Socialist Health Review 1984 Vol. 1, No. 3, December Work & Health.pdf
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POLITICS OF HEALTH RFID SAFETV
1LLAESS Q ACCIDEAT REPORTIAG IA IADUSTRV
HAZARDS OF AGRICULTURAL WORK
Yol X
Number* 3
WORK & HEALTH
93
EDITORIAL PERSPECTIVE
Ramana Dhara
1OO
THE BLACK LUNG MOVEMENT IN THE US
L.R.
102
Working Editors :
Amar Jesani,
Manisha Gupte,
Padma Prakash, Ravi Duggal
Editorial Collective :
Ramana Dhara, Vimal Balasubramanyam (A P),
Imrana
Quadeer, Sathyamala C (Delhi),
Dhruv Mankad (Karnataka), Binayak Sen,
Mira
Sadgopal
(M P),
Anant
Phadke,
Anjum Rajabali, Bharat Patankar, Jean D'Cunha,
Mona Daswani, Srilatha Batliwala (Maharashtra)
Amar Singh Azad (Punjab),
Ajoy Mitra
and Sniarajit Jana (West Bengal)
Editorial Correspondence :
POLITICS OF HEALTH AND SAFETY
Anurag Mehra and Sandeep Agarwal
1 IO
ILLNESS AND ACCIDENT REPORTING IN INDUSTRY
Jean D'Cunha, Loy Rego, Mihir Desai and
Vijay Kanhere
126
HAZARDS OF AGRICULTURAL WORK: A CASE
STUDY FROM PUNJAB
People’s Health Group
REGULAR FEATURES :
Newsclippings on health and medicine : 96;
Dialogue : 130; Review Article : 138
Socialist Health Review,
19 June Blossom Society,
60 A, Pali Road, Bandra (West)
Bombay - 400 050
Printed at :
Omega Printers, 316, Dr. S P. Mukherjee Road,
Belgaum 590001
Annual Contribution Rates :
Rs. 20/- for individuals,
Rs. 30/- for institutions
USS20 for the US, Europe and Japan
US ,$15 for other countries
We have special rates for developing
countries.
(Contributions to be made out in favour of
Amar Jesani or Padma Prakash)
We regret that we had to withold Ray H. Eiling s
article on 'Industrialization and Occupational Health
in Underdeveloped Countries' due to lack of space.
The views expressed in the signed articles do
not necessarily reflect the views of the editors.
Editorial Perspective
ASSAULT AT THE WORKPLACE
1 vB os* kinds of work can produce stress and
prove to be hazardous. In their efforts to
survive and thrive, early humans had to struggle
with the vagaries of nature, which, on many occasi
ons, must have proved fatally hazardous to some of
them. These hazards, however, would probably not
have been perceived as 'work hazards' but as a
part of living Obviously at this stage, there was a
difference between 'work' and 'life'. With technolo
gical progress, however, survival gradually became
less of a constant risk, and human beings settled
down to the business of production, the basic
means by which they existed and propagated
themselves. But thetechnological progress associated
with production had its own built-in problems,
which became more apparent after the Industrial
Revolution began.
Sickness and absenteeism are two words which
highlight the bourgeois perceptions of health. A
worker is considered to be 'healthy' when he is
'fit enough to work' and 'sick' when he is unable to
'work'. Under capitalism, therefore, health becomes
equated to the ability to produce goods, a concept
which dehumanises the worker and reduces him to
being just a form of energy for the production
process. Contrast this perception of health to that
of the World Health Organisation which defines
health as a state of complete physical, mental and
social well-being and not merely an absence of
disease and infirmity.
Wherever a new technology has been introduced
the effects of the impact of this technology on
ecology and human health have been recognised
only many years later. The interval between introduc
tion of this technology and recognition of its
effects has, in many cases been highly detrimental
to both man and his environment. This situation is
likely to continue as long as vested interests exist to
promote dangerous technologies in place where
general awareness about the dangers of these
technologies is limited.
With the increasing complexity of industrial
processes, more and more hazards have begun to
be recognised.
The brunt of these hazards fall
primarily on the working- class, the actual producers
of goods. When this class is looked upon merely as
December 1984
a tool in the production process, it is easy to
understand why neglect of safety precautions
occurs, particularly in countries where surplus
work-force exists. It is revealing to examine in this
context, two examples of safety standards set by
different countries. In the industrially advanced
capitalist countries, safety standards are higher and
better implemented than in the less advanced
capitalist countries. However it is in the socialist
countries, whether industrially advanced or other
wise, that safety standards are highest. This is
presumably due to the latter's commitment to
preventive health care. It must be noted that a
physically safe working environment is one of
several factors which contribute to achieving work
satisfaction. Other factors include a harmonious
'organisation of work', control over the production
process and channels of communication for workers
to express their feelings about various aspects of
their lives.
Let us take a look at the economics of workplace
neglect. For the industrialist, ignoring the provision
of a safe working environment means less economic
inputs into his industry for the same production
output. This saving therefore becomes, another
addition to the net profit. A similar situation holds
true for environmental neglect. Good housekeeping
and a clean environment means more investments
something which an industrialist would rather avoid
if he can get away with it.
An important issue currently being debated is
the question of why two different safety standards
should exist for worker and public exposure to
hazardous materials. Proponents of the double
standards (which exists today) have used four types
of arguments as justification for the status quo.
These arguments have been questioned by a group
from the Center for Technology, Environment and
Development at Clark University, U.S.A. (Science
Today, April 1982). I am briefly presenting the
debate as it examines a number of relevant topics
in work and health.
1. Proponents of the double standard argue that
workers must be involved in production even if it is
hazardous because it is for the larger benefit of
society. Any attempt to reduce the workers’ risk w\U
93
result in higher costs for the product, reduced
employment opportunities, etc. This is an argument
which tries to balance the wo kers' interest against
larger socJal interests. Opponents of this social
utility theory contend that there is no social justice
in this view and that the hazardous exposure is being
accepted with only very limited knowledge of the
short-term effect of these hazards. What will the
long term effects be ? And are we justified in expos
ing future communities to these hazards ?
2. The next argument uses the premise that certain
groups of workers are better able or more specialised
to face risks that others like children, pregnant
women or the elderly cannot. Though on the fact of
it this argument looks plausible, the face is that
distinctions in workforce are not always clear cut,
particulary in developing countries which have
child-labour etc.
3. Compensation has been given by employers and
even eagerly demanded and accepted by workers
exposed to hazardous operations. This has been in
the form of higher wages for riskier jobs as well as
compensation for damage to health. Very often
workers do not know and are not informed that a
particular job is risky. This is particularly true of the
chemical and dust industries. Even if we accept the
principle of compensation, the fact is that the system
of compensation is highly inadequate. How many
asbestos workers know that they (and their families)
stand a chance of contracting cancer as a result of
exposure to asbestos fibres ? The majority of accid
ents at work and occupational illness go unreported,
so in these cases the question of compensation does
not arise.
More importantly one must look at the question
of compensation from the viewpoint of social
justice. Can a noise-induced hearing loss really be
compensated ? How does one quantify the compen
sation for a chemically induced cancer. The problem
with this kind of compensation is that it may
legitimise the risks imposed on workers. A similar
type of legitimisation of protection of workers is
used by employers who give the milk-and-vitamin
tablets formula as a sop to workers who are exposed
to toxic substances.
4. Lastly, consent by workers to accept risks at
their jobs is used as a justification for the double
standards of exposure for workers and public. As a
corollary to this argument, it is also argued that the
public is unable to give consent, therefore their
exposure must be lower than that of the workers. A
closer examination of this argument shows that
94
truely informed consent cannot really be given by
workers. No job-aspirant is ever given a neutral
assessment of the hazards of his job by his employer.
More significantly for a worker, the decision to take
up a particular job is based largely on economic
necessity, job security and upward mobility, etc.
The feminist movement has given us new insi
ghts into women's work both in and out of the home.
For long it had not been realised that family and
household work done by the women could be vie
wed as an essential prop for the man working outside
and could therefore be quantified in economic terms.
Studies are now underway in India to formulate
methods of establishing money values for women's
work.
Mental stress from work can be brought on by
disruptive work patterns which alienate the worker
from his work. Productivity deals, work automations
physical discomforts and fragmentation of work,
contribute to the workers lack of control over the
pace of production and conditions of work and can
lead to severe psycho-social problems. These prob
lems are faced even by the socialist societies of today
and must therefore be closely examined and tackled
It is heartening to note that a number of indepen
dent left groups are actively taking up issues of
health and safety at work and related problems. One
must note that work of this nature cannot be done
in isolation only by trade unions or scientists but
must be done on an integrated basis with the work
ing class, environmentalists, members of the lay
public, occupation health experts, etc. to be really
effective. At first glance, there may appear to be a
contradiction between controlling environmental
pollution and the interests of the workers (who stand
the risk of losing their jobs if polluting industries are
hut down). However, it is imperative to note that
here is a common interest between environmenta
lists and workers who must exert a concerted effort
to force industries to clean up their environments
both within and without the factory. Even though
India is the eighth largest industrialised nation in the
world, it is regrettable that hardly any work has been
done in our country on work-related problems. Stud
ies done in the US have estimated that 5 per cent of
all illnesses are related to occupation. The figure for
India cannot be much less and in all probability is
greater considering the co-existing problems of pov
erty and undernutrition, a surplus work-force arid
almost no provision of safety measures particularly
for workers in the unorganised sector.
Socialist Health Review
The world economic order has had much to do
with the causation of occupational ill-health. Multi
nationals have relocated dangerous technologies,
e.g. asbestos from theirown countries to other poorer
nations, particularly, where there is ignorance about
these technologies and there is no significant labour
movement. There is a pressing need for a global
information system which informs trade unions about
new data on health risks, and about various news
being debated on work-related problems. Neither in
the curriculum of medical colleges nor in actual
medical practice is there an emphasis on the detection
of occupationally caused illness. Even the ESI medi
cal scheme which deals only with workers has not
instituted any major effort in occupational health.
The author wishes to thank members of the
editorial collective for their comments and suggestions
in preparing the editorial perspective.
Ramana Dhara
i&i
io:
fc:
The lack of concern among workers and their
unions, until recently, regarding health and safety
at the work-place, the apathy and corruption of the
State apparatus. The insupportable and manipulative
attitude of the capitalist and managerial class and
the acquiescence of the scientific and medical intellegentsia with the ruling class forms the major focus
of discussion in the present issue.
Working classes, for an intolerably long period,
have now been at the recieving end of the harmful
effects of industrial production that has not only
alienated them from the product of their labour but
also has abused and assaulted their faculties of body
and mind reducing them to objects in the process of
production. Health issues related to the workplace
environment do not find a priority in the agenda of
workers' struggles for their humane rights as parti
cipants in the productive workforce, especially in
underdeveloped capitalist countries, because their
day-to-day survival is still at stake.
Anurag Mehra and Sandeep Agarwal in the
Politics of Health and Safety discuss this unequal
contract between labour and capital and show how
the capitalist class has successfully established an
ideological
framework
that individualises
the
problem of health and safety at the workplace, there
fore preventing its graduation into a social issue
that could frustrate the profit-maximisation efforts
of the capitalist by the issue becoming a central
focus of the workers' movement.
The reporting system for occupational diseases
and accidents and relevant legislation in India has
December 1984
been reviewed in the article. Illness and Accident
Reporting by Jean D'cunha, Loy Rego, Mihir Desai
and Vijay Kanhere of the Health and Safety Unit "
Bombay. It is pointed out that, inspite of the gross
inadequacies in the reporting system, the accidents
reported in India are still considerably higher than
most highly industrialised countries. As for occupa
tional diseases the reporting is so small that it is
negligible, even when studies by various public
institutions like ICMR and CLI clearly indicate a high
prevalence of diseases like silicosis, byssinosis,
pneumoconiosis and asbestosis among others. The
various legislations pertaining to work and health
have been examined and it is shown how these
supposedly pro-worker legislations are openly
flouted by the factory owners in collusion with the
corrupt protectors and implemantors of the law.
It is not only in traditional and modern industry
that workers are exposed to health hazards. Agricul
tural workers too, encountrer illness-causing health
situations which are peculiar to their work. The
People's Health Group, Patiala describe in thisarticle,
the various hazards of agricultural work. They point
outthatthese hazards are not so much a consequence
of the introduction of new technology, as they are
of the prevalent exploitative relations of production.
A. D'Mello reviews the book which has been
much quoted by many of our authors in this issueDeath on the Job by Daniel Bergman. Although it
was published six years ago, the narrative, docume
ntation and analyses of occupational health and
safety struggles in the US about work-related health
issues of relevance to the growing awareness among
activists and health workers.
We introduce a new 'column' The Printed Word
which with your help can be a regular feature. On
these pages, we aim to give readers a glimpse of
the health scene as reported in the press. Please
help us to keep track of what the dailies (especially
the regional dailies) view as news, in the world
of health and medicine.
Ramana Dhara
Jana Clinic
Kushaiguda
Secunderabad
FORTHCOMING ISSUES
March 1985, Vol I no. 4 : Politics of
Population
Control
June 1985, Vol 11 No. 1 : Health and Imperialism
Sept. 1985, Vol II No. 2 : People in Health Cave
Dec. 1985, Vol II No. 3 : Systems of Medicine
95
The Printed Word
newsclippings in health and medicine, January-june 1984
The Health Status
Free
Press
Journal, 9 Ja :
Monkey fever claims 18 lives
in Malnad, Karnataka. A cure
for the epidemic which has
been taking a substantial toll
every year since 1952 still
eludes the medical profession.
Times of India, 15 January :
Nearly all 93 employees of the
state pencil units in Mandsur
district have been found to be
suffering from silicosis.
The Daily, : 87 out of 150
employees of the Golden Che
micals Ltd at Dahisar, one of
the largest manufacturers of
bichromates, basic chromium
sulphates and chromium deri
vatives in Bombay, are found
to have developed perforations
in the nasal septum, an ailment
induced by inhalation of chro
mium salts.
The Daily, 15 Feb. : In a span of
3 years, 16 workers of the
Asbestos Packing and Manu
facturing company in Bombay
have lost their lives either
because of asbestosis or TB,
cancer,
and heart ailments
caused by inhalation of asbes
tosis dust. A recent check'Up
by the ESIS doctors revealed
that 40 out of 240 workers
suffered from asbestosis with
lung function disability ranging
from 10 to 75 per cent. The
medical factory inspector has
not taken any action in the
last 20 years.
The Telegraph, 24 Feb. : Mystery
disease in Arunachala Pradesh
kills 20 in seven days.
The Statesman, 11 Mar. : Over
6,000 cases of malaria were
96
recorded in1983 at one centre
alone in Calcutta and the total
number will not be less than
15,000.
Indian Express, 23 Mar : Accord
ing to a study conducted by
the National Institute of Nutri
tion, some 600 persons out
of 2000 people of 28 villages
of Prakasam, Nalgonda and
Guntur district
of
Andhra
Pradesh have been crippled
for life by a disease named
Genu Valgum which results in
bow
legs. Scientists
have
linked this to
environmental
changes following the constru
ction of massive dam at Nagarjunasagar, which raised the
subsoil water, increasing its
alkalinity, leading to a concent
ration of trace elements like
molybdenum in food grains
grown in the soil. These moly
bdenum-rich foods
displace
copper in the body leading to
the crippling bone diseases.
The Statesman, 2 Apr. : Dysen
tery toll rises to 628 in West
Bengal. The number of people
attacked is 12,281, the worst
affected areas being Jalpaiguri,
Cooch Behar and Murshidabad.
The Statesman, 18 Apr. : Accor
ding to an Oxfam study, the
strange physical disorder (the
Handigodu syndrome) noticed
in some villages of the Shimoga
district in Karnataka is traceable
to the consumption of fish con
taminated by residues of 'endin',
a parthion chemical used in
paddy fields.
largest in Asia. The killer jaund
ice has claimed 300 lives inclu
ding that of 30 doctors.
Hindustan Times, 28 Apr. : More
than 5, 500 cases of malaria
were reported in Delhi since
January.
The Statesman, 4 May . Death
toll rises to 1,244 in West Ben
gal. Total number of people
stricken rose to 32,409
Free Press Journal 10 May :
recent study conducted by the
Institute of Genetics and Hospi
tal for Genetic Disease Hydera
bad has found that workers in
rubber, pharmaceuticals and as
bestos factories reveal an incre
ase in chromosomal aberrations
like gaps and breaks and chro
mosomal abnormalities due to
mutagenesis caused by the
pollutants.
The Statesman, 10 May : Dysen
tery toll in West Bengal now
1,592.
The Statesman, 19 May : Dysen
tery toll in West Bengal now
1,875. Total number of cases is
now 61,762.
Hindu, 20 May : Gujarat hepa
titis toll now 531.
Indian Express, 27 May : Dysen
tery which claimed 2,700 lives
in West Bengal, Assam, Tripura,
Orissa, Bihar, UP, Himachal
Pradesh, and Rajasthan contin
ues to spread claiming 1,987
lives in West Bengal alone.
Health Policy and the Health
Free Press Journal, 24 Apr. : The
Gujarat government has decided
to close down the 2000-bed
civil hospital in Ahmedabad, the
System
Deccan
Herald, 2 Jan. : An
integrated health and family
Socialist Health Review
planning programme is to be
launched in Kerala and Karna
taka with a credit of J 70
million from the International
Development Association (IDA)
the World Bank affiliates for
concessionary lending. The pro
gramme which
includes the
setting up of PHCs with a staff
each of three doctors covering
a 'block' of about 80,000 to
100,000 will benefit 20 million
people in Karnataka and 4
million in Kerala. The govern
ment of India and the state
governments of Karnataka and
Kerala
will
provide $ 53.8
million for the project which is
to cost 123.5 million dollars.
Free Press
Journal, 30 Jan. A
mysterious loss of eyes from a
corpse kept in the cold room
and awaiting postmortem at
the Irwin hospital and medical
college in Jamnagar has been
reported.
The Daily, 13 Jan. The Mahara
shtra Health minister Lalitha
Rao has agreed to a proposal
to set up a central maintenance
department of the health service
to be set up for the speedy
repair of medical equipment.
Deccan Herald, 2 Feb. According
to a study conducted by the
Trained Nurses Association of
India, in most hospitals one
nurse looks after as many as 50
patients and the nurse : doctor
ratio is 1:3.
Free Press Journal, 18Feb. : India,
the world's 'largest home of
medical manpower' has lost an
investment of 144 million doll
ars in training 15,000 physici
ans at present working abroad,
according to a WHO s.tudy.
The Daily, 19 Feb. : The anticorruption bureau has registered
criminal cases against seven
Bombay doctors who are panel
December 1984
men of the ESIS, for cheating
the scheme of more than Rs. 4
lakhs.
The Daily, 21 Feb. : 2,000 blood
transfusion bottles costing Rs.
50,000 have vanished without
a trace from the Lokmanya Tilak
Municipal hospital in Bombay.
Free Press Journal, 14 Mar. : A
Bill proposing the enforcement
of state government control
over medical centres run by
various charitable trusts was
introduced in the Maharashtra
Legislative Assembly. It calls
for the appointment of not
more than three nominees on
the governing bodies of the
trusts for supervising the work
ing of their medical centres.
Financial Fxpress, 2 Apr. : {Edi
torial) The five-point strategy of
the union health ministry to
discourage the migration of
doctors cannot be faulted. The
earlier ban on medical gradu
ates going abroad for courses
already available
here has
helped to stem the drain. The
latest proposal is to ban even
the sponsorship for employment
abroad of certain categories of
doctors whose services are
required within the country.
Hindustan Times, 25 Apr. : Soshit,
a legal aid society has moved a
petition in the Supreme Court
asking the Delhi administration
to explain why it should not be
directed to take care of the
large number of patients dying
in the Jayaprakash Narayan
hospital in Delhi while awaiting
treatment. The society alleges
that patients from neighbouring
states are allowed to die be
cause their bodies constitute a
valuable 'commodity' for the
morgue.
The
Statesman : The
West
Bengal health department has
requested the Left front to take
a decision on the continuation
of the Community Health Service
Scheme in view of the increas
ing availability of doctors to
serve in rural hospitals. The
scheme, under which a 3-year
medical training is given was
introduced at centres a few
years ago, when graduate
doctors used to refuse rural
postings.
The Hindu, 20 Mar. . The govern
ment of Tamil Nadu plans to
popularise the comprehensive
health check up scheme intro
duced in 1978.Anyone can have
a comprehensive check-up in
government hospitals for Rs. 10
including blood tests, urine
analysis, ECG, X-rays and also
tests to detect sugar, chole
sterol, albumen, and diseases
like VD. The results are usually
available the same day and a
health index card is given.
Times of India, 23 Mar. : An
anaesthetist at the RCF Hosp
ital in Bombay has been held
liable for causing the death of
a patient due to negligence. The
jury ruled in unanimous verdict,
upheld by the additional coroner
that the anaesthetist had over
looked necessary precautions
during the operation.
Medical
technlogy
and
developments in
medical
practice
Deccan Herald, 5 Jan. : Screening
units in the state hospitals in
Karnataka are being phased
out with a view to preventing
radiation hazard to patients.
They are being replaced by
safer devices called the Odelca
cameras, 6 of which will be
imported this year. Six others
have already been purchased.
Frees Press Journal, 10 Jan. .73
machines and instruments are
lying idle in different ’muncipal
97
hospitals and dispensaries in
Bombay
according
to
the
Municipal Commissioner D.‘NSukhtankar.
