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The socio-economic attributes of Indian villages are emulated through occupation. The principle types of occupation in Indian villages encompass of agriculture, fishing, weaving, cottage industry, handicrafts, etc. ‘Occupational health’ dichotomizes somatic and psychological health that encapsulate within and outside the workplace.
Objectives
This study will focus on the prevalence of self-rated health problems with the multiple responses of the workers, along with the determinants of occupational health problems among workers engaged in handloom sector.
Methods
Primary data was collected in Sualkuchi block, Kamrup Rural district, Assam through structured questionnaire during February to April 2016. Total 250 samples were interviewed and statistical techniques like Bivariate and Relative risk ratio was used.
Results
About 80% of the workers are suffering from health problems, which are a major concern in the handloom sector. More than half of the respondents reported suffering from musculoskeletal disorder, making it the most prevalent disorder in the sample. Statistical analyses revealed a positive significant association between the intensity of health problems and an increased number of years of work experience and hours of working.
Conclusion
The study underlines the need for further research regarding the postural strain of weavers and also suggests the implementation of ergonomic design into weaver workstations to minimize the adverse effect of their current working postures. Improving upon the weaver's work-posture could improve their quality of life.
Workers' health is an integral part of general health and daily life. Needless to say that if workers will be healthy, they will be productive for organization in which he/she works and raise healthy families too. The working environment engaged in handloom sector is informal in nature and are vulnerable in terms of health associated with the particular occupation. Moreover, there are various safety related issues associated with work place. Health becomes a basic requirement for raising income of the household, productivity and development. Moreover, adverse conditions of employment, occupation and the position in the workplace hierarchy also affect the health of workers.
Handloom weaving encompasses a multitude of tasks, which demands repeated movement of upper and lower limbs to operate pedals and shuttles, with arms rose away from the body.
The working environment engaged in handloom sector are informal in nature and are vulnerable in terms of health associated with their particular occupation. The condition of workers in unorganized sector is very wretched as they work at extremely low wages, without any job security and social security benefits, long hours of work, unsatisfactory working and living conditions.
Mainly the workers engaged in handloom sector work as pieceworkers, the self-employed workers, the paid workers and the unpaid workers in family business.
Health risks associated with workplace can be hazardous chemicals; heat, unsafe machines, noise, dust and psychological stress that instigate occupational diseases and can worsen other health problems. Stress, occurred due to working conditions is contemplated as damaging when mixed with physical and emotional responses and are divided into physical and psychosocial hazards. Anxiety and stress together can hamper the physical health of an employee and have a negative impact on the productivity and progress of the organization concerned.
Specifically, it can be argue that organizational factors may influence health directly or indirectly by increasing exposure to job-level hazards (Table 1).
Table 1The modified framework for Characteristics of Work organization and Occupational health.
Table 1The modified framework for Characteristics of Work organization and Occupational health.
Research reveals that work characteristics such as schedule, supervisory practices (ranging from abuse to promotion of safety climate), psychological demands, and physical demands have been associated with occupational illness, injury, musculoskeletal symptoms, and respiratory problems.
Associations between work organisation and job hazards seem to have most often been examined in relation to the psychosocial work environment such as physical motion patterns, rapid motions without rest breaks, and increased muscle tension. Moreover, health and well being of workers is a relevant question in the context of its interrelationships with the nature of employment, economic opportunities and resultant conditions of living, conditions of work, work induced health and health seeking behaviour and security.
Ravindran, Sundari T.K. Women's Health in a Rural Poor Population in Tamil Nadu. Edt in: Women's Health Situation in a Rural Population Edited by T.K.Sundari Ravindran. p.175–211.
which explains the economic power, is one of the determining factors of health. Higher the purchasing power, the better would be his/her nutritional status, which in effect will keep them in good health. Hence, it becomes imperative to examine the work-related diseases and injuries at work place in India with special focuses on unorganized handloom sector in rural Assam. In tune with these perspectives and comprehensive understanding for the readers, the next sections deal with data and analytical strategy, followed by results obtained from field survey, discussion and concluding remarks.
