Presentation from Dra Susan Gunn (photos: Dr David Parker) on child labour and health. Epidemiology in Occupational Health Conference (EPICOH) http://www.epicoh2016.org

1. “we know it’s bad, we don’t
need to study it”
Why health is the entry point
to stopping child labour and
protecting young workers

2. No conflict of interest
Study funded by: USDOL-ILAB; Kathmandu Medical School, UNICEF-
Afgh, Punjab Provincial Govt., University of Grenoble-Depts psych and
statistics, and approximately 40 people in 8 countries who volunteered
hours and days and months without pay because they are concerned.
Dedication: Saeed Awan

3. Overview of this presentation
• I. Why should we be concerned? Are there
grounds for putting higher priority on young
workers’ health? Is there anything different in
OSH for young workers than OSH for adults?
Is there a “YOSH”?
• II. What is hazardous work for youth?
• III. Exploring one of the major gaps

4. 1. Large numbers of children are working
• Of 1.2 billion young children
age 5-14 globally
• Of 365,495 million
adolescents age 15-17
• 144,066 million (11.8%) are
working
• 120,362 million (33%) are
working.
• Of these, 47.5 million are
doing hazardous work
• 1 in 10 children (5-17) are in
child labour
• 75 million youth (15-24) are
unemployed
Source: Diallo, Etienne, Mehran. Global Child Labour Trends 2008-2012, ILO Geneva

6. 2. Working children have high injury rates
• In a one year period, 106.4 million children, age 5-17,
experience a work-related injury.
• Of these, 15.1 million children suffer a work-related injury
sufficiently severe that it meets the impact threshold of
requiring medical attention and resulting in at least one day
lost from work or school.
• The incidence rate for injuries above the severity threshold is
4.1%
• Methodology: extrapolation for the year 2008, based on data
from child labour household surveys from 21 developing
countries between the years 2001 and 2009.
Source: de Cock, Mehran, Blanco: A Global Estimate of Work-related Injuries among Children 2010 ILO Geneva.

7. 3. Chronic/NCDs/PS conditions start early
• Longer period of exposure
• Disability in childhood incurs greater loss of productivity and
greater expense for health care
• To what degree does exposure in childhood to (mercury, lead,
PCBs, silica, denigration, etc.) increase the likelihood of
negative outcomes over exposure to these in adulthood?
• While we can be concerned about an aging, obese, or
stressed workforce, the time to prevent many work-related
disabilities is early
– In school starting at primary level
– Training on entry to the job

8. 4. Because it’s been ignored
• Most OSH studies do not include workers < age 18 or <15.
• Children’s health research has focused on 0-5 year olds.
• Older children and young adults are often assumed to be
pretty robust, resilient, and mature. And they often want to
convey that image themselves.
• Child workers tend to get less attention because their
assigned jobs are thought to be simple, undemanding, and
non-hazardous.
• OSH research instruments and interventions are geared to
adults, not children

9. II. Hazardous work is defined by ILO
Recommendation No. 190 as:
“work which exposes
children to physical,
psychological or
sexual abuse;

10. “work underground, under water,
at dangerous heights or in
confined spaces;”

11. “work with dangerous machinery,
equipment and tools”

12. “work which involves the manual
handling or transport of heavy
loads;

13. “work in an unhealthy
environment which may, for
example, expose children to
hazardous substances, agents or
processes, or to temperatures,
noise levels, or vibrations
damaging to their health

14. “work under particularly difficult
conditions such as work for long
hours or during the night or work
where the child is unreasonably
confined to the premises of the
employer.”

15. Challenges in identifying hazardous work
1. How heavy is a “heavy load”?
2. How long are “long hours”?
3. What constitutes “psychological abuse”?

16. Children are at higher risk because
• Have thinner skin, so toxics are more easily absorbed
• Breathe faster and more deeply, so they inhale more
dust and airborne pathogens
• Dehydrate more easily due to their larger skin
surface
• Absorb and retain heavy metals in the brain more
easily
• Have less experience and so lack judgment
• Are anxious to prove themselves and keep the job
• Lack status so cannot speak out about their rights

17. Special cautions for working children
• If PPEs are necessary, it
indicates that the work
is too dangerous for
those under 18 years.
Because:
– They are too big
– They give a false sense
of security
– They are not “cool” and
so not systematically
used

18. Special cautions for working children…
Long hours may be one of
the main sources of injury
of working young people
•Children require more
sleep than adults. Even 2
hours extra work per day
has been shown to affect
school performance.

