was the main purpose of the study conducted by Neil Schacheter et al in
2009. Result of the research reveals that there was high prevalence of acute and
chronic respiratory symptoms in all the ‘dusty’ studied groups compared to controls.
Significantly less chronic cough, chronic phlegm as well as chronic bronchitis was
found among women than among men after the adjustments for smoking, age and
duration of employment.
Women faced unique challenges in the occupation arenas, because of their
gender and were caught in a conflict between sex role expectations of fulfilling one’s
occupational potential. This may be the main reason that women often select
occupations that are more compatible with family roles are the main content of the
study done by Farmer et al in 1971.
There is an important link between women’s status and population parameters,
such as fertility and infant child mortality. O’Nell (1979) centered his work on the
health status of women. His study highlights that the health status of women reflects
their mental and social conditions as affected by the prevailing norms and attitudes of
society as well as their biological and physiological problems. Frequent and closely
spaced child bearing and heavy workload on women are regarded as major causes of
poor health status of women.
Employment outside the home is an important source of social support and
self-esteem and helps women to avoid social isolation in the home (Romito, 1994,
Razavi, 2000). Many jobs, especially those available to women in low income
countries or to poor, less- educated women in high-income countries, expose women
to harmful working environments.
There are so many studies related to occupational hazards and their effects
among women by Karl Messing and Evert. An early study by them in 1983 looked
into the work conditions and related health effects in male and female job ghettos in
Chapter 2 Review of Literature
Health problems of Industrial working women in Ernakulam District: An Economic Evaluation 27
fish processing plants in Quebec, Canada. They concluded that women were generally
required to work at a faster rate than men, with their additional responsibilities at
home such as housework and taking care of children having synergistic effects on
their health. Significant gender related lung function differences occurred in the textile
industry but not in the food processing industry or among farmers.
In general, women are exposed to some psychosocial risk factors at work, such
as negative stress, psychological and sexual harassment and monotonous work, more
often than men has been revealed through the study of Arcand et al, in 2000. Due to
their low status in the work hierarchy, women exert less control over their work
environment, a condition associated with cardiovascular, mental and musculoskeletal
ill health (Hall, 1989). Brisson et al, 1999 concentrates on the combination of paid and
unpaid work affects women’s health. Consequently, work related fatigue, repetitive
strain injury, infections and mental health problems are more common among women
than men according to Ostlin,2000.
Due to health and nutritional condition, nearly half a million maternal deaths
occur each year in developing countries. This unequal treatment makes women more
vulnerable to disease. This is particularly true in poor countries where deaths from
infectious disease are preventing (Breydon and Chant, 1989). Congruously, the high
rates of fertility and infant child mortality deplete women’s health. Repeated
pregnancies lead to severe anemia, frequent illness and in many cases maternal deaths
(Royston E, 1978; Seager and Olson, 1986; Kazl, 1989). Royaton’s study in 1978
reveals that two-thirds of women in Asia, one-half of women in Africa and one-sixth
of Latin American women are anemic.
A study conducted among the floricultural workers in Colombia reported the
adverse health effects of pesticide exposure include poisoning, cancer, skin diseases,
abortions, premature births and malformed babies (Restrepo et al, 1990). It also
noticed that the pesticides and chemicals are also widely used in high income
countries, where agricultural women workers are often excluded from occupational
health and safety legislation.
Chapter 2 Review of Literature
Health problems of Industrial working women in Ernakulam District: An Economic Evaluation 28
A Swedish study reveals that women and men are often offered different
rehabilitation measures for similar work related health problems. Men, more often than
women, receive in their rehabilitation programme, and women receive rehabilitation
benefits for a shorter period of time than men (Backstrom, 1997; Burell, 2002).