2. Data and analytical strategy
The empirical setting of this study is Sualkuchi block of Rural Kamrup district in the state of Assam, where handloom activity is the way of life that intensely linked to old traditional Assamese culture and heritage. Sualkuchi, popularly known as silk city of Assam, is situated on the north bank of the Brahmaputra River at a distance of 32 km west of the capital of Assam, and linked with the Hajo circle division and Palasbari. In Sualkuchi, nearly 92% workers were engaged in handloom activities and it has grown as a Development Block with population of more than 1 lakh. Here, handloom sector consists of a set of handloom weavers and intermediaries. The process of handloom weaving involves manual work, such as pre and post weaving activities as sorting raw material, carding and spinning, and dyeing the yarns. Weavers use hand-operated looms, which is operated by hand and foot pedals, and it requires repetitive movements of the upper and lower parts of the body to operate pedals and shuttles while weaving. Long working hours in a day and strenuous activity risk for work-related musculoskeletal disorders (WMSDs) for the workers, suggest that workers in this particular activity have a high prevalence of body pain
. Therefore, Sualkuchi purposively selected for the study as the concentration of handloom workers are in majority here, which can help to portray a vivid picture of their health condition and livelihood.
A cross-sectional study was performed across fourteen villages that were selected purposively with majority of handloom concentration on the basis of being fairly representative of the geographical and economic conditions. The selected samples were interviewed using structured questionnaire for collecting data on socio-economic and demographic characteristics, and workplace information along with health problems faced by the handloom workers.
For the purpose of statistical analysis, descriptive statistics and percentage values to explore the prevalence and distribution of health problems faced by the handloom workers were employed. However, it is apposite to mention that the questions, which encompass the health, related issues, were examined/scrutinized for the past three months prior to survey. This exercise has been done to avert the recall error from the samples.
Further, the relative risk estimates for workers to examine the influence of several demographic and socioeconomic factors on worker's health hazards was also calculated. The health risk was calculated for the following variables adopted from the methodology used by.
Agricultural diversification in south asia: patterns, determinants, and policy implications, discussion paper No. 57, markets and structural studies division.
International Food Policy Research Institute,
Washington, D.C.2003
relative risk or risk ratio (RR) is the ratio of the probability of an event occurring in an exposed group to that of non-exposed group. The values obtained by calculating the Relative risk (RR) can be explained in a simple comparison between an experimental group and a control group as:
i.
Relative risk RR of 1 means there is no difference in risk between the two groups.
ii.
RR of <1 means the event is less likely to occur in the experimental group than in the control group.
iii.
RR of >1 means the event is more likely to occur in the experimental group than in the control group
3. Results from the field survey
This section is based on the analytical part of data collected from the primary survey in the study area. It has been categorized into four sub sections. In the first section, the health problems among workers across the gender lines as expected that the intensity and magnitude of health problems among handloom workers vary with the sex of the workers be observed. Followed this, the health distresses faced by the workers since last 3 months prior to survey and epidemiological inquiry in terms of suffering during work i.e. by considering the days of work in a month and the hours of working in a day has been performed in the next section. The third section deals with the relative risk index to understand the health vulnerability among the workers. And finally, the study attempts to draw an immediate attention on the existing health scenario of the handloom sector and workers by highlighting some policy suggestions.
3.1 Gender differences in health problem
Generally, it is found from most of the treatise that women do the preparatory or allied work while men do the main weaving job. Across Northeast region, 99% of the handloom weavers are women
and they are equally playing important role in handloom industry as men. The occupational health problems of males and females vary as seen in Fig. 1. In case of female workers, most of them are suffering from musculoskeletal disorder i.e., pain in hands, arms, limbs, shoulder, and neck, along with severe headache most of the time. Several studies have also reported backache and joint pain usually affects the women's health.
The problem of pain mostly arises for those workers who have to depend solely on handloom work for their income, and has to bear a lot of pressure for their sustenance.
Fig. 1Prevalence of health problems among workers by Gender.