The Daily, 12 Jan. : A West
German organisation has sent
a Rs. 28 lakh gift package
comprising
X-ray machines,
cardiograms, dental chairs, op
eration tables, opthalmic instr
uments, infusion sets, 51 boxes
of medicines and art ambulance
to be distributed among organisationsjendering free medical
aid to the poor. The gifts are
being channelled through the
Shree Gadge Maharaj Mission
in Maharashtra.
Financial Express, 2 Apr~\ Th6
Chittaranjan National Cancer
Research Centre has decided to
purchase an electron1 micros
cope at a co§f 6f Rs. 20.25
lakhs from Hitachi,"a Japanese
company.
Scientists at the
centre have pointed out various
violatious of the norm.
Indian [Express, 5 Apr. : 12 out
of the 92 £X ray machines in
government hospitals in Maha
rashtra were not functioning.
Hindustan
Times,
10 Apr. :
According to a recent WHO
report, X-rays were given rout
inely without medical justifica
tion. So used and misused are
X-rays that they constitute a
major source of exposure to
man-made ionizing radiation.
Deccan Herald, 24 Apr. : India
would need electronic medical
equipment worth about Rs/
1,000 crores to achieve health
for all by 2000 A. D. According
to Dr. P. P. Gupta, the Secretary
to the Department of Electronics,
India had produced medical
electronics
equipment
worth
Rs. 13 crores in 1982 and was
expected to reach Rs. 20 crores
98
The Hindu. 26 Apr. : Hospitals
attached to f ive medical colleges
in Tamil Nadu are to be provided
with dialysers this year; at a
cost of Rs. 61 lakhs. The deci
sion was taken in view of the
spurt in toxic cases.
The Statesman, 26 Ma^ . India's
first indigenous body scanner
will be ready for installation in
September this ydar at a diagn
ostic centre in Calcutta, A new
manufacturing unit. Uniscans
and Sonics will be making six
CT head scanners and three CT
body scanners in a year.
Hindustan Times, 28 May : A Rs.
16-crore trauma centre is being
planned at the AllMS, New
Delhi. It is feared that the sett
ing up of the certtre is an excuse
to relocate a doctor with the
right connections who will be
retiring, who has not written a
single paper in the last decade
and m6Ye.
Deccan Herald, 12 Jun: Open heart
surgery, including
coronary
bypass surgery need only cost
Rs. 17,000 in India according to
Mr. Prathap Reddy the chairman
of the Apollo Hospital Pvt. Ltd,
Madras which has performed
about 100 such operations in
less than 100 days, saving the
country nearly 12 million in
foreign exchange.
Protests, Strikes
Agitations
and
Free
Press Journal, 4 Jan. :
Nearly 300 students of the
Tibbia Unani Medical College
have been on
strike since
the past one-and-a-half year
demanding retrospective affilia
tion for the past six batches to
the Bombay University. Twenty
students including eight girls
are on indefinite hunger strikes.
The College was previously
conducting a diploma course in
Unani medicine and surgery.
The Central Council of Indi
genous Medicine directed the
college in 1977 to affiliate with
the Bombay University, and
permitted the college to start a
6-year degree course (BUMS).
The college applied for affiliati
on, but nothing happened
Times of India, 21 Feb .-Junior
doctors went on strike at a
Municipal hospital in Bombay
in protest of the lack of basic
facilities, vital
druge
and
essential medical equipment
(including bandages).
The Hindu, Max. : The junior
doctors of the Government
college in Karnataka who were
on an indefinite strike to press
for improvements in emergency
services, drug availability and
increase in stipends and other
demands have withdrawn the
strike on a promise by the
Minister to look into the matter.
Indian Express, 12 Mar. : The
agitating students of the Unani
Medical College in Bombay
have finally succeeded in getting
affiliated
to
the
Bombay
University.
Free Press Journal, 17 Mar. :
The Gujarat chief minister Madhavsinh Solanki rejected the
demands of agitating medical
students and striking doctors
(allopathic) for cancellation of
the six-month emergency medi
cal course for homeopathic and
ayurvedic doctors.
The Telegraph, 18 Apr. : Nearly
3,000 medical students, house
staff and registrars and surgeo
ns are on strike in Orissa deman
ding upward revision of sti
pends, better equipment and
life saving drugs.
The Statesman, 6 May: The 24-day
strike of 3.000 medical students
and juniordoctors in Orissa has
been called off in response to
Socialist health Review
an appeal by a State-level citiz
en's committe.
Professional bodies in health
care
Hindustan Times, 18 May : The
strike of junior doctors of the
nine medical college hospitals
in Bihar has entered the fifth
day today. Doctors' demands
include absorption of all 4,000
unemployed medical graduates
in the state health services.
The Telegraph, 2 Apr. : Efforts
are underway to get the IMA
registered as a union, according
to Dr. V. Parameshwara, the
convener of IMA's first zonal
conference held in Bangalore
recently.
Deccan Herald, 13 June : Home
opathic students of two colle
ges in Bangalore have ended
their fast, which had been und
ertaken to press their demands
for the government take over
of the two private colleges.
The statesman, 25 June : The
The 44-day strike by junior
doctors which had paralysed
functioning of nine medical
college hospitals in Bihai has
been called off on an assu
rance that their main demands
would be considered shortly.
The Daily, 27 June : The Mah
arashtra Association of Junior
Doctors has called for a day's
token strike today. The strike
will involve 4,000 resident doc
tors and 500 post graduate
students. They are protesting
against the openings of capita
tion fee medical college in the
state.
Business Standard, 11 January :
Inaugurating the 59th All-India
Medical Conference the presi
dent of the IMA, Mr. J.
Mathias opposed any short
term or a condensed course as
demanded by the Nurses Asso
ciation of Tamil Nadu who had
suggested a condensed course
for qualified nurses to qualify
as rural medical officers. He
was also opposed to the change
in 1he medium of education in
medical colleges.
Deccan Herald, 18 May : The
Karnataka state branch of the
Indian Medical Asssociation,
I MA, has taken strong exception
to the state government's deci
sion to grant permission for
starting a new medical college.
The state IMA president Dr. V. S.
Achar said as many as 8000
medical graduates were unem
ployed. The
state already
has 13 medical colleges. More
institutions are needed to train
paramedical workers, but only
medical colleges make money.
Deccan Herald, 24 May : The
centre may soon amend the
Indian Medical Council Act to
put an end to the practice of
charging capitation
fee by
medical colleges. At present
there is no provison in the
Indian medical council act to
take prior approval of the
Union government for opening
a new college.
Deccan Herald, 1 June: The Homo
eopathy Teaching Council of
India has demanded immediate
government takeover of the two
private homeopathy colleges in
Bangalore.
Deccan Herald, 6 June : The Kar
nataka state has through an
executive order stopped all
admissions to aided and unaided
medical colleges for '84-'85
pending the framing of necess
ary rules under the Karnataka
Educational Institutions (Prohi
bition of capitation fees) Bill,
1984 which has been passed
by the state legislature and is
yet to get the President's
assent.
Compilation : P. P.
The news items have been compiled from the documentation files of the Centre for Education and Documentation, Bombay.
Book News
'TB and Society* : MFC Annual Meet
The 1985 Annual Meet of the Medico Friend Circle
will focus on 'TB and Society'. The dates of the
Meet are January 27 - 29 1985 and the venue.
Bangalore. For further information contact : Ravi
Narayan, Convener MFC, 326, V Main, I Block,
Koramangala, Bangalore 560 034.
December 1984
Human Stress, Work and Job Satisfaction ;
A Critical Approach, Occupational Safety and
Health byT.M. Fraser
Series no : 50, HO, Geneva, 1983, 15 swiss francs.
The book discusses man as a system and a system
component, the psychophysiology of human stress,
the needs and satisfactions of work, the psychophysi
ology of work and fatigue, stress mechanisms and
their manifestations in work and the interrelationship
between stress and satisfaction. He ends with a
series of remedial suggestions.
99
The Black Lung Movement in The U. S.
Black Lung Associations and
Brown Lung
Associations were two Organisations of US Coal
miners and textile workers respectively. The bulk of
their membership came from disabled workers or
their widows and their heroic struggles paved the
way for better H & S for all.
Coal mining is a hazardous occupation and one of
the earliest unionisation campaigns in the mines
gathered momentum in the aftermath of a serious
accident. In 1869, an accident in Avandale mine in
Pennsylvania killed 179 miners due to the refusal
of the mine-owners to build an escape exit. Spea
king to the people gathered to mourn the dead,
John Siney, President of the Working Men's Bene
volent Association ( forerunner of the United Mine
Workers, said "Men, If you must die with your boots
on, die for your families, your homes, your country,
bur do not consent to die like rats in a trap for those
who have no more interest in you than in the pick
you dig with". Thousands of people joined the
Association that day I
Despite these pledges to work for health and
safety, the struggles for health and safety at work
were at a low key, with the struggle of the Union
for survival, expansion and improvement in terms of
employment being more central. As the union grew,
the union bureaucracy in UMW became more
entrenched. The union had a department dealing
with health and safety but this was not able and did
not do much to improve working conditions.
It was only the sixties that the movement for better
working conditions took off. The focus became the
struggle to get pneumoconiosis- "black lung"recognised as a compensable disease. State and
federal government authorities had for decades
denied that coal dust was a hazard and caused
disease. In the early sixties diseased workers and
some socially active doctors began to tell other
workers of the dangers involved. "When we found
out what was actually going on/
says Bill
Worthington, a leader of the Black Lung movement,
"we began to get pretty angry. Coal Companies
were making millions of dollers off us, and when we
got too sick to work, they said we had "miners
asthma" for which there was no compensation."
In November 1978, Consolidated Coal Company,
Mine No. 9 in Farmington, West Virginia, blew up
killing seventy eight miners. Judith Henderson,
window of miner Paul Henderson recalls, "It was
cold arid snowy that November 20th morning when I
had turned the morning news on and heard the world
that were to begin a terrible nightmare. The rumour
that there had been an explosion was confined, and
all but 21 on the midnight shift were trapped.
This was where my husband worked and where the
nightmare began. We waited, hoped, prayed that
our men would be saved, but in vain. OnthelOlh
day they announced the mines would be sealed
because the Company Officials felt that no human
life could live after this time."
The UMW leadership took advantage of public
sympathy to press for a federal mine safety law,
ignoring the issue of Black Lung compensation and
Occupational health - believing it would jeopordise
the passage of a safety law. The Black Lung (BL)
movement received a spurt in the membership and
an added thrust after the Farmington disaster. The
various state Black Lung Associations together with
Associations of Disabled Miners and widows along
with progressive physicians and lawyers pressed for
BL compensation and controls on Coal dust.
In January, 1969, the Virginia (where Farmington
mine is located) BL Association was formed and
in February and March of that year, 42,000 of the
State's 44,000 miners walked off their jobs, pressing
for a new law. They marched to the State Capital and
demonstrated in front of the State Legislature
brandishing blackened Iungs obtained from autop
sies of pneumoconiosis (Black Lung) victims. The
strike hailed as "the most important political strike
in modern labour history" forced the first state
compensetion for Black Lung in West Virginia.
In December 1969, came a new federal law, the
Coal Mine Health and Safety Act of 1969, a
comprehensive bill dealing with
Black Lung
compensation, exposure to coal dust and safety. It
specified that coal miners, or their widows, could
apply for permanent black lung benefits regardles
of when they had quit the mines. Benefits were paid
from federal lax revenues and at first 60 percent of
the applicants won the benefits. The law also crea
ted a federal inspection system to enforce safety
and coal dust standards.
The passage of the Act gave new stength to the
BLAs. Retired miners and widows who had success
fully secured benefits began to lead others through
the social security maze, and consolidated them
selves into effective country-level organisations. A
coalition of such groups was formed for tackling
specific national level political battles like the
Socialist Health Review
100
passage of a new law, seeking to relax the medical
eligibility requirements under BL benefits. The Black
Lung Benefits Act was passed in 1972, under which
a miner who had worked for 15 years underground
was presumed to have compensable black lung, if
he was totally disabled by lung disease, regardless
of what X-Ray findings indicated. However, the
social security administration was successful in
reducing claims succes rate fram 60% to 1C%.
Yet, despite limitations in the implementation of
the Act, the black lung revolt has resulted in half a
million families getting some financial benefit. The
annual payment of a billion dollars is twenty times
the total paid out for Occupational Disease for all
other workers. Conditions in the mines too have
improved, with annual coal mine accident deaths
falling from 260 to 132 between the year 1970
to 1974.
The initiative for the BL movement was taken
outside UMW, by the force of rank and file pressure.
As a conscious organising strategy, partly determined
by the nature of the issue, it was the old retired
workers, many already ill, who were in the leadership
and therefore, free from threat of company reprisals.
the movement developed new strategies and a lang
uage of its own, with folk songs written about
their work lines by many BL members. Two of the
WHO'S THAT?
The BL Movement changed the face of the Union
movement in the mines as well as paved the way
for health and safety to become an issue on the
agenda of Union struggle and legislative action.
-L. R.
Li/NNS- AHO THEY
can't mhxe our.i
/TS ONLX (NtE Of OCA
TH/NX. HF WANTS
TO MEET US.
TO AE
December 1984
In most chemical-caused diseases, exposure is
limited to a section of the work-force and very often,
unless there is a vigorous educational campaign, it
becomes difficult for people to recognise disease as
work-related. Once the health effects of coal dust
were understood, the obvious and widespread
nature of the hazard was one of the reasons of the
relative success of coal miners securing compensa
tion for Black Lung. Due to the peculiar nature of
the Industry, the position of the miners vis-a-vis the
owners was strong. Demand for coal is high, and
most coal is manufactured in mines owned by large
companies with large unionised work-forces. The
public too was sympathetic to the obvious hazards
of the job and minershave repeatedly demonstrated
their capacity to strike and shut down the mines.
These factors can be identified as favouring the
emergence of the Black Lung revolt.
NT 6C& rrs 4 AA/A OF
NOT
(M ATrfN0/N(r
4 covfeae/we OH
EXECUTIVE STAESS.
MET t M.0.1
songs (reproduced in this issue ) were written by
an 83 old miner who had spent 40years in the mines.
The use of songs reflects the mass nature of the
movement.
woakfm. he sews
.
HE’S CON/HCr CE> W
FAST. AND-.SEEJHS ro 4E OAONMCi
Politics Of Health And Safety
anurag mehra and sandeep agarwal
The unequal contract between labour and capita! under the hegemony of capitalism results in the neglect of
the workplace environment leading to innumerable hazards to the health of workers. The capitalist class and it's
associates, like scientists, technocrats and doctors, who have monopolised the knowledge pertaining to work
processes and it's consequences for the working class, have also successfully promoted a model that deals with
the problem of health and safety as an individualistic and not a social phenomenon. The working class
on the other hand has failed to counter this ideology, especially in backward capitalist countries, because their
social and economic conditions do not permit them to go beyond their struggle for better wages.
The authors are members of the Health and Safety Group, Bombay
Work Relations and Occupational Health
Redefining Occupational Health
. labour is the workers' own life activity, the
manifestation of his own lite and this activity he sells
to another person to secure the necessary means of
subsistence. Thus his life activity is for him only a
means to enable him to exist. He works in order to
live. He does not even reckon labour as a part of
his life, it is rather a sacrifice of his life '
(Marx)
We will now examine how capital's definition of
occupational health is incorporated in the outlook of
bourgeois medicine itself - which lays a claim to
being value free, objective and socially neutral.
The social (contract) between labour and capital
grants to the owners of capital the right to maximise
their profits at the cost of labour. But to the workers,
it guarantees only the means to reproduce their labour
power, that is, their capacity to work. The worker is
thus reduced to an apppendage in the production
process, yet another part of the profit making machi
nery that must be kept Tunning' smoothly. For the
worker it is not a question just of wages but of his
whole experience of work which is hazardous.
stressful and monotonous and leads to his physical
and spiritual impoverishment. It is at this point of
confrontation that labour struggles for better working
conditions and organisation of work, and capital
tries to minimise its cost of production by minimising
its investment in health and safety and restructuring
of work, thereby making it more monotonous and
less skilled.
The unequal nature of this contract in favour of
capital can be clearly seen from the fact that workers
have little control over the conditions of work provi
ded to them. Atthe point of selling their labour power
workers lose a large measure of control over their
health. They are ensured only wages, not the guara
ntee of healthy working conditions. In resisting this
direct sale of health included in the sale of labour
power, the working class struggles against the hege
mony of capital at the workplace. Under conditions
of commodification of labour power, of which health
is a part, any working class demand related to occu
pational health is a positive assertion of its humanity.
102
But first let us look at some of the assumptions of
modern medicine itself. The concept of a disease
bases itself on the idea that disease is a result of
biological agents and their assaults upon the body.
The centre of conceptual locus is the organism. The
social conditions - poverty, underdevelopment and
the consequent everyday living conditions — under
which diseases spread, biological pathogens grow
and attack malnourished bodies are rarely the point
of a doctor's attention Likewise, this has led to the
concept of technological intervention upon the body—
drugs, thereby, medical aids — to destroy or cure
diseases. Medicine thus believes that with more and
more medical technology it can cure or control a
diseased body. The social conditions themselves are
not touched as the primary causatives; rather their
study and elimination is not a doctor's forte.
Within this context of medical ideology then, a dise
ase is reduced to its biological symptoms and cure
is reduced to a set of technological tools. The social
environment of human beings who suffer, is thought
to have very little to do with disease and disability.
Therefore health is seen in the individual not exhibi
ting any overt biological symptoms of a disease. The
focus is on the individual, his body which has rema
ined functional in doing what is expected of it, des
pite adverse conditions.
The medico-technical definition of occupational
health then, would have us believe that a worker's
health is merely his capability to be functional in
performing his work. Indeed its origins lie directly in
current medical ideology, presented above, which
defines health only as an absence of disease or
Socialist Health Review
disability ratherthan as a positive state of well being.
Such an approach inevitably leads to obscuring the
large range of damaging conditions to which wor
kers are exposed but to which they have, by sheer
necessity, adapted in a very perverse manner in the
sense of somehow managing to live with them. But
more than this a definition of occupational health of
this sort serves a profound!/ political purpose. It
serves to absolve capital and management of their
responsibility in creation of so much misery at the
workplace which according to some medically 'esta
blished' notions, can be declared non-medical and
hence not relating to health at all.
Our purpose here, then, is to point out that we
should reject this idea of occupational health and
replace it by a more comprehensive and broad
notion of health which transcends the narrow idea
that ill health is something that can be obviously
seen and that which generally requires serious
medical intervention. It is only then that long range
health disorders, problems of work-derived stress
and anxiety, the not so immediately apparent eveyday discomfort and alienation of the workplace,
monotony and repititiveness, a lack of creative
exercise and the intensity of work will become
problems of occupational health. It is only this that
will take occupational health beyond the realms of
conventional toxicology, industrial hygiene, safety
engineering and even so called industrial psychology.
All this brings us to the definitive thesis that the
question of occupational health and safety is not
primarily a matter of technical definitions nor is its
resolution a matter of relevant control technology.
It is primarily a question of the social relations of
production which finally determine the social condi
tions of work and thus in a very .direct way an
outcome of tna existing balance of class forces.
In essence, therefore, the question of what consti
tutes occupational health, its status, and recognition,
primarily arise out of the process of class struggle
and not out of any technical notion of health or the
availability of advanced technologies. And so it
follows that a resolution of this quesition is possible
only through class struggle where immediate mani
festations are the working class struggles for better
working conditions. The struggle for better and
shorter working hours and working conditions is
therefore identical with the struggle for the achieve
ment of health in relation to work.
Having thus established our conception of occupa
tional health, we should proceed to examine some
December 1984
of the ways in which reality on this issue is distorted
and falsified.
The Scientificity of Safety Standards
Inthisregarditis illuminating to examine an instance
of how a dehumanised 'science' has as its content,
quite explicitly, a partisan point of view in favour of
'Capital'. The 'science' under examination isindustrial
toxicology in general and the so called 'safety limits'
for various industrial chemicals in particular. In
professional terminology it is more commonly referred
to as 'Threshold Limit Value' -TLV for short. Essenti
ally it refers to that average concentration of chemical
present in the environs of the worker beyond which
it becomes dangerous to the worker's health — calcu
lated by assuming a daily dosage of fixed exposure
time. The dubious nature of this concept can be
demonstrated at a number of levels. At the level of
ideology the whole notion of such a quantifiable
concept arises from a top-down approach to health,
wherein the effort is to bring down the chemical
concentration of exposure to acceptable limits rather
than its exact reverse where the effort is to keep the
level of exposure as near zero as possible. This will
be clearly seen when we, later on, examine the
history ot TLVs in USA.
Above and beyond this, the decision as to what
constitutes a health danger in the long and short run,
the method of assesment and quantification are all
extremely suspect. It would perhaps be correct to
state that with management-oriented professional
experts the values obtained would be much higher
hence more damaging to health than those obtained
by a bottom upwards approach. The USSR presents
a completely obverse case in this respect when
compared to USA, in regard to safety limits. The
attempt here is to keep concentrations as low as
possible with stringent requirements on the 'Maxi
mum Allowable Concentration' (MAC) In fact, in
the USA, the lobbying that accompanies the accep
tance of a legal limit, clearly brings out the political
nature of the compromise the TLV represents, rather
than being an objective and scientific concentration
value. As an illustrativecase study (quoted in Berman
1978) the historyjof the asbestos safety standards in
USA serves to substantiate the points made above.