Women in non-traditional jobs are at special risk; those in traditional jobs are
also subject to discrimination on the basis of sex. In both situations, women may be
reluctant to argue for full protection for their health, especially where the health
problems concerned imply male/female differences, whether social or biological. It
has been shown that women in food processing in France and Canada subjected to
cold and or to irregular schedules have specific, sometimes incapacitating problems
associated with their menstrual periods. (Mergler and Vezina, 1985; Messing
et al, 1992, 1993).
A study conducted specifically to investigate the gynecological health
problems experienced by the women beedi workers in Indore found that all but one
woman worker reported some kind of problem. Exhaustion and dizziness werethe
most common problems. In addition, an earlier study had reported frequent
miscarriages among women beedi workers. (Patel, 1994).
A study dealt with health hazards in hospital setting in Mumbai, observed
certain effects on the predominantly female nursing staff. They contracted certain viral
infections like rubella while working in the infectious disease hospital. If the nurse is
pregnant, the fetus can be deformed or have a hearing impairment, etc. Hepatitis B or
HIV contracted easily especially in casualty wards where emergency cases were also
handled. Exposure to radiation in the X –ray laboratory during orthopaedic surgery
etc. needle pricks in the blood bank or while giving injections, and autopsy rooms all
come with their own set of health hazards. (Parhar, Maya 1997).
There are only a few studies conducted on the topic of Occupational Health in
Kerala. A comprehensive study by Narayana in 2004 points out the fact that in rural
Kerala has higher levels of reported illness (about forty percent higher) compared with its
urban population, which is another exception among the Indian states. Moreover, rural
Kerala records higher levels of both chronic and acute morbidity across all age groups.
Chapter 2 Review of Literature
Health problems of Industrial working women in Ernakulam District: An Economic Evaluation 29
A study on the health status of people in rural Kerala by A Ashokan and P
Ibrahim (2009) reveals that three fifths of its female population suffers from illness
related to chronic morbidity.
2.2 Work Environment and Occupational Diseases among the Women
Workers
Working conditions have greatly evolved in recent decades in developing
countries. This evolution has been accompanied with the appearance of new forms of
work organization that may be sources of stress and health risk for labour force. As
population are growing, these issues are particularly worrying in terms of the health
and health care expenditure. A look at the economic literature on the relationship
between working condition and health reveals that it has two distinct strands, not
opposite just parallel. One argument is by labour economists. Freeman (1978) said
that “subjective variables like job satisfaction which economists traditionally view
with suspicion contain useful information for predicting and understanding behavior,
but that they also lead to complexities due to their depending on psychological states”.
But afterwards, working conditions have been included in different economic analyses
through their impact on the health of individuals (see Faragher, Cass and Cooper
(2005) for a large review not only economic). Case and Deaton (2003) question the
evolution of health during the life cycle, and the influence of education, employment,
income and working condition in this evolution. They use the intertemporal model of
health capital put forward by Grossman (1972), which analyses the health level and
deterioration rate during the life cycle. The underlying idea of this representation is
that deterioration of health capital is a biological process, but that characteristics
related to consumption, healthcare and more generally living conditions, act on this
capital and its deterioration over time. This deterioration can depend on working
conditions. In this model, health status is explicitly linked to current and past working
conditions. This representation thus puts forward the idea that health status at the end
of working life results from current working conditions, as well as all previous work
(Currie and Madrian, 1999; Blanchet and Debrand, 2008), labour turnover (Clark,
Georgellis and Sanfey, 1998; Souza-Poza and Souza-Poza.2007),wages (Clark and
Oswald,1996).
Chapter 2 Review of Literature
Health problems of Industrial working women in Ernakulam District: An Economic Evaluation 30
Second strand of literature reflects the growing interest in the impact of
working condition on individual health status. According to the model of Karasek and
Theorell (1991), workplace organization determines some of the psycho-social
characteristics of work, which themselves have an influence on the health of the
workers. The authors develop the idea that a low level of control combined with a
strong demand represents a risk for health. They make the hypothesis of an intrinsic
effect of the work organization on health that is different from the individual’s own
characteristics. They show, for example, a high prevalence of symptoms of heart
disease among people who say they have both a low level of control and a high level
of demand. Other studies have shown the influence of these factors on the risk of
developing heart disease (Bosma et al, 1998) or mental illnesses (Stansfeld et al,
1999) and on the self-reported health status (Ostry et al, 2003).
