AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 3011 25-1 29 ( 1 996)

Hazards in Cottage lndustries in Developing Countries

Michael McCann, PhD, CIH

Occupational health and safety research and prevention programs in developing countries have focused almost exclusively on large-scale industries. The informal sector-especially home-based arts and crafts industries such as pottery, jewelry, weaving, and woodworking, as well as other cottage industries-are a major and neglected part of the economies of developing countries. These industries have many hazards, including lead, silica, toxic woods, cadmium, dyes, and ergonomic problems. Since the work is often done in the home and can involve whole families, the entire family, including children, can be at risk. Pre- vention programs involving training and education about the hazards, suitable precautions, and development of safer substitutes are needed. This will also require training of local health care providers in the diagnosis and treatment of occupational diseases related to hazards in these cottage industries. 0 1996 wiley-Liss, Inc.

KEY WORDS: occupational exposures, metals, fumes, dusts, developing countries, train- the-trainer programs

I NTRO D U CTI 0 N

Attention to occupational health and safety concerns in developing countries has for the most part been neglected in the drive for industrialization and modernization [Noweir, 1986; Christiani et al., 19901. The existing research, en- forcement and prevention programs in occupational safety and health have largely focused on problems in large-scale agriculture, mining, and manufacturing industries [Levy et al., 1992; Rylander et al., 19871. This has often been called the formal sector, as opposed to the informal sector, which is not regulated and does not have occupational safety and health programs [Christiani et al., 19901. Reasons for em- phasis on the formal sector include high visibility, large numbers of employees in one location, the presence of labor organizations, and, especially with multinational corpora- tions, the existence of some in-house occupational health services.

This focus on large-scale industry has ignored the fact

Center for Safety in the Arts, New York, New York. Address reprint requests to Or. McCann, 77 Seventh Avenue, #PhG, New York,

Accepted for publication July 6, 1995.

NY 1001 1-6645.

Q 1996 Wiley-Liss, Inc.

that a high percentage of the nonagricultural work force actually is employed in small-scale industry. Small scale industry is usually defined as employing less than one hun- dred workers. A World Health Organization (WHO) study found that 45-95% of the work force in developing coun- tries can be found in small factories and related industries [WHO, 19761, and studies have shown that more than 90% of registered factories and manufacturing industries in Hong Kong, the Philippines, Singapore, and South Korea are small-scale industries that employ 23-35% of the work force. [Reverente, 19921

These small shops have many problems not found in larger scale industry. Usually, the owners have limited fi- nancial resources, machinery is old, and buildings are prim- itive. There is also a lower level of education and skill among workers and owners, resulting in little knowledge of the hazards in their shops. Child labor is common. These factors result in a limited technical and economic ability to comply with health and safety regulations. In addition, the large number of work sites make enforcement of regulations difficult.

These small-scale industries are considered part of the formal sector if they are regulated, but in many developing countries, they are excluded from health and safety regula- tions [Reverente, 19921. Otherwise, they are part of the informal sector, which also includes the cottage industry

126 McCann

and many individual-oriented enterprises such as street ven- dors. One study found that the informal sector comprises 25-40% of the working population in several countries in Latin America and the Caribbean [PAHO, 19941, and recent studies have shown this has grown as high as 70% in some countries [Henao, 19941.

COlTAGE INDUSTRY HAZARDS

The cottage industry is a subgroup of this informal sector. This category is characterized by artisan and craft production, often organized around families and done in homes or backyards. Often these are skills have been handed down from generation to generation, and have been done in the same way for centuries. The hazards of many of these traditional crafts such as pottery, metalworking, and textile crafts were described by Bernardini Ramazzini al- most three centuries ago [Ramazzini, 17131.

Examples of occupational illnesses found among work- ers in the traditional crafts in developing countries include lead poisoning in potters and their families in Mexico [Ball- estros et al., 1983; Cornell, 19881 and Barbados [Koplan et al., 19771, lead poisoning in families in Sri Lanka recover- ing gold and silver from jeweler’s waste using a molten lead procedure [Ramakrishna et al, 19821, silicosis and other respiratory diseases in agate workers in India [Rastogi et al., 19911, asthma from carving ivory from elephant tusks in Africa [Armstrong et al., 19881, and respiratory and ergo- nomic problems among carpet weavers in India [Das et al., 19921.