The National Institute of Occupational Safety and
Health (NIOSH) after screening through scienti
fic data recommends a safety limit. Public hearings
are then held to debate and decide upon an enforc
eable and permanant standard. This is the normal,
time consuming and expensive procedure that is
followed.
A 03
Since the 1920s the asbestos manufacturing indust
ry has been aware of the hazards of asbestos and its
connection to asbestosis and lung cancer. This how
ever has not deterred the industry in expanding and
promoting the use of asbestos even till today. The
hazard is compounded by the fact that workers carry
home with them asbestos dust and fibres on their
clothes and person which can then affect sections
of the public. The first propaganda strategy the indu
stry adopted was to promote medical research to
dispute asbestos hazards. A number of studies and
data therein was suppressed and distorted till 1955
when the connection between cancer and asbestos
was unequivocally established. Very promptly scien
tists from all of the biggest manufacturing establish
ments disputed this without citing any evidence to
the contrary. In fact, till 1960, 63 papers on the
health hazards of asbestos were published. Of these
52, which were published independently of industry,
showed a positive connection between asbestos and
cancer, and the rest 11 studies sponsored by industry
presented opposite conclusions. The independent
studies remained in scientific and technical journals,
inaccessible to the public at large, and the major
decisions on standards were left to the industry and
a compliant government.
In 1970, with the passage of Occupational Safety
and Health Act (OSHA) and the public furore created
by some enlightened professionals, some scientists
independent of the industry recommended a standard
of 2 fibres/cm3 of air (not larger than 5 mm in length
for 8 hrs. a day). Many pressed for a total ban on
the use of asbestos. In this atmostphere, since indu
stry based denials of the hazards no longer had public
credibility, the strategy was changed. The industry
gradually took over financial control of most of the
research relating to asbestos in a bid to monopolise
all research and thereby minimise critcism of asbestos
use. There was a sudden spate in publicity and the
flow of funds, leaving hardly any asbestos research
untouched by industry control. And even though the
industry continued to flout the safety limits, even in
the public eye, pressure was brought upon the
government by labour to accept the standard of 2
fibres. The US government caught between the pres
sures of industry and pre-labour lobbies, declared
5 fibres as a temporary standard and initiated public
hearings for fixing a permanent one as industry
representatives at the hearings claimed that many US
plants would have to be shut down if the lower
standard of 2 fibres was accepted. The government
hurriedly asked a private consultant to study the
health effects of concentrations ranging from 2 to 30
fibres and the cost of reducing concentrations to
104
industry. The cost of lives of the workers and the
public were not considered but more than that "such
economic calculations were to become a permanent
part of the standards making '. The government
policy was that "the cost to employer of meeting
any new occupational health standards must fall
within an economic range acceptable to industry". The
accepted standard of 5 fibres was reduced to 2 fibres
as pressure mounted but by now the NIOSH had
recommended a safety limit of 0.1 fibres (1976).
Industry has reacted in man/ ways to these regula
tions. Many firms have sold over. Some others have
shifted over to Mexico, Taiwan and South Korea
where there are no legal limits to asbestos pollution.
Many companies have paid out fabulous sums of
money as compensation through lawsuits. However
the president of one of the companies persisted
in insisting that the problem was a technological
one 'This is an industrial hygiene problem, not a
problem of the public. (Berman 1978).
At the level of soundness of concept, there are
numerous laws in the notion of a TLV. For instance,
it does not cater to workers who may be hypersen
sitive to certain chemicals or who are genetically
deficient in withstanding the onslaught of such
workplace pollutants. The calculation assumes that
the people at risk are all healthy young men, rather
than women of childbearing age and elder people
who have already suffered serious damage to
their health. A further examination of the methods
of assesment reveals even more significant facts
which are, more often than not, relegated to the
realm of more scientific controversy. TLVs are
commonly arrived at by controlled experimentation
on rats, rabbits and the like, and the consequent
statistical analysis of the experimental data. These
are then exte'nded to apply to human guniea pigs an extrapolation that has no basis whatever other
than the fact that it is chosen as a basis precisely
because none other exists, and one is needed to
legitimise a certain level of workplace hazards if
industrial production is to remain economically
feasible. An illustration will make this clear. The
teratogen 'thalidomide' dose required to effect a
mouse is 31 mg/kg. of body weight whereas that
for a human being is 0.5-1.0 mg/kg of body
weight. If the mouse dose is extended on the body
weight basis to apply to human beings, consequ
ences can be disastrous. Still there exist a millions
of chemicals for which this distinction may not be
known so precisely. They must be taking their
daily toll in laborateries and factories. Moreover,
TLVs refer to concentrations of isolated chemicals
Socialist Health Review
individually. The synergistic effects, that
can
result by a mixing of a number of chemicals together
are not incorporated into the concept thereby mak
ing it even less representative of the hazards at the
workplace.
The sanctity of science thus bestowed upon such
concepts as TLVs is rather the attempt to project,
as socially neutral and objective, knowledge which
is overtly political.
Occupational Disease :
Yet another example of the ideological influence, in
occupational health, of capital can be seen clearly
when it comes to defining what constitutes an
occupational disease. For a disease to qualify as
being work-derived, the normal bourgeois provision
in law is to prove that the disease has exclusive and
unequivocal work-related origins. This indeed is a
monumental task. Often it is impossible to perform
since there are many diseases, not necessarily occu
pational, which have a lot of symptoms in common
with the occupational disease. The confusion bet
ween Byssinnosis (a disease derived from inhalation
of cotton dust; it affects the lungs and the respiratory
system) and chronic lungs disease, is a classic
example. Company doctors or management oriented
safety staff have often used this confusion to mask
the hazardous and disease producing effects of
contaminated cotton dust. One medical inspector of
factories commented, "All those with respiratory
troubles in a textile mill need not necessarily be the
victims of byssinnosis. Their standards of nutrition
and living environment and habits may have caused
the disease, which may appear like byssinnosis.’’
(quoted in Berman, 1978). That this confusion is to
some extent objective, is not derived. The above
statement as a matter of facts may not be wrong in
itself. The point however is that it is the starting ass
umption of all pre management studies.
Another ploy employed by the management is to
simply give the disease a different name. In this
process the blame of the disease is shifted from the
condition of work to the person suffering from it. An
American doctor, for instance, has this to say about
byssinosis. It is best described as a 'symptomcomplex'
rather than a disease in the usual sense. We feel that
this term may be preferable, first, in order not to
unduly alarm the workers as we attempt to protect
their health; and secondly, to help avoid unfair desi
gnation of cotton as an unduly hazardous material
for use in the textile industry, raising the fear the
engineering control of it may be costly and that it
may be better, therefore, to switch to some less costly
December 1984
material. (Quoted in Berman, 1978). The intention to
protect cotton manufacturers profits at the expense
of the workers' health could not be clearer. And it
is also clear that the choice whether byssinosis is a
disease or not, becomes a matter of political outlook,
not just scientific information.
Some Aspects Of Industrial Accidents
Management theories of accident, which pose as
objective sciences, are a sophisticated mixture of fact
and fiction. Despite numerous variations, one theme
is central to them - that workers' carelessness is
mainly responsible for the majority of injuries at the
workplace; that the sole capability and initiative to
undertake preventive measures lies with the manag
ement. Safety, as such finds little attention in mana
gement circles We will examine some aspects of
these theories and their practical and ideological role.
The extreme form of such an outlook can be seen
in the behavioural models of accident causation. The
reason for accidents are thus seen in the accidentproneness of individual workers. Accident-proneness
a phrase carved sometime in the early twenties, imm
ediately became popular among industrial psycholo
gists who claimed that workers are doomed to be
tension and anxiety ridden, and therefore liable to
carelessness at the workplace. Industrial psycholo
gists, at great pains, have defined various kinds of
nervous disorders existent in workers and their co
relation with actual incidence of injuries. (Table overleaf)
In spite of the usage of sophisticated psychological
terminology, this theory very faithfully reflects the
inherent attitudes of owners and managements, that
workers are ignorant, careless, destructive and
inferior. One does not find many overt references to
such models today.
Another model pictures accidents as a culmination
chain of multiple events. It is claimed that there is no
single identifiable reason for accidents but a host of
factors operating simultaneously. Safety films are
made which depict situations that make an accident
look really like an accidental occurance. A machine
goes out of order. A maintainance person tests the
machine, opens the guard and then leaves it running
while going for a cup of tea. The cleaner passes by,
accidentally dropping some piece of scrap on the
gangway. An unsuspecting office clerk hurriedly
crossing the gangway, steps over the scrap piece,
trips and lands his hand into the unguarded running
machine. Then a question is raised wisely as to who
is responsible for the injury. The movie usually ends
with prescriptions amounting to less carelessness and
A 05
Occupational Syndrome
Clinical or Dynamic Diagnosis Associated
Accident Syndrome
Impulsive characters anxiety reaction
Moonlighting
Compulsive personality, often with marital
problems
Pulmonary insufficiency ( "pneumoconiosis'',
"emphysema", "chronic bronchitis" )
Depressive reaction, anxiety reaction, psy
chophysiological reaction (asthma)
Women employees
Physiological cycles
Grievance proneness
Paranoid personality, compulsive persona
lity, depressive reaction.
Source : Powtes, W. f. and W.D. Ross. “Industrial and Occupational Psychiarty“ in American Handbook of Phychiatry, Basic
Books, 1966
more safety consciousness on the part of workers.
There are obvious ideological purposes which expla
nations of this kind serve. To a worker, it obscures the
fact that most accidents occur because of unsafe
work design, unguarded machines, faulty equipment
and high work intensity. It also absolves the manag
ement of its responsibility. More than that it puts
the blame oh the workers, thereby preventing any
protest on their part.
H. W. Heinrich, a US expert, did a massive study of
75,000 accidents and concluded that a distinction
should be made between accidents and injuries. All
accidents, according to him, do not lead to injuries.
On the contrary they go unnoticed till a major injury
is caused. He estimated that for every major injury,
there are 29 minor injuries and 300 accidents without
causing injuries. He, while advocating preventive
measures, classified about 88 percent of the 75,000
accidents as caused primarily by "unsafe action"
(unsafe action is defined as a departure from the
established work procedure). The percentage thus
classified can very widely depending on the investi
gators opinion about the extent to which physical
conditions reasonably need to be modified to prevent
injury. This choice is clearly political for technically,
it is impossible to have a sharp dividing line. Cases
which are normally identified as blatant examples
of unsafe action on the part of workers can also be
seen in the context of improper safety training on the
one hand and increasing work intensity, monotony/
fatigue, alienation on the other.
Safety engineers strongly advocate their case before
the managements by professing that it is cheaper to
106
prevent accidents in the long run. Terms like loss
control' and 'damage control' are used to give this
notion a scientific sanctity. It is maintained that acci
dents not only cause injuries, but also loss of prop
erty, loss of man and machine hours, stoppage of
work etc.; the management therefore must invest in
preventing accidents out of there own wish because
they will profit by this. This is a major argument given
by industries to project their self interest in taking
up safety measures. Needless to say, at its very out
set, their dehumanizing calculation betrays its ideolo
gical character. Cheysler Corporation of US actually
did this calculation and concluded that with the costs
of an accident. In a country like India, since compe
nsation is negligible, there is no reason for comp
anies to install safety measures, unless strong union
pressures exist.
The problematic of accidents can be questioned at
yet another level. Accidents are defined as notifiable
only when the injured worker does not report for
work within 48 hours (in India). This is in keeping
with a bourgeois notion of health which believes in
funcitonality, fatigue, sprains, aches, nicks, cuts,
burns, minor eye injuries, loss of consciousness-all
these form an important part of working life but are
never included in accident figures. It is not surprising,
that even by conservative estimates, if these injuries
are accounted for, accident, figures will multiply at
least tenfold. These aspects of quality of work are
of prime concern for the workers. Cuts on hands
during assembly, muscular strain and aches due to
improper work-place design, specks of dust in the
eye during grinding may go unnoticed by those who
Socialist Health Review
don't work with machines directly. The present
design of workplace is machine-centred, directed
towards maximization of productivity. Even though a
more safety-oriented design may not cost much the
outlook sometimes of the designer and industrial
engineers does not permit them to give importance
to safety. Workers of course, are not granted any
role in the design activity.
The present day managements try to impress upon
the workers and the public at large that workplace
health hazards have been reduced drastically with
improved technologies and automation of production
Accident statistics are offered to confirm this. But
such innocuous claims, in fact, serve a distinctive
ideological function. Long range health hazards,
problems of stress and monotony, the quality of
working life, all are kept into the background while
displaying of glittering success in accident control.
By hiding long term health hazards, management
attempts to lend credibility to the gradualist theory of
occupational hazards, where slow technological
changes are seen as determining factors in reduction
of health hazards.
Management Monopolony over Information
Thus one of the ways in which Capital seeks to
secure its domination over labour is by monopolising
and controlling the flow of information relating to
work. This is also true of information regarding
health hazards and safety, especially if such know
ledge can become a threat to profit.
As a case of outright concealment of true facts, the
beryllium industry in the US provides a typical exam
ple. For almost twenty years industry and the
Atomic Energy Commission had claimed worker
exposure to berylium was harmless. Only after the
death of a worker was this notion challenged. One
of the pioneers of occupational medicine Dr. Alice
Hamilton wrote of her findings, "With rare excep
tions, industry and insurance companies withhold
data on occupational disease—its character and
incidence. This fact has great influence on the
acquiring of knowledge of industrial illness in other
as well as the beryllium-using industry in the
US". The
conclusions placed responsibility for
beryllium poisoning with private
industrialists.
One of her own students wrote, "A few consultant
doctors and industrial hygienists, by their publica
tions, talks at professional societies and appearances
in court, appear to have been used by some
members of the beryllium industry to further what
are considered legitimate economic ends." (Hardy,
1965).
December 1984
We have seen in the case of asbestosis, the
active dissemination of false information and aggre
ssive promotion of research to generate this kind of
information by the industry to dispute the actual
hazards which were becoming known to the scienti
fic community. In cases where adverse opinion is
not strong, companies prefer to keep silent on the
hazards of materials in use. For example, in two
Mexican border towns employees of the US firm
Amatex, engaged in the manufacture of asbestos,
heard about the hazards from news accounts and
not from their employer. ( Castlemen and Vera,
1982). Nearer home, in Bombay, a fertiliser unit
uses casual workers to perform necessary tasks in
the most polluted points in the plant — where even
regular workers refuse to tread. Apart from the
very weak position of casual labourers, their igno
rance and illiteracy helps the management in stifling
whatever little resistance they may have to offer
in the face of such barbaric assignments. The
plants continue to pollute heavily but at the
expense of a number of casual worker fatalities.
Another example of the political helplessness and
the exploitation of ignorance of contract workers
is in the textile industry where they handle waste
or clean machinery - both operations where cotton
dust exposure is the highest. And according to
the medical inspector of factories, 'This way quite
a large group of textile workers prone to byssinosis go undetected. It is precisely ignorance of this
kind, deliberately perpetrated by managements, that
allows them to violate health and safety regula
tions blatantly.'
This practice of concealment, of cultivations of
systematic disinformation,
stems from a more
general philosophical outlook of the management
- the concept that workers have to be managed
and controlled. Braverman's seminal critique of the
capitalist organisation of work sums up the essence
of the process, "It becomes essential for the capita
list, that control over the labour process pass from
the hands of the worker into his own. This tran
sition represents itself in history as the progressive
alienation of the process of production from the
worker and to the capitalist it presents itself as the
problem of management" ( Braverman, 1979).
The effects of * scientific ‘ management on the
working class are manifold. Firstly the origins of
work related stress lie in the deskilling of the
worker, the destruction of his craft and the conse
quent division of labour wherein,he performs mono
tonous, repititive operations; the seperation of
execution and conception of work leads to a
management monopoly over creativity. Even more
significantly it has led to the isolation of the worker
behind an information barrier. His awareness and
natural curiosity with regard to his work have been
bullied into an indifference towards the science of
hisskill. Since he no longer participates in the
totality of the process of production but only as a
component part, he no longer feels the necessity
of knowledge other than learning the most basic
operations. The worker, who at one time, had his
own craft journals, today needs the help of the
professional to decipher the mysterious language of
technology, medicine and law.
Management monopoly over knowledge is acqu
ired at a more sophisticated level through the control
over the specialities such as occupational medicine
industrial hyiegene and safety engineering. One of
the major political functions of such disciplines has
been to mask overtly political knowledge as being
socially neutral. The dominant ideology that the
management inculcates within these disciplines is
its own. This is made easier by the fact that most
doctors are recruited to industry from private
practice and start out with the anti-worker attitudes
common to their class background. Furthermore by
according them a low status in the management
hierarchy of power, their urge for identification and
conformity with management views and practice is
intensified. Knowledge, thus restricted through
these mechanisms in the hands of a pre-capital class
becomes an instrument of power and manipulation.
As one spokesman of the industry put it in relation.
to workers' health : Our aim is “ to keep a check of
the workers' health while telling them as little as
possible.*' ( Berman, 1978 )
The Ideological Function of Law
It is a common feature of bourgeois governments
to enact laws which are progressive in content but
which are never implemented properly. A number of
reasons can account for this.
Firstly, such legislation and this is true for a number
of regulations also, significantly those relating to
health and safety - remains largely unimplemented
because the enforcement agencies created to imple
ment them are given very few powers. Whatever
little exists as an enforcement structure is not only
class based but also corrupt and bureaucratic. But
that is only a part of the story. The second, and more
important reason lies in the protective function of
state in bringing such legislation into force. It proje
cts the state as an authority which is above all classes
and legally legitimises a certain level of anti-working
class institutions and activities. It also helps to esta
108
blish a certain measure of control over information
and data which aids the state in regualting the issue
in question in favour of capital (which it dominantly
represents). To give an obvious analogy the state
intervenes to 'protect' tribals with its whole machi
nery of police, forest officers and magistrates, from
the clutches of 'extremists'. This protective function
need not be carried out so forcefully and at times.
offering the illusion of 'progressiveness' is enough
to contain protest movements which in fact may be
demanding much more.
Even though progressive legislation relating to hea
lth and safety in India or even elsewhere, represents
an advantage to the working class and is often used
by activists to their gain, the structure of factories
inspectorate, its powers, the status of occupational
health and safety legislation as well as regulations.
bear out above aspects of such regulations. At
the level of legislation an important point needs
to be made. Such 'progressive' legislation is often
flaunted in propaganda for its pro-worker content
while not mentioning that pretty little is actually
being done to enforce it. Minimum wages are there
fore paid on paper; thousands of bonded labourers
are released every year and the nation has perhaps
the cleanest and safest factories in the world !
Health and Safety Policy : US vs Sweden
The most incisive demonstration that health and
safety issues are political comes from a comparison
of the ways in which different governments with
different ideologies respond to such issues.
As Navarro rightly asserts, it is class conflict and
the balance of forces berween capital and labour that
dictate the policies of a nation - states, rather than
anytechnical state of development in the knowledge
of related disciplines or the attitudes of professional
experts or the socalled 'national character traits'. An
analytical comparison of two countries namely US
and Sweden will make this clear. (Navarro, 1983)
From 1932 to 1976 the Social Democratic Party
has been in power in Sweden even though in its own
internal configurations there occurred changes from
mild, legalistic evolution towards socialism to that of
social reformism with the framework of capitalism
it remained quite responsive to the pressures of the
working-class and the middle, clerical and profess
ional classes. On this situation capital has sacrificed
its stinginess in short-term matters to sateguard its
long-term profitability.
Consequently workers have a far greater control
over their work in most respects and notably they are
Socialist Health Review
adhered to. Managements tend to listen to factory
inspectors and implement their suggestions for
fear of closure.
In contrast, in US, almost every indictment by the
factory inspector is hauled to court. The antagonism
between state safety agencies and the industry is
sharp and clear. And quite often owners get away
with safety violations either for free or for an amount
which is much less than that required for preventive
measures.
These differences stem not, contary to what Ame
rican Professor Kelman says, from the assertive nature
of American people and their respect for individual
rights, as against the much more cowed down and
submissive-to-authority Swedish counterpart, but
from the differences in the political outlook of the
two regimes and the relative proximity to labour and
capital.
There are some distinctive features in the above
comparison. In Sweden the working class has acted
as a coherent whole, in forcing the government to
pass a large number of health legislations, and has
consistently favoured the formation of laws and acts
rather than indulge in private agreements with the
owners at the level of the enterprise or craft. On the
other hand, in the US the mode of individual agree
ment is prevalent which effectively neutralises the
collective bargaining power of labour as a class.
Even in the official setting of standards it is lobbying
and bargaining that decide the level of compromise
rather than a collective pressure from the working
class. And to complement this on floor and plant
level Swedish workers have much greater powers
including the refusal to work and much greater
access to the enforcement agencies than their
American counterpart.
Monetary Demands and Occupational Hazards
and Safety
Whenever labour demands betterment of working
conditions, capital's standard response is to bargain
by offering monetary benefits in exchange for that
irreversible loss of health. This strategy followed by
managements is straight forward since the cost of
such compensatory payments is often far lower than
the cost to actually improve the working conditions.
For instance an extremely dirty asbestos plant in the
US was fined a paltry 210 dollars for having
violated the OSHA standards by a large margin !
(Berman 1978).
