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Introduction
The United Arab Emirates is a fast-growing and diversified economy in the Gulf region. Its population is composed of different ethnic groups and nationalities coming from Southeast Asia, the Middle East, and Europe. International firms or multinationals help boost the economy. As a result, it has complicated health problems due to occupational hazards.
This is not the case if we look at the history of the UAE as a growing Muslim nation. Emiratis have the belief of environmental stewardship as ingrained in their Muslim culture. The Holy Quran teaches believers to care for animals and plants and tell Muslims to have great concern for the environment (Aspinall, 2006 as cited in Gibson et al., 2013).
Environmentalism is deeply seated in the peoples culture. His Excellency Sheikh Zayed, the UAEs founder, has been internationally recognized for his conservation efforts, having received no less than the Gold Panda Award from the international body, the World Wildlife Foundation (2000 as cited in Gibson et al., 2013). Sheikh Zayed also received posthumously the Champion of the Earth Award from the UN Environment Programme (Gibson et al., 2013). Despite their love for nature, Emiratis also want economic growth. There lies a complication because of the threat of the environment on peoples health.
This paper will discuss the UAEs environmental risks that have caused occupational health problems. The problem stems from the continuous economic growth which has triggered the influx of tourists and migrant workers in the country. First, there was the problem of infectious diseases, but due to the governments enhanced health programs, the problem has shifted to non-infectious diseases, such as cardiovascular disease, occupational injury, cancer, and respiratory illness.
This paper will first delve into the background of the country UAE, from its roots: seven hereditary monarchies that decided to form the UAE. Major economic activities began when it struck oil, and from this, the problem of health evolved. Discussion of the literature will focus on health issues and their causes. Some case studies on tumor and brain cancer suffered by workers in a chemical and manufacturing plant are also included in the final analysis of the literature. The conclusion and recommendations will discuss the governments strategic health plan. Future research should deal with longitudinal data that should be available for UAE strategic planning in health and safety programs. There is a lack of empirical research on this aspect.
Literature Review
The United Arab Emirates
The UAE is a country comprised of seven hereditary monarchies called emirates, established in the early part of the seventies. The country is blessed with so-called black gold, oil, but has successfully diversified its economy by attracting large multinationals to invest in its land. It has enhanced infrastructures, built skyscrapers, and diversified its manufacturing base of aluminum, steel, iron, and other metals, for local use and exports (Loney et al., 2013).
The UAE population is a combination of natural birth and migration of workers who are attracted to the countrys high wages and benefits and the quality of life afforded by foreign and local firms. This makes the countrys population structure unique. Foreign workers fill in the lack of skills of local workers. Abu Dhabi is the largest area and has a population of 2.3 million, but half of this is composed of migrant workers. In other words, the UAE population is composed of different nationalities of varying backgrounds, ethnicities, demographics, and cultural eccentricities (Loney et al., 2013).
With an annual growth of 6.5% of GDP from 2000 to 2005, the UAE is one of the most successful economies in the region of the Gulf Cooperation Council (UAE Bureau of Statistics as cited in Al-Kaabi, 2006). Construction had attributed 12% of the non-oil percentage of GDP in 2003. The construction labor force increases yearly; in 2003 the labor force had a yearly increase of 24% (UAE Bureau of Statistics as cited in Al-Kaabi, 2006).
Oil became a primary source of economic progress but the country was quick and the rulers wise enough to diversify. In the 1960s the UAE invested in various sectors to reduce economic dependence on oil. These sectors are global and required infrastructure development. Dubai and Abu Dhabi are the two Emirates which have experienced continuous construction projects (Najem, 2015). As billions of dollars are being infused into the economy, the construction workers are the main driving force in infrastructural development and the entire growth. According to Najem (2015), there is a sense of unfairness in how construction workers are being treated.
Before the UAE was formed, the Trucial States relied on trading, pearling, fishing, agriculture, and animal husbandry. The discovery of oil led to radical changes to the peoples daily activities and the growth course of the country. But before it struck oil, it has been a destination for migrant workers. The immigration of workers dates back to the pearling era in the 1800s.
