GLOBALISATION,  OCCUPATIONAL HEALTH AND THE AGRICULTURAL SECTOR IN SOUTHERN  AFRICA. 

Jonathan E. Myers

Professor and Director
Occupational and Environmental Health Research Unit
School of Public Health and Family Medicine
University of Cape Town
Anzio Road, Observatory 7925
SOUTH AFRICA
Tel: 021 4066898
Fax:  021 4066163
Email: myers@phfm.uct.ac.za

Word Count:  6059  including this title page

INTRODUCTION 

This article is the last in a  series of three which examines the impact of globalisation on occupational health in the agricultural sector in the Southern African context.  The first   focused on understanding the globalisation  process1, and the second2dealt  with the impact of globalisation on occupational health in the agricultural sector in general.   
The trends and problems considered thus far can be examined in greater detail through a focus on the South African  experience, as located within the broader Southern African Development Community (an economic bloc of fourteen Southern African countries) setting,  and as related to the rest of the sub-Saharan African region. South Africa is the center of this discussion because it is a key country within the sub-Saharan African region3, it has a relatively sophisticated industrial sector, and it shares with other countries in the region many of the problems associated with agriculture and the extractive industries. In South Africa's dual economy, the developed sector shares many of the globalisation-related features of developed countries, while the less developed sector reflects impacts of globalisation similar to those experienced by other countries in the region. Furthermore, most of the continent's professional activity related to occupational health is concentrated in South Africa.

Globalisation trends are similar to those in 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 industrialisation in South Africa, and the recent emergence of South Africa from the closed economy and society of the apartheid era. Many of the benefits of apartheid for the white population have continued under the impact of globalisation, in that there has been increased privatisation and less redistribution than was widely expected in 1994 and subsequently. For subSaharan Africa as a whole there has been poor growth over the past three decades, averaging just over 2 percent4. This trend was slightly more pronounced in the agricultural sector, thus reflecting the dominance of this sector over the stagnant industrial sector. The agricultural labour force remained at around 68 percent of the total, but agricultural GDP was only 18 percent. This region has the highest proportion of the population living in poverty in the world. The   impoverishment of the region, particularly in the rural areas, has resulted from a complex combination of factors. Among these were the colonial political pressure to drive people off the land by instituting poll taxes and seizing the prime agricultural lands, feudal employment relations in the agriculture sector after colonial conquest, and industrial-sector wages insufficient to support families.

Most economies in the region are dependent on 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 that 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 International Monetary Fund have squeezed public health and welfare resources in a setting with few safety nets, given constant disruption of agricultural subsistence production by warfare and political turmoil. The agricultural sector has come under increasing competitive pressure from more developed countries and technological developments and this pressure has led not only to more intensive cultivation and agrichemical use but also to increased morbidity, mortality, landlessness, and unemployment. Agribusiness has grown in response to increasingly competitive niches in agricultural products, the decline of gold mining, and the need of large mining corporations to diversify their investments. 

In the case of South Africa's agricultural sector, increased mechanisation and capitalisation have led to the loss of about a quarter of a million jobs over the past fifteen years, as well as an increase in output by about 25 percent5.  Apart from pockets in already well developed areas of the sector, there has been little evidence of a vigorous response overall from the agricultural sector in sub-Saharan Africa 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.

EXTRACTIVE INDUSTRY AND ITS LINKS TO THE RURAL AREAS

Rural areas within Africa, which abound with endemic and epidemic health problems, generally are mere dormitory areas that send labour to the mines, urban industries, and commercial agricultural employers, where working and living conditions are poor and stressful. Historically, in earlier periods of globalisation, the extractive industry in gold mining, especially in South Africa, imported labourers widely from the sub-Saharan African region and then exported sick and injured labourers back6, 7 to these sending areas. This pattern resulted in the spread of pneumoconiosis, tuberculosis8 , and sexually transmitted diseases. These problems, in turn, skewed the demography of the rural populations, undermined agriculture and subsistence production specifically, and brought about general impoverishment. Currently, the HIVIAIDS epidemic is spreading substantially via the same route from the 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, HIVIAIDS, and tuberculosis is substantial, with devastating effects on health at individual and community levels9. Silica dust exposure and silicosis constitute an added occupational health interaction.

