The agricultural sector is the major production sector in the less developed world containing the vast majority of humanity globally. Global inequalities in work therefore impact very substantially, directly or indirectly, on this sector. This chapter seeks to explore the topic both with respect to its components and as an overall coherent whole. The approach followed is to review the literature on globalisation including its principal drivers, and then to examine positive and negative effects in a general manner while focussing on less developed countries in particular as these impact occupational health in the agricultural sector. Special characteristics of the agricultural sector in less developed countries are examined in respect of its overwhelming size, the overlap with other non-farming rural production sectors, as well as absence of boundaries between work, life and the general environment. This provides a framework for considering vulnerable populations at occupational risk. The literature is then reviewed for impacts of global inequalities on occupational health in South Africa which is situated and contextualised within the Southern African Development Community region and also within the African region more generally. The Chapter closes with recommendations for grasping opportunities stemming from positive aspects, while working to ameliorate the negative effects, of globalisation on occupational health risks in the agricultural sector. A review of the scientific literature in MEDLINE produced a small yield of articles principally in the area of studies of specific risk factors within agriculture and their impacts on the health of workers. There is, however, a substantial body of literature produced by International Agencies such as the United Nations Development Program, International Labour Organisation and the World Health Organisation. To date aspects of globalisation, workplace inequities and the agricultural sector have not been systematically drawn together in one text, and this Chapter offers an opportunity to build on the existing literature to contribute to this goal.
There are many components to the definition of globalisation. According to the International Labour Organisation [1996], the 1999 Human Development Report [United Nations Development Programme, 1999] and the World Health Organisation Occupational Health Programme [Goldstein, 2001], globalisation refers to the process of increasing economic, political and cultural interdependence of countries over the past 2 to 3 decades.
The Human Development Report [1999] identified the main elements of the definition of globalisation. National economies are increasingly integrated into a world market with increasing trade, international capital flows(foreign exchange, bonds and equities), foreign direct investment (especially in emerging markets) and movement of people across national borders. Globally integrated production systems are characterized by increasing intra-firm trade in intermediate products and new forms of outsourcing of work across national borders. The private sector has assumed increased importance in the regulation of the global economy. There has been increasing removal of tariffs and subsidies, which previously protected and developed agricultural economies in developing countries. New technology, especially information and communication technology (computers and the internet), mobile telephony and the media, are diffusing increasingly rapidly across the globe allowing action at a distance in real time. New international organisations such as the World Trade Organization have arisen which are able to generate new rules and systems for regulating trade and intellectual property, and which are backed by global enforcement mechanisms binding on national governments.
An important political consequence of world production being increasingly transnational or borderless and subject to international market forces, is a decrease in the capacity of national states to control their economies and regulate, while transnational, corporation-driven governance increases. Globalisation has an important cultural dimension as developed country entertainment and media products and services dominate developing countries.
There are also very important cultural dimensions to globalisation involving specific aspects and products of the developed economies in particularly in entertainment and media which constitute a very large proportion of production, export and trade in and from the developed countries.
Globalisation in a general sense is of course not a new phenomenon and represents an historical continuity of the Western capitalist expansion over past centuries in a new form. Whether directly or indirectly, no country or region is untouched by the effects of globalisation.
Policy changes characterised by greater market orientation, liberalisation of trade, reduction in control over capital flows and massive changes in the direction of privatisation and deregulation have facilitated international trade and investment flows Technological factors reducing transport and communication costs have dramatically facilitated production and financial aspects of globalisation.
There are both positive and negative effects of globalisation. While there have been positive developments for some less developed countries many negative developments have been documented. The overall global result has been increasing inequality both within and between countries at different stages of development.
1.3.1 Positive features include faster economic growth worldwide consequent on a more efficient economy where production can be optimally located geographically, institutionally or financially with increasingly integrated production across borders and within corporate entities. Global trade has increased disproportionately to production. [Global markets may increase opportunities and pressure for ethical trade or environmentally sensitive production in primary producing countries. Consumers in the north can shape producer policies in the south (for good or bad!)] Cheaper information technology and easier access to information empowers small countries or geographically dispersed people and organisations with knowledge and the means to improve the efficiency of their participation in economic, political, social and cultural activities. For example, in occupational health and safety (OHS) harmonisation of standards and industrial practices could be beneficial if multinationals operating in both DCs and LDCs use best practice experience from their DC base for benchmarking in countries with less developed regulatory infrastructure[Frumkin, 1999; International Labour Organisation 1996; international Labour Organisation 2000.
1.3.2 Negative features include widespread economic restructuring with increased unemployment and inequality. The human development report [1999] indicated that globalisation was more profit than people-oriented. Consequently, a "regulatory"gap has developed between existing international institutions catering for open global markets and those yet to be born which would ensure ensuring human rights. Additionally unstable market forces have shown the ability to negatively impact non-market social goods and services as well as the environment.
The report went on to identify several areas of inequity highlighting challenges to global ethics and the frequent violation of human rights. It described considerable power and wealth inequities within and between countries. The income gap between the richest and poorest country increased from 35 to 1 in 1950, 44 to 1 in 1973 and 72 to 1 in 1992. An important aspect of this is the digital divide separating those connected to the new information and communication technologies from those unconnected. Inequities include the generation and retention of intellectual property.
Developed countries have been taking advantage of less developed systems in less developed countries to obtain globally enforceable patent rights and hence exclusive control over valuable natural and material goods in distant lands. For example, the phamaceutical giant Pfizer has obtained the intellectual property rights to an ingredient for a new and safer slimming agent through the local intermediate of the South African Council for Scientific and Industrial Research. This is an example where a large pharmaceutical company based in a developed country profits from indigenous knowledge of the San hunter-gatherer community in a developing country through the intermediation of a developing country institution, while the source community receives little in the way of benefit and loses the intellectual rights to property held collectively since time immemorial. Given the potential market for obesity reduction in developed countries, the financial implications are potentially vast [Mail and Guardian, 2001]. There are distinct shades of rights that are imperceptible to local people in developing countries exchanged for the modern equivalent of the shiny trinkets proferred by explorers in centuries past.