The present migration rates of the UAE are among the highest in the world, i.e. 13.5 migrant workers per 1,000 people (CIA World Factbook as cited in Najem, 2015). In this country, the population boom is parallel with infrastructural development. The countrys population is approximately nine million, a steady growth obtained because of workers migration (World Bank as cited in Najem, 2015).
The fear of life without oil had set in the countrys policy-making body. In the 1990s, the country began to realize that investing foreign assets abroad was just a few of the things it could do, and so it invested in agriculture and real estate to increase its foreign direct investment (FDI) and enhance domestic economic productivity across different sectors. Currently, the government has been investing in several new infrastructural projects to pursue economic diversity. The country has been most successful in such areas as tourism, financial services, trade, agriculture, real estate, and construction. But as a whole, investing in infrastructure has considerably increased FDI rates over time. It also has to increase its labor force continuously.
Historical Background
The literature provides vast evidence on the relationship between environmental sustainability and human health. Even medical artifacts dating back to the Assyrian and pre-historic times provide concepts of environmental conditions that cause diseases. Valleys and rivers were classified by ancient texts according to the health status of those areas and were analyzed as to whether they were safe or not for human habitation (Gibson et al., 2013).
Looking at the effects of health caused by the environment should stimulate research on several significant factors, such as analyzing the probability theory and connect this with the problem at hand, discussion on the instruments to quantify the presence of pollutants in the environment, mathematical calculations on epidemiologic research linking the quantified presence of pollutants to certain health problems, public health records, and instruments or computer software that provide a simulation of environment pollution and community. These data and instruments were not available during the Renaissance period but techniques then were already formulated and applied today, though the present time has the knowledge and technology to measure and simulate to assess the environment.
The Renaissance era provided the present time with facts on the probability theory. Before this time, policymakers used very risky and uncertain methods, in consultation with the clergy and religious people, instead of using reliable tools of probability (Gibson et al., 2013).
Aside from theory, decision-makers can also use quantitative methods in assessing health risk data, and mathematical relationships relating to contact with the identified contaminants to certain health causes as a result of toxicologic and epidemiologic research. This scarcity of tools and instrumentation and the lack of appropriate public data recording were major barriers to assessing the relationship between environmental hazards and human health (Covello & Mumpower as cited in Gibson et al., 2013, p. 3).
Measuring or quantifying the link between the amount of contaminant in contact with the human body and the resultant disease is a current technique but the science of toxicology dates back to the time of historic physician Paracelsus who formulated the basic principle of toxicology which states that the amount of dose determines the poison caused on the human body (Graham as cited in Gibson et al., 2013). Covello and Mumpower (as cited in Gibson et al., 2013) added that the nineteenth-century scientist Pasteur understood and clearly explained the idea of infection or the link between the environment that carries contaminants and poisonous agents and the infected human body.
Health Priority Issues in the UAE
The study of Loney et al. (2013) focused on major public health issues affected by the current economic boom and other major activities. The researchers used secondary data or peer-reviewed journals and articles from different databases and government publications and websites which publish articles focusing on this particular issue. The researchers were looking for public health priority problems, such as cardiovascular disease, injury caused by occupational factors, cancer, and other diseases including respiratory illness.
According to the study, fertility rates have significantly declined in the UAE caused by rapid urbanization, changing beliefs about family growth, and enhanced education and employment for women leading to reduced marriages. On the other hand, life expectancy has also improved since men and women are now reaching the ages of 77 to 79 years old, respectively.
Infectious diseases, once a major concern of the governments health department, is caused by the migration of foreign labor and the temporary influx of people from the different parts of the world. Nevertheless, the standard of living has improved even to the lowly Emirati, so that infectious diseases are no longer a problem as this is being effectively addressed by the governments health care services. In the past few years, attention has shifted to non-infectious diseases which have rapidly increased (Gibson & Farah, 2012).
