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Iman A. Nuwayhid, MD, DrPH

Correspondence: Requests for reprints should be sent to Iman Nuwayhid, MD, DrPH, Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Bliss St, Beirut, Lebanon (e-mail: nuwayhid{at}aub.edu.lb).

Abrams eloquently argues that linking occupational health, and for that matter health in general, with the social context is not limited to developing countries but is equally applicable to developed countries. There is no doubt in my mind that this is true, but in my article I argued that occupational health researchers in developing countries have no leeway, so to speak.

Most occupational health researchers in developed countries limit their research to the "internal domain" of occupational health (e.g., workplace hazards, exposure–disease spectrum) and have recently focused on long-term exposure to low concentrations and the development of sensitive measures of exposure and outcome. In doing this, they count on institutes (e.g., the National Institutes of Health) that generously fund such endeavors and on a political-legal system that, sooner or later, translates their research findings into policies and new standards, depending on the political environment.

Some researchers advocate a similar approach to occupational health research in developing countries. They argue that providing hard data and evidence on occupational hazards, diseases, and injuries would alert policymakers to the magnitude of the problem. In my article I argued that occupational health researchers in most developing countries do not enjoy this "luxury." Most of them work in countries where policymaking is not responsive to this kind of research. In fact, it is common knowledge that working conditions in developing countries are poor. Yet occupational health is still neglected. Funds, when available, are very limited and can barely support studies that go beyond documenting what is obvious to the naked eye. Hence research in the "internal domain," although needed, cannot make a real impact on health and safety in the workplace.

Occupational health researchers in developed countries sometimes achieve policy results without advocating and without entering into alliances with other groups. This does not mean that they might not achieve better results if they did enter into alliances. In developing countries, researchers have no option. If they are interested in any significant policy change, they have to examine occupational health within the social context, hand in hand with social and political scientists, labor unions, and community groups. This is a challenging approach and requires a major reorientation.

Acknowledgments

I thank Abbas El-Zein for his comments.

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