Research Agenda
Before 1996, there was no known national effort to identify and promote an occupational health research agenda. That changed with NIOSH taking the lead to launch the National Occupational Research Agenda (NORA) (U.S. DHHS 1996). Since then, a number of other countries in the industrial world have launched similar efforts (for example, Italy, Sweden, and the United Kingdom). Although all these efforts are relevant to the developing world, the reality is that country-specific research, even at the risk of reinventing the wheel, is often needed to strengthen political will to effect policy. Moreover, although traditional epidemiological etiologic research in occupational health is not a priority or even feasible for much of the developing world, research targeted at local conditions and institutions is often what is most needed. Six areas are identified, with appropriate modifications for local conditions, as ongoing research priorities to address injury and disease control strategies in the developing world. This research need not be undertaken solely—and sometimes not even in part—in the countries of concern, but rather is likely to be aided by the capacity building derived from partnership between academic institutions and government agencies across countries of different levels of development.
Public Health Systems Research
Although health services research has emerged as an important area of inquiry in the health field in the industrial world over the past few decades, scant attention has been paid to public health systems research (Institute of Medicine 2003). Given that occupational health sits at the interface between individual and population health, this area of inquiry is particularly germane to research in the field. This research would examine the effectiveness of government systems working in coordination with other sectors (academic institutions, employers, unions, voluntary agencies) in promoting occupational health status.
Occupational Health Policy Research
Public policy to address improving occupational health in the developing world should rest on a sound scientific base (that is, be evidence based) and should be coupled with an understanding of the local and national frameworks for policy (whether through legislative, regulatory, or other means). Adequate research has not been undertaken to evaluate policy development and implementation in public health in general and occupational health specifically. As with the need for new health systems research, this area of inquiry would undoubtedly benefit from partnerships among countries in the industrial world and in the developing and industrializing world.
Intervention Effectiveness Research
Intervention effectiveness research, a cornerstone of the U.S. NORA initiative, is critical to advancing occupational health in the developing world. The absence of data in this chapter to demonstrate cost-effectiveness of occupational health measures is indicative of the need for more such information to target what will always be a demand for limited resources. Recognizing the relative dearth of intervention effectiveness research in countries with high research investments, this recommendation is made cautiously for countries with fewer resources. However, it is assumed all too often that an accepted intervention in a country with higher economic productivity might not be viable in one with fewer resources. The research agenda for the developing world in this arena needs to be tailored to what is known and proven coupled with local and national conditions and needs.
Control Technology and Protective Equipment Research
Investigation of control technology and protective equipment, another NORA priority, is critical for developing effective and feasible control strategies in the developing world. Much of the primary research in this category can be done in the industrial world, but along with investments in intervention effectiveness research, new technologies may still need to be tested in real situations in developing countries. Simplified approaches to management of chemicals suitable to the local work settings have been developed in Indonesia and are being evaluated, and the International Program for Chemical Safety is helping other countries modify, implement, and evaluate the U.K. system, which was originally designed for use by small enterprises in the United Kingdom (ILO 2003).
Disease and Injury Research
Many questions of epidemiologic importance to improving the health of all workers can best be answered in settings in the developing world. This situation is not unique to occupational health, but in the occupational health arena, it is important to recognize that workers are often the first exposed and are exposed to the highest levels of potential hazards (as compared with their community counterparts). So, too, are levels of exposure to many hazards far greater in the developing world than elsewhere, and undertaking studies becomes efficient and feasible in these settings that would prove difficult if not impossible in settings where exposures are lower and larger numbers of study participants are needed to detect meaningful differences in risk. Not surprisingly, then, sentinel studies of health effects of interest to the industrial world have been undertaken in other countries—for example, studies in Latin America identifying the potential for acute pesticide intoxication to cause chronic neurological effects (Rosenstock and others 1991).
Surveillance Research
Surveillance is a critical component of all effective occupational health programs; thus, continuing research is needed into the most effective ways to gather and interpret this information. Surveillance systems are often limited at best in many developing countries, and evaluation research needs to be undertaken to determine the benefits of investing in gathering both generic (absences from work, for example) and specific (blood lead levels, for example) information on which to target public health action.