The UAEs fast economic advancement has enhanced public health but brought some problems, in particular an increase in non-infectious diseases such as heart problems, cancer, type II diabetes, and respiratory diseases. Environmental risk is number one, which has brought national attention as constantly reported in the media.
The Environmental Agency-Abu Dhabi (EAD) made immediate moves in 2007 to address the issue, particularly by measuring the environmental burden on public health. EAD asked for a strategic plan, which was then awarded to a consortium composed of two universities: one from North Carolina the Norwegian Institute for Air Quality Research and the UAE University (Gibson & Farah, 2012). This was an ambitious project and a model for the Middle East. The World Health Organization hailed this project and also provided help through oversight and some methods to be used. The study focused on occupational risk factors, particularly on exposure to harmful chemical and other biological agents, and exposures in the industrial and agricultural sectors.
The study found that a perfect environmental health plan could not be attained, but it recommended some possible effective methods in dealing with non-infectious diseases. The group developed a five-step strategy that measures the weight of the disease pointing to every risk factor and asked the stakeholders to focus on those risk factors and define the possible solutions. These steps are explained in the following paragraphs.
- Measure the risks. Gibson and Farah (2012) and the researchers measured the risks related to the identified 14 risk factors. The estimates of deaths and diseases possibly caused by occupational factors were based on methods used by the WHO and normally practiced in quantification cases for public health. The researchers used the Analytica software in encoding the risk mathematical solutions. They arrived at a simulation model titled the UAE Environmental Burden of Disease Model which could enable future works to quantify the results of interventions that can minimize pollutant intervention (Gibson & Farah, 2012, p. 683).
- The researchers used the deliberative technique in prioritizing risks, the one proposed by the U.S. Office of Science and Technology Policy. This technique integrates both quantitative risk data and stakeholders thoughts systematically.
- Define effective initiatives for minimizing risks and quantifying development. The plan had to provide recommendations using the initiatives or steps that could be implemented shortly (possibly 4 to 20 years) to lessen risks. The process had to identify key performance indicators (KPI) to measure improvement. The identification of KPIs was provided by scientists.
- Ask for members feedback and suggestions. This was possible by conducting workshops and consultations with stakeholders to study, debate, and revise the recommended initiatives and KPIs.
- Prepare the discussed plan and put the plan into action. The risk ranking and planning activity was put into a formal document.
Cardiovascular Disease
One of the major causes of mortality is cardiovascular disease, which accounts for 30% of all deaths in the UAE. The Emirati diet has been much influenced by western culture as Western tourists and workers enter the country. Musaiger (2010) has noted that the consumption of fresh vegetables and fruits has been reduced and substituted with pork, chicken meat, sugar, and fat. Adult men are into smoking, with 25% perceived smokers, and only 1.6% of Emirati women. Risk factors for CVD are prevalent among Emiratis. Changes in lifestyle, particularly diet, have contributed to the prevalence of CVD.
Similarly, in health studies in Korea, cardiovascular disease due to overwork was found to be the primary cause of death and disability among Koreans; thus costs for compensation for this disease have increased significantly (Won, Hong, & Hwang, 2013).
WHO (1990 as cited in Musaiger, 2010) reports that among the different nationalities in the UAE, there are sharp contrasts between ethnic groups which could exacerbate the risk factors for CVD.
Factors Linked to CVD
Nutritional Factors
Studies about UAE nutrition are scarce. The Preventive Medicine Department (1995 as cited in Musaiger, 2010) reported that the UAE food consumption has been affected by western food patterns. Traditional food has not been largely patronized and there has been a steep decline in consumption of this type of food. This lifestyle contributes to chronic diseases. A study in Bahrain states that patients with myocardial infarction were not consumers of fresh vegetables and fruits. The study of Musaiger and Abuirmeileh (1998 as cited in Musaiger, 2010) found that Emiratis had a slow intake of fresh fruits and vegetables. Daily intake of fruits and vegetables can prevent or reduce the prevalence of CVD because dietary fiber present in such foods can lower serum cholesterol (Sharpnel et al., 1992 as cited in Musaiger, 2010).