The relationship of monetary demands and health
and safety demands becomes very complex at the
December 1984
level of organised struggle by the working class. To
begin with, therefore, a distinction must be made
between health and safety demands which talk of
changing the actual working conditions and health
and safety related demands which propose some
other mode of exchange, i.e. stake a claim in the
form the incentives or benefits in lieu of the occupa
tional hazards. The myth that management perpe
tuates is to confuse between the two and in the
ultimate analysis substitute the latter for the former.
In promoting this myth capital exploits a number of
other falsely held beliefs, for instance the inevi
tability of pollution and hazards as being inherent
to all kinds of technology. The natural implication is
that the only way in which hazards can be paid for
is by monetary compensation. By making monetary
benefits and allowances the exclusive point of
bargaining, managements use compensation ideology
firstly, to save on costs and secondly to contain more
authentic and dangerous forms of working class pro
tests. Altogether, it gives to the management a
licence to pour out its hazards and effluents into
the work environment. By institutionalising discontent
over health and safety within the framework of its
own ideology, Capital seeks to assert its ideological
hegemony.
Unfortunately this ideology of compensation and
insurance, which seeks to blur the distinction bet
ween when compensation should be demanded and
when not, breeds quite easily in labour surplus
economies of the Third World and the West. In the
under-developed countries where wages are meagre,
unemployment and consequent job insecurity looms
large, the working class is often forced into positions
of weakness. In such a milieu even the demand for
minimal compensation payments can be a militant
victory for workers. However, in nations like the US
too unions have to fight against the fear of loss of
job. But wages are not that meagre and militant
union laedership, rank and file activist and the
workers themselves have insisted on actual changes
in working conditions. An enlightened working class
has insisted on compensation as a minimal demand
and a change in working conditions as an ultimate
objective. This and only this will ensure that Capital
cannot indulge in the unbridled purchase of health
of labouring human beings.
References
Berman, D. M. ' Death on the Job ‘,
New York, pp. 83-88, 1978.
Monthly
Review
Press,
Braverman, H. Labor and Monopoly Capital. Social Scientist Press,
Trivandrum, pp. 55, 1979.
(Contd. on page 125)
A09
ILLNESS AND ACCIDENT REPORTING IN INDUSTRY
A Review of Statistics and Legislation in India
jean d'cunha, loy rego, mihir desai and vijay kanhere
Abuse of workers' well-being at their workplace is a characteristic feature of industrial capitalism,
especially backward capitalism, where workers' consciousness about health rights is submerged under the
burden of immediate survival. The problems and manipulations associated with reporting ( in fact gross under
reporting ) of occupational accidents and diseases, the inert nature of taws pertaining to health and
safety at the workplace, the collusion between the management protectors and enforcers of the laws and
the medical profession; and the workers' and their unions' apathy towards this issue are highlighted by the
authors who are members of the Health and Safety Unit, Bombay.
While the deaths in the communal riotsin Bhiwandi,
or the casualties in Punjab, shock the country and
emphasise the horror of events, the fact that every
day, at work, many are wounded and some people
die, due to industrial accidents and occupational
diseases ( IA and OD ) produces few headlines and
no danger signals. The workplace is becoming a
battle-field, with casualties as severe as many a
modern war; and despite this genocide of so many
workers, the problem of health and safety at work
is far from being a front line area of social and poli
tical concern and action in India. Exploring possibili
ties for action thus becomes necessary.
The first step in acting on a problem is to know
about it, and understand its dynamics correctly. It is
important, therefore, to know the extent of IA and
OD in the country, the reasons for its occurence, and
the perceptions and attitudes of the government,
public bodies, industry, workers and unions to the
problem.
In this article we attempt an examination of the
statistics available'with the government, make, an
estimate of accidents and diseases actually occurring
and identify and discuss the reasons for their
occurence. However, in the absence of an organized
health and safety movement by workers in India, the
poverty of documented information on the same is
inevitable. Our perceptions of the problem are thus
tentative and impressionistic as they are based on a
limited number of observations and interviews with
workers.
Occupational Accidents and Diseases :
A Statistical Profile
Every year, in India, 3-4 lakh people are injured
and about 800 of them lose their lives due to
industrial accidents. Table I shows these figures for
6 years. From these figures it becomes obvious that
for this period, 1126 persons were injured and 3
persons lost their lives daily, due to industrial acci
dents. 1 In Maharashtra alone, one fatal accident
110
occurs on the average every two days, while in
Uttar Pradesh, once in three days.
Accidents cause an absence from work due to
temporary disablement. For a sample year 1 980, on
the basis of available figures, accidents resulted in
3,322,829 (3.3 million) mandays absence from work
due to disablement (ILYB 1981). Whereas 21.3
million man-days were lost due to strikes and
lockouts (industrial disputes) during this period.
(PBLS, 1982, 1983)
This means that there is a daily absenteeism of
11,076 workers due to industrial accidents, and on
an average it takes 10 days for a person to recover
from his accident. And the above figures pertain only
to industrial accidents, those occuring in factories,
excluding those workplaces like ports and docks,
Railways and Mines. Table II shows casualties
occuring to employees in Mines, Railways and Ports
and Docks. Including these casualties makes the
picture far more alarming raising the daily toll to
almost 5 fatalities and 1228 injuries. 2
Certain states have a larger incidence of accid
ents. Six states Maharashtra, West Bengal, Gujarat,
Madhya Pradesh, Tamil Nadu and Uttar Pradesh,
with 62.5% of total factory employment, accounted
for over 80% of the injuries. Rather than conclude
that industries in these states are more hazardous,
the statistics probably reflect a relatively better
rate of reporting. But it is clear, however, that injuries
themselves are on the rise. In Maharashtra, which
today has the highest share of injuries, while
employment rose by 40% during 1961 to 1978/
injuries rose by over 100% (Nair, 1982).
Different industries have different rates of accidents,
some industries being inherently more hazardous.
Five industries, textiles, basic metal and metal pro
ducts, machinery (manufacture), chemicals and trans
port equipment, with just about 60% of°the total
factory employment, account for over 80% of the
Socialist Health Review
injuries. Textiles, the oldest industry in the country,
with 24% of the total employment has the highest
share (54-%) of the injuries. In fact, injuries in the
textile industry have increased by 626% between
1951 and 1978, while in that period, employment
has grown by only 38% (Nair, 1982),
Turning to the disease chart. Table III, shows the
number of cases of occupational diseases reported
all over India for the period from 1960 (last year for
which statistics are available). 639 cases have been
reported during these 21 years giving an average of
a paltry 30 cases a year.
Nair's article shows that both fatal and non-fatal
industrial accidents have been rising over the last
30 years. Fatal injuries rose by 225% from 248 in
1950 to 806 in 1980 and non-fatal, even more
sharply by 393% from 76,000 in 1950 to more than
355,000 in 1980. He argues further that this cannot
be explained as a result of industrial expansion
alone, as accidents have increased relative to the
rise in persons employed and increase in the number
of factories. While the number of factories has in
creased by 388% from 32,000 in 1951 to 125,000
in 1978 average daily employment has risen by only
120% from 3000,000 in 1 950 to 6500,000 in 1978
(Nair, 1982).
Table IV shows the break-up of the 98 cases of
diseases reported during the period 1976 to 1980
(detailed statistics only available for this period).
Out of 22 types of occupational diseases notifiable,
only 11 of these have been reported during this
period. Of those un-reported are such well known
killers like Byssinossis, Brownlung which all textile
workers are prone to, and Carbon disulphide poison
ing (in rayon plants) which, as Padmanabhan's study
(Padmanabham, 1983) "the Gas Chamber of the
Chambal" showed, affected many workers. Noise
induced hearing loss, one of the commonest and
most widespread disorder has also gone unreported.
And among the reported diseases only one case of
asbestosis was reported in five years, when during
this very period, an American asbestos company
John-Mansville went bankrupt due to successful
compensation suits filed against it by its workers.
(Castleman and Vera, 1982).
A comparison of rates of accidents in India and
other countries is also revealing. During 1 976, the
number of accidents per 100 workers employed
in all manufacturing industries was India (60.2)
UK (34.8) and USA (24.74) (CLI)
While some statistical experts challenge the validity
of the above due to different methods for reporting
accidents in different countries, comparison of fatal
accident rates reveals the same trend. The figures of
number of fatal injuries per million man hours worked
during 1979 and 1980 are (PBLS, 1982, 1983)
USA
UK
Japan
Yugoslavia
India
1979
1980
0.03
0.03
0.02
0.07
0.15
—
0.03
0 01
0.08
0.15
Thus accident ratesin India are far more than many
industrialised countries.
This alarming magnitude of accidents is according
to various experts, however, a gross under-estima
tion to say the least, in view of the numerous cases
that go unreported.
Occupational Diseases :
Accidents are only one of the industrial killers.
Occupational diseases are another one and compared
to accidents are far more insiduous in their onset
and therefore often just not perceptible. And yet, in
terms of damage to health, they are as fearsome,
perhaps more so.
December 1984
The geographical spread of these cases indicates
that out of the 22 states and Union territories, only
8 states report any cases at all. There are no cases
from industrially advanced states like Tamil Nadu
and Andhra or from Madhya Pradesh, Uttar Pradesh
and Kerala.
Table V shows the number of cases reported under
the Workman's Compensation Act 1923 for the years
1966 to 1979. A total of 1159 cases were reported
during these 14 years, an average of 83 cases repor
ted a year. For the 10 years for which break-up is
available, of the 710 cases reported, 303 people
died and 395 were permanently disabled. These
cases cover only five states out of the 22 states in
the country, implying that no compensation for OD
had been paid during this 14 year period in states
like Maharashtra, West Bengal, Tamil Nadu or Uttar
Pradesh. Of the 6 states from which there are
reports, Kerala and Orissa report in 1 year only,
Madhya Pradesh twice, Andhra Pradesh in 7 years.
Karnataka is the only state reporting every year. In
fact 90 percent of the OD reports are from Karnataka.
There are 22 types of diseases which are compen
sable under the Workman's Compensation Act 1923,
for the period in question, though this has been
raised to 34 since July 1984. For the years 1972 to
1980, during which period detailed statistics are
111
available, all 642 cases reported are that of silicosis.
638 of them are from Karnatakas. The other 21
diseases therefore, have never been reported or
compensated.
other types of textiles are excluded from this
estimate. Their inclusion would raise the figure
still higher and yet not a single case of byssinossis
has ever been reported.
Table VI shows the incidence of various notifiable
and compensable diseases identified in the Indian
environment by research studies, and indicates that
6% to 44% of workers under study are affected by
various OD. To overcome the complete absence of
data on national incidence of diseases an attempt is
made to estimates the same from the studies done.
Even conservative estimates of a few diseases from
a few workplaces reveal that thousands of workers
have been affected. For one disease in one industry
only(silicosis in potteries) we get an estimate of 1 845
cases, which is itself more than the total number of
cases, reported for all diseases (1 798) under both,
the Factories, and Workmen's compensation acts for
the relevant periods under study.
All these are but a few cases of positive 'death on
the job' ihe proportion and intensity of which is
reaching astronomical dimensions.
Let us consider the cases of asbestosis, lead
poisoning and byssinossis - 3 dreaded and rampant
diseases separately.
Asbestosis : Our estimates indicate about 1500
workers suffer from this disease nationally among
those working in manufacture of asbestos cement
and its products alone. Thus, workers handling
finished products in other locations are also affected
by disease, for which no estimate has been made
yet. Only one case is reported to date under the
Factories Act. In the West, because of the campaign
by workers, supported by the general
public,
detection of asbestosis cases base increased and
working conditions have been imperoved and yet
in 1978 US Health authorities estimated 5000 new
cases of asbestosis due to past exposure would be
detected annually till the end of this century.
(Audyogjk Jeevan 5 March, 1982)
Lead Poisoning: Our estimates indicate over 500
workers to be suffering from this disease nationally
in one industry alone-storage battery manufacture
(Chakravarti and Dhar, 1981) Since the industry uses
40% of the total consumption of lead in India the
total figure for lead poisoning itself are likely to
be much higher. Only 10 cases have been reported
from Bihar, while not a single case has been
reported from any of the factories or states where
the study (Table VI) was carried out.
Byssinossis: Our estimates reveal that 37 thousand
people are affected by this disease from cotton
textile manufacture in the organised sector.alone.
Those working in cotton ginning, power looms and
112
Why Does This Happen ?
The decapitated worker that emerges from impo
verished and dehumanising work and living condi
tions is the legacy that industrial capitalism has
handed down to us. That the wheels of such a
system are propelled by profit, needs no further
elaboration. In its competitive bid for survival and
capital accumulation, newer production processes
and products are introduced with 'cost-criteria,
gaining an edge over 'health, safety and worker
welfare criteria.' The increasing monetary stress,
fatigue, decreased creativity, skill and control of
newer work processes are evidences of the above.
The numerous toxic-chemical agents, biological
agents (fungi, bacteria, parasites), physical agents
(noise, extreme temperatures and humidity, radia
tion, abnormal airpressure, weightlifting, repeated
motions, shocks and vibrations) and mechanical
agents, which are callously introduced at the work
place lead to further impoverishment of a worker's
life. All this again is consistent with the principle of
generalized commodity production, where the
worker is perceived as a commodity and his capacity
to labour commanding a price. Hence in a labour
surplus capitalist economy, any depreciation in the
health and wellbeing of a worker, arising out of his
work and living conditions and leading to a drop in
his efficiency and productivity at work, may be over
come by a replacement from the industrial reserve
army.
Attitudes to Health and safety :
The State Workers Unions and Management
It is a paradox that though the Directive Principles
of State Policy guarantee the health, safety and
well-being ( including occupational health and
safety) to every citizen, government's attitude to the
problem has been callous. There is no well establi
shed Industrial Health Service Agency for occupa
tional diseases in India. While the objectives and
policy measures of government health programmes
have been geared towards control and eradication
of communicable diseases, curative and preventive
health services in rural areas via Primary Health
Centres, training for medical staff, government s
Socialist Health Review
treatment of occupational Health and safety has
been stepmotherly. What is also worth noting is
that very little emphasis is accorded to occupational
health and safety in the medical syllabus and in the
training of medical personnel-
The State's piecemeal tteatment of the problem of
occupational Health and Safety is further refelcted
in four pieces of legislation allegedly designed to
ensure the health and wellbeing of the worker.
The law regarding health and safety of workers in
India, like the law in any other country must be
viewed from three angles :
(a) The underlying principles behind the whole
gamut of health and safety laws (In India this is
achieved through the Employer's Liability Act, 1926)
(b) A set of rules defining duties meant to be
imposed so as to reduce the risks i. e. the preventive
angle (The Factories Act, 1948, The Mines Act etc.)
(c) The instrument to secure forms of compen
sation for the employee in which the rules governing
liability are formulated and interpreted largely after
the event, to determine the fault and then to align
damages or other forms of compensation, according
to the measure of the injury, i. e. the curative aspect.
(This is represented by the Employer's State Insu
rance Act, 1958 - ESI Act and the Workmen's
Compensation Act, 1923). But ultimately, law is,
what law does, and hence it becomes extremely
relevant to examine these laws not only with res
pect to their scope and formulation, but also with
respect to the extent and nature of their implemen
tation. It is also necessary to determine the gover
ning ideology behind these laws, the extent to which
they protect the worker and changes that need to be
made in these laws.
The Employer's Liability Act 1926 : Prior to
1926, the governing ideology, as reflected inlaws
or lack of them, was that whenever an employee,
a natural autonomous individual, chooses to enter
into a contract of employment with an employer another
natural
autonomous
individual - the
employee is presumed to accept all the risks invol
ved in the employment. The natural consequence
was that an employer could not be held liable for
any injury suffered by the employee even if it was
due to the horrendous and thoroughly unhygenic
working conditions. A further underlying principle
was that in case the contract of employment imposed
some liability upon the employer, he could avoid it,
if the injury caused had resulted from a co
December 1984
worker's or another person's negligence. This is
what in legal parlance was known as the doctrine
of common employment. The Employer's Liability
Act abolished both these principles establishing a
new and progressive principle that no employee
could be presumed to have accepted any risk invol
ved in any employment. The Act does not stop here
but further prohibits any Agreement which puts
even partial responsibility of an employment risk on
the worker. The act also abolished the concept of
common employment. The resulting consequence of
this Act quite simply is that the risks involved in
Employment are altogether the employer's responsi
bility and neither a contrary agreement with the
workmen nor the negligence of a co-workman can
change this position.
Though the Act as such is a radical departure from
the earlier concept, it still leaves much to be desired.
It is curative in nature, as it lays down the principles
regarding the remedies available to the workers sub
sequent to the infirmity or disease but does not lay
down any principle regarding the prevention of
unsafe working condition. Guarantee of healthy
working condition is not even laid down as a
principle.
The Factories Act, 1948 : This is the only
act of general applicability which is preventive in
nature.lt allegedly provides for positive action to
be taken by the employer to ensure a safe place of
work. The act however remains
a paper tiger.
It provides various facilities and protections to the
workers at the shopfloor without affording either the
woker or the Unions a right to demand the same.
The workers cannot directly take a factory owner to
court even if he violates all the provisions of the
act. The grievances are funnelled through the Insp
ector of Factories. This a classic example of taking
away with the left hand what is given by the right.
The act and the rules which run into 300 pages or
more do not contain guidelines for procedures in
which grievances may be brought to the fore. There
is no mention whatsoever as to how workers are
supposed to demand what is due to them.
The officially recorded statistics on occupational
accidents (O.A's) are based on accident reports
received under the Factories Act, 1948 by the
factories inspectorate, while that of occupational
disease (O D's) are based on reports received under
the Workmen's Compensation Act, 1923 and the
Factories Act, 1948.
The introduction to the Section on 0. D. in the
Labour Year Book (Compiled by the labour Burearu,
113
reported under this Act. They were all silicosis, cases
from Karnataka. Two of the 91 workers who died
as a result were compensated with Rs. 8000 each,
while the other 89 workers who were permanently
disabled were paid Rs. 1890 each. (ILYB, 1982)
This serious under-reporting is once more indica
tive of the lethargy, incompetence, and inadequacy
of the enforcement agency, the corrupt collusion
between factory managements and the lacunae in
channels for collection and compilation of data and
the definition of injury in the Act.
The Employees State Insurance Act : The Act
provides an employee with sickness, maternity, dis
ability, benefits and the like It applies to factories
using power and employing 20 or more workers.
Even in these factories, it covers only those employ
ees earning less than Rs. 1000/- per month. The Act
does not apply to seasonal factories and of the fact
ories that remain, the Government is vested with the
power to grant exemptions. Thus like the Factories
Act, it excludes a large section ofjhe workforce from
its purview.
An Employee State Insurance Board, acting like
'the big brother', is formed under the Act. A Standing
Committee and other local boards are further consti
tuted under this. The Board consists of 40 members
five of which are surprisingly worker representatives.
This is comprehensible in view of the fact that they
are not elected even by a farcial contest, but nomin
ated by the Central Government. The 40 members
include two medical persons as well, nominated by
the Central Government; so much for an act that
deals purely with medical aspects.
The Act provides for a joint contribution by the
employee to be paid into a common fund. All emplo
yees governed by the ESI act must be compulsorily
insured. Four types of benefits are available to them
viz (1) maternity benefit, (2) disablement benefit
(injury or disease in the course of employment), (3.‘
dependants benefit (in case of death of an employee
due to injury in the course of employment), and (4)
medical and funeral benefit. The funeral benefit of
course cannot exceed Rs. 100/-.
These benefits however cannot be availed of unless
an employee has contributed for atleast 13 months
to the common fund. In the event of an injury in the
course of employment, occurring within 13 months,
for instance, of his employment, he is not entitled to
any benefits under the Act.
The Corporation is empowered to demand more
money from an employer if it believes that an unhy
116
gienic factory environment or violation of health
regulations is raising the incidence of ill-health to a
proportion higher than what it should be. It, ofcourse,
has no right to enforce the stipulated health and
safety norms. Again medical benefits which are paid
in cash require indisputable proof of illness. Evidence
beyond a doctor's certificate is needed to establish
that a worker was ill.
Also benefits under different heads cannot be clai
med simultaneously What this implies is that if a
woman on maternity leave falls ill, she has to choose
between the maternity benefit or the sickness bene
fit. She cannot encash both. Further, a worker
entitled to benefits under this Act, cannot claim them
under any other Act, including the Workmen's
Compensation Act. Besides, prolonged illness of a
worker may result in his employer dispensing with
him lock, stock and barrel.
In the case of a dispute, various courts have been
constituted under th;s Act. Red tape, nepotism and
bureaucratic delays are all that the functioning of
these courts offer to employees.
Finally the ESI Scheme functions with little or no
infrastructure to provide even basic medical treat
ment. Most workers thus regard it as gcod for
obtaining a bogus medical certificate but useless to
cure any illness, let alone occupational disease. A
perusal of these acts reveals that they do not even
perform the rcle of paper tigers A bare reading of
them suffices to indicate (a) that they exclude a
major portion or segment of the workforce from their
scope (b) Workmen are not granted sufficient rights
to enforce the privileges occurring to them, (c) the
privileges themselves are few and far between
(d) the personnel in the enforcment department are
not socially committed, nor are they technically
equipped or numerically adequate to grapple with
problems.
Furthermore, corruption and a managementoriented ideology that permeates the enforcement
agency, prevents the rights and privileges of the
workers from becoming a reality. Within the manage
ment frame of thought, a worker is perceived as a
machine who must keep on functioning. In a country
like India where the supply of such a 'machine
outstrips demand the enforcement agency does not
care a straw to ensure the functioning of 'the
Machine' nor does it care for its breakdown.
