‘Looking at risk with both eyes’: health and safety in the Cerro Rico of Potosí (Bolivia)

This thesis is concerned with core assumptions and practices in dominant approaches to Occupational Health and Safety (hereafter, OHS). I critically evaluate these through an anthropological exploration of the everyday perceptions, experiences and practices related to OHS risks amongst the cooperative miners employed in the Cerro Rico of Potosí (Bolivian Highlands). Drawing on 17 months of ethnographic fieldwork conducted between 2009 and 2011, the thesis examines the lives and livelihoods of the miners during a time of socio-political and economic transformations and of industry upheaval due to rising mineral prices. I describe how men and women navigate the challenges and opportunities in their lives and livelihoods and how these affect their perceptions and ability to manage the OHS risks associated with cooperative mining. The thesis hinges on the Andean idea of ‘looking at risk with both eyes’, which connotes various overlapping and changing ways of understanding, perceiving and managing OHS hazards. This approach makes visible numerous inter-connected issues, which include the miners’ individual subjectivities and values, backgrounds and lives, their different motivations for mining and the consequent everyday relations in the mine and beyond. It also allows unveiling the complex net of actors, factors and relationships which, from the individual to the global spheres and vice-versa frame, in a diverse and dynamic manner, both the OHS choices and opportunities of the miners and the particular risks they encounter. On the basis of this ethnographic evidence about miners’ shifting and context-specific perceptions and behaviours in managing risks that are transformed as circumstances change, I question the value of a universalising OHS approach based on assumptions of static and manageable OHS risks that disregard the precarious, complex, uncertain, heterogenic and mutable context in which miners live and work

Precarious bodies: occupational risk assemblages in Bolivia and Trinidad

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Labour rights abuses in surgical products

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The psychosocial impacts of skin-neglected tropical diseases (SNTDs) as perceived by the affected persons: A systematic review

Background Neglected Tropical Diseases (NTDs) disproportionately affect marginalised groups within impoverished communities, conferring devastating physical, financial and psychosocial effects. Skin-NTDs (SNTDs) are uniquely stigmatising due to their visible nature, rendering affected individuals vulnerable to psychosocial risk and the associated decline in social participation, quality of life and mental health. In response to knowledge gaps identified by current global efforts for integrated control of SNTDs this review gathers existing evidence on the psychosocial effects of SNTDs, with consideration given to the influence of gender. Methods The study protocol is registered with PROSPERO (CRD42022336676). Data was collected from Embase, Global Health, Medline and Web of Science, with additional articles identified through Google Scholar and bibliography tracking. Qualitative studies published in English between 2005 and 2024 reporting men’s and women’s experiences with SNTDs were searched. Appropriate data from each included study were inputted into NVivo software to facilitate thematic synthesis. Descriptive and analytic themes were generated through lineby- line coding using an inductive approach. Results 27 articles of high and moderate quality were included. They pertained to buruli ulcer, cutaneous leishmaniasis, leprosy, lymphatic filariasis, tungiasis, onchocerciasis, schistosomiasis and podoconiosis. Men and women across SNTDs and contexts reported debilitating physical symptoms which impaired their ability to work, socialise and carry out usual daily activities. Some felt (at least initially) well supported by partners and relatives, whereas most experienced avoidance, abandonment and even violence, with women incurring worse SNTD-related social consequences. Many men and most women experienced stigma, with discriminatory behaviours largely attributed to fear of infection, decreased ability to perform gender-specific daily activities, and the perceived association between SNTDs and sinfulness. Self-reported impacts of SNTDs on men’s and women’s mental wellbeing included low mood, anxiety, low self-esteem, and suicidal ideation. Disease-specific knowledge, early treatment, social support, and disease acceptance were mentioned as protective factors.Conclusion SNTDs cause significant psychosocial harms, particularly for women. Implementing mythbusting and contact-based educational campaigns and improving access to treatment and to livelihood opportunities and social protection schemes for men and women with a SNTD will help prevent and mitigate these.</p

‘My appetite and mind would go’: Inuit perceptions of (im)mobility and wellbeing loss under climate change across Inuit Nunangat in the Canadian Arctic