Smoking
Smoking is the most common cause of CVD morbidity and mortality. Smoking causes four times increased risk of heart disease and a high risk of death (Lakier, 1992 as cited in Musiager, 2010). Again, there is less research being conducted on the prevalence of smoking in the UAE. The study of Musaiger reported that 25% of UAE men aged 20-80 years were smokers, but there were only about 1.6% of women smokers of the same age. Second-hand smoking is also a threat to ones health. Leone (1993 as cited in Musaiger, 2010) indicated that active and passive smokers had low concern for the effects of smoking, such as atherosclerotic coronary alterations, focal myocardial lesions, and arrhythmias. Bender et al.s (1993 as cited in Musaiger, 2010) study found that most UAE physicians were smokers, but the physicians agreed that smoking was dangerous to their health. The study focused on 275 physicians, where 36% were found to be current smokers, and 12.7% were former smokers.
Hypercholesterolemia
A study in the UAE about the relationship of serum cholesterol and CVD showed that the prevalence was found between 47 to 53% among Arab nationals and from 22.7 to 44.5% among non-Arabs (Musaiger, 2010). Hypercholesterolemia was prevalent among the different nationalities in the UAE. Twenty percent of Emirati nationals were found to have high cholesterol, 34% were within the borderline, while 46% had desirable blood cholesterol, and about 50% overall were affected.
Overweight and Obesity
Across the population, there has been a stable growth in food energy consumption, yet physical exercise is found to be uncommon among Emiratis (Musaiger, 2010). Overweight and obesity are also contributors to CVD among Emiratis. In a study in early 2000, 33% of married women were overweight and 38% were obese. Obesity among women increased with age, reaching its height at age 30-39 years, but fell slightly when they reached 40 years and above. Married men were less prone to obesity compared to women. Moussa et al. (1994 as cited in Musaiger, 2010) researched the effect of body fat and fat localization on blood pressure levels in school children of Al-Ain, UAE. The study recorded that there was a significant difference in systolic and diastolic blood pressure means between obese and non-obese children.
Occupational Injury
Injury is one of the causes of death and disability in the UAE. It can be accident-related, like falls or drowning. Children under 15 years old account for about 9% of injury-related deaths between 2000 and 2008, with about 104 children dying annually because of it (Loney et al., 2013). Traffic injury is mostly the case, next is drowning and then falls. Males are mostly the victim of injury than females (Loney et al., 2013).
Occupational factors include exposures, indoor air pollution, unclean water condition, seafood factors, and ambient air pollution, among others. Outdoor air pollution is considered the highest risk, with studies indicating a mean rank of 1.4. Indoor air pollution is next with a mean rank of 3.3. Gibson and Farahs (2012) study pinpointed 216 possible interventions in mitigating environmental risks to diseases in the UAE.
Toxicants
There are several occupational injuries since the UAE is into manufacturing, using various metals and chemicals. A chemical that is harmful to human health is known as formaldehyde, or formalin (O3). This is used in medical laboratories and mortuaries, but is also present in other products or chemicals; it can be used as a cleaning agent or disinfectant, or in paper products and even plywood (Ahmed, 2011). Severe and long-lasting exposure to this chemical by inhalation can cause respiratory illness. If it hits the eye, it can cause blindness. Over-exposure is indeed discouraged as it can lead to lung cancer. Laboratory technicians, including students and professors in universities using the chemical, are at greater risk.