Power and systematic legal inequities related to the recent attempt via the World Trade Organisation to enforce of TRIPS (Trade Related Intellectual Property) in respect of the availability and affordability of anti-retroviral medications for HIV/AIDS in less developed countries consitute a poignant example of global human rights. Countries like South Africa or Brazil with huge HIV/AIDS problems and which are able to manufacture generic antiretroviral drugs at a fraction of the cost of patented drugs are under legal constraint by world trade enforcement mechanisms to solve their problems in the most cost-efficient manner.
People and countries have been marginalized by distortions and inequities inherent in the development of globalised relationships. Removal of tarrif barriers and subsidies have for example developed unevenly with developing countries being forced to relinquish their tariffs and subsidies in order to access developed country markets, while developed country farmers have remained protected. In many Less developed countries a dual economy has developed - a global formal economy for the connected, and an informal local one for the marginalized.
Human insecurity linked to employment opportunities consequent on the instability of financial and political systems has increased. This includes inequitable changes in employment patterns whereby mobility advantages for skilled business and professional groups contrast with restricted markets for unskilled labour between and within countries - even less developed countries. Unstable financial conditions have exaggerated effects on small enterprises with fewer resources at their disposal. Unemployment and job insecurity have become widespread and long lasting. The International Labour Organisation estimates that the number of people unemployed or underemployed in the world today exceeds 800 million. This amounts to nearly one-third of the global labour force, rising to even in some developed countries to as high as 11 per cent [ International Labour Organisation 1996]. New forms of employment and changes in global labour policies, corporate restructuring, and the changing class structure of modern societies have gone hand in hand with increased insecurity, stress and lower incomes in both developed countries and less developed countries. Structural adjustment policies have given rise to adverse effects on social goods and services in less developed countries as resources for these have come under pressure and have been seriously cut back. The institutions of social protection have been progressively dismantled under the pressure of privatisation and deregulation contributing substantially to human insecurity.
Easier transfer of hazards in the form of materials, products and production processes to less protective and regulated jurisdictions in less developed countries has had adverse impacts on environmental sustainability - both locally and globally. Chronic environmental degradation threatens large numbers of people world-wide. Poor people have little choice but to put pressure on the environment, while the high resource consumption of the rich nations continues to pose multiple environmental and ecological threats. The growing export markets for many (agricultural) products mean depleted stocks, less bio-diversity and fewer forests.
Development and social programmes benefiting the poor and marginalized are adversely affected because the global economy is mainly the economy of the multinational private sector which in many instances overshadows national economies. The rush to the bottom for cheaper production costs [Frumkin, 1999] may lead to the exploitation of ever cheaper labour in poorer countries and populations. Financial instability can undermine development efforts disproportionately in less developed countries.
Substantial impacts on employment, conditions of work and working life have resulted from the globalisation process particularly as a consequence of increased competition, deregulation, privatisation, corporate restructuring and transfer of old and introduction of new technologies and hazards. Prevention of occupational injury and disease and promotion of worker health are increasingly seen as a cost, as has been the case traditionally, and also as barriers to trade in the global economy. For example, free trade zones have typically been characterized by the suspension of occupational health and safety regulations as incentives to investors. In another example, Canada opposed the process of instituting an European ban on trade in asbestos by taking the issue to the World Trade Organisation. It claimed that its right to do business was being compromised in terms of World Trade Organisation rules and sought to have the ban overturned on grounds of freedom of trade with no reference to health and safety considerations. It could be argued that under globalisation there is an accelerated and systematic externalization of the real costs of occupational injury and illness. The implications for work in the agricultural sector are legion and include for example increased trade in pesticides that are banned in DCs but marketed to less developed countries.
This section is mainly based upon a close reading of the few publications cited below, which are mainly products of the International Labour Organisation.
Half of the world’s labour force (or 1.3 billion) is employed in Agriculture [International Labour Organisation 2000a], and in less develeloped countriesupwards of 60% of the workforce are in agriculture. About half of these again are waged labour. The agricultural sector is of critical importance to development - both historically and currently. Historically in the seventeenth, eighteenth and nineteenth centuries, the agricultural sector facilitated industrialization by providing surplus product and labour for the urban areas. More recently in the twentieth century successfully industrializing societies in East Asia have managed to achieve relatively faster growth in the industrial sector and have been able to absorb displaced rural workers. Their manufacturing exports have grown much faster than agricultural exports. Rural workers have taken advantage of better paying urban wages supplementing family rural incomes. Eventually demand for rural labour results in increased wages and the spread of development to all sectors. In this way they have followed the historical development of today’s developed countries in the new era defined by the current phase of globalisation. However, sub-Saharan Africa as a region has not fared well in this regard.
The gross domestic product and employment contributions of the agricultural sector have declined relative to urban industrial areas. Key success factors were strong agricultural production sustaining rural and urban populations while these changes were in progress.
Agricultural work takes place in mainly rural environments where working and living conditions are frequently poor and where boundaries are blurred between family and workforce, and domestic, work and general environments. resulting in a different patter of participation of women and children from the industrial sector.
