SHORT SYNOPSIS
FOR
Ph.D Programme 2009-10
Effectiveness of Worksite Health Promotion Programme for Female Workers in Leather Industry
DEPARTMENT OF NUTRITION AND DIETETICS
FACULTY OF APPLIED SCIENCE
Submitted By:Supervisor:
Name: Gurjeet Kaur Chawla Name: Prof. (Dr) G.l. Khanna
Signatures:Signatures:
Email id: Designation: Prof. & Dean, FAS
Contact No:09871080908Contact No : 09810339290
Registration Date: 20 Feb’ 2010
Registration No.: 09039990021
Uploaded on:
Certificate
This is to certify that the synopsis entitled “Effectiveness of Worksite Health Promotion Programme for Female Workers in Leather Industry” by Gurjeet Kaur Chawla, submitted in fulfilment of the requirement for the degree of Doctor of Philosophy in Health Promotion under the Faculty of Applied Science, Manav Rachna International University, Faridabad, during the academic year 2009-2010, is a bonafide record of work carried out under my guidance and supervision.
Prof. (Dr) G.l.Khanna
Dean
Faculty of Applied Science
ManavRachnaInternationalUniversity
ABSTRACT
Women around the world are working in industries in large number. One of the major industries which occupy a place of prominence is the leather industry, where approximately 30 percent of the workforces are women. Health hazards that women workers face in the leather industry been traditionally underestimated. There is an urgent need for worksite health promotion program for female workers to raise their health status.
The present study will be conducted among 200 female workers (35-65yrs) in small and medium leather industries in Delhi National Capital Region to assess the workplace health conditions and health status of the female workers, to study the relationship between workplace health conditions and health status and also to find out the impact of health promotion intervention programmes. A detailed standardised tool comprising of a Workplace Health Assessment Comprehensive Survey Form and an Employee Health Survey Form will be developed which will combine answer scale and open ended responses. Based on the data collected, anIntervention Programme for Health Promotion for six months will be formulated. A monitoring and evaluation tool will be administered which will reflect progress on an ongoing basis of theprogramme.Data coding, entry and validation will be done using appropriate software for analysing the data.Frequency and percentages will be calculated. Data collected will be statistically analysed. Various appropriate statistical tests will be applied which will include mean, standard deviation, correlation, variance and ANNOVA. Graphical representation through bar graphs and pie charts will also be done to aid understanding and comprehension
Key Words: Worksite, Health Promotion, Health, Safety, Hazards, intervention
Table of Contents
Sl No. / Chapter Name / Page No.1 / Introduction / 1-6
2 / Literature Review / 7-11
3 / Description of the topic / 12
4 / Objectives of Research / 13
5 / Hypothesis / 13
6 / Methodology to be adopted / 14-19
7 / Proposed expected outcome of the research / 19
References ( in alphabetical order)
INTRODUCTION
1.1 HEALTH
“Health is state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”...... WHO
Health includes the ability to realise aspirations, satisfy needs, and cope with changes in the body or the environment. It is seen as a resource for everyday life, not the objective of living. It is a positive concept emphasising social and personal resources as well as physical capabilities Ottawa Charter for Health promotion (1986).
1.2 HEALTH PROMOTION
Health promotion is the process of enabling people to exert control over the determinants of health and thereby improve their health. As a concept and set of practical strategies it remains an essential guide in addressing the major health challenges faced by developing and developed nations, including communicable and non-communicable diseases and issues related to human development and health Ottawa Charter for Health Promotion,WHO (1986). Health promotion is an important issue that aims to maintain the level of health, work ability and strengthen potential resources for health.Thus, health promotion is not something that is done on or to people; it is done by, with and for people either as individuals or as groups.