The academic literature on personal experiences of climate-induced wellbeing erosion (often conceptualised as ‘non-economic losses and damages’) is still limited. This represents a serious climate policy gap that hinders support for marginalised people across the world including Indigenous People. Lately, we have seen a rapid growth in empirical studies exploring linkages between climate change and mental health among Indigenous Inuit in Canada. However, its association with human (im)mobility remains unexplored. This review article brings together the empirical evidence of Inuit experiences and perceptions of climate-related wellbeing loss and (im)mobility while providing climate policy with guidance for appropriate action. The systematic review investigates how Inuit in Arctic Canada felt that climatic changes impacted their (im)mobility and mental health while putting these feelings into a wider context of colonial violence, forced child removal, the residential schools, and other systematic human rights abuses. Twelve electronic databases (four specific to Arctic research) were searched for English and French, peer reviewed, qualitative studies published between 2000 and 2021. Fifteen selected articles were analysed using NVivo and thematic narrative analysis from a climate-violence-health nexus systems approach. Three overarching climate-related wellbeing loss themes, all strongly intertwined with feelings of immobility, emerged from the literature namely ‘identity and cultural loss’, ‘land connection as a source of healing’, and ‘changing environment triggering emotional distress’. The narratives circled around Inuit land connection and how climate-induced temporary (im)mobility interrupted this relationship. Climatic changes isolated Inuit away from the land and cut off their ability to partake in land activities. This strongly eroded Inuit wellbeing, expressed through distress, anxiety, depression, social tension, suicide ideation and deep feelings of cultural loss. The findings showed how Inuit mental health strongly depend on a sustained connection to the land. Further empirical research among other Indigenous People or nomadic groups on wellbeing loss and climate-induced involuntary immobility is urgently needed. Future research should particularly explore how such mental health impacts tie into past and present (post)colonial traumas and current suicide occurrences. This will help climate policy, research, and adaptation planning better prepare and propose more contextually and culturally appropriate health actions in the future.</p

Synergistic state governance of labour standards in global value chains: forced labour in the Malaysia-Nepal-UK medical gloves supply chain

Drawing on research into medical gloves global value chains (GVCs), this article examines the interacting roles that states differently positioned in GVCs have played in preventing and eliminating forced labour. Our case study, based on a worker survey and semi-structured interviews across GVC actors, focuses on forced labour in the Malaysian medical gloves sector during the COVID-19 pandemic, linking production in Malaysia, end markets in the UK (primarily through procurement for the National Health Service), and migrant-sending countries, especially Nepal. We analyze the intermeshing effects of the different roles of states, operating at either the horizontal or vertical level of GVC governance, in terms of contributing to issues of forced labour. We identify three state roles in the Malaysia-UK medical gloves chain: producer state (Malaysia), migrant-sending state (Nepal) and regulator-buyer state (UK). We also identify some of the most persistent barriers to resolving forced labour in the value chain. Our research illustrates that Malaysia’s complex regulatory, political and institutional dynamics most directly influence forced labour in gloves production, but Nepal’s migration policies and the UK’s healthcare procurement practices also create forced labour risk in Malaysia. Advancing Gereffi and Lee’s (2016: 25) notion of “synergistc governance” and Jessop’s (2016) strategic-relational approach (SRA) to the state, we thus argue that the creation of sustained and positive regulatory synergies among states differently positioned in GVCs is necessary for the prevention and elimination of forced labour.</p

Country of origin of medical products and risk of labour rights abuse: a cross-sectional analysis using four procurement datasets