A study on exposure to the chemical was conducted in the laboratories of Sharjah University. Different concentrations of formaldehyde were measured in the different laboratories of the university. It was noted that the chemical had been constantly used in the laboratories for the preservation of animals and other specimens for study. In medical schools, formalin was also used to preserve or embalm cadavers used by students in medical research. In the process of preservation, it was possible that the students could inhale the chemical vapors. The study found that the measured concentration of the chemical was higher in the anatomy laboratory, or higher than the ceiling standard imposed by the USA-NIOSH, which was just 0.1ppm. The researchers recorded that about 94% of the students and instructors were exposed to the chemical, who then displayed symptoms of eye irritation and other symptoms in the primary organs of sensation (Ahmed, 2011).
Other toxicants include carbon monoxide, a highly lethal pollutant which connects with the bodys hemoglobin, and the association results in carboxyhemoglobin that affects the vital organs of the body. Carbon dioxide (CO2) also has harmful effects on the human body and particularly injurious to children in school. Another deadly pollutant is a classification of volatile organic compounds (VOC) which comes from biogenic chemicals or car exhaust and is dangerous for respiratory diseases. A large amount of VOC can cause cancer. Methane is also produced in manufacturing plants in Dubai and can cause respiratory disease for workers if a large amount is inhaled (Behzadi & Fadeyi, 2012).
Indoor Air Pollutants
Indoor air pollutants in the UAE work environment include carbon monoxide, a large amount of hydrogen sulfide, nitrogen, and sulfur. One of the leading causes of respiratory diseases is indoor air pollution. Contaminants are gases, combustion chemicals to organic chemicals. They come from outdoor pollutants and penetrate in residences (Funk et al., 2014).
The governments of Dubai and Abu Dhabi, particularly the Environmental Agency-Abu Dhabi (EAD), have continuously conducted studies on the effects of chemical and indoor pollutants on human health. One of these studies includes indoor quality research (IAQ) in schools in Dubai whose aim was to formulate a program to protect children from indoor pollutants in schools (Behzadi & Fadeyi, 2012). Various schools were the subject of the study in which the amounts of IAQ were measured. The results yielded positive for indoor pollutants, but immediately after the study the researchers and school authorities conducted cleaning of the school atmosphere and the appliances, including the air conditioning units which were to be cleaned every 3 months (Behzadi & Fadeyi, 2012).
Occupational Safety
Work in a construction project is a dangerous occupation, particularly in the Middle East, where projects are accomplished for a short period. The construction work in the UAE are mostly performed by foreign workers, many of them are not trained for construction work (Al-Kaabi, 2006).
Accidents in the Workplace
The UAE construction sites are unsafe to work with (Al-Kaabi, 2006). In Dubai, construction accidents increased by 70% in 2004, accounting for 105 injuries. Several accidents in the different sectors in agriculture, mining, industry, construction, transportation, has not been regularly reported. More than 77 construction companies have reported zero accidents, per a report from the UAE Ministry of Labor and Social Affairs (2000 as cited in Al-Kaabi, 2006), which seems unbelievable considering that these construction companies have various violations in employing foreign workers. The law requires that companies provide an accident report to the Ministry of Labor and Social Affairs. The Bureau of Statistics (2000 as cited in Al-Kaabi, 2006) reported occupational accidents that seemed incomplete, as shown in the table below.
Table 1. Number of accidents in 1999 (Bureau of Statistics, 2000 as cited in Al-Kaabi, 2006).
The table above does not conform to international standards of reporting of accidents because of its lack of details, such as classification per industry category and there is no further information whether those accidents occurred during construction operations.
Some cases of construction accidents can be stated here. One case involved a worker who was hit by a falling piece of scaffolding that resulted in the instant death of the victim (Hadad, 2005 as cited in Al-Kaabi, 2006). Carelessness indeed can lead to accidents. The collapse of a crane led to severe injuries for two workers, one had injured head and the other broken bones. When the roof of a building collapsed, six died and six were injured (Abdullah, 2004 as cited in Al-Kaabi, 2006). Two other accidents happened in Sharjah in 2002 and the other one in Dubai, costing nine workers lives (Al-Kaabi, 2006, p. 18). Many cases were considered near misses, but they occurred because of violation of rules and standard procedures by the company concerned.