1.3 WORKSITE HEALTH PROMOTION
The WHO has proposed the definition of a healthy workplace as a place where everyone works together to achieve an agreed vision for the health and wellbeing of workers and the surrounding community. It provides all members of the workforce with physical, psychological, social and organisational conditions that protect and promote health and safety. It enables managers and workers to increase control over their own health and to improve it and to become more energetic, positive and contented WHO (2009). In other words, workplace health is a comprehensive and integrated approach to health which focuses on the general population at a workplace and the organisation as a whole. Its strategies are not limited to a specific health problem, or to a specific set of behaviours but enables people to increase control over and to improve their health.
Workplace health initiatives around the world are growing in number and scope as employers come to realise that addressing employee health and wellness is linked to increased productivity and reduced absenteeism Bending(2008), and that the return on this strategic investment and overall health cost savings are high Vaughan-Jones(2010). The dramatic global increase in chronic Non-Communicable Diseases (NCDs) in recent years is also playing a part in the spread of these initiatives. Between them, the four major NCDs – cardiovascular disease (heart disease and stroke), cancer, Type 2 diabetes and chronic lung disease – account for over 60 percent of deaths in the world, double the number of deaths from all infectious diseases (including HIV/AIDS, TB and malaria), maternal and perinatal conditions, and nutritional deficiencies combined WHO(2005). The majority up to 80 percent of premature deaths from these diseases could be prevented by tackling just three risk factors: poor diet (including the harmful use of alcohol), tobacco use and lack of physical activity. Crucially for employers, 9 million of the 36 million deaths from NCDs each year occur in those aged under 60 (in other words, among the working-age population) World Health Organisation(2010). The cost to the world economy of these diseases over the next 20 years is estimated by the World Health Organisation and HarvardUniversity to be approximately $30 trillion World Economic Forum(2011).
Health Promotion Programmes, which are also termed Worksite or Workplace Health Awareness or Health Promotion Programmes promote three basic elements of a healthy workplace. First, a healthy physical environment addresses the health and safety of the employer and employees, for example, ensuring an adequate workplace and clean air. It goes beyond basic health and safety legislation. The physical environment is also influenced by workplace policies that address issues such as ergonomics and special needs of employees with disabilities. Indeed, many Worksite Health Promotion (WHP) programmes are considered a feasible way to reach many individuals and they are shown to positively affect health and increase employee productivity. The largest benefits, however, are most likely reached if individuals with the poorest health participate in the programme, Jonsdottir et al. (2011). Second, a healthy workplace supports healthy lifestyles and encourages positive behavioural changes, for example, with smoking cessation programmes, the introduction of options for healthy food choices and opportunities to become more physically active. An analysis Groeneveld et al. (2011) on “Lifestyle Intervention” showed that a reduction of smoking and snack intake and an increase in fruit intake can be achieved by an individual-based lifestyle intervention among workers with an elevated risk of cardiovascular disease.Another study Kreis et al. (2004) also showed that work-related programmes can help reduce smoking behavior, control weight, improve the attitude towards nutrition, lower blood cholesterol and increase physical activity .Finally, the last element of a WHP concerns the social environment or culture as experienced by its employees - it deals with the organisation and design of work.
All these components constitute a healthy workplace .These are the co-coordinated efforts of the employers and employees to improve the health conditions at the work place. The employers have the major role to make these worksite health promotion programmes successful and fruitful. The ultimate objective of these programmes is to maintain a congenial healthy working environment. Employers are experimenting with different forms of worksite-based programmes aimed at improving the health of their workers. Many employers have become convinced that their organisations can play an important role in reducing health risk factors among employees, which, in turn, will lead to lower health care costs, reduced absenteeism, and improved on-the-job productivity Goetzel et al. (2008).
The workplace is increasingly being used as a setting for health promotion and preventive health activities; not only to prevent occupational injury, but to assess and improve workers’ overall health World Health Organisation (2010) and The Bangkok Charter for Health Promotion in a Globalised World (2010). Globally, two million people die each year as a result of occupational accidents and work-related illnesses or injuries International Labour Organisation(2010). Another 268 million non-fatal workplace accidents result in an average of three lost workdays per casualty, as well as 160 million new cases of work-related illness each year International Labour Organisation (2005). Additionally, eight percent of the global burden of disease from depression is currently attributed to occupational risks Prüss-Ustün (2006).
