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Improving occupational health with CAREX in Latin America and the Caribbean


Canadian researchers are collaborating with counterparts in Latin America and the Caribbean (LAC) to estimate workers’ exposure to cancer-causing agents. Since 2014, their work has greatly expanded pre-existing research in the region by introducing LAC researchers to a trusted method of gathering national-level data on workplace exposure to carcinogens. Thanks to a small grant from IDRC, governments, labour unions, and employers throughout LAC are set to benefit from data generated in their own countries and shared through a regional network.

Establishing CAREX in Latin America and the Caribbean

Canadian researchers Paul Demers and Cheryl Peters from the Occupational Cancer Research Centre (OCRC) in Toronto and CAREX Canada in Burnaby, British Columbia, together with Manisha Pahwa from OCRC, have been working with LAC colleagues to adapt and apply CARcinogen EXposure (CAREX) in both Canadian and LAC contexts.

Developed in Finland, CAREX is a trusted and adaptable method to generate estimates of workers’ exposure to cancer-causing agents in the workplace. The first application of CAREX outside of Europe was in Costa Rica, which laid an important foundation for subsequent research in LAC. Canada’s CAREX project was initiated shortly thereafter. Canada now boasts a national network of researchers within and associated with CAREX Canada.

A small grant from IDRC funded both OCRC and the Pan American Health Organization (PAHO) to introduce and bolster CAREX capacity in LAC. “The grant [from IDRC] is seen as seed money that really sparked off other interests,” said Pahwa. One such spin-off came in late 2016 when PAHO launched a Caribbean project to introduce the method to several island nations. 

A person working in a quarry

Innovating in LAC

IDRC’s small grant to OCRC and PAHO supported a two-day symposium in 2014 in Bogota, Colombia, that introduced and connected researchers from 13 Latin American countries to CAREX. Following the symposium, the first comprehensive guide to CAREX in Spanish was developed for use in LAC.

The Bogota symposium set the foundation for LAC-wide collaboration that has blossomed beyond the small grant’s initial goals to convene a workshop and create a technical guide. The symposium was the start of a network between LAC and CAREX researchers, technical cooperation with OCRC and CAREX Canada, and resources such as fact sheets describing lung cancer carcinogens in the construction and mining sectors in Canada. “If we didn’t have that first workshop, none of the rest would have happened,” said Julietta Rodriguez-Guzmán, regional advisor on worker and consumer health at PAHO.

Technical guide reflects LAC realities

In the months following the workshop, partners from Universidad El Bosque in Bogota, the Instituto Tecnológico de Costa Rica, and IRET/Universidad Nacional de Costa Rica helped the IDRC-funded partners create a 41-page guide, Developing National CAREX Projects in Latin America and the Caribbean. Available in Spanish and English, the guide offers step-by-step advice and worksheets to set up national CAREX projects that generate estimates of the number of workers exposed to carcinogens in a country.

Estimating carcinogenic exposure in informal workers

Millions of people throughout LAC are exposed to a wide range of hazards every day. In industries like construction and mining, workers may be exposed to carcinogens such as crystalline silica, asbestos, and solar ultraviolet radiation.

Diesel fumes are another well-known carcinogen. Although people working as street vendors — often women and youth — may inhale those fumes all day long, too often informal work is poorly captured by national employment statistics. There is little to no information about the carcinogenic exposure of informal workers in many countries.

A man working in a mine.

International Labour Organization data from 2016 shows that 55% of citizens in Central America are employed in the informal economy and 45% of workers fall into this category throughout LAC. The authors of the CAREX guide for LAC recognize that informal work “remains pervasive and disproportionally occurs in women, Indigenous, and migrant populations, and it is inherent in child and bonded labour.”

LAC researchers stressed that informal sector workers are a substantial and diverse group whose carcinogenic exposures at work need to be reflected in CAREX work. Canadian researchers learned that a “workplace” carries broader meaning than how it is typically defined in Canada. The project’s knowledge transfer is working both ways — from South to North and vice versa.

A CAREX LAC steering committee led by PAHO is supporting ongoing research partnerships in the region. It will expand the original project’s impact by continuing to share knowledge and resources and driving LAC innovation in CAREX methods.

Benefits and value to Canada

Due to its partnership with PAHO in the CAREX project, OCRC was designated by the World Health Organization as a collaborating centre in occupational and environmental cancer. This involves a four-year partnership that expands on accomplishments of the IDRC-funded CAREX project.

Canadian researchers are now looking at ways to estimate carcinogenic pesticide exposure among workers in Canada. Additionally, CAREX Canada’s occupational carcinogen exposure estimates have been used in the Burden of Occupational Cancer in Canada Study, a four-year project led by the OCRC. It is hoped that these results, as well as exposure estimates generated from LAC CAREX projects, will contribute towards improving estimates of the global burden of disease.