Al-Kaabi (2006) surveyed to analyze basic safety aspects, for example, accident types, workers safety training, safety monitoring, and other safety measures instituted by the construction companies. The author had vast experience in construction in the UAE which allowed him to have a deep grasp of safety measures and programs in the country. The survey method was by way of questionnaires, focusing on safety measures, precautions, programs, and outcomes. The questionnaires were sent to construction contractors in Abu Dhabi and Dubai. Most of the companies involved in the study were relatively large and had vast experience in construction. The companies were involved in various construction projects that included residential buildings, commercial buildings, highways, bridges, and other steel construction.
Almost all (96%) of construction companies provided workers with certain types of insurance, but five small companies (4%) did not provide insurance to their workers. Insurance coverage included compensation in case of an accident, life insurance, government care, all-risks insurance, and health insurance, etc. Orientation, education, and training were provided to newly accepted workers. Workers were also provided with personal protective equipment (PPE), such as helmet, gloves, boots, and eye/face goggles. A UAE law prescribes issuance of PPE for workers in workplaces, such as construction sites.
Al-Kaabis (2006) study found that approximately 30% of the companies did not provide PPE to their workers. But 91 contractors (75%) complied with the law and strictly implemented the use of PPE. Companies that did not provide PPE reasoned out that PPE was too expensive and that its use was against cultural practices.
Contractors were also asked to provide data regarding on-site safety measures, for example, guardrails, signs, fences, shelters, and other safety measures. The questions regarding equipment and tools focused on the maintenance and handling of heavy equipment. Al-Kaabis (2006) survey also focused on health and hygiene. Construction sites had lavatories, safe drinking water, and lunch and rest areas. All companies maintained regular site cleanliness.
Cancer
Cancer is something that the UAE people must be serious about because the majority of Emiratis do not attend cancer screening. The UAE Cancer Registry (2006 as cited in Gulf News, 2015) indicated that the five cancers that Emiratis should be aware of are breast, colorectal, gastric, thyroid and lung (Gulf News, 2015). Early detection is the key to the successful treatment of cancer.
Mesothelioma is an occupation cancer as it is the result of inhalation of the building material asbestos that causes cancer in the lungs. The use of asbestos has been banned in many countries, but this material is very useful in manufacturing. Despite the danger, some countries still use asbestos because it is cheap. In Dubai, citizens still adhere to the use of asbestos because of the lack of knowledge about the danger of asbestos, particularly that it causes Mesothelioma cancer. Patients who have contracted Mesothelioma display symptoms of shortness of breath, chest pains, and gradual or sudden weight drop. Symptoms of the disease may usually take 20 to 50 years to be detected.
The most common cancer for UAE men is colorectal, lung, leukemia, prostate, and others; whereas women are prone to breast, thyroid, colorectal, and cervical. Leukemia and lung cancers are common for both gender, and the most ranking for males are prostate and lung cancer (Glob Health Action, 2013 as cited in Loney et al., 2013).
Respiratory Illness
A recent virus outbreak has occurred in the UAE and also in the Middle East region. This is known as the MERS-Cov (Middle East Respiratory Syndrome Coronavirus). People who get infected with this virus develop serious respiratory illness accompanied by fever, cough, and difficulty in breathing (Sasendran, 2014).
Respiratory illness for Emiratis is mostly caused by inhalation of chemicals and gases, dust and other undesirable vapors, or poor air quality. Exposures to fumes can cause asthma, bronchitis, and various diseases of the lungs or possibly cancer. The study of Loney et al. (2013) found that Emiratis and migrant workers are at high risk of exposures to gases and fumes because of heightened economic development, dependence on motorized transport and traffic bottlenecks, unfavorable weather patterns as the atmosphere is mixed with dust and fumes, and the vast economic and manufacturing activities that emit different kinds of air pollutants.