BackgroundCase studies have highlighted labour rights abuse in the manufacture of several healthcare products, but little is known about the scale of the problem or the specific products involved. We aimed to quantify and compare the overall and product-specific risks of labour rights abuse in the manufacture of healthcare products supplied to high-income settings using multiple datasets on the product country of origin (COO).MethodsPublic procurement data from South-Eastern Norway (n=23,972 products) were compared to datasets from three other high-income settings: procurement data from Cambridge University Hospitals, trade data from UN Comtrade, and registry data from the US Food and Drug Administration (FDA). In each dataset, the product COO was matched to the International Trade Union Confederation risk rating for labour abuse and deemed high-risk when rated 4, 5, or 5+.ResultsIn the Norway data, 55.4% of products by value had a COO declared, 49.1% of which mapped as high-risk of labour rights abuses. COO was identified for 70/100 products in the Cambridge data, with COO matching high-risk at 59.9% by value. The level of risk for specific medical product categories varied between the Norway, US FDA, and UN Comtrade datasets, but those with higher proportional risk included medical/surgical gloves and electrosurgical products.ConclusionEvidence of high-risk of labour rights abuse in the manufacture of healthcare products present in these data indicates a likely high level of risk across the sector. There is an urgent need for global legislative and political reform, with a particular focus on supply chain transparency as a key mechanism for tackling this issue.</p

Country of origin of medical products and risk of labour rights abuse: a cross-sectional analysis using four procurement datasets

BackgroundCase studies have highlighted labour rights abuse in the manufacture of several healthcare products, but little is known about the scale of the problem or the specific products involved. We aimed to quantify and compare the overall and product-specific risks of labour rights abuse in the manufacture of healthcare products supplied to high-income settings using multiple datasets on the product country of origin (COO).MethodsPublic procurement data from South-Eastern Norway (n=23,972 products) were compared to datasets from three other high-income settings: procurement data from Cambridge University Hospitals, trade data from UN Comtrade, and registry data from the US Food and Drug Administration (FDA). In each dataset, the product COO was matched to the International Trade Union Confederation risk rating for labour abuse and deemed high-risk when rated 4, 5, or 5+.ResultsIn the Norway data, 55.4% of products by value had a COO declared, 49.1% of which mapped as high-risk of labour rights abuses. COO was identified for 70/100 products in the Cambridge data, with COO matching high-risk at 59.9% by value. The level of risk for specific medical product categories varied between the Norway, US FDA, and UN Comtrade datasets, but those with higher proportional risk included medical/surgical gloves and electrosurgical products.ConclusionEvidence of high-risk of labour rights abuse in the manufacture of healthcare products present in these data indicates a likely high level of risk across the sector. There is an urgent need for global legislative and political reform, with a particular focus on supply chain transparency as a key mechanism for tackling this issue.</p

Confirming non-endemicity of podoconiosis in Guatemala and in Idukki District in Kerala (India): a comparison of two approaches potentially suitable for other Neglected Tropical Diseases

Background: Podoconiosis is an underreported lymphoedema whose distribution is uncertain at global level and within endemic countries. Previous work has identified countries with historical evidence of podoconiosis, but which do not currently report cases. Podoconiosis may persist in these countries or have been eliminated due to socioeconomic development. Here we describe two different approaches used to clarify podoconiosis endemicity status in Guatemala and in Idukki District (Kerala State, India). Methods: Two different epidemiological approaches were used by different research teams, determined by the available resources and contextual factors in the two settings. In Guatemala, where lymphoedema cases are routinely recorded in the health information system, 102 municipalities with suspected cases, historical evidence of podoconiosis, or environmental suitability for the disease were visited. Active case searches were conducted from July 2016- October 2018, and suspected cases were clinically examined to confirm or rule out podoconiosis. In Idukki, where lymphoedema cases were not routinely recorded, a population-based prevalence survey for lymphoedema was conducted from September- December 2022, covering 13,664 individuals aged 15 years and older. Results: Both approaches were effective at clarifying podoconiosis endemicity. In Guatemala, 20 cases with lower limb swelling were investigated. Podoconiosis was ruled out in all cases, and filarial lymphoedema was suspected in three. In Idukki District, 105 cases of lower limb swelling were identified. None were confirmed to have podoconiosis, with post-surgical lymphoedema and hypertension being the most common diagnoses. Active filarial infection was identified in two cases in Idukki District. Conclusions: These investigations provide evidence that podoconiosis is currently non-endemic in Guatemala and in Idukki District in India. They also demonstrate that population-based surveys and targeted case searches both provide effective ways to explore disease endemicity in areas where this is uncertain. The most appropriate approach depends on a combination of contextual and research-based factors, including evidence for endemicity, resources available, and geographical, population, and health system factors.</p