19. III. Addressing an important gap:
psychosocial risks & impacts
Child workers are
•criticized, yelled at, denigrated, intimidated, target of jokes
•may suffer sexual abuse or harassment
•generally have low status, little job control
•exposed to adult behaviours (drinking, swearing, drugs)
•employed in precarious jobs, and without contracts
•doing work that is frequently monotonous, repetitive, yet may
also require intense concentration and speed
•often carrying a heavy sense of responsibility for the welfare of
family especially younger siblings
•often working in isolation from family, peers, social contacts

20. The brick kiln studies
• 4 countries
• Total of 1,553 children age
8-17
• Examined:
– Physical health
– Psychological well-being
– Environmental context
– Work activities
– Working conditions
Working
children
Comp
Group
Total
Afghanistan 398 403 801
Bangladesh 70 40 110
Nepal 197 106 303
Pakistan 250 89 339
915 638 1553

21. Psychosocial component required:
1. Instrument development
• Literature reviews
• Consultation
• Draft (48 questions)
• Testing (2 x)
• Revision
• Validation
• Selection of “mini” version
for surveys
Total 2.5 years
2. Preparing research setting
• Convincing partner agencies
• Securing funds
• Training interviewers
• Selecting areas where PS
effects might be significant
Result: the questionnaire and
its 2 subcomponents had
good internal coherence

22. Instrument reliability
Items N Cronbach’s Alpha
Whole questionnaire 1 to 48 (-13 & 17) 319 .838
Sub-component for workers 1 to 16 (-13) (886 .740
Sub-component for both
workers and comparison group
18 to 48 1470 .746

23. Woodhead domains re impact of work on
children’s psychosocial health
• Cognitive abilities and cultural competencies
• Personal security, social integration, and social competence
• Personal identity and valuation
• Self-concept and self-esteem
• Personal agency
– (locus of control, learned helplessness, attributional style)
• Emotional and somatic expressions of well-being
– (stress, anxiety, depression, trauma)

25. Findings from wkr/non-wkr comparisons
• The study demonstrates that, in spite of the fact that parents/
adults keep children from doing hazardous tasks (e.g. feeding
the kilns), the children are in the category of hazardous work
due to the psychological risks
• The differences between working children and non-working
children are “massive and unequivocal” with respect to:
– Sense of being maltreated
– Social support
– Emotional states (depression, anxiety, angry)
• Among the working children, the girls are at even greater risk:
– .17 pts greater than boys on perceived maltreatment
– .11 pts less than boys in social support
– .28+ pts more than boys on negative emotional states

26. Findings with regard to emotional states
• Each year of work is associated with increased emotional
problems.
• The countries and cultures within them show considerable
variation with regard to emotional states e.g. Afghanistan(!)
• Schooling has an important protective effect (.14)
• There is a definable group of children who are at extreme
risk: female, living with their parents, older, never attended
school, and working.

27. Findings with regard to social support
• children who work feel much less support from family and
from peers than those who don’t work
• They have less optimism about the future
• They feel insecure and afraid
• Girls feel that there is little chance that their lives will
improve – much worse than the boys.
• Migration status has no effect on this.

28. Challenges
• Underestimated because children may be accepting an
intolerable situation because they have no choice or because
looking at its intolerability is painful.
• Methodology is weak (selection of controls, poor coding)
• Confounding factors So hard to isolate health impacts due to
work, from those emanating from the non-work environment.

29. The challenges & rewards
Why researching CL is hard
• Occurs in difficult places (war
zones, under urgent or
emergency conditionsp, rural
areas, clandestine, population
generally wants to keep their jobs
• Don’t have local expertise or
necessary measuring equipment
• Action agencies don’t have time
to do extensive lit reviews and
probably wouldn’t be able to
understand the epi papers even if
they did …. much less design a
proper study
Why it is rewarding
• You are developing local
capacity through training
• You are drawing attention
to the issue, simply by your
presence
• You may actually be saving
lives.

30. Conclusions & Recommendations
• Urgent. Reduce the risks then figure out the rest.
• Work with action agencies to establish an evidence base for
their interventions
• Include younger age groups in any study.
• Don’t assume that children have 1 job. Compute the total
number of hours of work – especially for girls – that includes
chores and home-based enterprises. Consider time in school
and homework
• Identify the most likely health risks in each economic sector
where children work (avoid fishing).
• Be practical. With young workers the aim is keeping them IN
work, reaching the maximum number, and keeping them safe
• An ideal field of work for young and new research