Women perform the bulk of agricultural work in the region. The contribution of children has increased dramatically in recent years due to the advent of the AIDS epidemic and the sharp increase in the number of orphans. In this sense, globalisation is continuing its long history of undermining agriculture (that is, subsistence agriculture and family production) while favoring plantation-type agribusiness. The mining industry has long been active in trying to remove tuberculosis as a compensable occupational disease in South Africa and has argued that the source of infection is in the rural areas (despite the history of the mining industry seeding infection in the rural areas).  This attempt by the industry has reached new heights in the HIV/AIDS era with the impact of immunodeficiency on tuberculosis.  The industry is  currently attempting to do the same with respect to HIV/AIDS, which is expressly not viewed as an occupational disease. Given the conditions of work in the mining industry, however, there are clearly occupational factors that contribute to the transmission of infection to miners and, hence, to and from  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 and infection flows.

	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, with their extensive effects on agriculture and rural populations, may also be considered health risks and are often predicated on the spoils of the extractive industry (diamonds, oil, and timber). Examples include the longstanding war in Angola that, since 1975, has revolved around oil and diamond extraction; the current war in the Democratic Republic of the Congo and central Africa involving diamonds and minerals; and the long-term instability in West Africa involving diamonds and timber.

CHEMICAL HAZARDS

Chemicals feature very prominently in  risks to health in the agricultural sector, and there is a substantial local literature on pesticide health effects10-17. The use of chemicals has increased substantially over the past few decades, and continues to increase under conditions of poor regulation, information, and communication. Chemicals banned in developed countries find their way to less developed countries and are in daily use. Acute poisoning is clearly a significant, widespread problem that is seriously underreported, if ever ascertained18,19. It is, in fact, second only to drowning as a cause of morbidity and mortality on South African farms20. Because of the demographic peculiarities of the subsistence sector, women (especially pregnant women) and children are exposed in their homes that abut the fields, as well as in the fields. Sometimes these homes are in the middle of the crops (as with coffee farming in East Africa) 21. A potent toxic cocktail of hazards results from the combination of a number of factors: potent agrichemicals; poorly educated and illiterate farmers; the absence of boundaries between the home, work, and general environments; poor regulation; and poor hazard-communication mechanisms.

International policy has been developing over the past few years. The Stockholm Protocol, signed in May 2001, bans trade in persistent organic pollutants22 (Stockholm 2001). However, policy at the national level is often absent or fragmented22a, and even when it is well developed it is often not implemented or feasible to implement. Even when international regulation is achieved, however, there can be unexpected effects. The issue of the continued use of DDT as a mosquito insecticide for the prevention of malaria since the 1950s is a case in point. There has been a major recrudescence of malaria, which is one of the top causes of mortality in Africa. This may in part have been due to developed countries' negative attitudes toward DDT and pressures on less developed countries not to use DDT for this purpose. However, this is difficult to disentangle because many other factors have also been implicated in the resurgence of malaria including war, collapse of control programs, insect resistance, global warming and floods.  Another agrichemical banned for use in developed countries is paraquat, and its toxicity has been demonstrated for the respiratory system1.  These effects may interact synergistically with TB, smoking, and other respiratory hazards to cause impairment10. Acute episodes of poisoning with organophosphates are well documented as leading to permanent impairment of the nervous system, and such poisoning interacts with other determinants such as poor education, alcohol abuse, and violence to cause problems for farm populations24-26. This is a particular problem in the wine-farming areas where the infamous practice of paying workers with alcohol persists, despite having been outlawed27,28.

INADEQUATE OR INACCURATE DATA

Intentional injuries are very prevalent among farmworkers, especially those on plantations and commercial farms. Occupational injuries are also a big problem. Even when mortality results, however, the reported statistics do not reliably estimate true incidence. In South Africa, only approximately 20 percent of all occupational fatalities are reported20. The comparison with the urban situation is striking; but even there, 25 percent underreporting still occurs29. Given that South Africa 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 in relation to both mortality and pesticide poisoning18,20. Substantial child mortality and morbidity occur not only in South African agriculture but even in the developed world30 (Reed and Claunch 2000), and these problems have recently received much media attention. Farmworkers' children as young as nine or ten 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.

A precise estimate of the  burden of occupational injury and disease is currently unavailable, although there have been attempts to estimate it31. It is extremely difficult to quantify because of lack of data, low employment, and the unusually high degree of externalisation of costs to the victims and their communities, both historically and 
currently6-8.  Currently, moves are afoot by the WHO Occupational Health Program to commission a study to estimate this through the work of local African institutions and WHO-collabourating centres. It is worth emphasizing that the massive dominance of the informal sector -especially women's domestic, agricultural, and commercial work--in the African region generally distorts the meaning of all traditionally used measures for determining the burden of occupational disease and injury. This means that substantial methodological difficulties will affect any such estimation process and the validity of comparisons across regions with different levels of development.