To conclude one may assert that though the laws
are far from adequate, there are certain rights and
Socialist Health Review
privileges granted to a workman, which if enforced
can help ameliorate their situation. The irresistable
conclusion is that in a country like India the struggle
for enforcement of these rights is as important as the
struggle for better laws.
Let us now turn our attention to workers and
management who are directly concerned with the
problems of occupational health and safety.
Workers
Wo'kers' perceptionsand responses to the problem
of occupational health and safety is noteworthyConsistent with the notion that opressed groups
adopt the ideological formats and practices of the
oppressor, workers and unions too, have internalised
Management conceptsand values concerning health
and safety. Health is viewed by them as the
absence of disease rather than general physical fitness
and well-being. It is perceived as a private issue
dependent on each individual being’s physiologi
cal and psychological makeup and the unique
ways in which they respond to disease-causing
agents like germs and microbes. The vehement
emphasis by management on a worker's unsafe
action as the primary cause for workplace accidents
also individualises the issue of safety. Cure, within
this framwork, for the injury or the malfunctioning
organism is supposed to restore health. This too
becomes privatised. Again health and health services
are not recognized as rights but commodities whose
availability depends on the individual's purchasing
power. All this only serves to mask the social and
political roots of health, shifting the onus of health
and safety to the individual worker. Collective
struggle by workers for better health and safety
conditions, facilitating greater worker control over
the work process and thus upsetting the balance
of power between labour and capital within the
overall political struggle is thus curbed.
Worker's internalisation of such a perspective
cannot be merely attributed to a management con
spiracy. It serves to also create for workers possi
bilities and guidelines for human action giving
rise either to an attitude of peace and acceptance
or to struggle against existing health and safety
conditions. Workers response to occupational health
and safety thus covers a wide spectrum ranging
from stark ignorance to powerlessness, apathy,
individualism and consumerism rising conscious
ness and a desire to struggle.
In a third world country like India, the combined
effect of a dust-infested work environment together
with poverty, malnutrition, insanitary living condi
tions, environmental pollution, alcoholism, smoking
December 1984
and drug-intake, brings about a synergistic effect,
causing so called classical occupational disease
like pneumoconiosis in coal miners and asbestos
workers, byssinnosis in cotton textile workers and
bagassiosis in sugar-cane crushers. A worker thus
often finds it difficult to discern between ill-health
caused due to poor living conditions and his occu
pational environment. For example, at a recent
workshop on occupational health in Bombay, the
comment of a socially conscious trade union acti
vist working in a Kanpur textile mill is telling "We
definitely feel uncomfortable working amidst cotton
fibre and high relative humidity. Many of us have
T.B . which we always assumed was due to our
living in slums and poor living standards. But
only after this doctor here told us of byssinossis
do we know that it is the cotton fibre which is
disabling us".
Again certain occupational diseases like cancer
are slow and insiduous in their onset, and mani
fest themselves after a long time, often towards
the end of the worker's career span or after he
retires. He thus remains unaware of the damage
done to him in the course of his work, eliminating
all possibilities of struggle.
The worker is often ill-informed or ignorant of
the products and materials he handles and hence
unaware of the impact it is likely to have on his
health Even if he is mildly conscious that his work
environment is responsible for the deterioration of
his health, he lacks precise knowledge regarding
the specific nature and extent of damage to his
health or the medical remedies he can resort to.
He thus, for instance, succumbs to milk or poly
vitamin prescriptions by managements as a panacea
for respiratory problems caused by inhalation of
zinc fumes and dust. Due to his own backwardness
or his preemption from technical and engineering
know-how regarding industrial health and safety, he
is not only unaware of the precise health and safety,
status of his work place but also the avai
lable pollution control measures, possible safety
mechanisms and safer substitute materials that
management can very well introduce. He thus
swallows the management bait, particularly that
advocated by the chemical industry management
that work hazards and pollution is inevitable and
bearing with one's lot is the only alternative.
Again in the wake of unemployment and tight
economic constraints, acquiring and maintaining a
job is of foremost importance to a worker, regard
less of health hazards at work, even if he is aware
of them.
H7
In the much exploited unorganised sector, the
demand for unionisation and higher wages assumes
precedence over health and safety. The fear of
termination of services in the event of being decl
ared medically unfit by the medical inspector of
factories often inhibits workers from demanding
medical examinations or raising health demands.
The organised and better paid workers though
in a more objective position to take up health and
safety issue, have by and large failed to do so. If
an incentive scheme (productivity linked wage or
piece rate) is under operation the workers may
themselves not report minor injuries and just con
tinue working, sometimes even without first-aid.
If there are group incentives for production or even
safety (award for million man-hours worked with
out an accident), group anxiety to acquire the
bonus may pressurise the injured worker not to
report the accident but to resume work as soon as
possible after first-aid. Health and safety is thus
preempted from being taken up as an issue.
Workers also fear plant shut-downs to rectify
hazardous conditions in the work environment. This
inevitably implies a loss of wages and a cut in
overtime payment if any. They thus refrain from
raising health and safety demands.
Finally, it is only when facilities consequent on
an accident (i. e. paid special leave and compen
sation for disablement) are significant financially
that workers make a particular effort to alleast
report accidents, however small. In most compa
nies, however, accident prevention facilities are
not particularly good.
For the above reasons a number of health hazards
never enter the official records of even the factory,
in the first place, let alone being raised as an issue
by workers.
Health and safety action has however been
observed in certain dust prone chemical and engi
neering industries because of the high and severe
incidence of diseases like asbestosis, silicosis and
lead-poisoning or serious injuries and deaths resul
ting from work place accidents. These occurrences
have shaken workers into realising the gravity of
the situation and the danger to their health and
lives.
The workers have resorted to an aggressive
propaganda on a specific incident and the hazar
dous work environment through posters, pamph
lets, news-items, gate-meeting and personal talks
118
with other workers. The Unions have raised demands
tor medical examination of all workers, inspection
and assessment of work environment and the right
to obtain medical and factory assessment reports.
Pressure has also been put on the management to
control pollution and provide workers with per
sonal protective epuipment like respirators, masks,
goggles, gloves, overalls and safety boots. Safety
guards and fencing for machines have also been
demanded. Workers have also pressurised the
management to set up a Safety division and safety
committees within the factory. Even in these
industries where health and safety has been taken
up as a struggle issue, it has often been translated
into a monetary demand in the form of compensation
or a hazard allowance. It is interesting to observe
that workers in an engineering industry did
not use the gloves and protective equipment
provided. They sold good quality protective foot
wear or wore it out of the work environment.
Safety guards were removed from machines to
complete production quotas in shorter periods
and escape from work place. This is symptomatic
of the discomfort caused by protective equipment
through the long hours of work, lack of adequate
awareness regarding safety, habituation to sparse
clothing and working in slippers, the prestige and
status of using shoes out of work, and an alie
nation, monotomy and boredom which preempts
getting away from work as soon as possible even
at the risk of one's safety.
Workers and their unions are thus permeated by
the corporate culture. They are steeped in indivi
dualism, economism, consumerism and bureaucracy.
Workers and their unions perceive man as an
'economic man' rather than envisaging the total
intellectual, emotional, political and socio-cultural
development of the human being. They have also
internalised management attitudes and values to
health and safety. This coupled with the deterio
rating economic situation has prompted unions into
preoccupation with day to day problems of workers
like wages, leave, reinstatement and the like. Tradi
tional unions have failed to take stock of techno
logical and work process changes that bring in their
train new problems and open up new areas of
demands. Even if unions are aware of this, a leap
from economic demands to health and safety issues
would involve demands like change in plant outlay,
use of substitute products, installation of safety
devices and pollution control equipment. This
would mean a greater control over the labour
process, essentially a political demand which
managements would fight tooth and nail, against
Socialist Health Review
unions who would refrain from stamping too hard
on management's toes. Defeat on such demands or
neglect of every day problems of workers who
have not yet perceived health and safety as an
issue could mean loss of workers support or loosing
out to a rival union
Unions would refrain from
this risk.
Health and safety action therefore wherever initia
ted has been sporadic and timely, coinciding with
the occurrence of the catastrophe and petering out
with the meeting of demands. It has not yet
become a consistent and cohesive class-based
movemement.
Management
Management's response to the problem of occupa
tional health and safety is broadly governed by
cost considerations and the strength of the union.
Action has spanned from flagrant abuse of health
and safety stipulations of the Factories Act, collu
sion with officials to punitive measures against
workers, to sophisticated ideological and institu
tional co-optation, to progressive measures which
work in the interests of management and appease
workers.
Non-registration of factories, failure to submit
returns and records to the factory inspectorate,
flouting of TLV limits for dust, toxic chemicals,
and physical agents, absence of appropriate poll
ution control measures, use of hazardous materials
and obsolete machines, non-provision or provision
of substandard
personal protective equipment,
absence of safety guards and fencing for machines,
lack of proper canteen, sanitation and clean drin
king water facilities, poor plant layout and bad
housekeeping, absence of periodical medical check
ups for workers or reg ular inspection of factories
are but a few open transgressions of the law. This
is indeed effected with the active connivance of
the factory inspectorate officials through personal
and political favours and backdoor cash receipts.
Furthermore, management withholds from work
ers information regarding the process of production,
materials used in production and their effects on
health, number of accidents, hazardous locations,
pollution control records, toxicity levels, investiga
tive reports of accidents, factory assessment and
medical reports and recommendations for improve
ments made by the factory inspectorate and gove
rnment agencies.
Health and safety demands are often mht with
management's emphasis on the inevitability of
December 1984
works hazards, collusion with medical personnel to
give inaccurare medical reports or refrain from attri
buting a worker's ill health to his occupational
environment is yet one more method of containing
the workers, placating ignorant workers with medi
caments and beverages, or monetizing the demand
with a paltry compensation or hazard allowance
and cash incentives for accident-free records are
often resorted to by managements. Transfers, plant
shutdowns, or retrenchment of workers on medical
grounds after a medical examination is an oft
used preventive measure. Isolationist tactics like
transfer of workers, keeping woiker off from the
plant premises by sponsoring them for out of plant
training courses in health and safety, preventing
workers from entering other plants during rest
intervals or lunch breaks to discuss problems on
health and safety is another means employed to
thwart worker initiative.
A 1976 ammedment to the Factories Act 1948,
provides for the appointment of a safety officer
in factories employing 1000 workers or more. In
Maharashtra, out of 224 undertakings required to
appoint safety officers, only 97 officers have been
appointed to date. This ammendment has brought
about a shift in management perspective by
incorporating safety in to the structure of the
Corporation, thus avoiding too much interaction
with outside authorities.
The safety departments which by and large consist
of safety officers, assistant safety officers, assistant
safety engineers, and other safety assistants are
empowered to receive accident reports, investigate
causes for accidents and prescribe corrective action.
Often these departments lack sufficient and compe
tent personnel. Although the inspection rounds
and the issuing out of safety equipment are by and
large the only occassions for contact with the
workers, safety officers are often prevented from
going to the shop floor and communicating with
workers. They rarely record workers' complaints
during their infrequent rounds. Nor do they inves
tigate" specific complaints of workers and unions.
Reporting of accidents occurs in two phases. The
first is from the worker and his supervisor to the
management. The second is the reporting of the
accident by the factory to the Fl and the ESIS.
Suppression of reports takes place at both levels
as we shall see.
When a worker is injured within the factory,
he gets first aid from the dispensary or the first
aid centre on the premises. A written report of the
119
accident is sent to the authority in the factory
assigned the task of collecting reports i.e. fire
office, personnel or Safety department where it
exists.
Certain non-external injuries like back-aches or
sprains may not even be complained of by the
worker, and even when he obtains first-aid and
fills up a report, this may not be accepted, the
authorities questioning the existence of the injury
as well as whether it happened at work. Where
the injury is minor supervisors may not allow the
workers to leave the shop. The supervisor may
even refrain from reporting an accident if he is
likely to be hauled up. Often first-aid may be
provided in the shop and the worker asked to
continue his work. In all such cases accidents are
not even reported and hence not recorded. Incen
tive schemes, group incentives for production and
safety may often prevent a worker from reporting
injuries. Though in most companies accident bene
fits are rare, the existence of these may prompt
reporting. A number of work
place accidents,
therefore, never enter official factory records.
On the next stage too, i. e. reporting of accidents
to the Factory Inspector and ESI, there is suppre
ssion of reports, both by just not reporting certain
cases, as well as by toning down the seriousness
of the injury or the event, thus falsifying the report.
This happens because managements are keen not
to have absenteeism, to avoid payment for compen
sation as well as avoid prosecutions for negligence
under various acts; or for even more prosaic reasons
like keeping down accident rates to win national
or international awards for safety performance. In
the absence of statutory rights of workers to report
accidents, as well as the non-submission of annual
returns by managements, reportage of accidents
and hence prosecutions on the same are unheard
of. If the Factory Inspector is aware of the occurence of accidents more aften than not he is
silenced with bribes of various kinds.
Then at the time of compilation of the OA stati
stics, only 'reportable' accidents (these resulting in
more than 2 days disablement) are included and
according to figures for one engineering company,
only about 1 accident in 10 is "reportable". Thus
millions of minor nicks and cuts, burns, foreign
particles in eye, lumps and sprains, with less than
2 days disablement, though reported in the factory
go unrecorded in the official statistics.
There is an an even more severe under-reporting
of diseases as compared to accidents, the causes
120
lying both in the detection and diagnosis of causes.
Accident injuries are diiectly perceptible and their
existence cannot be denied. Secondly, their inst
antaneous occurrence clearly ascertains the cause
and effect relationship between accident injuries
and work On the other hand, diseases are usually
systematic malfunctioning, detection of which is
time-consuming, the existence of which can be
doubted- Since they are slow acting, the occupa
tional origin of a disease, or when this is accepted,
its link with a particular work place can easily be
denied. Government authorities point out lack of
expertise as a cause. This again has its origin in
the lack of emphasis on study of diagnosis and
treatment of OD in medical education, and in that
most doctors, in any case, lack clinical experience
of detection of such cases.
As regards reporting of cases to the Fl, the
responsibility lies with the factory managements
and doctors. Factory managements have no interest
in detecting OD's and would be keen that such
information does not reach the Fl or their workers.
Medical practitioners are statutorily required to
report cases of occupational diseases they detect.
The paltry penalty for non-compliance extending
to a maximum of Rs 50/- proves no dis-incentive
to any doctor, though needless to say no such
penalty has ever been awarded. With those being
the agencies statutorily responsible for reporting,
it is no suprise that so few cases are reported.
With certain categories of medical practitioners
other considerations operate. Doctors employed
by factory management function in the interst of
managements, and even if cases are detected
these are only disclosed in confidential memo
to top managements. In such case, particularly
in larger companies, hazardous operations may
be transferred out to the small scale sector.
Other Industrial health or medical consultants are
reluctant to certify any illness as occupational
diseases, since this may antagonise the company
involved and result in his removal from the com
panies approved panel of doctors and consequent
loss of business.
The example of Rashtriya Chemical
Fertilizers
(RCF) a Public Sector Chemical concern, for instance,
raises questions on'management-medical collusion'.
A medical exmination in 1983, of 1 1 3 of workers
of the nitric Acid plant by Dr. S R, Kamat, chest
disease expert of KEM Hospital, revealed that 51%
of these workers had severe basal scars on their
lungs. Dr. Kamat attributed this probably to the
occupational environment. A subsequent examin
Socialist Health Review
nation of more than 600 workers from different
plants in the RCF by Dr. Kothari of Bombay Hospital
(Rao and Kothari) 1984 showed that only 10 wor
kers had damaged lungs. There was no trace of
carboxyhaemoglobin and methaemoglobin in the
blood samples and strangely the damage to the
1 0 workers was attributed due to smoking. This is
in glaring contradiction to the previous report.
Further Dr. Kothari was a person of management’s
choice, the latter having succeeded in circumventing
the union's demand of a medical panel chosen by
both workers and management.
Safety Programmes of the Safety Department
The safety programmes initiated by the Safety
Department stress on unsafe worker action as the
cause of accidents. Worker carelessness, lack of
precaution, and dare-devil tactics attributed do
workers are said to be the root to accident causa
tion. In view of raising safety consciousness, safety
schemes for workers are actively advocated, thus
absolving industry of blame and responsibility and
averting demands for workers control over the work
process.
While normal medium sized managements resort
to minium compliance with the law, if they cannot
bribe the factory inspector, the larger more prog
ressive
management, particularly in chemical,
petro chemical and engineering industries, are more
sensitive to health and safety issues as precau
tionary measures. The primary focus is on the safety
of equipment in order to avoid losses that can
accrue from accidents. Expert personnel and agen
cies may even be invited by management to
undertake research studies on the health and safety
conditions in the plant and make suggestions for
improvement. The reports however remain the
management's private property. Competing trends in
industry to have accident free records and thus
merit national safety council awards are another
motivation to improve health and safety conditions.
It must however be noted, that though technical
solutions like fencing of machinery and fitting of
guards is
resorted to with
swiftness,
basic
restructuring of the work environment and work
processes is rarely done from the safety point of
view. In the final analysis health and safety action
by Maganement is undertaken at management's
pace, under management initiative and control,
with professional management appointed presonnel
on the job thus smothering worker initiative at
every stage.
December 1984
Thus tens of thousands of workers are injured
in work place accidents. Several more suffer from
occupational diseases and keep dying, while no
one bothers to notice.
Conclusion
It is thus necessary for unions to begin questioning
their management-oriented conceptions of occu
pational health and safety and begin to clearly locate
the roots of occupational diseases and accidents,
link with pro-worker specialists and institutions/
centres on health and safety in India and abroad
as well as workers in other industries in India or
abroad must be created. This will help the acqui
sition of information with respect to one's own
industry as well as other industries. It also helps
build support structures and co-ordination between
workers of various industries prior to and during
a struggle. Furthermore, a struggle for stringent
implementation of the laws needs to be made. The
demand for a comprehensive law speciffically
relating to health and safety may also be raised.
The law must be changed to involve workers and
their unions in the process of detection and repor
ting and providing direct access from them to the
factory inspectorate and other public agencies and
institutions concerned with occupational health
and safety. It is necessary for workers to demand
formally created channels in their unions to monitor
accidents and ill health at work and demands for
personal protective equipment, safety mechanisms
or even basic restructuring of the work process
may be raised (whenever and wherever possible).
Finally, it must be stated that a meaningful
change can only come about through a revoluionary transformation of the capitalist social order
and the constitution of a 'genuine workers’ "State"
that will ensure safe working conditions and a
disease-free work environment, the formation of
such a state is however a long term goal, the move
ment towards which can in part be initiated by
certain concrete short term actions on health
and safety here and now.
This can become the
the springboard for a consistent and consistent and
consolidated health and safety movement in India
within the framework of a generalised revolutionary
struggle for health and safety.
( See tables overleaf)
TABLE I
No. of industrial injuries
Year
No. of Fatal accidents
1976
1977
197$
1979
1980
1981
$00 319
316,273
347,016
$16,481
356,3.41
390,783
831
690
776
852
806
843
Annual Average during this period
337,869
799
Source : Indian Labour Yearbook. 1377-81»
TABLE It
Total for period 1976-1981
Annual Average
1686
16936
281
2823
1823
155041
304
25840
124
10397
1733
MINES
Fatal
Serious-
RAILWAY
Fataf
Non-Fatal
PORTS & docks;
Fatal
Non-Fatal
21
TOTAL
606
30396
Fatal
Non- Fatal
Source ; ILYB 1977-81;
PBLS 1982-83
TABLE HI
Cases of Occupational Diseases Reported Under the Factories Act, 1948 for the years 1960 - 1980
Year
No. of
Year
No. of
cases
1975
1974
1973
1972
1971
27
19
14
17
3
cases
1980
1979
1978
1977
1976
32
12
19
23
12
Year
No. of
cases
1970
1969
1968
1967
1966
1965
42
38
22
37
50
5
Year
No. of
cases
1964
1963
1962
1961
1960
17
30
76
106
38
Compiled from Indian .Labpur Book, 1967-1982, figures being obtained from reports of Factory Inspectorates of the States.
122
Socialist Health Review
Table IV
Cases of Occupational Diseases Reported Under the Factories Act, 1948
During the years 1976-1980
Name of disease
NAME OF STATE
Maha
Punj
Hary
Karn
Bihar
Rajas
West Beng
1. Chrome Ulceration/
Poisoning
—
22
3
—
—
—
2. Silicosis
1
—
—
—
—
2
—
3. Halogen Poisoning
11
—
—
13
—
—
4
4. Benzene Poisoning
12
—
2
—
—
5. Lead Poisoning
—
—
—
—
6. Toxic Jaundice
—
1
4
7. Toxic Anaemia
—
—
4
Oris
TOTAL
—
27
15
—
1
—
—
—
—
14
10
—
—
—
10
—
—
—
—
—
5
—
—
—
—
—
4
15
8. Dermatitis
—
—
2
—
—
—
2
—
4
9. Phosphorus Poisoning
2
—
—
—
—
—
—
—
2
10. Asbestosis
1
—
—
—
—
—
—
—
1
11. Nitrous Poisoning
1
—
—
—
—
—
—
—
1
Tota I
28
23
15
13
10
4
4
1
98
Compiled from Indian Labour Year Books for the years 1977 to 1982, published by Labour Bureau, Simla.
