Construction work is the second largest industry in India, employing more than 74 million workers. It is also one of the most hazardous.
A 2016 study found that of the approximately 48,000 work-related deaths in India each year, nearly a quarter were in the construction industry.
Lesser known and studied is how construction work is associated with another serious occupational hazard: cancer.
Studies from other countries suggest construction workers are at a higher risk of being diagnosed with cancer, given the many known carcinogens used in the industry.
Construction work has been linked to mesothelioma and cancers of the lung, head and neck, oesophagus and prostate.
There is limited research on occupational cancers related to construction work in India. Those that do exist tend to focus on how the behavior of construction workers contributes to cancer risk rather than the dangers inherent in construction work itself.
In addition to the high mortality rate, construction work is also associated with increased risks of disease and illness.
Numerous studies document serious musculoskeletal morbidities resulting from construction work and other health issues including heat exhaustion, hearing loss due to noise, and skin and respiratory conditions from exposure to dust and chemicals.
Despite laws and regulations concerning construction and occupational safety, protective gear such as steel-toed boots, hard hats, ear muffs, masks or harnesses and cables are rarely spelled out and generally not observed on Indian construction sites.
The burden of safety often falls upon the workers themselves.
During research fieldwork among migrant construction workers in two sites in Bangalore in 2019 and 2020, Dharini, 43, noted that her employer advised workers like her to be careful on the worksite as treatment costs related to an injury would come out of their income.
Challenges to healthcare seeking
Most construction workers in India are rural migrants, who move to cities due to socio-economic disadvantages and the lack of livelihood opportunities in rural areas.
Once there, they find it challenging to find a foothold, given the high cost of living, discrimination and lack of social mobility and the desire to maintain a financial and affective connection to their native place.
As a result, many engage in a form of circular or temporary migration between their homes and the city, and are generally ill-served by existing health systems in both places.
The persistent poverty that drives migration is itself a significant risk factor for poor health, including cancer. But the risks are hardly mitigated in urban settings, where the hazards of construction work are exacerbated by other factors that contribute to poor health.
Migrant workers live in impermanent, crowded and unsanitary living conditions, which can lead to a number of vector-borne and communicable diseases. Urban living in such conditions is associated with poor mental health and wellbeing and an increase in non-communicable diseases, including certain types of cancer.
Recent research conducted in Bangalore suggests many barriers to seeking healthcare by migrant construction workers, with economic concerns primary among them.
As many construction workers engage in daily wage labour, they may be reluctant to take a day off from work to seek care. Furthermore, the cost of care may itself be daunting.
While government entitlement schemes are designed to be portable, institutional structures make it challenging for them to access programmes that may improve their health, including nutrition schemes, immunisation programmes or antenatal care. This was a recurrent complaint made by many workers.
Many workers come to urban areas through informal arrangements. They do not belong to unions and lack access to benefits or protections that union membership may offer, such as payment of lost wages or treatment coverage in case of illness, injury or death.
When they do seek care from public facilities, workers report running into further challenges such as inconvenient clinic timings or language issues. Research also indicates that they report being poorly treated by healthcare providers.
Seshamma, 40, a migrant female construction worker said: "They don't care for poor people like us, they tell us to come tomorrow or the day after. They keep misleading us.
"[They say] that the doctor is not there, the nurse is not there. Some machine is not working for the blood tests. This is how they fool us. What if we die waiting two to three days for the doctor to come?"
Such treatment can deter them from seeking future healthcare. Instead, many prefer to treat minor aches and pains with easily available medicines from pharmacies or home remedies, and choose to pursue care for more serious or chronic conditions in their hometowns.
The way forward
An intersection of socioeconomic, regional, financial and occupational disadvantages drives poor health in construction workers. Hence addressing the health needs of this vulnerable population and reducing their cancer risk also requires a multi-pronged approach.
Practically, this would involve the enforcement of laws around construction workplace safety, regular mobile health and cancer screening programmes outside of regular working hours, mental health support and the development of localised health insurance schemes that specifically address the needs of this population. Some such programmes already exist in the southern Indian states of Karnataka and Kerala.
Assistance from community health workers can ensure construction workers are aware of, enrol in and use such schemes.
Additional research is needed to understand how construction work leads to various types of cancer and other medical conditions in India and how temporary migrant status and other axes of disadvantage, such as gender and caste, can influence these pathways.
In the coming decades, three trends are expected to occur in parallel. India's construction industry will continue to grow and employ close to 100 million workers. At the same time, demographic trends suggest the rate of temporary migration will continue to increase.
Finally, the incidence of cancer is expected to rise significantly. Taken together, this suggests the challenges and needs of this population will continue to grow and merits urgent policy and program attention.
(The author is a research scientist and Assistant Professor at the Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore. This article was originally published under Creative Commons by 360info)
