Reassessing the burden of work-related cancer: hidden inequalities
In “Is It Time to Rethink the Way We Assess the Burden of Work-Related Cancer?” Émilie Counil and Emmanuel Henry “review published estimates of the percentage of cancer attributed to causal agents in the workplace,” which range “from less than 2% to more than 8%” in high-income countries, “with an average of 4-5%.” They are also are concerned to analyze current use of certain estimation methods “from the perspective of their potential effects on population health iniquities.”
Whereas evidence shows that people’s working conditions affect their health and their risk of death, cancer is often considered primarily in relation to individual behavior determinants and perceived as the effect of unhealthy personal lifestyles while social health determinants are left out of the equation. Is occupational cancer underestimated? Given the fact that cancer rates vary widely from one occupational category to another, how much of an occupational group’s mortality (morbidity) can be attributed to work environment and how much can be attributed to way of life?
While “‘modern epidemiology’”—particularly the concept of “attributable fraction” (“promoted by epidemiologists in the early 1950s to quantify the proportion of people afflicted by lung cancer whose disease was attributable to cigarette smoking”)—has increasingly become a tool in public policy-making, such policy has tended to focus on “major health risks threatening large populations, the most representative of them being tobacco-related lung cancers.” However, this has “also made it more difficult to understand less massive risks,” considered less important; namely, the reiterated exposure to occupational hazards that some occupational groups have to cope with. Moreover, relatively little research is done on smaller groups showing high concentrations of cancer
Authors Émilie Counil and Emmanuel Henry suggest that the time has come to rethink the way epidemiological quantification is applied, and they put forward an three-part outline for a paradigm shift. First, “switching from a perspective on population health to one on population health iniquities when trying to assess the burden of work-related cancer”: this would show the degree to which work accounts for those iniquities. Second, changing the scope of “our definition of occupational cancer” to encompass “informal or less recognized work situations,” and not only harsh or health-degrading working conditions but also such occupational features as “work stress, work organization, and precarious employment”; also, widening the focus to include workers’ occupational trajectories and how they fit together with changes in health-related behaviors through life (this could be done by way of cohort studies, for example). Third, “changing metrics”: given the complexity of the processes involved, it seems crucial to combine several types of indicators (not only attributable fractions but also “average age at onset” and “years of potential life lost,” for example), thereby achieving a much more comprehensive image of this public health problem, one which has proved difficult to define, understand, and consolidate as such.
Source : Emilie Counil and Emmanuel Henry, 2019, Is It Time to Rethink the Way We Assess the Burden of Work-Related Cancer?, Current epidemiology reports
Contact: Emilie Counil
Online: October 2020