The proportion of women and children in agricultural employment is increasing and child labour is widespread in agriculture. The International Labour Organisation estimates that in a number of developing countries, the proportion of economically active children between the ages 5 to 14 may be as high as 30 % of the agricultural workforce. It is estimated that about 90 million full time child workers are to be found in the agricultural sector [International Labour Organisation 2000a] with a third of these in Africa which has twice the proportion of children at work as the rest of the world. All occupational health risks are amplified for children, for example tools and equipment designed for adults are not ergonomically appropriate for child workers. Child workers form part of the household work for subsistence farming, but may also be found in commercial agriculture or be hired out as part of family labour by labour tenants or landless migrant farmworkers. The latter setting differs from the domestic labour context in that the element of coercion Is less likely to be present where the employment relationship is tempered by familial relationships. There can be substantial abuse of family members by making household chores so onerous that they are no different from labour. This may get worse as the closeness of familial ties becomes more distant and the the more distant child relative is more likely to be exploited than the immediate child or sibling. Unpublished data from South African has shown children working up to 30 hours a week on domestic labour alone.
Women account for 20 to 30 % of total agricultural waged employment but their overall contribution is much higher than is currently recorded. In Sub-Saharan Africa women bear the brunt of agricultural production particularly in the domestic, subsistence and informal sectors, while they also have substantial participation in the formal agricultural sector [Myers, 1996]. Despite the fact that women perform the largest proportion of farmwork they are often seriously disadvantaged by gender inequalities concerning land tenure, control of income and expenditure, and poor access to finance, markets and government assistance.
General conditions for rural and agricultural workers are typically poor in less developed countries. Labour rights are difficult to obtain for agricultural workers due to geographical and social isolation. Labour organization is typically weak and working conditions are characterized by a typically unskilled labour force which is frequently migrant or on contract, low wages, high unemployment, high rates of casual labour, and landlessness. Agricultural work is among the top 3 hazardous occupations, and labor inspection and social and health services are typically absent. Distortions of the rural demographic structure brought about by migrancy place particularly heavy burdens on women and children who are burdened with caring activities in relation to infants, small children, the sick and the elderly.
There are many general problems in rural areas where basic public services such as water, sewerage, shelter and electrification are inadequate or absent. Travel and communications infrastructure are similarly inadequate. Social services such as health, education an welfare services are poorly represented and difficult to access from a rural base. A large proportion of rural dwellers particularly in less developed countries live in poverty with poor nutrition and general health status.
Globalisation as a creature of the modern urban industrial and financial sectors has had few direct effects on the agricultural sector. There have been indirect impacts that have mostly to do with marginalisation of the agricultural sector which is typically more backward and less productive than the industrial sector, particularly in less developed countries.
Prices and productivity for traditional cash crops which characterized earlier phases of globalisation, and whose production is increasing in sub-Saharan Africa, have been static or declining. This is both a result and a determinant of unsuccessfully globalising countries.
Declines in transport and storage costs have opening up new market potential for non-traditional exports, and some less developed countries have been able to take advantage of these advances of globalisation and to diversify their exports into new crops that are in increasing demand such as flowers, fruit and vegetables. However, poor infrastructure in rural areas in the less developed countries has meant that these countries have nevertheless been slow in adopting new technologies and in attracting foreign direct investment to their agricultural sectors.
The impact of communications technology and genetic modification of organisms and livestock is very limited at present although this could increase dramatically in future. Currently, even in developed countries there are some brakes on their diffusion in consequence of uncertain environmental and health effects. Nevertheless genetically modified crops constitute one aspect of new global technology which has managed to penetrate into the rural agricultural sector. While many prospective benefits have been proposed by the purveyors of this technology, there has been considerable uneasiness at a global level culminating in the Cartagena Protocol on Biosafety to the Convention on Biodiversity in 2000 regulating the use, handling and cross-border transfers of genetically modified organisms , and the moratorium on genetically modified organisms by the 8th Session of the Commission on Sustainable Development in 2000 pending further research. Some developed countries have been successful in mounting resistance to the penetration of these new technologies on grounds of the precautionary principle fearing the possibility of serious environmental harm. For poor farmers in less developed countries there are additional risks relating to increasing economic dependence on the multinationals for seed and agrochemicals. Loss of biodiversity and environmental degradation are additional concerns.
The Cartagena Protocol represents an advance in balancing environmental concerns with free trade, interests that are not easily reconciled. The key provision requires exporters to obtain prior permission from the importing country for the first shipment of a "living modified organism" for release into the environment, but not for commodities intended for food, feed or processing. The "precautionary principle" introduced in the treaty states that a nation can take action to protect itself - in this case by barring importation of a genetically modified organisms - even in the absence of scientific certainty about the danger. .
Given that for many less developed countries especially in sub-Saharan Africa more than half the labour force is in this agricultural sector, even if technological developments could penetrate significantly there would be an additional risk that large numbers of agricultural workers could be displaced with serious implications for both food security as agricultural production stimulated by foreign direct investment and increased trade linkage is likely to be directed to non-food products. Additionally newer agricultural technologies are likely to saddle a poor workforce with low levels of literacy and education and high participation rates of children and women, with disproportionally greater risks from the increasing use of hazardous chemical and other mechanical inputs to production.
Paradoxically the greatest impact of globalisation on the rural agricultural sector in less developed countries has been from the increasing information flows accompanying increased global trade. Increasing demands from consumer groups and environmental groups in developed countries for standards to be met in respect of occupational safety and health of workers, employment of children, gender equity, worker rights and environmentally sound practices. This has resulted in governments and farmers taking steps to ameliorate the worst abuses of people and environments although these are not always well balanced and tend to favour narrow consumer interests first and those of rural producers and rural environments second. One institutional form that these processes have taken is that of private voluntary initiatives like social labeling and codes of conduct. There may be a potential niche area in organic farming for less developed countries given the extreme difficulty of escaping ubiquitous chemical and increasingly genetically modified crop pollution in developed countries.