Table
V
Cases of Occupational Diseases Reported Under The Workmen's Compensation Act, 1923
for the years 1966-1979
Year
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
Temporary
Disability
Permanent
Disability
Deaths
Total No.
of cases
—
—
—
NA
—
—
—
—
•—
51
10
1
NA
NA
89
86
NA
NA
2
2
NA
NA
91
96
33
34
14
13
14
4
NA
NA
91
88
102
107
91
96
33
34
24
73
91
89
125
115
—
—
—
—
10
59
67
84
NA
NA
States form
which reports
Kar
Kar-84; AP
Kar
Kar
Kar
Kar
Kar
Kar
Kar; MP; AP
Kar; AP; MP; Ker
Kar; AP; Ori
Kar; AP
Kar; AP
Kar; AP
Compiled from Indian Labour Year Books 1 967-1982
Kar : Karnataka; AP : Andhra Pradesh; MP : Madhya Pradesh ; Ker : Kerala; Ori : Orissa.
December 1984
123
Table Vt
Estimates of Incidence of Occupational Disease based on Sample Studies
Disease
Sample
Size
Percentage
affected
1953
1970
1976
(ICMR)
808
464
899
196Z
1989
16
33
14-Carding
10-Spinning
11 -Weaving
7.8
900
Storage
Batteries
1981
(CLI)
1981
(CLI)
Occupation
Silicosis
Silicosis
Byssi nosis
Potteries
Foundries
Cotton
Textiles
Asbestosis
Asbestos
Lead
Poisoning
Year
6.5 (p)
30.0 (P)
9.1
365
Silicosis
Slate Pencil
1979
151
57
Carbon
Disulphide
poisoning
Rayon
1958
270
27
Silicosis
Gold mining
1947
7655
43.8
Pneumoco
niosis
Coal mining
1961
950
19
Manganese
poisoning
Ferro-manganese manuf.
1961
179
Chrome
Ulceration
on skin
Dichromate
Manufacture
1963
631
(D) :
Definite Asbestosis
(P) :
z
Size of Workforce
Estimate of Disease
(for this industry nationally )
23,060
66,000
743 630
1845
10560
37181
8,210
11.230
258
1231
511
24
20
Possible Asbestosis
Data on Sample studies from Indian Jorurnal of Occupational Health and Central Labour Institute, Bombay,
Table VII
Prosecutions under the Factories Act for the year 1979
No. of
Convictions
Type of conviction
Percentage
1) Non-compliance with Provisions
of Notices, Registers and returns.
4679
31.4
2) Convictions for long hours of
work and employment of women:
in hazardous occupations.
2133
14.3
2090
14.0
1617
10.8
4383
29.5
14902
100.00
3; Violation of Health
provisions.
and safety
4) Violation of health, sanitary ancf
welfare Provisions.
5) Others
6) AIT convictions
..... —fa
Source : Compiled from Indian Labour Year Book/ 1982
124
Socialist Health Review
Table VIII
Percentage of loss
of earning capacity.
Description of Injury
1.
Loss of thumb
30
2.
Loss of thumb and its metacarpal bone.
40
3.
Amputation from 20.32 cms from
tip of acroman to less than 11.43 cms.
below tip of olecranon.
70
4.
Amputation below hip with stump not
exceeding 12.70 cms. in length measured
from tip of great trechanter.
8G
5.
Crullotine loss of tip
without loss of bone
4
of
middle
finger
Source : Workmen's Compersation Act, 1923
Notes
1.
It is assumed that there are 300 working days
to the year. For this period on an average 8
persons died every 3 days. The number of
deaths in Maharashtra and Uttar Pradesh
respectively over these 6 years is 866 and 639.
2.
For all fatalities i.e. 1405 per year, works out
to average of 14 deaths every 3 days.
3.
The large number of cases in Karnataka are
those of silicosis from the gold mines at Kolar
gold fields, where studies as early as 1947
showed a high incidence (44%) of workers
affected by silicosis. The fact that a large
number of cases are reported and compensated
shows how widespread the disease is, as well
as indicates an active workers' organisation
and a functioning occupational health faculty.
Further investigation is called for.
4.
Estimate of this for this industry nationally
== Workers employed in this industry x 0.5
x % of workers affected in sample study 4-100.
References
Audyogik Jeevan Manch, Asbestosis, a killer disease Pune, March
1982.
Background papers for the national seminar on Safety Manage
ment in Industry February 1984. Published in Industrial Safety
Chronicle, January-March 1984.
Behare, Meenakshi, Killer Asbestos, Special Report I Business
India, January 17-31, 1983.
Castleman I.C. and Vera, J.V. The Selling of Asbestos, Science
Today, pp 47, July 1982.
Central Labour Institute (CLI). Handout on Accident Prevention
September 1982.
Centre for Education and Documentation. Asbestos - The dust
that kills Counterfact, Bombay 1983.
December 1984
Chakravarti, S and Bhar. S. Occupational Lead Exposure in IndiaLead Acid Storage Battery Manufacturing Industry. Central Labour
Institute, 1981.
Indian Labour Year Book, 1977, Report of the Director-General
Mine Safety.
Indian Labour Year Book, 1982, 1983.
Kamat, S.R.
Nair, R. R. Workplace accidents are increasing. Science Today,
September 1982.
Padmanabhan. V.T. The Gas Chamber on the Chambal. PUCL,
Madhya Pradesh, 1983.
Jean D'Cunha
Empress Estate
Govandi Road, Chembur
Bombay 400 071
(Contd. from page 109)
References
Castleman, I. C. and Vera, J. V. The selling of Asbestos, Science
Today, pp. 47, July 1982.
Hardy, H.L. ' Beryllium Poisoning - Lessons in Control of Man Made Disease New England Journal of Medicine, November
25, 1965, pp. 1188, as quoted in Berman, ‘Death on the Job '
( PP. 92 ).
Marx, K. ‘Wage Labor and Capital', Selected Works, Vol. I, Progress
Publishers, Moscow, pp. 153.
Navarro V. ' The Determinants of Social Policy, A case study ;
Regulating Health and Safety at the workplace in Sweden',
International Journal of Health Services, 13:4 (517), 1983.
Powles, W.E, and Ross, W. D. Industrial 8 Occupational Psychi
atry in American Handbook of Psychiatry. Basic Books Inc., NY,
pp. 588-601, 1966.
Transactions of the National Conference on Cotton Dust and
Health, May 2, 1970, pp. 89, as quoted in Berman, ' Death on
the Job ' ( pp. 93).
Sandeep Agarwal
405/B-39 Yogi Nagar
Borivili (W) Bombay 400 092
A 25
HAZARDS OF AGRICULTURAL WORK
A Case Study from Punjab
peoples health group
Hazards of agricultural work are not only a consequence of the intervention of modern technology, such
as machinery and chemicals. More importantly, they may be traced to the prevalent exploitative mode of produc
tion and class relations. Agricultural workers encounter a wide range of health hazards — injuries du° to
farm machinery, fertiliser and pesticide poisoning, animal bites, electric shocks and others. This is a report
of an analysis of thresher accidents recorded in one hospital in Punjab. Overwork, defective machinery,
drug addiction and other such factors are also considered.
I-H rom time immemorial the issue of health and dis
ease has been vitally linked with the total humen
environment (physical biological and socio-political).
This link is as important today, as it ever was.
Shortcomings in the different aspects of environ
ment give rise to specific disease patterns.
In a country like ours, most of the diseases
are the result of the interact.ipn of poor quality of
nutrition, clothing, housing, water-supply, excreta
disposal, working conditions, transport facilities,
environment and socio-psychological interactions.
In all these aspects of life, which are vital for
the health of the people, the issue of class is
almost always involved directly or indirectly. The
most exploited and poor classes in a stratified
society like ours, are the worst victims of the
various aspects of pathogenic environment. The
diseases produced by various aspects of the disease
producing environment are further interlinked with
each other. The diseases created by one aspect of
the environment influence and are influenced by
the diseases produced by other aspects of the
environment. The ones placed low.est in the, class
hierarchy are the worst, victims of this vicious cycle.
The issue of class is again central in the prevention
and treatment of diseases in a stratified society.
The facilites for prevention and treatment are. avai
lable according to the position in the hierarchy of
classes.
Environment of the work place has always played
an important role in the pathogeneses of disease.
Over a period of time this influence of working
conditions on the issue of health and disease has
enormously increased because of introduction of
various advanced techniques in different fields of
life including agriculture. The introduction of mecha
nisation, high yielding varieties of seeds and the
associated use of pesticides and fertilisers has
ir>creased productivity enormously. But in the present
126
set of socio economic conditions, which are based
on callous profit earning, these techniques have
brought in new health hazards also. The benefits of
these techniques being used for the so-called green
revolution' have reached the people in direct propor
tion to their assets. The d'spossessed i.e. the
agricultural workers are least benefitted. However,
they have received a maximum share of the ill effects
of these developments. It must be emphasised that
health hazards to which the agricultural workers are
exposed are not qualitatively different from those of
poor and middle peasants. The reason is very obvious.
These health hazards baing connected with agricul
tural work affect whosoever is physically involved
in the work. However given the class nature of our
rural society, more the hazardous work, more the
likelihood of it being done by the lowest placed
classes. It must be added further that in most parts
of our country agricultural workers are synonomous
with harijans. Thus in the hierarchy of class and
caste in our rural areas the agricultural workers/
harijans are much more likely to be the victims of
health hazards in agricultural work than the other
relatively privileged classes/castes. Ignorance and
illiteracy of the downtrodden further viciates the
, problem.
The various health hazards connected with agricul
tural work are enumerated below :
(a)
Injuries connected with agricultural work partic
ularly those caused by farm machinery.
(b)
Poisoning with pesticides.
(c)
Skin disorders due
fertilisers.
(d)
Health hazards of overwork, particular postures
and drug addictions.
(e)
Bites by various poisonous animals.
(f)
Electric shocks.
(g)
to the use of
chemical
Miscellaneous, including sun stioke, heat stroke,
. allergies and hook worm etc.
Socialist Health Review
People involved in agricultural work are highly
prone to various injuries. The cause of injury ranges
from compulsion to work barefoot to the use of
fast moving farm machinery. Amongst the machines
which are likely to cause injury , to the user the
wheat thresher occupies the top position. Due to
this the injuries caused by the thresher machine
have been discussed in a bit of detail. In a state
like Punjab, old methods of threshing of wheat
have altogether been replaced by the thresher
machines and combine harvesters. About 2 lac thre
shers are used in Punjab during each harvesting
season. The number of those who get serious inju
ries is expected to be around 1000 each year.
According to official information given in the Punjab
assembly on Sept. 7, 1978, 841 cases of loss of limb
or life occured during the previous three years;
eight agricultural labourers were killed and 24 cases
lost two or more limbs, in others one limb was
affected.
Study of Thresher Accidents
People s Health Group, Punjab, has analysed the
data of 48 cases of thresher injuries who came for
treatment to Rajindra Hospital, Patiala, from January,
1982 to June 1984. Sixry percent of the cases were
agricultural labourers while the rest 40 percent were
poor and middle peasants. Out of the 28 cases of
agricultural labourers 8 were from outside the state
while others were Punjabis. Sixty five percent cases
were young i.e. below 25 years of age (the youngest
being 14 years) 20% were between 25 to 50 years
of age while the rest 15% were above 50 years of
age. Two cases were around 60 years of age.
Extent and Nature of Injury: Out of 48 cases,
six (12.5 percent) involved lower limb injuries while
in the rest 42 (87.5 percent), upper limbs were
involved. In all cases of lower limb injury the
amputation was below the knee. It looks strange
how leg injuries could be caused by a thresher
machine ? In all these cases the leg was used to
push the stuck up fagot of crop when force of the
hand was not enough. The strucking up may occur
due to defect in the machine or putting in too
much crop due to haste. Out of 42 cases in which
the upper limb was involved, in 31 (73.881 percent)
the limb was right while in 11 (26.19 percent) cases
it was left. Amputation was below the elbow in 35
(83.33 percent) cases while it was above the elbow
in 7 (16.67 percent) cases.
Causes of Thresher Accidents: None of the
threshers being used had any protective device at the
time of the accident, all threshers being usedin the
December 1984
above cases were cheap models which costabout
Rs. 4000/-. In all thesecases ISI standards wersgrossly
violated. It is a known fact that only 10 percent of
threshers being used in Punjab come upto the ISI
standards. There is a long standing dispute bet
ween the industries department of the Punjab govt.
and the Thresher Manufacturers Association. The
industries departmemt insists on ISI standards while
the manufacturer's association tries to bypass these
standards under one excuse or the other. Many
improved models of threshing machines have be
come available in the market but have failed to gain
popularity because of the high costs. The best model
of thresher costs Rs. 40,000/-. In all these improved
models the chances of accident are minimal, in
addition to the increase in efficiency. Even the
cheapest models which were being used in the above
quoted cases, can be provided with some protective
measures without adding much to the cost. The only
drawback of such protective measures is that it
reduces efficiency to some extent. Because of this,
even when provided at the time of manufacture,
they are removed by the land-owners when the
threshers are put to use.
Landowners have a tendency to invest least amo
unt of money on the thresher machine because it is
to be used only for a few days in a year and that
too mostly by the hired labour.
In addition to this major cause of accidents i. e.
the defective machines, other factors also contribute
significantly(i)
Every peasant cannot afford to buy a thresher
machine alongwith motor or engine. Thus
many poor farmers either hire a thesher or share
it with their friends and relatives. This increases
the quantum of work on each thresher. Thus
generating the tendency to run it round the
clock.
(ii)
Most of the farmers lack space to store the grain
and thus are compelled to take it straight from
the fields to the market. Fearing the uncertain
weather which may damage the unthreshed
crops and threshed grains, the farmers have a
tendency to finish the threshing work as quickly
as possible.
(iii)
The govt, usually puts up a time limit for the
supply of electricity for threshing purposes. Thus
the farmers are compelled to finish the work
during that limited period which is possible only
by overwork.
A 27
(iv)
The agricultural workers easily surrender to dd
overwork because in addition to the psycholog
ical pressure of their employer they are anxious
to earn for the lean months as the employment
is only seasonal one.
Under these circumstances overwork is a universal
phenomenon during the harvesting season which is
possible only under some sort of intoxication. The
most common intoxicant used in such situation is
opium which is offered to the labourers by the land
owners. It is a well known fact, at least in Punjab
that many agricultural labourers become opium
addicts during the harvesting seasons. When they
become addicted they have to purchase the opium
which results in economic and other related conse
quences affecting directly and indirectly the health
of whole of the family. The other intoxicants
commonly used are country made liquor, chewing
and smoking of tobacoo and poppy husks etc. All
these intoxicants, have a tendency of habit form
ation with their consequent effects. In a nutshell the
combination of overwork beyond a physiological
limit and intoxication make the worker prone to
the accident in an unsafe machine.
In the above 48 cases which were studied by us,
55 percent cases confessed of having resorted to
over work ranging from 9 to 40 hours without any
rest. However, this percentage was higher 65 percent
when calculated for agricultural workers alone. The
use of intoxicants was recorded in only 10% of the
cases. This was in contrast to the observation by
many of our friends who are directly related to
agricultural work. The person dealing with such
cases in Rajendra Hospital Patiala told us that
the fact of intoxication is Usually concealed because
of the fear that blame will be put on them and any
possible compensation including the free treatment
in the hospital may be denied.
The above facts clearly reveal that accidents are
not mostly with the use of machinery rather, it is the
type of class relationships and mode of production
which is responsible for the high prevalence of
accidents in the use of farming machinery. Very low
incidence of such accidents in China is the best
example to contrast backward capitalist mode of
India with socialist mode of production.
Further the quality of treatment and rehabilitation
will again depend on the class status of the victim
because these are purchaseable commodities. Again
to contrast the two modes of production, highly
advanced reconstructive surgery is available in
China to the workers if he or she happens to get
128
Such an injury. To think of reconstructive surgery
for the Indian workers seems quite foolish. In a
nutshell, the chances of having an accident and the
amount of final disability depends on the class/
caste of the person and the mode of production in
that society.
The health hazards associated with agricultural
work next to injuries is poisoning due to the use of
chemicals for plant protection. In the underdevelo
ped capitalist countries pesticides are being used
on a very large scale, both, for agricultural and
public health purpose. The high yielding varieties
of seeds which are being used as part of strategy
of the green revolution' are highly sucesptible to
diseases and to safeguard them highly poisonous
chemicals are used. In India in 1983-84 the propo
sed consumption of various pesticides in the agri
cultural sector was as follows :
1)
Organochlorine compounds - 65,035 tonnes
(D.D.T., B.H.C., and Aldrin etc.)
2)
Organophosphorus compounds
(like malathion, parathion etc.)
23,000 tonnes
3)
Carbamates
6310 tonnes
4)
Plant origin
120 tonnes
5)
Fumigants
1300 tonnes
The pesticide most commonly being used in
India and other backward capitalist (BC.) countries
are organochlorine and organophorus compounds
which had long been banned in the Western count
ries where their manufacture originally started.
Now, either the factories have been shifted to the
BC. countries where they are being run with the
collaboration of Western transnational companies
or the pesticide is being exported after its manu
facture. Two lac of such chemicals are being expor
ted from the US. to the BC. countries.
A recent report of the International Development
Research Centre, Ottawa, reveals that there are seven
and a half lac cases of acute poisoning with various
varieties of pesticides. Half of these are reported
from the third world countries out of which one-third
are reported from India alone. The number of deaths
from poisoning are reported to be 10,000 annually
in the third world out of which one-third are from
India. The extent of chronic poisoning is so huge
that it is very difficult to evaluate its effects. Indians
have highest tissue level of DDT in the world i.e.
12.8 to 31.0 parts per million (PPM). The average
DDT intake of an Indian is 0.27 mgm/day/person.
Socialist Health Review
In India there is a 5% annual growth rate of
pesticide consumption since 1972 with a corres
ponding increase in the number of cases of poison
ing. The people involved in agricultural work are
more likely to have acute as well as chronic poison
ing than the people at large. Further out of these
the
agricultural workers are even more prone
because the land owner who can afford to purchase
pesticides, is usually not involved physically in the
plant protection work. The study undertaken in five
districts of Gujarat (E. P. W., 1980) also reveals this
fact. Farm labourers are worst affected because
majority of them are exposed for a longer period
due to their continuous contact during spraying
operations, and that also without any protective
devices. The protective devices are almost invariably
not
used;
firstly, because the manufacturing
companies underplay the toxic effects of their
product and also are disinterested in the manufacture
of protective devices (As quoted in the E. P. W.
study only 2 out of the 58 companies studied were
manufacturing protective devices); secondly, the
whole system being profit oriented and exploitative
the rich farmer is not interested in spending for the
safety of the agricultural worker, thirdly, because of
the fact that the agricultural workers being poorly
paid are unable to purchase the protective devices
by themselves and lastly because of illiteracy and
lack of information the extent of toxic effects are not
fully known to the workers.
Very few studies have been conducted on the
long term bad effects of pesticides. The Indian
Toxicology Research Centre in collaboration with
the neurology Department of K. G. Medical college,
Lucknow, have conducted some studies. These
studies revealed that one-fifth of the farm workers
involved in spraying had impaired eyesight follow
ing muscular degeneration. Cases of cancer, stunted
growth of their children, deformities, blindness,
diseases of liver and nervous system have been
identified in the cotton growing areas where the use
of pesticides is more frequent. A recent study has
shown that 73% of these workers had toxic
manifestationsincluding cardiovascular and intestinal
problems. The agricultural workers of Karnataka,
who used to eat fish and crabs from the paddy
fields in which they were working and spraying
pesticides, were afflicted with severe paralysis and
other diseases including what is called "Handigodu
Syndrome."
The study of Gujarat quoted earlier had taken the
figures of poisoning cases from the civil hospitals of
Vadodara and Surat. In all 70 patients of acute
December 1984
poisoning in three years from 1976 to 1978 were
studied. AH these 70 cases were agricultural workers
including two women. None of these workers was
provided with any protective device. The hospital
admissions are a very poor index of the extent of
poisoning. Firstly because all the cases don't reach
the hospital, and secondly these are only of acute
poisoning which is only a fraction of the total
poisoning being done.
There is no legal protection to 'the victims of such
accidents and poisoning cases Workers Compensa
tion Act does not include these cases under the
pretext that the act is only applicable to industrial
workers. None of the 48 cases which we studied
turned up to obtain any certificate for the purpose of
compensation. Similar was the case with the poiso
ning in Gujarat who were not given any sort of
compensation.
We could not trace a case in our study in relation
to dermatitis caused by the use of fertilisers,
particularly at the time of sowing of paddy, though
it is a known fact that handling of fertilizers causes
skin diseases which are sometimes so severe that the
worker has to abandon the contact with fertilisers.
There is a whole range of morbid conditions resul
ting from overwork, working in unphysiological
postures, and the associated drug at use. With the
introduction of mechanisation in agriculture and
strengthening of its bonds with the market has in
creased the intensity of exploitation of labourers.
The intensity of extraction of surplus labour has
increased many folds which in the given set of
class relationships is bound to increase the aliena
tion of the workers because psychological aliena
tion is in direct proportion to the extent of aliena
tion of labour power. The usual expressions of
psychological alienation i.e. psychosomatic disor
ders, psychological diseases, use of intoxicants
and crimes etc. are bound to increase. Though no
study evaluating these effects could be traced, yet
one can easily feel their increasing trends. The
rise in all these disorders in society, including
rural, is clearly visible. Though these disorders
are not confined to the agricultural workers, the
total quantum of morbidity in this context is very
obviously more on them than the other relatively
privileged classes.