In case of the workers Figs. 1 and 75% male responses and 81% females are suffering from headaches. The second most occurring health problem reported by the workers was musculoskeletal disorder. 65% males and 74% females suffered from musculoskeletal disorder. Similarly, other problems like injury during work, is also found to be chronic between both the gender, 50% workers suffered from injuries. Responses with difficulty in eyesight were 30% for both males and females. 25% males and 31% females reported digestive tract disorder. From the study it is highlighted that women are more prone to health ailments than the male counterparts. The reason behind this can be stated, as women have to work for both household chores as well as work in the work-shed, due to which they have to spend much time for both the activities. Taking care of the children along with the family as again working for the day log handloom activity makes their condition vulnerable. Workers reported about their ill health as:
I have been working in this occupation for 17 years, and due to the posture at workplace I am suffering from muscles pain, joint pains, back pain and headache most of the time ---- 44 years old lady worker.
I have given all my time energy on this occupation, and in return my health condition has deteriorated day by day working for long hours. -----55 years old male worker.
These were the responses from the workers interviewed in the production units, where workers were engaged for their day-to-day work and they reported about their whereabouts in the workplace.
3.2 Health problems by days of work
Workload affects the health of workers. From Fig. 2, it depicts that responses with less than 10 days of work reported 74% got injuries during work; 69% reported regular headaches as the second most occurring health problems; 51% suffered from musculoskeletal disorder; 42% complained about the digestive tract disorder; 29% reported difficulty with eyesight; 16% reported noise induced problems and 7% reported respiratory problem as other health problems.
Fig. 2Prevalence of health problems among workers by Days of work.
Similarly, those who worked for 11–19 days in a month reported 79% suffering from regular headaches; 77% with musculoskeletal disorder; 51% complained about the injuries during work; 36% complaint about their weak eye-sights; 28% complained about the digestive disorder for sitting long for weaving; 17% reported noise induced problems from the working looms; and 20% reported having other health problems. Responses with 20–30 days of work reported musculoskeletal disorder 80%, 72% as the first occurring health problem; 79% suffering from regular headaches; 56% reported injury during work; 44% reported difficulty with eyesight; 31% suffering from digestive tract disorder; 16% suffering from noise induced problems along with other health problems. The number of days states that the more a weaver spends his/her time on looms, the more their health gets deteriorated.
3.3 Health problems by hours of work
The working hours generally starts from 8:30 a.m. to 6:00 p.m. in the study area. The long working hours has a hostile effect on the health of the workers in handloom sector as they have to spend a daylong weaving in the looms. Fig. 3 presents the prevalence of occupational health problems. The worker responses reported that as the hours of working exceeds the health burden also increases. Workers who worked for less than 7 h reported headaches as their major health problem; 65% reported having injuries during work; 55% worker responded musculoskeletal disorder as the third major health problem followed by 37% having difficulty with eyesight; 35% having digestive tract disorder; 27% reported other health problems and 15% having noise induced problem. Other health ailments occur due to long sitting positions.
Fig. 3Prevalence of health problems among workers by Hours of work.
Sittings half in the pit our hands and legs move to and fro and up and down in a monotonous rhythm. We work for more than 8 hoursa day. Our occasional respite is during rituals and festivals and meal times. Falling ill is our time of rest, but the price is heavy as it comes at the cost of losing wages. Though it is convenient staying at home and working instead of walking down to the company, it is sickening to be enclosed in the same room all the time weaving, constantly listening to the loud noise, 40 year old worker reported.
3.4 Health problems by years of working
A group of weavers aged above 60, during our discussion, narrated their lives as workers in the weaving unit. They said, “As far as weaving unit is concerned, with aging one gets deported due to the bone-breaking nature of work. The progress is not from less paid to higher paid occupation. It is actually the reverse; they are relegated to the lowest paid reeling section with aging. Women who start their career in weaving at 14–15 years age continue to work up to their 60s.
A 62 years old weaver reported, “a weaver dies as a spinner or at the most as a weaver only. I started as a weaver in my 20s and was continuing with it till my 50s, after that my system did not permit me to operate the loom. And in the process I have become a spinner. All through my life, I have been working hard as a weaver, but despite that my condition never gets improved. It is in fact worsening and retaining my earning capacity has become difficult. What I earn now is half the amount what I used to earn when I was young.