UNEMPLOYMENT, HIV/AIDS DRUGS, AND BIOPROSPECTING

There are other, less direct health impacts that are mediated by the general environment. Increasing unemployment resulting from global and local restructuring has affected all farming sectors. Large numbers of jobs have been lost in the past decade in South Africa-the estimate is about 10 percent of the workforce (currently, 10 million) over the  six years5  to 2001. 

Other major impacts have resulted from the combined effects of new notions of intellectual property, patents, and the interventions  threatened by the World Trade Organisation (WTO), which have made treatment with antiretroviral drugs for HIV/AIDS unaffordable in sub-Saharan Africa even as the epidemic is rapidly gaining momentum. The magnitude of this epidemic--and therefore the enormity of the drug-access problem-may be illustrated by a recent report on AIDS mortality. This showed South African AIDS deaths in the year 2000 to have already equaled those from all other causes of mortality.  It further  predicted seven to nine million deaths from AIDS over the period to 201032. Recently, the pharmaceutical companies collectively took the South Aftican 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, as in (theoretically) being able to get antiretroviral drugs more cheaply from another less developed country such as India, and the downside of globalisation, as in dealing with international codes such as Trade Related Intellectual Property Rights (TRIPS)  that are enforced against governments of less developed countries even as they struggle within their meager budgets to tackle a major epidemic.  Such manifestations of globalisation make it appear that multinational corporations are seeking simply to prize open the global clam for their own one-way access to profits, while unfairly suppressing competition from weaker, less developed countries – at the ultimate expense of people in these countries who are the victims of HIV/AIDS. The slogan coined by protestors-"Patient rights, not patent rights"--succinctly summarizes the issue.

There has been active bioprospecting in South Africa and elsewhere of local plant and animal materials that traditional healers use for their medicinal products. The goal is to see if active agents can be isolated and replicated by these same pharmaceutical companies, as well as other multinationals. Because the residents of less developed countries, in contrast to the companies' representatives, have known little about the issues involved, the companies have been able to purchase the intellectual rights to the genetic code of natural products by obtaining patents to genetic information, and to use  the Trade Related Intellectual Property Rights code to enforce their patent rights. This new slippery form of product and the profits that potentially flow from it are invisible--especially to the more naive on the wrong side of the digital divide. A recent contract with the South African National Botanical Institute, which is a governmental agency, and a US horticultural company allowed the latter to secure the rights to globally unique Western Cape indigenous flora in return for limited-duration royalties--yet another modern variety of the bright trinkets that the globalisers of centuries past traded with the natives for gold and other much more valuable goods. The difference here is that even though the natives are now better organized and have their own government institutions with which to negotiate, the knowledge divide and the power inequality in terms of intellectual property place peripheral and marginalized countries at a considerable disadvantage. The power imbalance constitutes a serious economic risk in the agricultural sector that will inevitably result in indirect health effects caused by reduced or lost development opportunities.

BEYOND SOUTH AFRICA

Once one moves away from South Africa, urbanisation and industrialisation  decline very dramatically. In the Southern African Development Community region of fourteen countries, for example, more than 80 percent of the residents live in rural areas and are engaged in agriculture in one way or another.  Only in South Africa is the proportion of rural dwellers as low as 50%.  The other countries are all overwhelmingly rural.  The region’s occupational health regulatory structure, still in its infancy, is and fragmented.  It has proved extraordinarily difficult to promote harmonisation of occupational health standards or occupational health  capacity development, despite concerted activity since 1997. More broadly viewed  sub-Saharan Africa as a whole has failed to respond positively to globalisation and is not experiencing growth and development overall, the occupational (and general) health of its inhabitants is being undermined, The region's serious disparities and severe problems with land tenure, which simmer in South Africa, have left the Zimbabwe economy and polity devastated in the past year or two, As the country with the region's most developed economy, South Africa has a well-developed policy and legal infrastructure, including a regulatory framework and human resources in most aspects of occupational health, There have been important advances in general public policy and practice in relation to gender equity and land redistribution, Labour organisation 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 policies alone are not enough.