Because of the above facts combined with the
changing social pattern and breaking down of old
values, the use of drug intoxication is on the rise.
The effect of those intoxications is bound to be
worse on agricultural labourers because of their
( Contd. on page 14Q j
a 29
DIALOGUE
Marxist View of Health & Medicine : A Rejoinder
Bharat Patankar and Jogin Sen Gupta
In its first issue SHR rightly carries articles on
historical and general perspectives. We think it is
necessary to give an immediate response to the
perspective which comes out in this issue of SHR
(1 : D
In his review of A Cultural Critique of Modern
Medicine Anant Phadke writes, "John Ehrenreich
first traces the historical and political origins of
the 'cultural critique' of modern medicine. Ehren
reich alleges that the political economic critique
concentrates its fire on the inequitable distribution
of health services, on the problems of organisation
of medical care and is not much concerned with
the nature of medicine itself. Ehrenreich is not
entirely correct in his analysis. There are marxist
analysts who analyse the political economy of
health not primarily from the standpoint of distri
bution of medical services.”
While it is true that "there are” marxist analysts
who take a different approach, the point is that
the vast majority of them take the viewpoint criti
qued by Ehrenreich. In India, for example, we
must ask, among thousands of marxist doctors,
political economists and cultural workers, what
sort of debates on the cultural and political aspects
of medicine we have had up to now?
Howard Waitzkin's article is revealing as it
purports to give a detailed and researched account,
with 260 references, of marxist analyses in the
field of health care covering about 150 years. It is
an excellent example of Ehrenreich's claim.
Waitzkin starts from Engels' The Condition of the
Working Class in England. In this, "the first major
marxist study of health care... Engels traced such
diseases...to inadequate housing, malnutrition,conta
minated water supply and overcrowding .. This
treatment was to have a profound effect on the
emergence of social medicine.” With this, he makes
his views about "health” and "health care” explicit
at the outset. Can causes and removal of "poverty
diseases” be the central problematic of Marxism
in "health care”? (Even Marx and Engels were
less ^confused about their target - not poverty but
exploitation and oppression). In developing coun
tries, "poverty diseases" still play a huge role.
But what is the situation in Waitzkin's own country
and the rest of the developed world? Today, the
advanced bourgeoisie and the modern state have
130
almost eliminated "poverty diseases”, as Waitzkin
also observes later. Poverty, unplanned industrial
isation and to an extent ecological imbalance as the
causes of "ill health” are not only propagated by
established sciences but are incorporated in some
form or other in the legal provisions of the bourgeois
states, e.g. OSHA (Occupational Safety and Health
Act) in the U.S.A. But this transforming of sick
slaves of capital and the state into healthy ones
has not weakened the system at all; it has led to
strengthening itstentaclesof exploitation and control.
And, did the world have to wait until Engels to
learn that bad living conditions lead to many
diseases? Did these start with capitalist industri
alisation? These stated far earlier—from the time of
the city-state-civilisations. Tribal communities were
much healthier. The sanitation engineers of Mohenjodaro surely had a clear understanding, of the
problem.
With such a traditionally defined view of disease,
the central aspects related to health in both the
"developed” and "developing” world —ecological
devastation, poisoning of the environment, alienated
relations between humans and nature, militarism
that threatens the survival of all life, sexism and
racism, large-scale cultural-psychological perver
sions, and destruction of human relations — are
ignored completely by Waitzkin. Realisation of
such factors has raised basic questions for Marxists
in the "developed" world : such as, can one solve
such problems simply by taking over the existing
poisonous forces of production?
And, given
massive
cultural-ideological-psychological muti
lations produced by the system, can the "working
class take over the state”? Also, arethese problems
simply due to the capitalist mode of production,
as Waitzkin's approach implies, or are they the
end result of an accumulated chain of patriarchal,
statist and class societies?
Waitzkin gives great emphasis to the nature of
exploitation in the capitalist production process in
terms of surplus value and the class structure
defined by that. He takes this as Marx's approach.
To do this is a very limited cognisance of the
analysis of the capitalist system given by Marx
himself. In Capital Marx deals with many other
aspects like alienation/estrangement, devastation
of natural resources, destruction of cycles of nature
etc. The article also ignores recent studies of the
Socialist Health Review
nature of the internal structures of industries and
of their production including their effects. This
narrow approach forces the author in to the trap of
emphasising control of the means of production
and poverty, which cannot lead to any alternate
conception of illness and health care differing from
the established concept. The most serious effect of
this is the complete disregard of relation between
questions of health and the oppression of women,
minorities, lower castes and others. In the author's
own country there are countless examples of women's
groups and minority groups and alternate-psychiatry
groups raising these issues. In this situation igno
ring this challenge is an inexcusable mistake. For
the last some years communist parties
and
marxists in general have been facing many diffi
culties in trying to deal with such issues within
the framework of a narrow approach to 'surplus
value and class exploitation." Many marxist studies
have come up which are trying to develop a new
approach. But the author does not confront this
issue. He talks about women at one point. "Hist
orically, women's use of health facilities and the
attitudes of medical practitioners towards women's
health problems have depended largely on women's
class position" (1.1) ignoring the specific oppre
ssion of women even within the working class.
Some words mentioning "housewives’ problems"
cannot wash out this serious error. The fact is that
in the USA it is not working class struggles in the
economic sense that have transformed the meaning
of "health", but the anti-sexist, anti-racist move
ments and those in the area of ecology and
militarism right up to the tiny but significant issues
raised by alternate psychiatry, gay and other move
ments that have forced us to re-examine our
concept of "health"The author's mention
of
his
view about
revolution at the end of the article expresses in a
nutshell, his imprisonment in a mechanical and
outdated approach towards alternate health. He
writes "Gaining control of the state through a
revolutionary party remains a central strategic
problem for activists struggling for the advent of
socialism." (1 :1) Among other things, this conception
becomes dangerous for the emergence of any
perspective of alternate health. First of all, it is a
serious distortion to give the reference of Lenin for
this statement. Whatever may have followed the
October revolution, Lenin did not have a conception
of "gaining control of the state through a revolu
tionary party". His was a conception of smashing the
old state and establishing Soviet power which was
also supposed to go on withering away. This
December 1984
approach at least implies peoples' control and
gradual decentralisation and dissolution of cent
ralised power over the heads of the people. Such a
view has very positive implications for alternate
health practices in relation with the emergence of
the self-management of health by the people them
selves. At the same time, with the experiences of
the post-revolutionary societies it is evident by now
that a statist approach gives rise only to a new but
still oppressive system and maintains the powerless
ness of the working masses. Atone point the author
touches the problem briefly where he disusses the
USSR in relation to the class position of medical
professionals. But mainly he poses increasing state
management of health as a progressive development
by showing how capitalists oppose it or how
private practice interests still manage to exploit it.
This cannot explain the existence of severe health
problems for the mass of the population in countries
like India where the state sector is predominant in
health, or even in the Soviet Union, China and
other such countries where frightening things like
devastating ecological imbalances, the masses spread
of alcoholism and so on, continue to occur.
The party-controlled state and the conception of
revolution which emerges out of the concrete practices
of post-revolutionary societies can create nothing
but a society in which health-related major ecological
problems of capitalist industrialisation and agricul
tural production continue to exist. It cannot create
a health system which is not alienated from peoples'
creativity and the natural balances between humans
and nature. Of course, from Waitzkin's view of
health care specialist doctors plan rationally, the
state implements it. If health is lack of some illne
sses and mortality/morbidity rates are the indicator,
there seems to be no problem. But in our concep
tion, illness and health care are a mode in the
relation between people. This can be liberative or
oppressive. Liberative, when it is an aspect of a
movement against distortions of our mind and for
social liberation Health work can grow in terms of
increased mutual and community care when it
becomes a means of building up the solidarity,
humanity and autonomy of people in communities,
with technology
and
specialised
knowledge
shaped by and helping the control of these pro
cesses. Conversely, the state may soak up this
possibility of mutual help and self-management
and strengthen the top-down, specialist apparatus
and power over the people. Such a way strengthens
the mode of life based on "Give power to the
leadership/state and they will look after you."
Waitzkin misses the fact that the more "efficiently*’
13A
and "successfully" this mode functions, in reducing
mortality and morbidity, the more is its success in
empowering the state at the cost of the people.
Illusions created by the "public-private contra
diction" have made many communist parties and
otaer marxists think that the growth of the state
sector is something progressive and going nearer to
socialism. But the health system will not radically
change to become a liberative process if the new
arrangement only subtracts the bourgeoisie and
replaces it with experts and bureaucrats while
organising a better distribution of the existing type
of facilities. We have to break from the prevalent
concept of health forced upon us by centuries of
the health establishment and society — and to under
stand a health system as itself a process of
liberation.
Finally, after defining the ''central
strategic
problem for activists," Waitzkin concludes by des
cribing what they are doing. But this can be
extremely misleading, for of the three trends he
more or less classifies as those advocating a "van
guard party", a "mass party" or "counterhegemonic" work, only a very small minority hold the
mechanical view of taking control of the state which
he puts forward in the article. To say that "Party
building is now taking place throughout the United
States (1.1.)" is an inaccurate, to say it most kindly,
depiction of the innumerable mass movements the
US has seen.
If we look back at Waitzkin's own bibliography of
260 references, there is hardly any marxist critique of
health before 1970 in the USA. The reason seems to
be that it was the struggles of blacks, women youth
and othersthat transformed the earlier sterile attitudes
towards health and stirred them up. It is sad that
Waitzkin, instead of starting from the reality of the
movements, reverses this process by trying to fit the
creative activism of the people into the "work of
Party builders" and into such an authoritarian and
narrow concept of Marxism. In the end, his type of
"marxist view" raises the question, what was Marx's
view? Marx vigorously supported movements against
exploitation and oppression and tried to learn from
them. In his openness to learn from rebellions he
was ready to throw away much of his earlier views.
This, and not narrow theoretical preconceptions, we
think, should be the "marxist view."
Need for Analtqical Rigour
Imrana Quadeer
SHR's effort to provide a platform for discussions
and interaction between activists in the field of
health and its focus on the process of distilling the
truth from various trends within the marxist movement
is most welcome. However, the fact that health and
medicine cannot be separated from the problems of
the wider social order, underlines the dilemma that
no serious analysts of health and medicine in India
can afford to take for granted the issues within this
wider social order. A theory of health and medicine
is not possible in isolation. Those who try to build
such a theory would be required to develop an
analysis of society as well. SHR has circumvented
the problem by leaving this task to other forums and
have presumed that readers will either know the
debates on these issues or will accept the views
that contributors present. An easy way out perhaps,
but not one that is conducive to constructive debate
on either the specific theory of radical health action
or general theory of radical political action. For
example, when we talk of "political economy of
health", "articulation of medicine within a mode of
production" or "class structure in health system"
without specifying our understanding of the terms
132
used, we not only fail to communicate but often
create confusion.
It seems to me that a debate concentrating on
health and medicine alone, however rigorous, tends
to treat these generel concepts superficially. Thereby,
hampering the very purpose that it set for itself, that
is, understanding the relationship between health
and society. I would plead therefore, that even if
SHR is interested in a very restricted readership of
the aware converts, it still needs to handle the wider
social system with much greater rigour. However,
if SHR is interested in a readership, of doctors and
other health workers who were attracted to marxism
because in it we found a better approach to handle
our own contradictions and for relating ourselves to
the wider society, then SHR's policy becomes a
major handicap. For us, the study of health, medicine
and health services in India has not only been
instrumental in deciding our professional roles but
it is also a tool for understanding the society we
live in. SHR does not seem to be interested in that
window.
Socialist Health Review
I would infact argue that this neglect leads SHR
into an uncritical acceptance of certain general
formulations which might sound very radical but
which do not stand the test of scrutiny. The mere
quantum of the so-called marxist analysis of health,
done in the west has so impressed us that we have
literally lifted their formulations and transplanted
them on the Indian scene, without even thinking
whether they are applicable. Further, in our hurry to
fill in the gaps in our knowledge, we have concen
trated on theory of health and medicine. That theory
however, has been sought by filling the accepted
theoretical constructs with Indian data and develo
pments rather than beginning with health and health
services itself to test the assumptions as well as the
theoretical constructs. Such an approach creates
many conceptual and merhodological problems.
Another weakness has been our definitions and
terms and the lack of empirical analysis and date
base.
that input in health care by the state has an econo
mic basis because it is necessary in the creation of
surplus value. Even the fact that in India 90 percent
of the industries belong to the unorganised sectors
whose workers are provided no facilities for health
care, agricultural producers who contribute 45-50
percent to the GNP have little access to health serv
ices and the existing health care facilities of the
country are utilised by the elite and the middle class
not the labouring classes has not provoked us. Could
it be that tha existence of a large reserve of surplus
labour and the nature of technology combined with
organisational forms like ''contract labour" and
"casual labour" devalue this concept in the Indian
setting ?
(b) within a mode of production also, patterns of
health care may vary depending upon the preva
iling social relations.
Related to this question is yet another formulation
which needs to be looked into and that is "commo
dification of health care in capitalism". The authors
argue, "it is immaterial whether the surplus value is
realised directly through the productive activities in
the clinic and hospitals owned by the capitalist or
indirectly through the provision of services by the
state ....... ". In either case, the maintenance of prod
uctive capacity of labour is central in the creation
of surplus value. It is assumed then that in commo
dity "health service", the surplus is not generated
in the process of commodity production but outside
it I A strange view of Marx's "surplus value". The
confusion has perhaps arisen because we do not
make the distinction between the 'service' and
'material' outputs (like drugs, instruments, equip
ment etc) of the health industry. The later like any
other commodity, generates surplus value and the
refore profits. In the service component of the
output, things are quite different. The surplus in
clinics and hospitals or any other medical care
institution comes from the exploitation of the health
workers who are paid wages. They are paid for
their subsistence (socially determined) whether they
are in a private hospital or a public hospital. It is
this that must be understood to appreciate why in
capitalism, welfare is not an economic proposition.
The services though in the name of the poor and
the labouring go to the unproductive sections of
population and hence in reality, there is relatively
little investment in the labour power of the indu
strial or agricultural workers. At the same time the
socially determined subsistence for doctors — the
pillars of health services — are undesirably high.
The other theoretical construct that is assumed
as proven and asserted vigorously to make a point
instead of empirical data, is the concept of health as
labour power. On this is based the understanding
It must also be realised that a practitioner even in
a capitalist formation continues to provide service
( commodity ) without creating any surplus value
for he is charging for his hours of labour and not
Let me take the first issue of SHR to illustrate my
points. I would treat. Amar and Padma's1 as the
central paper and touch upon others when needed.
The Use of Concepts
An important assumption of the analytical frame
work is that mode of production in a society deter
mines directly its health care as well as patterns of illn
ess but it has never been proved and often negated.
According to the authors, the socioeconomic struc
ture even after independence remained more or less
intact, the bourgeoisie dominated the scene and till
today capitalism remains the dominant mode of pro
duction. If that be so, then there should be no
change in the basic pattern of modern medicine. The
authors in fact demonstrate to the contrary that there
has been a major shift from "scientific medicine" to
"community medicine." Furthermore, it is argued
that the major factor which influenced changes in
health care were the notion of welfare state, planned
development, pressures of world capital class con
flicts and project optimisation. It appears then that :
(a) the period covered in the main article is not
sufficient to use the analytical category of mode
of production.
December 1984
A 33
his subsistence. That is why a private practitioner
earns even more than a doctor who is paid wages
even though he may be of the same status. It
appears then that the production of surplus value
is not as intimately associated with profits in the
provision of health services as it is assumed. Hence
the economic reason for the state to run health
services becomes less tenable.
Yet another formulation that needs to be corrected
is that "modern medicine and hospital systems re
produce the social structure of bourgeois society.”
I would think that the two may replicate or mirror
bourgeois relations or structures but can not repro
duce it. If they could, then, the sheer presence of
hospitals and modern medicine in Russia, China,
Cuba, and Vietnam would be a threat to their
present social systems. A proposition which is just
as ridiculous as it sounds. Also in Dalli Rajhara,
the hospital workers would not be able to practice
modern medicine and at the same time attempt to
evolve a new set of social relations. In other words
there is a need to realise that a system based on
division of labour and controlled by a collective
is different from one where division of labour as
well as ownership is a function of class.
Need for analytical rigour
The above discussion brings us to the question
of class analysis and its relevance for the under
standing of " political economy of health.' At this
point I would not go into the question what this
term denotes but assume that the effort is to see
how class configurations influence patterns of
health care. To approach this question, the authours
go in great details of the industrial and agricultural
growth pattern and the emergence of various classes.
In tracing the evolution of the peasantry though,
no mention is made of the rich peasants' role in the
green revolution areas as well as those where green
revolution did not happen. We are told that the
marginal and small peasants did well in both
these areas. This is unconvincing as it neither
explains the increasing numbers below the poverty
line since 50's nor does it explain the process
of proletarianisation and pauperisation of the pea
santry. Secondly, though the emergence of these
classes is traced, the differences in health needs of
these classes are never discussed. We are at a loss
then to see if that too played any role in shaping
the health services. Thirdly, in their attempt to estab
lish causalty between health service development
and changing balance of class alliances and class
conflicts, they make some weak propositions and
offer scant data to substantiate their arguments.
134
(i) It is argued that bourgeois radicalism "can best
be viewed as concessions gained by working class
militancy '. Hence all expansion in services is pro
jected as a result of protest and struggle. We there
fore fail to make the crucial distinction between
a conscious demand ( or protest ) for health and
socio-economic unrest or instability which is often
appeased by offers of bonuses and concessions in
welfare services In the former the ruling classes are
forced to give in, in the latter they provide health
services by choice and refuse what is really needed.
Apart from this strategy of appeasment, the ruling
classes also provide services because of their own
direct interests economic, political, ideological 2
and physical. Also they use both preventive and
curative services not just curative as the authors
tend to believe. It is then necessary that to estab
lish that expansion of services ("implementation
of various reports” ) was a result of struggle, we
locate those struggles specifically and show that
provision of health services was one of their
demands.
(ii) In their analysis of the 70s, they say that the
emphasis on rural inputs and family planning was
an attempt to postpone 'the crisis'. Without identi
fying the full nature of the crisis fa part of which
was industrial stagnation) they further argue that
the rationale of the Indian bourgeoisie in adopting a
massive family planning (FP) drive was a means
of controlling labour supply to suit the expansion
of more capital intensive modern industries. Firstly
how a capital intensive expansion of industry can be
possible when there is a glut and how is it going
to remove industrial stagnation or the crisis is not
indicated. Secondly, despiie the fact that they
mention expanding numbers of unemployed people,
increasing population and imperialist pressure as
factors influencing acceptance of F.P.P, why they
consider
"controlling labour supply as ''the
rationale” of the bourgeoise” is never clarified.
The questions regarding the nature and resolution
of the crisis can only be answered by taking up the
nature of the state and the problems of surplus
accumulation in India. I will not go into them, but
to analyse the rationale of F.P.P. we should have
certainly made some efforts. The facts are,
a) that the emphasis on F.P.P. came in the 3rd
plan itself when the investments in F.P rose from
30 million to 26.97 million rupees.
b) that though it is true that in 70's the popu
lation growth rate was high, it is not adequate to
Socialist Health Review
say that "the population went on rising, hence the
labour force continued to expand". The rates of
expansion of these two are not equal. Since the
labour force increases only by new enterants into
it (young people) who were born at least 10 years
back. Therefore, labour force increases at a rate
which is equal to growth rates of population 10
years back which in our case was much lower (22.2
in, 70s, 18.9 in, 60s and 12.5 in, 50s).
It appears then that the control of numbers of
labour force alone could not be the main rationale
for accepting the F.P.P One expected that instead
of treating F.P.P as a welfare programme, its real
nature would be exposed (where compulsion and
force made their appearance as early as 1966-67).
and its class orientation made explicit. F.P-P neither
came as a concession to the growing political clout
of the middle farmers nor it ever lost its ideological
value for the classes for which it was meant. That
is why it still survives in almost the same form as
it did a decade ago.
(iii) Throughout it is argued that the model of
'scientific" medicine (with all its social relations and
economic possibilities) was suited to the Indian
bourgeoisie, and therefore it expanded. The working
class continued to extract more and more through
its struggles ( or so we would like to believe) and
the rise of the peasantry created additional press
ures Suddenly however, we are told that by the
second half of the, 70s this specific model, "no
longer performed either this ideological role or achi
eved their socio-political objectives". In fact, "it was
no longer a good economic option". Hence a shift
in strategy by the bourgeoisie from "scientific"
medicine to "community" medicine. Why all of a
sudden welfarism lost its value why health services
started eating into the surplus and why they
no longer performed their legitimising role, are
questions left unanswered.
I suspect that the idea of failure of the western
model is located in our minds and is strengthened
by the "radical bourgeois documents" which are
forever crying their hearts out. Our susceptibility
leads us into accepting their logic rather than
exploring the truth. Let us answer the following
questions. For which classes, hospitals and the
PHC complex are no more the answers to their
health problem? Even when they get nothing out of
the government health institutions, do they not go
to the private clinics of the same doctors for better
scientific mediQine? Given the choice will people
prefer a community health worker or a doctor?
December 1984
The answers tell us that in India as yet, modern
medicine faces no crisis. The crisis is of the bour
geoisie. who even if they wanted, can not provide
it to the people and therefore must create blinkers.