Fig. 4 reveals that as the years of working increases, the health conditions also deteriorates. Workers who worked for 8–10 years reported 77% suffered from headaches and musculoskeletal disorder; 55% reported injury during work; 46% reported difficulty with eyesight. Workers who worked for 10–12 years, 84% reported musculoskeletal disorder as their first health problems, headache was reported as the second most regular problem among the responses 72%; 47% responded having injury during work. Moreover, workers who worked for more than 12 years has reported suffering from 83% from headaches as the first health issue; 80% reported musculoskeletal disorder as the second most occurring health issue; 75% having difficulty with eyesight; 41% complained about the injuries during work as other health problems along with the major ones.
Fig. 4Prevalence of health problems among workers by Years of working.
In the study, the most determining factor, which ascertains their ability to take up weaving, is their physical maturity and specially the maturity of the hands and legs. One should be tall enough to touch the shuttle in a way that their legs touch the pedal and hands touch the shuttle and ropes of the loom. Once they satisfy these conditions, they undertake weaving or else they are left with the option of doing other subsidiary works related to weaving.
Across the age group from Fig. 5, workers of age-group 21–30 years responded 80% reported headaches as the major health problem; 65% reported musculoskeletal disorder and injury during work as the next most occurring health disorder. As the age of the workers increases, the health problems or the responses with ailments also shows a higher percentage. Responses with age group 31–40 years responded 77% suffered from musculoskeletal disorder and headaches; 54% reported injury during work; 33% reported difficulty with eyesight. Workers with age 41–50 years reported 76% with musculoskeletal disorder; 74% with headaches; 48% having injuries during work; 43% having difficulty with eyesight; 27% with digestive disorder and 19% reported suffering from other health problems. Workers with more than 50 years of age reported 77% from musculoskeletal disorder and headaches; 51% suffered from difficulty with eyesight working in the sector and 40% got injuries during work.
Fig. 5The modified framework for characteristics of work organisation and occupational health.
Result suggests that health deterioration with increasing age is more pronounced in workers with shifting of work in a day. From the field it was noted that the younger groups are more susceptible than adults to accident, injury, and occupational disease.
4. Relative risk estimate of the workers' health
Relative risk estimates the health for the workers in handloom sector with the help of relevant explanatory variables. Table 2 includes RRR's (Relative risk ratio) from the multinomial logit model, with socio-demographic variables such as age, sex, marital status, education, days of work, hours of work, duration of work, work status, health insurance and benefits awareness for the sample workers. Age of the workers, hours of working and regular workers are more likely than married workers and workers who worked for more than 10 years to have ‘Regular headaches compared to ‘Musculoskeletal disorder’. For example, workers more than 35 years of age are less likely to have regular headaches compared to musculoskeletal disorder (RRR = 0.04, 95%CI = 0.02–0.06). Working hours of workers has lower risk of ‘Regular headaches compared to musculoskeletal disorder’ (RRR = 0.53, 95%CI = 0.35–0.79). Workers with regular status of work have 1.74 times higher risk of ‘regular headaches compared to musculoskeletal disorders’ (RRR = 1.74, 95%CI = 1.21–2.50). In addition, married worker, literate worker and workers with awareness and benefitted from health schemes are less likely to have risk of regular headaches.
Table 2Relative risk estimates from multinomial regression model for Socio-demographic variables and workers health problems in the study population.
Explanatory variables
Regular headaches vs. Musculoskeletal disorder
Injury during work vs. Musculoskeletal disorder
Other health issues vs. Musculoskeletal disorder
RRR
95% CI
RRR
95% CI
RRR
95% CI
Females against males
0.88
0.62–1.25
0.89
0.62–1.28
0.81
0.49–1.31
Age more than 35 years against less than 35 years
0.04 ***
0.02–0.06
0.08 ***
0.04–0.15
0.34 *
0.14–0.83
Married against unmarried
1.01
0.63–1.61
0.80
0.50–1.26
0.72
0.38–1.35
Literate against illiterate
1.06
0.73–1.53
1.03
0.71–1.49
1.24
0.73–2.09
Days of work more than 10 against less than 10
0.79
0.45–1.37
0.88
0.49–1.57
0.88
0.41–1.91
Hours more than 7 against less than 7 h
0.53 ***
0.35–0.79
0.59 *
0.39–0.90
0.60
0.34–1.05
Duration of work more than 10 years against less than 10 years
1.04
0.68–1.58
1.15
0.75–1.76
1.58
0.84–2.95
Regular work against temporary work
1.74 ***
1.21–2.50
1.42
0.98–2.04
1.12
0.68–1.83
Health insurance awareness against unawareness
0.64
0.36–1.11
0.62
0.35–1.09
0.82
0.39–1.67
Health benefit as against not benefitted
1.17
0.62–2.20
1.01
0.52–1.95
0.58
0.24–1.44
Source: Author's calculation from Field Survey, February–April 2016, N = 250.