2.3.1 Occupational injury and disease indicators: Poor occupational health and safety led globally, according to the International Labour Organisation and the World Health Organisation, to 250 million accidents and 335,000 fatalities, and 60 - 150 million occupational diseases, which altogether result in 1.2 million work-related deaths a year [International Labour Organisation, 1999]. Adverse and substandard conditions of work constitute an enormous and unnecessary health loss, great suffering and economic loss amounting to 4 - 5% of GDP of countries.
All of this is magnified in rural environments and agricultural work constitutes one of the three most hazardous occupations along with the extractive industry and construction worldwide [International Labour Organisation, 1999]. This is the case even in the developed countries where the preventive infrastructure is much more developed. For example in the US the fatality rate for farmworkers is 5 times that of all other sectors. The main problems are occupational injuries (including fatalities) arising from machinery and transport equipment, and poisoning from agrichemicals. All the other generic occupational risks abound whether physical, biological, ergonomic or social-organisational. The World Health Organisation has estimated that between 3 and 4 million pesticide poisonings occur each year with tens of thousands of fatalities.
These risks interact with general public health problems, with poor basic conditions of life and work, to create a hazardous environment for vulnerable working populations, particularly women and children. Hazard communication failure, inappropriate personal protective equipment and poorly developed public policy provide the context for increased risk to poor and poorly educated farmers in of farmers in less developed countries. Part of these poor conditions relate to the parlous state of society’s responses when it comes to recording problems, conducting relevant health related surveillance, and the ability to respond meaningfully with promotive, preventive, protective, curative and rehabilitative measures that would ameliorate the risks and their consequences.
2.3.2 Validity and coverage of indicators: Poorly developed infrastructure makes it difficult to record, or process data relating to health meaningfully. Additionally, the characteristic feature of the agricultural sector is the blurring of boundaries which makes it difficult to distinguish occupational from nonoccupational determinants for injuries and disease, and therefore to easily obtain valid indicators of the extent of risk. Furthermore, recognition of the occupational determinants of morbidity and mortality is a major problem especially in less developed countries. Atypical but common occupational causes of mortality such as drownings of farmworkers are not recognized as occupationally related, while obvious instances of direct occupational causation, such as deaths of children from farm machinery injuries, are poorly recognized as occupationally related in the mortality statistics [Schierhout et al., 1997]. More indirect, complicated and subtle determinants of less traditional occupational health outcomes are typically missed altogether and the true burden of disease in agriculture can only be guessed at. Pesticide related morbidity and mortaility exemplify problems of under-ascertainment of the scope, extent and gendered character of the problem. This will be dealt with in greater detail in section 3.
Much of what is specifically known about health and occupational health, in particular in the agricultural sector in less developed countries is speculative due to the absence of research. It can however, be assumed that traditionally well documented and well recognized hazards characteristic of the agricultural sector in countries with well-developed information systems are generally present in less developed settings. Acute and chronic conditions involving musculoskeletal, allergic, respiratory and nervous and mental health systems are bound to be exaggerated as poor general conditions for rural dwellers interact in less developed countries interact with work-related hazards.
Globalisation has brought increasing movement of goods and people across border of many countries eg sub-Saharan Africa and this is reflected in a rise in the incidence of diseases which are usually considered to be non-occupational such as sexually transmitted diseases , malaria, cholera, HIV/AIDS, but which on closer inspection can be seen to be occupationally related and bound up with working conditions and the relationships between the rural agricultural and urban industrial sectors. Movement of migrant workers to urban centers where there is employment or mining or extractive industries in rural settings results in the transfer of infectious agents on the one hand, and in the development of social conditions that cater to single men away from their families in the form of the services of sex workers on the other.
The much touted need to integrate occupational health services with the primary health care infrastructure is double edged and often results in obscuring the occupational nature of causation or contribution to morbidity and mortality, as health care personnel unskilled in occupational health are the first point of contact with agricultural workers and their families when they experience work-related health problems. The blurring of the boundaries between work and life in agriculture deflects attention away from occupational health considerations. In agribusiness and the commercial parts of the agricultural sector the more traditional attitudes of occupational health personnel in less developed settings are evident. Occupational health considerations typically give way to general primary care related concerns. Even if occupational determinants of illnesses are recognized, they tend to be downplayed in relation to more general determinants which are often blamed on the behaviour of the victims, directing attention away from the workplace risks.
The effects on health by way of the general environment from, for instance, pesticides and genetically modified organisms, are as yet unspecified and difficult, if not impossible, to ascertain. In the case of pesticides, however, generally increased awareness of the risks to health and the environment from agrichemicals has led to the development over time of integrated pest management practices and programmes involving producers, manufacturers and regulators. There is also increasing awareness amongst farmowners, governments and policy makers of the high externalized social costs of occupational health risks.
2.3.3 Access to occupational health services as well as health and social services more generally: Occupational health services are generally absent in the rural agricultural sector with the exception of agribusiness and large scale plantations where these tend to be present. However, the form they take is often similar but inferior to those occupational health services provided by the extractive industry (eg mining) which are more oriented to providing general health services to migrant worker populations. For resident populations there is little of this in operation. General health services do not really cover this gap as they too are relatively inaccessible and unavailable in rural areas. Uneven and skewed development in DCs have lead to concentrations of health services in urban areas and to a particular profile where secondary and tertiary level hospital based services massively predominate. So much in the way of health care resources are tied up in this system that even in the era of PHC, and global and national policies to implement PHC very little in the way of resources are free for allocation to the primary level. General poor provision of physical infrastructural and social services interact with occupational health risks to produce a high toll from communicable and vector-borne diseases and poor nutrition.