The use of modern chemicals and processes in the arts and crafts industry also can result in occupational diseases affecting workers and their families. Examples include as many as 93 cases of peripheral neuropathy from the use of hexane-based adhesives in sandal-making in Japan in the late 1960s [Sofue et al., 19681; paralysis in 44 apprentice shoe-makers in Morocco due to glues containing tri-ortho- cresyl phosphate [Balafrej et al., 19841; lead poisoning in lead battery repair workers and their families in Jamaica [Matte et al., 19891; and leg, arm, and back pain and other occupational health problems in home-based, ready-made garment workers in India [Chaterjee, 19901. A modem trend is for large textile manufacturers to hire cottage industry workers on a piece work basis to sew garments at home.

Thus, cottage industry workers experience many of the same occupational diseases found in larger-scale industries using the same materials. This is not unique to developing countries, since similar occupational illnesses are also found amongst the arts and crafts segment of the cottage industry in developed countries like the United States [McCann, 1992a1. Table I lists common hazards of many of the arts and craft processes found in developed countries and many developing countries.

A major problem in the cottage industry is usually a

lack of knowledge of the hazards of the materials and pro- cesses and how to work safely. Cottage industry workers who do develop occupational diseases often do not realize the connection between their illness and their exposures to hazardous materials, and are less likely to obtain proper medical assistance. In addition, whole families can be at risk, not only those adults and children actively working with the materials, but also younger children and infants who are present, since these crafts are usually done in the home. Even when children are not actually present around hazardous substances, hazardous materials can be trans- ported from the work site into the home on clothes of the workers [Knishkowy and Baker, 19861.

The cottage industry is almost completely unregulated in most developed and developing countries. They are usu- ally not registered with government agencies and are often exempted from worker compensation laws and other occu- pational health and safety regulations, as are many small shops. Even countries with good regulations rarely enforce them.

In trying to overcome these difficulties, the provision of occupational health and safety services to the cottage indus- try can be divided into two aspects: (1) training and educa- tion of workers about the hazards and suitable precautions, and (2) ensuring adequate access to medical services.

TRAINING AND EDUCATION OF COTTAGE INDUSTRY WORKERS

Education of cottage industry workers means finding ways to reach the millions of individual artisans and their families. Inspections of individual work sites by govern- ment agencies clearly will not work, both because of their multiplicity, and the fact that government agencies usually do not have these cottage industries registered.

In the United States, efforts to reach individual artists and craftspeople were accomplished through their profes- sional organizations, publications, and the mass media. [McCann, 1992bl In addition, outreach was made to the schools, professional teachers’ organizations, and teachers’ unions in order to reach the upcoming generation of artists and craftspeople. Artists and craftspeople in the developed countries also have access to government agencies that of- ten can provide technical assistance.

These educational and technical assistance methods have limited applicability to developing countries for a va- riety of reasons. Cottage industry workers tend to have a lower level of education, thus limiting the use of traditional print media, and lack access to audiovisual training meth- ods. Most do not belong to professional organizations and have learned their craft through an informal apprenticeship system.

They often live in isolated villages not easily accessi-

TABLE I. Hazards of Craft Materials and Processes*

Craft Material/process Hazard

Batik

Ceramics

Electroplating

Enameling

Forging

Glassblowing

Jewelry

Lapidary

Lithography

Lost wax casting

Neon signs Painting

Pastels Photography

Relief printing Screen printing

Sculpture, clay Sculpture, plastics

Sculpture, stone

Stained glass

Weaving

Welding

Woodworking

WaX Dyeing Clay dust Glazes Slip casting Kiln firing Gold, silver Other metals Enamels Kiln firing Hammering Hot forge Batch process Furnaces Coloring Etching Sandblasting Silver soldering Pickling baths Gold reclaiming Gemstones Grinding Solvents Acids Talc Inks Photolithography Investment Wax burnout Crucible furnace Metal pouring Sandblasting Neon tubes Pigments Oils, alkyds Acrylics Pigment dusts Developing bath Stop bath Fixing bath Intensifier Toning Color processes Solvents Pigments Solvents photoemulsions

Epoxy resin Polyester resin Polyurethane resins Marble Soapstone Granite, sandstone Pneumatic tools Lead came Soldering Etching Loom Dyeing Oxyacetylene Arc Metal fumes Machining Glues Paint strippers Paints and finishes Preservatives