Indian industrial workers suffer from a high prevalence of risk factors and morbidity due to NCDs. A study of employees and family members in 10 Indian industrial settings has shown the overall prevalence of most NCD risk factors to be high; with 50.9% of men and 51.9% of women being overweight, central obesity observed among 30.9% of men and 32.8% of women, and 40.2% of men and 14.9% of women reporting current tobacco use Reddy (2006). Another study by the Confederation of Indian Industry (CII) revealed that 11.6% employees had had the unhealthy habit of consuming tobacco and alcohol for more than 5 years. About 46% of the respondents in the service sector with stress had diabetes, 39% had heart problems, 49% had a history of hypertension and 31% showed symptoms of Chronic Obstructive Pulmonary Disease (COPD). Significantly, women (52.4%) had higher levels of stress than men (40.1%) Ahuja (2007).
1.4 LEATHER INDUSTRY
A major industry which occupies a place of prominence in the Indian economy because of its massive potential for employment, growth and exports is the leather industry, which employs about 2.5 million people, out of which 30 percent are women. The Indian leather industry has both organised and unorganised sectors. The organised manufacturing sector broadly consists of tanning and dressing of leather and the manufacture of luggage, handbags, saddlery, harnesses and footwear. Currently, the unorganised sector makes up the lion’s share of the Indian leather industry. According to National Productivity Counciltogether, the small-scale, cottage and artisanal subsectors account for over 75 per cent of the total production of the Indian leather industry and the majority of them belong to the unorganised sector. There has been increasing emphasis on its planned development, aimed at the optimum utilisation of available raw materials for maximising the returns, particularly from exports Sarbapriya R (2011). In addition, according to National Sample Survey data, out of 18 million urban women workers, around 6 million women workers are involved in the textile, garment and leather industries.
In the leather industry, apart from noise, dimly lit working conditions, bad odour and polluted air, workers may face the following problems:
- Waste discharge from tanneries pollutes the air, soil and water, causing serious health problems. Exposure to such contaminated environmental milieu has been seen to culminate in multiple arrays of disease processes including asthma, dermatitis, hepatic and neurological disorders and various malignancies, Syed et al. (2010).
- Both male and female fertility drops, producing various reproductive hazards while others suffer from dermatological hazards and bladder cancer Syed et al. (2010).
- Leather tanners report dermatological diseases such as rashes and papules along with complaints of itching and burning sensations Rastogi KS et al.(2008).
- Workers face respiratory illness and pulmonary impairment associated with certain characteristic symptoms such as dry cough, throat irritation and lung congestion Rastogi KS et al.(2008).
- An important health risk factor for the tannery workers is occupational exposure to chromium, which is used as a basic tanning pigment. Workers exposed to leather dust, which contains chromium in the protein-bound form exhibited a higher mean concentration of urinary and blood chromium than reference valuesRastogiKSet al.(2008).
1.5 WOMEN AT WORK
There is widespread agreement among global agencies including the WHO and ILO that the health, safety and wellbeing of workers who make up nearly half the global population is of paramount importance. Women around the world have moved into industry in increasing numbers. In the past 15 years, they have become almost 50 percent of the workforce in many countries. Half the world’s stock of intelligence is female, and half the world’s human resources are embodied by women, Bullock(1994). Women have always worked, but until the past century their work has been confined almost entirely to the domestic setting and it has been, for the most part, unpaid labor Dublin Thomas (1981).