This section addresses mainly South African experience located within the broader Southern African Development Community setting with more limited reference to the rest of the sub-Saharan African region. South Africa has been chosen as it is a key country within the sub-Saharan African region with a dual economy and a relatively sophisticated industrial sector while sharing many of the problems of other countries in the region as far as agriculture and the extractive industries are concerned. It has a dual economy. The developed sector shares many of the globalisation related features of developed countries, while the less developed sector has many similarities to other countries in the region. It is consequently an interesting example where internal and external forces coexist in a complex interplay. Most occupational health professional activity is concentrated in South Africa.
Globalisation trends in sub-Saharan Africa are similar to other parts of the less developed world. There are however specific aspects such as the extreme marginalisation of the region as a whole, the relatively high level of industrialization and the recent emergence of South Africa from the closed economy and society of the Apartheid era. The benefits of Apartheid for the white population have continued under the impact of globalisation in that there has been increased privatization and less redistribution that was widely expected in 1994 and subsequently. For sub-Saharan Africa as a whole there has been poor growth over the past 3 decades averaging just over 2% [ International Labour Organisation, 2000b] slightly higher in the agricultural sector which reflects the massive preponderance of this sector in relation to the stagnant industrial sector. The agricultural labour force remained at 68 per cent of the total, but agricultural GDP was only 18 per cent The region has the highest proportion of the population living in poverty in the world . Most economies in the region are dependent upon a few primary commodities for which global prices have fallen unrelentingly over a long period of time. Countries have also been saddled with heavy debt burdens which prevent the application of export revenues to development. The social context has been one of political turmoil and continued warfare over the past few decades. Food security is precarious and the structural adjustment policies of the international agencies such as the World Bank and the IMF have squeezed public health and welfare resources in a setting where safety nets are few, given the disruption to agricultural subsistence production from warfare.
The agricultural sector has come under increasing competitive pressure and this has had important consequences for more intensive cultivation and agrichemical use with concomitant increases in morbidity and mortality along with increased landlessness and unemployment. The growth of agribusiness has arisen in response to increasing competitive niches in agricultural products and also the decline of gold mining and the need of the large mining corporations to diversify their investments.
In the case of South Africa, the agricultural sector has managed by means of increased mechanization and capitalization to shed about 0,25 million jobs over the past 15 years, while increasing output about 25%.
Apart from pockets in already well-developed areas of the sector, there has been little overall evidence of a vigorous response from the agricultural sector in sub-Saharan African by way of movement into new agricultural products(flowers, fruits or vegetables) or technologies [such as genetically modified organisms) and the effects of globalisation in Africa have therefore been more indirect and negative, taking the form of marginalisation.
The general health status of rural African populations is poor as is the availability of social and health services. Rural areas within Africa abound with endemic and epidemic health problems. They are generally dormitory areas sending labour to the mines, industries in the cities and to commercial agricultural employers where working conditions and living conditions are very poor and stressful.
Historically, in earlier periods of globalisation, the extractive industry in gold mining especially in SA imported labour widely from the sub-Saharan African region and the exported sick and injured labour back [Steen et al., 1994; Trapido et al,. 1996] to these sending areas spreading pneumoconiosis, TB [Packard, 1989] and sexually transmitted diseases, skewing the demography of the rural populations, undermining agriculture specifically subsistence production and bringing about general impoverishment. The combination of colonial political pressure in terms of the institution of poll taxes and seizure of the prime agricultural lands and the institution of feudal employment relations in the agriculture sector as well as industrial sector remuneration at below family reproduction levels has led to widespread impoverishment in the region, particularly in the rural areas.
Currently, the HIV AIDS epidemic is spreading substantially via the same route from mining industry and the cities to the rural areas. There are also other sources of infection relating to increased movements of people across borders and overland transport routes. The interaction between sexually transmitted diseases, HIV/AIDS and TB is substantial with devastating effects on health at individual and community levels.
Women perform the bulk of agricultural work in the region. The contribution of children has increased dramatically in the recent period due to the advent of the AIDS epidemic and the sharp increase in the number of orphans. In this sense globalisation continues its long history from the 19th century of undermining agriculture of the majority sector of the population while favouring plantation type agribusiness at the expense of subsistence agriculture and family production. The mining industry has for a long time been active in trying to remove TB as a compensable occupational disease in SA, arguing that the source of infection is in the rural areas (despite the history of the mining industry in seeding infection in the rural areas). It is currently attempting to do the same with respect to HIV/AIDS which is not viewed as an occupational disease. Given the conditions of work however in the mining industry there are clearly factors that contribute to the transmission of infection to miners and hence to rural farming families. The migrant labour system continues to be a vector. Often mines and industrial activities or dams are located in rural areas and have additional direct impacts on demographic flows and health.
Rural underdevelopment is also associated with other severe epidemics like malaria and cholera which are important contributors to mortality and morbidity in the region. Continued war and political instability may also be considered a health risk and is predicated on the extractive industry (diamonds, oil and timber) with widely ramifying effects on agriculture and rural populations. Examples include the longstanding war in Angola which revolves around oil and diamond extraction, the current war in the Democratic Republic of the Congo and central Africa involving diamonds and minerals, as well as the longstanding and spreading instability in West Africa involving diamonds and timber.
Chemicals feature very prominently in the risks to health in the agricultural sector, and there is a substantial local literature on pesticide health effects [Myers, 1990; London, 1992; London & Myers, 1995a, London & Myers, 1995b; Dalvie et al, 1999]. Use of chemicals has increased substantially over the past few decades and continues to increase under conditions of poor regulation, information and communication. Banned chemicals in developed countries find their way to less developed countries and are in frequent and daily use.
