Knowledge gap on RMG workers' occupational health
The disasters including a fire incident that killed 112 workers and a factory collapse killing 1122 workers provoked widespread calls for improved workplace safety measures in Bangladesh's garment industry. It also focused global attention on the low wages, benefits, and facilities at many of these factories. Simple workplace programmes, policies, and practices, like having building safety inspection, fire-fighting capability, and access to fire exits could have prevented the horrifying tragedies.
In industrialised countries, with strong protective policies and practices in the workplace including improved ergonomics, timely medical care, and appropriate engineering control measures, workplace health and safety have improved greatly. The vast majority of workers who are evaluated and treated for a work-related illness or injury return to work without unexpected delays and or disability. However, this scenario is not true for developing nations such as Bangladesh, where a large number of workers lack access to any occupational health/occupational medicine-related health care and have access to very poor quality primary care provided mostly in the public sector.
The industry is critical to Bangladesh's national economy as its primary source of employment and foreign currency. Garments constitute about four-fifths of its manufacturing exports, and the industry is expected to grow rapidly over the next decade as China has started to divest from this business as the cost of labor and production is rising there.
Bangladesh's success in this booming garment business largely depends on keeping wages and benefits quite low and restricting the rights and workplace facilities of workers. The wage in the garment industry is very low, unions are almost nonexistent, and garment industry owners, who are primarily male, have gained tremendous wealth, and social power and have a strong influence over government policy-making. Whereas, discontent among garment workers has grown over the years and protests have been increasingly common over wages, benefits, and work conditions. Some of these protests have involved agitated street processions and even violence including occasional vandalizing of factories.
Anecdotal reports from garment factory workers in Bangladesh have identified customary complaints like chest discomfort, headaches, weight loss, fatigue, ear complaints, and dyspnea. Other less common symptoms are hoarseness of voice, stomach ache, swelling in fingers, heartburn, pain in various body parts (i.e., lower back, foot, shoulder, knees, elbows), and breathing difficulty. However, these data have not been systematically collected in Bangladesh to help determine the scope of these problems, with certainty. These data are needed to inform future injury and illness prevention programs, which are common in factories like these in other countries but nonexistent at present in Bangladesh.
Bangladeshi women work in unforgiving conditions at garment factories with inadequate workplace health and safety regulations, programmes, policies, or practices. Workplace injuries cause an enormous amount of physical, financial, and emotional hardship for individual workers and their families. The goal of developing injury and illness prevention programmes at garment factories should be to prevent workplace injuries, illnesses, and deaths, the suffering these events cause workers.
Possible occupation-related health hazards in readymade garment factories generally include poor ergonomics leading to a variety of musculoskeletal disorders, vision problems, and possible exposure to various chemical and toxic agents due to inadequate ventilation or improper/lack of use of appropriate personal protective equipment (respirator, facial mask and/or suit). The squatting working position for prolonged hours, in general, may lead to arthritis of the knees, and various lumbar, cervical, and thoracic spine disorders ranging from mild strain/sprain to sacroiliac joint dysfunction. Eyesight disorders also occur due to constant close attention to the point of weaving or knotting under inadequate light. Fibre dust exposure can lead to a variety of pulmonary disorders like chronic cough, reactive airway dysfunction syndrome, and bronchial asthma.
The very few studies published so far on garment workers in general and particularly in developing countries have been descriptive in nature, comprising largely of case reports, case series, and cross-sectional designs that limit the ability to identify the risk factors and hazards and correlate them with adverse health outcome. These studies depended on data collection from small samples of the target and at-risk population with ad-hoc or pilot scale data collections. In the absence of well-designed and large-scale epidemiological studies that incorporate workplace factors (occupation, department, exposure level and duration, shift-work, length of shift, overtime, the flexibility of work schedule, fire drilling, on-site care, location of the factory etc.) and socio-demographic characteristics of the workers (age, gender, education, family composition, family income etc.) and other factors (sickness and vacation leave policy, management style, health insurance, compensation claims, fire drills etc.), preventive measures will not be based on evidence.
Such limitations mean that these studies may not have captured important variables and risk factors for adverse health outcomes. As a result, there is a great need for identification and systematic data collection of key workplace hazards as well as health outcome in resource-poor settings.
Serious and comprehensively done research studies must attempt to work towards addressing this knowledge gap among garment workers in Bangladesh and generating much-needed evidence so that stakeholders and safety advocates may acquire resources and put useful interventions in place.
Hasnat M Alamgir is Professor and Chair of Public Health at IUBAT- International University of Business Agriculture and Technology, Dhaka.