Ironically, however, health hazards faced by women workers have been traditionally under-estimated because safety and health hazards standards and hazardous substance exposure limits based on male populations and laboratory tests. A recent survey of home-based workers by the Delhi unit of the All India Democratic Women’s Association showed that thousands of women employed in outsourced trades linked to manufacturing units such as garment or shoe manufactories are working from home at extremely low rates. They work longer hours than men and have a greater range of responsibilities but the work they do is often neither publicly nor privately acknowledged. Women have in common the multiple activities they are expected to carry out while their ‘official’ sphere of responsibility remains the home and family. These factors contribute to work injuries, illnesses, physical stress and hypertension causing the deterioration of the health of women workers, often leading to fatalities. The extent of female disadvantage, and the forms it take may vary but what remain constant is that women have seldom been more advantaged than man in any society, Bullock (1994).
Unfortunately, there is no single comprehensive and in-depth study touching upon various aspects of WHPs for female workers in industry. Most studies are partial or are restricted to men. Unlike other studies, this topic has not been able to draw the attention of researchers and experts to any noticeable extent. As a result, there is an urgent need to examine important aspects such as health promotion for female workers working in industries, wages given to female workers, environmental factors in industry affecting women workers’ health, the need for good nutrition and healthy life to improve female workers’ workplace efficiency and the need to recognise their skills. There is an urgent need for WHP programmes for female workers in industries to raise their health and nutritional status and increase their work efficiency, which will directly affect their work and earning capability and enhance their quality of life. It is amply manifest and greatly emphasised that greater attention needs to be paid to worksite conditions of working women particularly in industries as women face a wide range of health and nutrition related problems throughout their working life.
WHO also recognizes this, stating in the Global Plan of Action on Worker Health, “Measures need to be taken to minimise the gaps between different groups of workers in terms of levels of risk. Particular attention needs to be paid to vulnerable working populations, taking into account gender aspects.” WHO(2007).
LITERATURE REVIEW
Worksites are viewed as an effective setting for health promotion. Not only are worksite conditions associated with employee health and wellbeing, worksites are where most people spend the majority of their time and worksites can usually be easily reached by health promotion activities. However, not all companies implement comprehensive worksite health promotion and even if they do, it is not always supported by management processes. The result is a great need to establish worksite health promotion programme in more companies and to ensure that it is being implemented systematically Jung et al.(2010). There is a great need to have WHP programmes based on different genders as the needs and problems faced by men and women are different at different settings .Women working in the public service sector in “overstrained” situations run the risk of musculoskeletal symptoms and long-term sick leave. In order to maintain the level of health and work ability and strengthen the potential resources for health, it is important that employees gain greater control over decisions and actions affecting their health, a process associated with the concept of self-efficacy. A study Larsson et al. (2008) showed positiveeffects of intervention on women with musculoskeletal symptoms .Positive effects in perceived work ability were found in the self-efficacy group. The ergonomic education group showed increased positive beliefs about future work ability and a more frequent use of pain coping strategies. Kuoppala et al.(2008) also found moderate, statistically significant effects of WHP, especially exercise, on “work ability” and “overall well-being”; noting furthermore that, “sickness absences seem to be reduced by activities promoting a healthy lifestyle”. Another model of intentional health-related behaviours was tested by Spilman (2002) to predict men’s and women’s participation in six worksite health promotion programmes. It was found that in every program type, the factors that influence women’s participation were different from those affecting men and also that women with children showed a different pattern of influence compared to women without children. The pattern of influence is consistent with two sources for women’s greater concern with treating poor health: their nurturant role responsibilities and a particular emphasis by the medical profession on women and women’s concerns.Another study done by Kreis and Bodeker (2004) also showed that work-related programmes can help reduce smoking behavior, control weight, improve attitude towards nutrition, lower blood cholesterol, and increase physical activity. Sockoll and Bodeker (2009) concluded that work related exercise program increased physical activity of employees, prevented musculoskeletal disorders and decreased fatigue and exhaustion. These are especially effective when scientific behaviour change theory is incorporated and when sports facilities are provided.