Because of the demographic peculiarities of the subsistence sector, women (especially pregnant women) and children are exposed in the fields and also in their homes which abut the fields, and may even be found in the middle of the crops (eg coffee farming in East Africa). The combination of potent agrichemicals, poorly educated and illiterate farmers, absence of boundaries between the home, work, and general environments, poor regulation and poor hazard communication mechanisms combine in a potent toxic cocktail of hazards.
International level policy has been developing over the past few years. The Stockholm Protocol was signed in May, 2001 banning trade in persistent organic pollutants (POPS). However, policy at the national level is often absent or fragmented [London & Rother, 2001b], and even if it is well developed, is not implemented or implementable.
The data show that acute poisoning is clearly a big problem [Baillie & London, 1998; London and Baillie, 2001], that it is seriously underreported or not ascertained at all, and is a substantial contributor to morbidity and mortality [Schierhout et al, 1997] second only to drowning on farms in SA. Even when international level regulation is achieved as in the case of the POPS treaty there can also be contrary effects. The issue of the continued use of DDT as a mosquito insecticide for prevention of malaria is a case in point. There has been a major recrudescence in the incidence of malaria which is the number one killer in Africa. This may in part have been due to developed country attitudes towards DDT as some pressure has been applied by donor countries on less developed countries not to use DDT for this purpose. However this is difficult to disentangle as many other factors have also been implicatged in the resurgence of malaria, including war, collapse of control programmes, insect resistance, global warming and floods.
Chronic paraquat (another agrichemical banned for use in developed countries) toxicity has been demonstrated for the respiratory system and these effects may interact synergistically with TB, smoking and other respiratory hazards to cause impairment [Dalvie et al, 1999]. Acute episodes of poisoning with organophosphates is well documented as leading to permanent impairment of the nervous system, and interacts with other determinants such as poor education, alcohol abuse and violence to cause problems for farm populations [London et al, 1994; London et al, 1998a; Robins et al., 1998]. This is a particular problem in the wine farming areas where the infamous practice of paying workers with alcohol persists despite being outlawed [London, 1999; London et al, 1998b].
Intentional Injuries are very prominent amongst farmworkers especially those on plantations and commercial farms. Occupational injuries are also a big problem. One might think that for hard outcomes such as mortality from occupational injury would be relatively reliable as an estimate of the true incidence. However SA studies show very substantial underreporting with only some 20% of all occupational fatalities reported [Schierhout et al, 1997]. The differential with the urban situation is quite striking but even there 25% underreporting still occurs [Lerer & Myers, 1994]. As SA is the most developed country in the region, ascertainment can be assumed to be much worse elsewhere. Gender bias in the reporting system has been shown with both mortality reporting and with pesticide poisoning. [Bailie and London, 1998;Schierhout et al, 1997]. There is a substantial child mortality and morbidity occurrence in SA agriculture too which has recently received much media attention. Farmworkers children as young as 9 or 10 are made to work with their parents at harvest time on commercial farms and are mainly involved in transport or farm machinery injuries, pesticide poisonings and drownings.
The burden of occupational injury and disease is currently unknown although there have been attempts made to estimate it [Loewenson R, 1999]. It is extremely difficult to quantify not only because of the absence of data but also because of the low employment in these countries and the unusually high degree of externalization of costs to the victims and their communities both historically and currently [Packard, 1989; Steen et al, 1994; Trapido, 1996]. Currently, moves are afoot by the World Health Organisation occupational health program to commission a study to estimate this through the work of local African institutions and World Health Organisation collaborating centres.
There are other less direct health impacts that are mediated through the general environment. Increasing unemployment consequent on global and local restructuring which has impacted all farming sectors with large numbers of jobs have been lost in the past decade in South Africa estimated at around 10% of the current workforce of 10 million over the past 6 years. New notions of intellectual property, patents and the interventions of the World Trade Organisation have conspired to make treatment with antiretroviral drugs for HIV/AIDS unaffordable in sub-Saharan Africa at a time when the epidemic is rapidly gaining momentum. The magnitude of this epidemic and therefore the enormity of this problem may be illustrated by a recent report on AIDS mortality which predict 7 to 9 million deaths from AIDS over to 2010 and which shows that in the year 2000 there were already the same number of AIDS deaths as those for all other causes of mortality [Medical Research Council, 2001]. The pharmaceutical industry recently collectively took the South African government to court to prevent a national law permitting the government to import the cheapest product on the global market or to manufacture generic drugs locally and sell them at a lower price than that set internationally by the companies. In the three years it took for the industry to withdraw its lawsuit under international and local pressure the epidemic has progressed substantially with many new infections of both adults and infants. There is a stark contradiction between the benefits of globalisation (being able to theoretically source antiretroviral drugs from other less developed countries, and to do so cheaply from another less developed country such as India, and the downside of globalisation being international codes such as TRIPS enforced against governments of less developed countries trying within their meagre budgets to tackle a major epidemic. Such manifestations of globalisation make it appear as simply a means to prise open the global clam for one-way access by multinational corporations while unfairly suppressing weaker less developed country -based competitors, at the ultimate expense of people in these countries who are the victims of HIV/AIDS. The slogan coined by protestors - "patient rights to patent rights" - is a succinct summary of the issue.
There has been active bioprospecting into local plant and animal materials used by traditional healers for their medicinal products to see if active agents can be isolated and replicated by these same and other multinationals. Because there is such a vast information divide between DC and lessl developed country parties, it has been possible to purchase the intellectual rights to the genetic code of natural products by obtaining patents to genetic information and using TRIPS to enforce patent rights. This new form of product and the profit that potentially flows from it is invisible especially to the more naïve on the other side of the digital divide. A recent contract with the SA National Botanical Institute - a government agency - and a US horticultural company allowed the company to secure the rights to globally unique Western Cape indigenous flora in return for yet another modern variety of the bright trinkets (limited duration royalties) that the globalisers of former centuries traded the natives for gold and other valuable objects. The difference here is that even though the natives are now organized and have their own government institutions with which to negotiate, the knowledge divide and power inequality in terms of intellectual property places peripheral and marginalized countries at considerable disadvantage. The power imbalance constitutes a serious economic risk in the agricultural sector which will inevitably result in health effects consequent on reduced or lost development opportunities.