The authors have themselves shown that the present
policy paper is nothing but an effort at stream
lining health services in a way that the old model
remains its core and is assisted by the so called
"community
medicine"
component
to create
profits, provide political legitimisation an ideological
domination. Secondly, the argument that "there
had not been any large scale improvements in
health indicators in the past years" is also not
adequate to locate the crisis of health care in late
70s. These indicators are neither indicative of
health status of classes nor do they show overall
worsening (death rates for '50s, 60s &' 70s were
22.8, 19.0 and 14.8).
While Amar and Padma make one think about all
these questions, Waitzkin in his article creates much
confusion on the very subject of class analysis of
medicine. Having located the structural source of
exploitation in the process of surplus production,
he introduces the notion of "persistence or
reappearance of class structure usually based on
expertise and professionalism in countries where
social revolutions have taken place", without,
even going into the definition of 'class' used by
Bettelheim and Ehrenreich. At the same time he
takes great pains to tell us about Alford's research
which talks of ''interest group" analysis without
any comments on the value of this analytical cate
gory vis-a-vis 'classes' understood by marxists.
Waitzkin not only indulges in such ' innocent"
confusions but also misleads. For example, he
introduces the concept of "social imperialism of the
USSR*' and attributes it to Navarro who in fact
though critical of the "party domination" and
"managerialism
in Soviet Union, has never used
this concept. In the book quoted by Waitzkin,
Navarro has actually argued against the theory of
convergence and criticised those Western scholars
who project managers, administrators, and technoc
rats as a "new class" of controllers of the system.
He underlines the fact that supermacy of the political
party over these groups is distinct in the Russian
society.
Need for better empirical basis
Yet another methodological point that needs to be
repeated is the need to validate arguments and
proposition. The practice of making conjectures
which are not substantiated must be avoided at all
135
costs. For example, when we say that "by the 60 s
increasing urbanisation with a 40 percent increase
of urban population, inadequate housing and living
conditions, low availability of food and impoveri
shment and unemployment has pushed up disease
incidence, "we have neither data nor logic on our
side. Disease incidence rates or morbidity data for
the country simply don't exist and logic says that if
people are migrating from villages to urban areas
they must have good reason to do so. Will they move
from better into the worse ? Similarly, whie talking
of the early '50s, it is said, "recent series of famine
and draught, increased exploitation of wars, further
deterioration of the abysmal public health services
the post partition exodus had resulted in a labour
force .which obviously could not contribute its best
in terms of productivity". Here again the emphasis
on health which seems so obvious to the authors, is
never really validated. Unless we explore all the
factors which were responsible for the disruption of
industrial production or for its low performance,
(investments, technology, social situation) to isolate
poor health of the worker is to blame him for non
performance.
Use of dialectical approach
In outlining the political econmy of health, the
authors repeatedly use the terms "western medicine"
"scientific medicine" "allopathic medicine" and
"modern allopathic medicine" interchangeably and
then criticise scientific medicine because it developed
in a capitalist setting and was moulded by it. It
becomes difficult to judge therefore, whether they
are critical of the allopathic system's body of know
ledge (of which preventive medicine is a part) or
its organisation in a capitalist setting or both.
Specially because, despite their ideological criticisms,
they do not deny that the increase in the number of
health personnel and institutions was necessary or
useful-. The problem is further confounded when
talking about the '50s they claim, "if the recommen
dations of Chopra Committee were implemented at
that time they would have resulted in a drastically
different system of medicine". Firstly, why a system
of medicine that developed in a feudal society
would offer a better alternative to the set of social
relations imbued in "scientific medicine" is not
argued. Secondly, even at the level of ideology why
ayurveda as practised in the British period was less
class-based, sex-biased and individualistic than
allopathy (not to mention its dependence on
obscurantism and mystification) is never explained
and thirdly, why indigenous medicine would not be
just as easily ammenable to capitalist commodity
136
production and absorption in the capitalist system
like other feudal institutions is never clarified.
If we agree that the indigenous systems were
more widespread and culturally more suited then,
we should also grant the bourgeoisie the intelligence
to see the profits of a wider market and easy profits
of indigenous medicine. However, our
intense
dislike of the bourgeoisie never really allows us to
explore what could have been their other reasons
for rejecting indigenous medicines4. The problem is,
lack of appreciation of the dialectical nature of
medicine (allopathic or ayurvedic) which alone can
help us to trace the roots of an alternative medical
science and technology and an alternative basis for
organisation of medical care. Waitzkin does mention
a different kind of 'modern medicine' which was
practiced by Virchow. However, he does not explore
the reasons why the germ theory instead of streng
thening actually undermined both epidemiology
and public health and what role these disciplines
played in the 18th and 19th century.
A much discussed subject is reformist and non
reformist reforms Every one seems to agree that
the former is bad and the latter good because non
reformist reform alone can lead to revolution while
the former only strengthens the system. What we
tend to forget is that implimentation of reforms is a
tool for survial for the bourgeoisie and not the
function of a revolutionary movement. The latter
extracts reforms, struggles for it but does not
implement it. Lessons from history teach us that the
essence of
a reform is in the change that it
introduces in the structure of the bourgeois society
and not the material benefits (though they are very
important at that point of time). Reform has its own
dialectics, it may diffuse a struggle but it also
heightens the contradictions'within the bourgeois
structure. In other words, it sows the seed of change
in the objective reality of social structure and not in
the subjective reality of working class consciousness.
That is the role of revolutionaries.
To say that experiments which help leaders of a
working class movement in increasing class consci
ousness is reform (even if it is called radical) or to
claim unimplemented drafts of the opposition as
radical reforms (they are demands for reform not
reform) is not only wrong but misleading. Mis
leading because it tends to divert attention from the
essence of reform (structural change) and confuses
it with either "mobilisation of political support" as
claimed by Waitzkin or with' strengthening of a
union as Binayak and Ilina do. They ignore the fact
Socialist Health Review
that a politicalised union as strong as Chhattisgarh
Mukti Morcha is not making provision of health
services a part of its demands and extracting it out
of the management, instead, it is providing these
out of the wage of workers (same as the bourgeo
isie) ! In doing so it leaves the health structure
created by the bourgeosie intact and therefore is
not struggling or extracting reforms at all. The step
might be radical but there certainly are no reforms.
The issue whether a revolutionary union is justified
in running its own hospitals, schools and industries
is a separate issue all together and I won't go
into it. But I would like to point out that Binayak
and Hina tend to confuse "reforms" with "reformism".
The former is a visible change in the objective
reality, the later an approach, a subjective component
of ones ideology. A reformist (whose ideology may
be reformism) may attempt to "suppress emerging
class antagonisms" through reforms and might
"need to derive strength" from wherever but the
reform is innate (it cannot be vitally conscious of
itself) and is the seed of change for it has the
potential of hightening contradictions and weak
ening the very system which the reformist tries to
save.
some, one eulogises free medical care the other
promotes private service, one emphasises preventive
the other curative medicine and promotes technology
to solve social problems) will help us locate the
relevance of what was mentioned in passing in the
main article as "constraints" to bourgeois "options".
These 'constraints" of foreign capital intervention,
class pressures and class conflicts and a policy of
welfarism in absence of adequate capital accumula
tion are actually the links between health planning
and the wider socio-political and economic frame
of the society. Links which need to be further
studied with references to health as well as the
Indian social formation.
The challenge that SHR faces is to build up a
theory rooted in Indian reality. For this four things
are necessary. One, that the frame-work that we
use must be first critically evaluated. Second, that
our analysis must concentrate on trends emerging
from the available information and data on health.
Third, we must attempt at collecting data where it is
necessary. Lastly, if our study demands an explora
tion of the wider social system then that must be
attempted. Towards this I join you in solidarity.
Unless we appreciate this dialectical nature of
reform (and all other phenomenon) we would
never grasp the meaning of the quotes that we
quote. We would continue to make the mistake of
rejecting things in toto — whether it is "text book
epidemiology" or " operation research rooted in
capitalist culture" and not apprehend the elements
of a revolutionary alternative which exist not outside
but within the bourgeois society.
Notes
If we agree that the basic assumptions which
we started need to be reexamined in our given
context, then we might also agree that perhaps the
way to make a beginning is to attempt detailed
analysis of the contradictions within the health
system and their manifestations. For example a study
of contradictions in health care policy and practice
(one professes service to all, the other provides for
1.
I hope they would not mind my use of first
names. My effort is not to score points but to
share with them what I think and first names
make it easier.
2.
Liberalism is very much a part of bourgeois
ideology which reflects the positive forces
within it.
3.
Even if they really consider it futile then their
rejection of modern medicine is clear and my
argument does not change.
4.
I do not mean that indigenous medicine is to be
rejected. My plea is that the same analytical
framework should be used for indigenous medi
cine if is to be compared with modern medicine.
WORK HAZARDS : WHAT CAN WORKERS DO ?
The best devices for detecting hazards in your workplace :
Nose : To smell foul odours as a tip off to hazards and to stick where management says it doesn't belong I
Ears
: To listen to the complaints of the workers
Eyes : To spot hazards and poor work conditions
Mouth : To argue the worker's point of view
Guts : To have a gut level reaction about what's right and what's wrong and to have the strength to stand
up and get the hazards corrected
Brain : To be imaginitive in building the union's safety programme
COMMUNITY HEALTH CELL
December 1984
326, V Main, I Block
Korambngala
Bangalove-5600?> .
Wia
137
REVIEW ARTICLE
'Death on the Job'
a d'mello
Death on the Job — Occupational health and safety struggles in the USA. Daniel M. Bergman.
Monthly Review Press, New York, 1978, 2 pp. 12.95 dollars
The movement for awareness about occupational
health and safety is still in its infancy in India. Trade
union activists and social workers involved in welfare
projects for industrial workers will be mollified by
knowing that even in what is probably one of the
most unionised countries in the world, the movement
has still not caught on in a big way. Occupational
health and safety struggles have still a long way to
go before they make a dent in governmental and
industrial circles.
Daniel M. Berman in his book ''Death on the Job",
which deals with occupational health and safety
struggles in the USA, states that despite the passage
of the 1970 Occupational Safety and Health Act
(OSHA) as a consequence of widespread social dis
content in the 1960's, major changes still remain to
be achieved. "Violence against the spirits and bodies
of workers continues".
The author states that business has been forced to
deal with issues of occupational safety and health
under two different sets of conditions, during war
imposed labour shortages and during periods of
severe social upheaval. When labour is extremely
scarce, employers worry about preserving the labour
they control by making the work more attractive.
During times of severe social unrest workers dem
and better conditions. In both cases business tries
to jump ahead of the workers and create institu
tions which define the problems of health and
safety in non-threatening ways and take the sting
out of the workers unrest. Berman speculates that
perhaps the new occupational health and safety
movement arose during an epoch that combined
labour shortages and widespread protest against
the unpopular war in Vietnam.
Tracing the history of the movement, the book
deals with the manner in which the early twent
ieth century US corporations responded to concern
about work accidents by setting up a business
controlled compensation safety apparatus which
held down compensation costs and did little to
improve working conditions. This apparatus was
able to exclude the issue of occupational health
and safety from open debate until the late 1960's
through its control of research, education, workers
138
compensation, governmental appointments and by
creating the public impression that health problems
in the workplace were non-existent. As a result,
the pain and bloodshed and nearly all the money
for the costs of work-related diseases and injuries
are still borne by workers and their families, and
the public at large. That way, say's Berman, its
cheaper for the industry.
With the exception of the United Mine Workers'
activities and sporadic local uprisings, unions have
been seriously involved in health and safety only in
the last decade since they mobilised to pass the
Occupational Safety and Health Act of 1970 The
OSHA law says Berman, was made possible because
of a tight labour market, worker dissatisfaction, the
new environmental consciousness, the aid of progre
ssive professionals and a climate of social unrest in
the USA.
Berman, while giving reasons for the lax safety
standards in the industrial sector, pinpoints the poli
tical-economic context of industrial safety at the turn
of the century. The rapid industrialisation of the
United States produced a multitude of new dangers
for workers. Big business, unable to control ruinous
competition and confronting a militant working class
and a growing socialist movement, sought the aid
of the federal government. The fruits of fabulous pro
ductivity increases were gradually concentrated in
fewer hands, symbolised in 1901 by the organisation
of the United States Steel Corporation, the nation's
first billion dollar business. As a result the compe
titive sector i.e. independent farmers and small
businesses, were squeezed by the relentless advance
of big business allied to the banks. Smaller manu
facturers, unable to raise prices easily violently
fought unionisation, while few leaders from the
monoply sector began to devise sophisticated me
thods to forestall unionisation through token welfare
policies.
Meanwhile, by the end of the nineteenth century'
large corporations and sweatshops began employ
ing millions of hopeful immigrants in dirty jobs that
still paid better than peasent work in Southern and
Eastern Europe. Giant corporations, led by the rail
roads, usually learned to use regulatory commissions
Socialist Health Review
to consolidate their control of markets and public
opinion. The Congress and the Presidency were
finally secured for big business by the elections of
William Mokinley in 1896 over the ragtag Demo
cratic-Populist coalition. Labour, beaten badly in a
series of strikes in the late 1880's was on ascend
ancy in 1900 but unions made little progress in
organising the new mass-production industries. A
1 904 report in the labour press estimated that 27,000
workers were killed on the job each year, and a 1907
Bureau of Labour report put the annual death toll at
15,000 to 1 7 000 of 26 million male workers. Wom
en's work was low paid and sometimes more
dangerous.
Even though there were unions fighting the issue
of workers compensation the odds were stacked
against the workers right from the beginning. By
1908 workers' compensation and job accidents had
become major items on corporate agendas. Existing
common law doctrines made it impossible for
workers to collect damages for injuries suffered on
the job because the worker had to prove the
employerwas at fault. This was particularly difficult
for severely injured workers to collect damages for
injuries suffered or for workers killed on the job
whose relatives had to depend on the testimony of
supervisors and co-workers who could be bought
under employer pressure.
Though workers' compensation became a major
theme by 1920 occupational diseases however never
merited much attention in either the model or actual
laws, and so they remained as they were till the late
1960's. Till then the workers compensation systems
and the unenforced industrial safety laws proved to
be everything their corporate sponsors had hoped
for. Both management and insurance interests
benefited by the shift from chancy jury trials to
administrative agencies whose employees could be
boughtoff or coopted. Physicians were hired to deal
with work injuries and to represent employers
within the compensation bureaucracy, creating that
peculiar
institutional "ghetto"
called industrial
medicine.
Berman gives interesting details on what methods
the big corporations adopted when they were
dealing with workers who were organised. One such
example is the case of the Amalgmated Association
of Iron, Steel and Tin Workers, a craft union,
enrolling only skilled workers. The Amalgmated
Association reached its height of power in the late
1890's and the Homestead, Pennsylvania, mill was
its biggest locale. It was also the biggest mill of
Carnegie Steel, the largest US steelmaker.
December 1984
"At Homestead about 25 per cent of the 4,000
workers were in the union, where they controlled
all aspects of production. This situation was unsatis
factory to Carnegie Steel for two reasons : according
to the contract, workers got a constant share of the
increasing sales of the mill, and they had the power
to prevent
the introduction of labour-saving
technology if it did not suit them. Carnegie resolved
to break the labour in a definitive test of strength.
Before the contract expired in 1982, the management
built a three mile long fence around the plant
with shoulder level rifle holes every 25 feet. The
workers were told that after June 24 the Carnegie
would deal with them only as individuals. On July 2
most unionised workers were locked out. The union
backed by all the workers responded by shutting
down the mill renting a steam boat
to
patrol
the Monoghaela river, and orgainsing the whole
town for resistance. When bargeloads of three
hundred armed Pinkerton men were brought to force
the mill open and bring in scabs, an open gun
battle resulted, sixteen were killed, including seven
Pinkerton agents and the rest of the invaders
surrendered to the workers and their families. But
aftera four month strike Carnegie won the Homestead
war with the help of the Pennsylvania militia and
the plant resumed production without a union. Loss
of its most important outpost was the beginning of
a rapid decline for the Association. After a disastr
ous strike in 1902, the union was completely
uprooted from the steel industry".
In 1910, U.S. Steel inaugurated the Voluntary
Accident Relief Plan, based on models developed
in Bismarkian Germany by a conservative capitalist
class under challenge from the fastest growing
socialist movement in Europe. jThe programme, soon
superceded by the state workers compensation
laws, was the first of its kind in the USA and paid
workers or their families fixed amounts for jobrelated injuries causing disability and death. The
plan for all its purported liberality stated explicity :
''No relief will be paid to any employee or his family
if suit is brought against the company' and workers
who received relief were required to sign away any
further rights to sue U.S. steel. This became the
model for the rest of the USA.
The compensation safety apparatus is the complex
of mostly private, corporate-dominated organisa
tions which are concerned with compensation,
workplace inspection, standard-setting, research,
and education in occupational health and safety. It
is called the compensation-safety apparatus beca
use it emphasises compensation over prevention
A 39
and safety over health in its activities. It is an
apparatus because it has executed the policies of
only business and insurance interests for decades as
the organised constituency in occupational safety and
health. Only in the last ten years has its dominance
been challenged by workers, unions and their
progressive allies.
Serious attack on the compensation-safety appara
tus began in the late 1960's in the coal mines, over
issues of black lung. The issue was taken up by
workers in industries all over the USA. President
Nixon finally signed the Occupational Safety Health
Act of 1970. The law, says Berman, promises more
than it delivers. However from this step onward
things begin to change and various unions take up
the issue of occupational health on a larger scale.
Berman goes into details about the conditions of
work in the oil, chemical, rubber and atomic indust
ries and the way in which their respective unions
tackle the problem of occupational safety. Interesting
details emerge of the lifestyles of some of the Ame
(Contd. from page 129)
rican labour leaders. Referring to the largest union
in the USA the "Teamsters" Berman states that "Top
Teamster officials live royally on the members fees. Five
jet aircraft and two turboprops worth over 1 3 million,
dollars and costing over 2 million dollars annually, fly
the top leadership to its missions. Frank E. Fitssimmons, general president, recieves an annual salary of
156 000 dollars and a host of other benefits, and
Harold Friedman, president of Bakers Local 19, a Cle
veland local associated with Teamsters, recieved the
astonishing total of 35?,330 dollars from his various
union jobs in 1976. Compared with their leaders
lifestyle the Teamsters efforts in health and safety
are decidedly meagre".
There is also a chapter on the future politics of
working conditions and Berman says that with the
coming of more and more automation the future
worker will suffer more from stress hazards as comp
ared with the worker of today. The book contains
useful tables and statistical information about the
compensation apparatus in the USA.
already poor health due to the vicious cycle of
disease and environment as already pointed out.
infections of the skin are some of the other examp
les of morbidities which the agiicultural labourers
likely are to suffer from.
There are certain morbid conditions which are
associated with the unphysiological posture while
doing agricultural work, for examples while sowing
paddy one has to stoop for hours together which
ersults in backache. Postures during harvesting of
wheat and rice are also uncomfortable and unphysi
ological giving rise to a variety of joint problems.
In the profit generating exploitative socio eco
nomic pattern of production human labour has been
reduced to a mere commodity. Least concern is
made for this perishable tool (the labour) in the
race of maximum profits. The working conditions
adversely affect the workers health and in some
cases prove to be fatal.
Lastly, there is a miscellaneous group of disor
ders to which agricultural workers are much more
prone than the people at large. Sun stroke and
heat stroke are quite common because of prolon
ged hours of work in the scorching heat. Ailments
of the eye are also more common because of the
harmful sun rays and dust falling on the unprote
cted eyes. Injuries to the eyes are also quite com
mon because of the same reason. Agricultural
workers are quite familiar with the bites of poiso
nous animals like snakes and scorpions etc. Preval
ence of hookworm infestation is much higher than
the general population because of their compulsion
to work barefooted in the fields. Farmer's lung,
hay fever, allergies of various types and fungal
Pale skinned, thin dyspnoic labourers working
in chemicals and pesticides factories : Pneumo
coniosis affected child labour in slate, lead, silicon
industry convey the same story.
140
We have made an attempt to focus attention
on the health hazards which the agricultural labour
is exposed to. We hope that it will initiate a debate
which will improvise and enrich our understanding
and contribute to the vital struggle for equality
and justice.
People's Health Group
Galli No 3
Gurbux Colony
Patiala, Punjab
Socialist Health Review
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issues in health from a radical or marxist perspective. We believe that only through
such interaction can a coherent radical and marxist critique of health and health care
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Each issue of the journal will focus on one theme, but it will also carry (i) Discus
sions on articles published in earlier issues (ii).Commentaries, reports, shorter contri
butions outside the main theme.
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the spellings and referencing style of reprint articles are as in the original and are NOT
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PIN
Push Back the Catasrophes
I don't want a drought to feed on itself
through the tattoed holes in my belly
I don't want a spectacular desert of
charred stems and rabbit hairs
in my throat of accumulated matter
I don't want to burn and cut through the forest
like a greedy mercenary drilling into
the sugar cane of the bones
Push back the advancing sands
the polluted sewage
the dust demons the dying timber
the upper atmosphere of nitrogen
push back the catastrophes
Enough of the missiles
the submarines
the aircraft carriers
the biological weapons
No more sickness sadness poverty
exploitation destabilization
illiteracy and bombing
Let's move towards peace
towards equality and justice
that's what I want
To breathe clean air
to drink pure water to plant new crops
to soak up the rain to wash off the stink
to hold this body and soul together in peace
that's it
Push back the catastrophes
—Jayne Cortez (black woman poet)
(From : Coagulations : New and Selected Poems, 1984)
Position: 1797 (3 views)