Note: *** = Significant at 1% level (p < 0.001); ** Significant at 5% level (p < 0.05); and * Significant at 10% level (p < 0.10).
In comparison between ‘Injury during work and musculoskeletal disorder’, age of the workers (RRR = 0.08, 95%CI = 0.04–0.15) is statistically significant for having risk from injury during work and hours of working (RRR = 0.59, 95%CI = 0.39–0.90) are having half the risk of injury during work compared to musculoskeletal disorder. In addition, duration of work and regular worker is having marginally higher risk of injury during work compared to musculoskeletal disorder. For the ‘Others category versus musculoskeletal disorder’, age of the workers (RRR = 0.34, 95% CI = 0.14–0.83) is having lower risk of health problems. Duration of work of the workers is nearly twice the risk of having other health issues compared to musculoskeletal disorder. Likewise, literate and regular worker are more likely to have risk from other health problems.
Consequently, lengthy working hours, longer sittings, adult workers age and longer job duration have been interconnected with musculoskeletal disorder and other chronic health problems.
5. Discussion and experiences from the field survey
As reported by many workers in the study area, the workplaces are oppressively hot, and in most of the factories the workers have to pay themselves for the power connection and also for the usage of ceiling fan in the work-shed. Thus, the workers undergo considerable off-work heat stress, especially during the long hot summer. Handloom is back breaking work, as working all day long in one position makes the body very painful especially the hands and legs. The situation is better in the modern large industrial units where the workers are benefitted with paid incentives and better living standard, but in case of small and cottage industries the situation is in veil.
Apart from the occupational health parameters, the workers do not lead a healthy lifestyle; like some are in habit of tobacco smoking and chewing pan masala. Pan-tamul (local name of betel leaves and betel nut) is being used by most of the households in Assam and mostly the middle age group uses it in regular basis. It is detrimental to health as it can cause many problems of throat, mouth and lung cancer. During the survey almost 80% workers were found with this sort of eating habits. Not only male but also females are found to consume it on daily basis. Majority of those belonging to lower socio-economic backgrounds consumes it as a regular routine. Along with the long working hours, workers keep on chewing and continue their process of weaving. Handloom workers also suffer several occupational health problems due to the unjust working conditions, working hours, low wages and the habit of chewing pan masala, and tobacco smoking is making the health of the workers in miserable condition.
The informal workplace is still vulnerable to workers in terms of disorders and diseases. Even, it can be considered as a death trap for the workers. Poor health and occupational disability are often endorsed to health risk factors working in the low standard workplace without proper ventilation in the work-shed and toilets for the workers. Apart from the Occupational health problems which includes the physical, chemical, and biological hazards, the challenges like flexible employment and other psychosocial factors, inbuilt and proper work-shed is a necessity for the workers as they have to work for a whole day long. It is also mentioned that one of the major reason of the severe consequences of the health hazards faced by the workers are mostly because of the poor living environment, poor working area, and substandard housing quality and also the lifestyle habits.
Hence, there is no age bar for the better or poor health status of the workers in the handloom industry. Their lifestyle behavior along with the living and working environment determines the condition of health.
On the basis of primary survey, the policy should be made in such a manner, which can curtail the rift between customer design preference and the products produced by weavers. Moreover, the dominant role of the female workers is also evident, and therefore it is almost important to emphasize upon their training as they mostly rely upon the job practice to hone their skills. Also it is prudent to create policies that would provide better job opportunities and diminish the gender preferred biasness and impartiality in wages, exposure and approbation. Central government effort of distribution of identity cards is a commendable feature; the state government should also establish more perceive stratagems to make it a more organized affair, by partaking more contemporary welfare measures to burgeon the working environment and social security of weavers. Handloom producing hotspots can also be made into tourist spots to further attract more budgetary profits. Moreover, this research is quite exiguous to elucidate all the loopholes of an industry that had such an illustrious immemorial.