Once one moves away from SA the urbanization and industrialization component declines very dramatically. In the Southern African Development Community region of 14 countries for example, more than 80% of the population are rural and engaged in agriculture in one way or another. The regional occupational health regulatory structure is very weak and fragmented and in its infancy. It has proved extraordinarly difficult to promote harmonization of occupational health standards or professional capacity development despite concerted activity since 1997.
Since the sub-Saharan African region as a whole has failed to respond positively to globalisation, and is not experiencing growth and development in an overall sense, the occupational (and general) health of its inhabitants is being undermined. There are serious disparities in the region and severe problems with land tenure which have seen the Zimbabwe economy and polity devastated in the past year or two, and which simmer in SA. As the most developed economy, South Africa has a well developed policy and legal infrastructure including a regulatory framework and human resources in most aspects of OH. There have been important advances in general public policy and practice in relation to gender equity and land redistribution. Labour organization and rights are well entrenched and supported by a constitution. Even so, there are major problems in implementation due to human and other resource constraints, and policy is not enough.
There have been some very encouraging recent initiatives aimed at developing capacity in occupational health for the African region and within the Southern African Development Community region especially. This should impact on the rural sector as well. To an important extent these initiatives are also rooted in the phenomenon of globalisation, representing its positive face and hope for the future.
The globalization process has raised a new set of trans-national problems which cannot be dealt with in isolation by institutions that have arisen in relation to single national governmental sector issues like food production, health, or labour.
In order for globalisation to take on a healthier character, especially in less developed countries, more holistic attention needs to be paid to its integrated impact looking beyond trade in the private sector to the totality of social and public life.
A governance system which reflects this must have international (global), national and local components and these all need to be accessible to less developed countries and poor or marginalized groups within these. Additionally all the levels must articulate for meaningful action. This is a tall order for all or any of these governance levels, including the aspect of overall integration across these levels.
The three principal dimensions of the globalisation process viz. growing trade, foreign direct investment and increased communication/technology/information diffusion provide a useful framework for approaching these tasks.
With respect to trade more appropriate representation in fora such as the WTO and other international bodies is required to ensure a more even-handed approach than hitherto, and to inject equity (eg trade barriers need to be porous in both directions) into the situation. Moves are currently afoot headed by South Africa to bring about greater participation of the smaller players particularly in the African region. The South African President has called for an African Renaissance and has elaborated a strategy of taking up together with other African countries the unified promotion of their interests within the international fora. This is also taking the form of new political structures across the continent. A regional Africa wide response to globalisation pressures is beginning to emerge.
Advice about foreign direct investment should be obtainable from international institutions with prior experience, particularly in the agricultural sector. These include international agencies charged with development such as the Food and Agricultural Organisation and the International Labour Organisation. Also international financial bodies should help developing countries adopt strategies that constitute positive responses to global pressures There needs to be a particular sensitivity to the vulnerabilities of the agricultural sector and its inhabitants in less developed countries. For example, the cashew nut processing industry in Mozambique has been totally destroyed over the past few years by the imposition of World Bank policies on government and producers. Government was prevailed upon to drop subsidies despite warnings that this would put an end of cashew nut processing in the country. With the disappearance of subsidies, cashew nuts could no longer be processed. India, a competitor was able to process the nuts more cheaply and bought up raw nuts at a fraction of the price for which the processed nuts could be sold. This led to bankruptcy and the abandonment of nut growing as well as processing.
These macro issues as they impact on production and occupational safety and health are on the agendas of the large international agencies like International Labour Organisation and World Health Organisation at the current time.
The International Labour Organisation has been particularly active in researching and learning from its vast global experience, and has launched multifarious activities and publications which are available in the public domain on the internet. These and other global organizations have not been slow to provide the necessary information, advice and even resources to bring about an integrated global response directed to better global governance.
When it comes to occupational risk, availability of information is necessary but not sufficient for redressing global and other inequities. It potentially empowers national and local players and enables them to set meaningful objectives in relation to managing the impact of globalisation at their local level.
As agriculture is such a key sector particularly in the less developed countries, and because of its historical and current linkages with industrial development, the need for a concerted approach is paramount. Specifically, this will involve policy formulation and implementation at international and national levels. Specific issues requiring to be addressed are how to direct appropriate resources to agricultural areas to facilitate development in such a manner so as not to displace large numbers of landless people and disrupt or skew development possibilities. There needs to be a plan for developing sustainable agriculture [ International Labour Organisation 2000]. Sustainable agricultural practices include the pursuit of global food security using safe nutrients, crop rotations, integrated pest management, and supporting biological diversity by recourse to productivity gains through the application of appropriate technology and good labour practices and security of land tenure. An interesting possibility is whether the developing world can create a niche market out of organic agriculture. Organic farming in developed countries faces considerable obstacles due to the difficulty of finding a field or water course free of pesticides, or in future of genetically modified crops. This may be possible in less developed countries, where usage of high-input chemicals are still limited, and where a different development path may be possible.The parties should work together to reduce the displacement of labour, as a result of mechanization. International, national and local agencies will have to work in a participatory manner with local people to ensure the use of locally adapted and integrated farming practices, representation of farmers and farm workers (including wage workers) in all aspects of decision-making, and more equitable distribution of access to resources, food and information. Participation should include farmers’ associations, labour organizations, community groups, women’s groups, NGOs, the private sector, and government agencies. International conventions need to be mindful of local Developing Country specificities.Government can provide an enabling policy environment, and information, and help to set research priorities for locally relevant agricultural production and development.