There have been some very encouraging recent initiatives aimed at developing capacity in occupational health for the WHO African region and within the Southern African Development Community region especially, These are explicitly focused on the main problem sectors - agriculture, the extractive industry, and the informal sector. All these initiatives focus on the agricultural sector in a major way.  To an important extent, these initiatives are also rooted in the phenomenon of globalisation, representing its positive face and its hope for the future,

 RECOMMENDATIONS FOR CHANGE

The globalisation process has raised a new set of transnational problems that cannot be dealt with in isolation by institutions that have arisen to address national needs or single-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, and more effort needs to be made to look beyond trade in the private sector to the totality of social and public life.  A governance system that reflects holistic thinking must have international, national, and local components.  Furthermore, these all need to be accessible to less developed countries and particularly to poor and marginalized groups within these.  All the levels must then work together to devise meaningful actions --a tall order for all or any of these governance levels, even without the need  to coordinate their efforts.

Achieving Balance through Comprehensive Efforts

The main characteristics of globalisation need to be comprehensively addressed to ensure balance. Three of these are increased trade, foreign direct investment and increased diffusion of communication technologies and information. With respect to trade, more appropriate representation in forums such as the WTO and other international bodies is required to ensure a more even-handed and equitable approach than has yet applied (for example, by insisting that trade barriers need to be porous in both directions). 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 joining with other African countries to promote of their joint interests within international forums. These efforts are also taking the form of new political structures across the continent, and an Africa-wide response to globalisation pressures is beginning to emerge.  The new African Union is a concrete manifestation of these developments.

	Less developed countries should be able to obtain advice about foreign direct investment from international institutions with experience particularly in the agricultural sector. These include international agencies charged with development, such as the Food and Agricultural Organisation and the ILO. 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. The government was prevailed upon to drop subsidies, despite warnings that this would put an end to indigenous cashew nut processing. With the disappearance of subsidies, India, a competitor, was able to process the nuts more cheaply than Mozambican growers and bought up raw nuts at a fraction of the price for which the processed nuts could have been sold by Mozambicans.  This led to bankruptcies among processors and hardships for growers in Mozambique, and the abandonment of their cashew nut industry.  

These macro issues , as they affect production and occupational safety and health, are currently on the agendas of the large international agencies like the ILO and the WHO. While there has been criticism of the role of the international governmental agencies33, their responses to globalisation are still emerging and cannot yet be fully   evaluated. The ILO has been particularly active in researching and learning from its vast global experience, and it has launched wide-ranging activities and produced publications that are available in the public domain on the internet These and other global organisations have diligently been working to provide the necessary information, advice, and  resources to bring about an integrated global response directed to better global governance. When it comes to occupational health risks, the availability of information is necessary, since it potentially empowers national and local players and enables them to set meaningful objectives for locally managing the impacts of globalization. Nevertheless, the availability of information is not sufficient for redressing global and other inequities, and many other actions must be joined to make a difference.

What Needs to Be Done in the Agricultural Sector

Given the  key role of agriculture in developing countries and its historical and current linkages with industrial development, the need for a concerted approach to addressing problems in this sector is paramount. Specifically, such an approach involves policy formulation and implementation at international and national levels. A major issue needing attention is how to direct appropriate resources to agricultural areas so that development is facilitated, but without displacing large numbers of landless people to precipitately and disrupting or skewing development possibilities.

A Plan for Sustainable Agriculture

In particular, there needs to be a plan for developing sustainable agriculture. The plan outlined by the ILO4,34 includes the pursuit of global food security through various approaches: using safe nutrients, crop rotations, and integrated pest management, as well as supporting biological diversity and productivity through the application of appropriate technology, good labour practices, and security of land tenure.  An interesting possibility is for the developing world to create a niche market in organic agriculture.  Organic farming in developed countries faces considerable obstacles due to the difficulty of finding fields and water courses free of pesticides, or  in future, uncontaminated by genetically modified crops. This may be possible in less developed countries, where usage of high-input chemicals is still limited and where a different development path may still be possible. The major stakeholders should work together to reduce the displacement of labour resulting from mechanisation. International, national, and local agencies will have to participate 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 access to resources, food, and information. Participation should include farmers' associations, labour organisations, community groups, women's groups, nongovernmental organisations, the private sector, and government agencies. National governments will need not only to provide an enabling policy environment and specific information but also to help set research priorities for locally relevant agricultural production and development.