6. Limitation of the study
The limitations to this study reflect the health problems of workers depicted through self-reported health, as there was not any clinical trial performed. However, caution should be exercised regarding the generalization of the results. Apart from clinical trial, more quantitative as well as in-depth qualitative study is needed to deliver solid evidence of adverse impacts on health due to non-appropriate safety measures at work place. Notwithstanding, this study may enhance to present knowledge and supplement to significant preventive policy implications for millions of workers engaged in handloom sector as well as other informal workers.
7. Concluding thought and policy suggestion
The present study focused on occupational health of workers engaged in handloom sector of rural Assam with a case study of Sualkuchi block. Finding from the study reflect the fact that employment and working conditions have powerful effects on health equity. When these are achieved, it can provide social protection, social status, personal development, social relations and self-esteem, protection from physical and psychosocial hazards, and positive health effects to an individual. There should be effective interventions to prevent occupational diseases. For example encapsulation of pollution sources, ventilation, noise control, substitution of dangerous chemicals, improvement of furniture and the organization of work. Developing roadmaps for scaling up access of workers to essential interventions and services, as defined nationally, for prevention and control of occupational and work-related diseases, which include monitoring coverage and setting realistic targets in line with available health and local traditions.
Although, the Government of India is aware that, on the one hand the hard competition from power loom and several mill sector which allow the cheaper textile materials, economic liberalization has also threatened the vitality of handloom sector on the other hand. Therefore, for holistic development of this sector and welfare of handloom workers, the Government of India has been implementing several schemes such as Integrated Handlooms Development Scheme, Marketing and Export Promotion Scheme, Handloom Weavers Comprehensive Welfare Scheme, Diversified Handlooms Development Scheme, Mahatma Gandhi Bunkar Yojana, and Hastkala Sahyog Shivirs. However, the Central and the State Governments are the implementing agencies for enforcement of the provisions of the Act in their respective jurisdiction. Moreover, Directive Principles of State Policy of the Constitution of India also envisaged the protection and welfare of the workers under Article 42: ‘The State shall make provision for securing just and humane conditions of work and for maternity relief’. At the macro perspective there is a need for the industry body concerned and the government machinery to pass certain legislations with respect to provision of basic safety and hygienic and clean work environment at handloom mills. A check on whether occupational health and safety standards are being obeyed by must be emphasized. Steps must be taken to provide awareness of the health issues at the work places so that weavers are ready to follow the guidelines listed to them. As most of the health issues are musculoskeletal oriented, ergonomically designed chairs and footrest must be provided to reduce these problems. Authorities can educate the weavers on the benefits they can claim through medical insurance available. Regular medical camps can also be conducted to improve and monitor the health conditions of the workers. Further preventive programs need to be developed for work related health risks in the handloom sector. Occupational Safety and Health is one of the subjects allotted to Ministry of Labour and Employment under the Government of India Allocation of Business Rules, as the ministry is responsible for the safety and health of the workers. On the basis of Directive Principles and international means, the Government of India declares its policy, priorities, strategies and purposes through the exercise of its power. The Government is committed to regulate all economic activities within the country with a view to ensuring that every working employee is provided with safe and healthful working conditions.
Funding
No funding of any kind was granted for carrying out this study.
Authors' contribution
The author conceptualized the study and analyzed the data, and interpreted the results. The final draft was read and approved by the author.
Declaration of competing interest
Author reports there is no conflict of interest.
Acknowledgement
Author conveys her immense thanks to Professor Dipendra Nath Das, Centre for the Study of Regional Study, Jawaharlal Nehru University for his encouragement, and valuable comments for this study. Author also delivers her thanks to respondents of Sualkuchi block for their immense participation in conducting the field survey.
References
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Vyas H.
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Occupational health scenario of Indian informal sector.
Ravindran, Sundari T.K. Women's Health in a Rural Poor Population in Tamil Nadu. Edt in: Women's Health Situation in a Rural Population Edited by T.K.Sundari Ravindran. p.175–211.
Agricultural diversification in south asia: patterns, determinants, and policy implications, discussion paper No. 57, markets and structural studies division.
International Food Policy Research Institute,
Washington, D.C.2003
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