The wealth of knowledge currently held by international agencies and NGOs in the developed world should be made accessible for use in the less developed countries in order to facilitate the positive aspects and counteract the negative aspects of globalisation. For instance, International Labour Organisation experience in Central America on OHS in agriculture between 1993 and 1998 aimed at developing a model for national policy development in developing countries might be applied in other regions in respect of legislation and policy develoment, management of agrochemicals, construction of health surveillance systems and human resource development [ International Labour Organisation, 1999]. At the time of writing this model is being evaluated and the results are not yet available.
Special attention should be paid to, and special action taken to, ensure that rural populations as a whole, and women and children will not to be marginalized. Children and women are particularly affected in agricultural production and special care needs to be taken to ensure that they are catered for in terms of their overall needs. Strategies need to be developed to empower rural populations, and especially women within these populations as women are the principal source of agricultural labour and product in the region. Every attempt should be made to eliminate poverty - the underlying cause of child labour.
OHS requirements include improving safety and health training for agricultural workers and farmers (including the self-employed); promotion of alternatives to hazardous chemicals; strengthening and enforcing existing laws against exposure to hazardous chemicals; improving the state and availability of and access to occupational safety and health services and public health services - all in the context of helping to promote sustainable agriculture.
Permanent institutional links need to be built between international, national and local organizations concerned with promoting occupational health and safety. This needs to include the private sector as well as the governmental and non-governmental sectors.
Important issues to be addressed by linked organizations include the potential occupational and environmental health consequences of uncontrolled globalization, specifically, the implications of trade agreements and transfer of work processes; technology for minimising harmful and maximising positive effects on worker health and the environment; and ways of involving decision makers at various levels.
These issues will be incorporated into the revised World Health Organisation Plan of Action, for the implementation of the Global Strategy on Occupational Health for All for 2002-2005.
The current plan [Lehtinen, 2001] envisages systematically addresses development of health policy, health promotion, occupational health services, occupational health support services, appropriate standards, human resources, information systems and research. It also seeks to encourage member states to devise national programmes on occupational health for all, based on the global strategy, with special attention to full occupational health services for the working population, including migrant workers, workers in small industries and in the informal sector, and other occupational groups at high risk and with special needs, including child workers. Member states are urged to develop updated education and training curricula for developing human resources for occupational health, including both occupational health and safety professionals (occupational physicians, ergonomists, occupational health nurses, occupational hygienists, and other experts) and professionals responsible for the design and management of the workplace (architects, engineers and managers) and to give them corresponding support. The Network of the World Health Organisation Collaborating Centres in Occupational Health will be entrained to facilitate and support the implementation of the global strategy as this develops.
These goals can only be achieved by means of international collaboration and the international agencies working together in a concerted effort, and the possibilities for global action through existing structures (eg purpose built for the region, and existing structures ranging from governments to World Health Organisation collaborating centres) are outlined in the plan, all of which have application to less developed countries and the agricultural sector.
In order to contribute to this complex set of goals at all levels of governance, a plan for a new initiative in occupational health in the African region ("The African Initiative on Occupational Health") emerged at a World Health Organisation meeting in Pretoria in October 2000 on occupational health in the informal sector. In March 2001 the world Health Organisation- International Labour OrganisationJoint Effort on Occupational Safety and Health in Africa [world Health Organisation-international Labour Organisation 2001] was launched to collaborate in the region to reduce the burden of occupational disease and injury through coordination of OHS activities in human resource and capacity development; national policy, programme and legislation development; information research and awareness raising; and promotion of OHS in particularly hazardous occupations, vulnerable groups (informal sector, women and children) and in newly transferred technologies.
This is the first time that there has been a global response to OHS focusing on the African regional as a World Health Organisation, and as such constitutes a great step forward. An ambitious programme of action has been drawn up listing future activities in the four areas and includes OH services audit, burden of disease surveillance and research, developing professional and educational capacity, assisting and implementing national policies, programmes and legislation, establishing technical support and information centers in various countries in the region, and focusing these activities around vulnerable groups and high priority hazardous occupations. This process has just recently begun with the appointment of a regional coordinator.
The joint effort has already prioritized the agricultural and mining sectors as those in which the majority of the working population whether formal or informal work.
There are also other initiatives afoot in the Southern African Development Community region, notably the US Fogarty Programme in Occupational and Environmental Health research capacity development which is now in its second 5 year period, and the new Triregional Programme in Occupational Health and Safety involving Central America, Southern African Development Community and Scandinavia led by Sweden (SIDA and NIWL) in the development of OH capacity. The three initiatives bring together organizationally distinct stakeholders and inject significant heterogeneity into the hoped-for development scenario. Apart from the international governmental organizations, the Swedish organizations have an impressive track record of capacity development in the occupational health in the agricultural sector in Central America, while the Fogarty training programme has a similar track record in developing occupational and environmental health capacity in South Africa over the past 5 years.
There is now good convergence of all these initiatives which put together international agencies, supra-governmental organizations ( Southern African Development Community structures), governments, academic and training institutions, and local groups and organizations. With concerted effort and mutual support and learning by all these players it seems that the next period could well see a better balanced truly globalised network of people and resources being brought to bear on occupational health (with focus on the agricultural sector) in the African region. If these activities take off and are sustained by good participation at international global and local levels, the question about whether it is possible for the poor and marginalized to benefit from the advantages of globalisation while meaningfully managing the disadvantages using international best knowledge and practice, will hopefully begin to be answered.