Access to the Knowledge of the Agencies

The wealth of knowledge currently held by international agencies and nongovernmental organisations in the developed world should be made more accessible for use in developing countries in order to facilitate the positive aspects and counteract the negative aspects of globalisation. For instance, the Central American experiences related to occupational health and safety in agriculture of the ILO in the  late 1990s  involved efforts to build a model for national policy development in developing countries.  These might  be  applied in other regions with respect to legislation and policy development, management of agrochemicals, construction of health surveillance systems, and human resource development35. This model is currently undergoing evaluation, and the results are not yet available.

Attention to Rural Residents' Needs

Whatever the approach,  special attention should be paid and special action taken to ensure that rural populations as a whole, and women and children in particular, will not be marginalized.  Also, for all the reasons discussed thus far, every attempt should be made to eliminate poverty, the underlying cause of child labour.  To improve occupational health and safety, necessary efforts will include improving safety and health training for agricultural workers and farmers (including the self-employed); promoting alternatives to hazardous chemicals; strengthening and enforcing existing laws against exposure to hazardous chemicals; and improving availability and access to occupational safety and health services, as well as public health services.

Infrastructural and Governance Arrangements

Permanent institutional links need to be built between international, national, and local organisations concerned with promoting occupational health and safety. This effort needs to include the private sector, as well as the governmental and nongovernmental sectors. Important issues to be addressed by linked organisations include the potential occupational and environmental health consequences of uncontrolled globalisation, specifically, the implications of trade agreements and transfer of work processes; technology for minimizing harmful effects and maximizing positive ones on workers' health and the environment; and ways of involving decision makers at various levels. 

These issues have recently been incorporated into the revised WHO Plan of Action, for the implementation of the Global Strategy on Occupational Health for All for 2002-2005. The current plan makes a good starting point and already envisages systematically addressing development of health policy, health promotion,  occupational health services, occupational health support services, appropriate standards, human resources, information systems, and research36. It also seeks to encourage member states to devise national programs on occupational health for all, based on the WHO global strategy, with special attention to providing 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 have been  urged to prepare updated education and training curricula for developing human resources for occupational health, including both occupational health and safety professionals. These goals can be achieved, however, only by means of international collaboration and the concerted effort of the international agencies.
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 an October 2000 WHO meeting in Pretoria on occupational health in the informal sector. In March 2001 the WHO-ILO Joint Effort on Occupational Safety and Health in Africa (WHO-ILO 2001) was launched to collaborate in the region to reduce the burden of occupational disease and injury through coordination of occupational health and safety activities.  Areas of activity include a) human resource and capacity development; b) national policy; program and legislation development; c) information research and awareness  raising; and d) promotion of occupational health and safety in particularly hazardous occupations, in vulnerable groups (such as the informal sector or women and children), and with newly transferred technologies.

	This is the first time there has been a global response to occupational health and safety focusing on the African region as a whole, and the Joint Effort thus constitutes a great step forward. An ambitious program of action has been drawn up listing future activities in the four areas. This includes implementing occupational health services audits; monitoring and studying who bears the greatest burdens associated with diseases, developing professional and educational capacities; assisting and implementing national policies, programs, and legislation; establishing technical support and information centers in various countries in the region; and focusing these activities around vulnerable groups (particularly the informal sector) and high-priority hazardous occupations. The Joint Effort has already prioritized the agricultural and mining sectors, since those involve the majority of the formal and informal workers. Implementation is proceeding, and a regional coordinator was recently appointed.

There are also other initiatives afoot in the Southern African Development Community region, and they have the strength of bringing together organisationally distinct stakeholders. Two notable initiatives are the United States Fogarty Program in Occupational and Environmental Health Research Capacity Development, which is now in the second of its two five-year terms, and the new Biregional Program in Occupational Health and Safety involving SADC, the Swedish International Development Agency and the National Institute for Working Life  in the development of occupational health and safety capacity.   The Swedish organizations have an impressive track record of capacity development in occupational health and safety in Central America's agricultural sector, while the Fogarty training program has a similar track record in having developed occupational and environmental health capacity in South Africa over the past 8 years. Capacity development focuses on transferring knowledge and skills to bring about improvements in health and safety for working populations.

A productive convergence is now occurring with all of these initiatives that put together governmental, nongovernmental, and academic and training institutions at local, national, and international levels. With concerted effort and mutual support and learning by all these players, it seems that the next step could well bring a better-balanced, truly globalised network of people and resources to address occupational health (in the agricultural sector, especially) in the African region. If these activities take off and are sustained by committed participation, new answers may emerge to the question of whether the   poor and marginalized can benefit from the advantages of globalisation, while meaningfully managing the disadvantages.

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