Fire, wax fumes Dyes Silica Silica, lead, cadmium, and other toxic metals Talc, asbestiform materials Sulfur dioxide, carbon monoxide, fluorides, infrared radiation, burns Cyanide salts, hydrogen cyanide Acids, electricity Lead, cadmium, arsenic, cobalt, etc. Infrared radiation, burns Noise Carbon monoxide, polycyclic aromatic hydrocarbons, burns Lead, silica, arsenic, other metals Heat, infrared radiation, burns Metal fumes Hydrofluoric acid, fluoride salts Silica Cadmium fumes, fluoride fluxes, burns Acids, sulfur oxides Mercury, lead, cyanide Silica Noise, silica Mineral spirits, kerosene, gasoline Phosphoric, nitric, hydrofluoric acids Asbestiform materials See Painting pigments Solvents, dichromates Silica Wax fumes, carbon monoxide Carbon monoxide, metal fumes Metal fumes, infrared radiation, burns Silica Mercury, electricity, ultraviolet radiation, phosphors Cadmium, cobalt, lead, manganese, mercury, etc. Turpentine, mineral spirits Trace ammonia, formaldehyde See Painting pigments Hydroquinone, monomethyl-paminophenol sulfate, alkalis Acetic acid Sulfur dioxide Dichromates, hydrochloric acid Selenium compounds, hydrogen sulfide, sulfur dioxide, etc. Formaldehyde, solvents, color developers Mineral spirits See Painting pigments Mineral spirits, toluene, xylene Ammonium dichromate See Ceramics Amines, diglycidyl ethers Styrene, methyl ethyl ketone peroxide Isocyanates, organotin compounds, amines, solvents Nuisance dust Silica, talc, asbestiform materials Silica Vibration, noise Lead Lead, zinc chloride fumes, burns Hydrofluoric acid, ammonium hydrogen fluoride Ergonomic problems Dyes, acids, dichromates, Carbon monoxide, fire and explosion, burns Ozone, nitrogen dioxide, ultraviolet and infrared radiation, electricity, burns Copper, zinc, lead, nickel, etc. Toxic wood dust, noise, fire, injuries Formaldehyde, epoxy Methylene chloride, toluene, methyl alcohol, etc. Mineral spirits, toluene, turpentine, ethyl alcohol, etc. Chromated copper arsenate pentachlorophenol, creosote

*Adapted from McCann (1992a, pp. 11-14]

128 McCann

ble. Government workers who could do training often do not speak the different languages found in many isolated areas. In addition, in some countries, there is a distrust of the government due to ongoing unrest and sometimes even ac- tive civil wars.

New ways are needed to reach out to train and educate these cottage industry workers about the hazards and pre- cautions associated with their work. With limited resources, a first step is to determine which cottage industries are at highest risk. Industrial hygiene surveys of the various cot- tage industries in a country could establish priorities. This could be followed up by demonstration projects involving possible safer substitutes and appropriate precautions. A train-the-trainer approach could help provide a way to ed- ucate cottage industry workers about the hazards and pre- cautions.

Outreach programs could be aimed at cooperatives or centralized markets through which cottage workers often sell their products. In addition, since many urban craft workers congregate in particular areas of the city, there could be possible outreach through existing community groups. In some countries, suppliers of raw materials might be a vehicle for reaching their customers. Nongovernmental organizations might be able to play a substantial role by providing opportunities for basic education about the haz- ards of cottage industries and simple precautions that can be taken.

ACCESS TO MEDICAL CARE AND FOLLOW-UP

Cottage industry workers do not generally have access to formal occupational health medical services. Local clin- ics, hospitals, “barefoot” doctors, and other primary med- ical care services are usually their only realistic access to medical help, if they have access at all. Any program to provide occupational health services to cottage industry worker will have to depend on the primary medical care system.

This approach means that cottage industry workers must have access to this primary health care system. The primary health care workers will have to be trained in the basic recognition and treatment of occupational diseases. This approach has been advocated by a number of writers concerned with hazards in small scale industries in devel- oping countries [Noweir, 1986; WHO, 1976; Reverente, 19921.

For this approach to work, government occupational health agencies and available non-governmental organiza- tions have to provide education, industrial hygiene services, and occupational medical backup services to the primary medical care system. Diagnosis of occupational diseases amongst a sector of cottage industry workers could then provide a trigger for follow-up consisting of epidemiologi-

cal surveys and educational programs in that particular seg- ment of the cottage industry.

CONCLUSION

Cottage industry workers in the developing countries, like their counterparts in the developed countries, face a wide variety of hazards from their materials and processes, and frequently lack awareness of these hazards and suitable precautions. Industrial hygiene and training programs coor- dinated with primary health care delivery systems are needed to address this poorly recognized occupational health problem.

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