California Occupational and Environmental Health Centre (COEH) conducted
several researches on the work environment and the physical health risk of
individuals. A study done by them says that a variety of work place physical
exposures (noise, heat, cold, heavy lighting) and chemical exposures(lead, carbon
monoxide, carbon disulfide) increase the risk of cardio vascular diseases. The
evidence that psychosocial work factors are an important cause of CVD among men
and women is strongest and most consistent for job strain.
The Indian Toxicology Research Centre studied the incidence of skin disease
among the workers in the tan yard was very high as compared to those not working in
the tan yard. This study was conducted among 266 tannery workers using case control
method; 166 tanneries formed the case while 99 workers of the same factory but in
different departments formed the control group. This study done by Parikh in 1984 has
confined itself to identifying the skin diseases to the exclusion of all other diseases.
With technology replacing human labour, peripheral production is left to the
human hands of women, making them vulnerable to double burden of domestic and
paid work. Dungo in 2001 point out the shift to technological production in the
manufacturing industries also has an implication to subcontracting work or home
work. Another study of Lu in 2004 make sure that women workers in the electronic
sector had high blood lead levels and experience work stress, musculoskeletal
Chapter 2 Review of Literature
Health problems of Industrial working women in Ernakulam District: An Economic Evaluation 31
disorders and carpal tunnel syndrome. A study by Mahoney in 2010 says that female
electronic workers on 8 hour as well as 12 hour shift schedules reported complaints of
sleep problems and tiredness.
The European Foundation’s (1996) Working Conditions Report indicated that a
high proportion of workers across the European Union work long hours (49percent
work more than 40 hours per week, and 23percent more than 45hours). The data also
revealed that health problems (stress and back ache) increased with the hours worked.
Compressed work weeks, with 12 hour working days, have been associated with
feelings of increased fatigue (Rosa and Colligan, 1986). Rosa et al (1989) have shown
that after seven months adaptation to a 3-4 day/12 hour rotating shift schedule there
were reductions in sleep and decrements in subjective alertness compared to previous
work on a 5-7 day/8 hour schedule. The increases in self reported stress which also
occurred were attenuated by the shortened work week.
Feminization of workforce in industries in the Philippines specifically in
garment manufacturing, microchip, computerized manufacturing and electronics
industry, operating inside export processing zones reported certain occupational risks
and disbenefits to these women workers including low salaries and deficient
enforcement of health and safety regulations has been pointed out by Edralin and
(2001) and Estrella – Gust(2000).
Nearly a quarter of workers report suffering headache or/ and muscle pain in
shoulders/neck or/ upper and lower limbs related to their work. These perceptions are
linked to known risk factors for electronic equipment assembly, and supermarket
check - out staff. What all these occupations have in common is that (excessive)
repetitive movements of the upper limbs are required to perform their work tasks
(Schneider and Irastorza 2010: 37).
Difficult working condition are detrimental to health, reduce the productivity
of workers, increase their absenteeism rate and the probability of them losing their job
and incite them to leave the employment market as soon as possible has been revealed
through the study of Blanchet and Debrand in 2005. Focusing on hours of work,
Spurgeon, Harrington and Cooper’s(1997) research analyses that there is sufficient
Chapter 2 Review of Literature
Health problems of Industrial working women in Ernakulam District: An Economic Evaluation 32
evidence to raise concerns about the health risks of long working hours(over fifty
hours per week). This is despite, the well-known fact that prolonged exposures to
physical risk factors are strongly associated with musculoskeletal disorders (Bernard,
1997). Shift work has been well studied and results show physical health problems of