Entry and exit points in Abu Dhabi, Dubai, and Sharjah receive and send off visitors traveling from the different countries of the world. This scenario poses the increased threat of the spread of diseases and the UAE is at a possible risk from respiratory diseases because of airborne viruses that carry SARS or Mers-COV. Traditional respiratory disease like tuberculosis can also be transmitted here. New viruses roam around the earths atmosphere. The UAE and every airport, entry or exit points, must be constantly guarded.
In addition to the above health problems suffered by migrant workers and the UAE population in general, there are also psychiatric problems that have to be dealt with. One is the so-called Dubai Syndrome (Al-Maskari et al., 2011), which refers to stress and a feeling of deprivation suffered by spouses and families of migrant workers. Aside from the debts incurred by applicants before they are accepted for work in the UAE, there are other reasons the applicants feel, such as the guilt for leaving . The Philippine ambassador to the UAE explained that the migrants families back home think the migrants are earning thousands of dollars, and the poor migrant goes deeper into debt & (Najem, 2015, p. 30).
Poor working conditions in construction sites exacerbate the migrant workers emotional state. There are suicide cases, albeit this news lacks epidemiological data, caused probably by the low priority of psychiatric health research in the UAE (Statistical Yearbook of Abu Dhabi, 2006 as cited in Al-Maskari et al., 2011).
Psychiatric problems are societal, which have to be given much concern because it involves migrant workers. Health problems such as this can lead to functional injury in a sense, reduced quality of life, low performance at work, lost productivity, and so on. Globally, suicide cases account for about 1.5% of the worldwide burden of diseases.
Case Study
Refining and Petrochemical Production
In a cohort study of 1,205 respondents working in a Canadian oil refinery for more than five years, the researchers recorded three deaths due to brain cancer (Theriault & Goulet, 1979 as cited in Thomas, 1986). This was non-significant as the work histories of the three brain cancer cases were ambiguous about occupational exposures. A proportionate mortality ratio study of deceased, active and retired members of the Oil, Chemical, and Atomic Workers International Union (OCAW) in Texas indicated an increased frequency of deaths due to brain cancer among white male hourly workers employed in petroleum refining and petrochemical plants (Thomas et al., 1980 as cited in Thomas, 1986).
The increased relative frequency of brain tumor deaths occurred primarily among active employees in three oil refineries in the Beaumont-Port Arthur area of the Texas Gulf Coast. A nested case-control study comparing work histories of the brain tumor cases with those of persons who died from other causes indicated an elevated brain tumor mortality risk among OCAW members whose jobs involved the intraplate pumping and transporting of bulk liquids (crude oil and products) and the manufacture of lubricating oil, but the odds ratios were not statistically significant (Thomas et al., 1980 as cited in Thomas, 1986).
In a mortality study of oil refinery workers employed by 19 U.S. companies, 8 deaths due to brain cancer were observed and 4.9 were expected (Schottenfeld et al., 1981 as cited in Thomas, 1986). The investigators indicated that there may have been underreporting of deaths because of the short study period (2 years) and the lag time between the date of death and receipt of a death certificate.
Cancer incidents among actively employed refinery workers during the study period were compared with that for the U.S. using cancer registry incidence data. Nine incident cases of brain cancer were reported and about seven were expected. No analyses by the duration of employment or occupation were shown.
Brain cancer mortality was not excessive among 35,000 employees of eight British oil refineries between January 1950 and December 1975 (Rushton & Alderson, 1981 as cited in Thomas, 1986). However, approximately 20 percent of the study subjects had scientific, technical, administrative, clerical, or engineering jobs, most of which are presumably low-exposure occupations. This same difficulty occurred in a cohort of workers at oil distribution centers in England (Rushton & Alderson, 1981 as cited in Thomas, 1986), where supervisors, managers, administrators, and clerical workers were included in the analyses. In one study of refinery workers, investigators found no association between brain cancer risk and oil refinery employment (Hanis et al., 1982), and two other groups of investigators did not report observed and expected numbers for brain cancer (Hanis et al., 1982; Tabershaw as cited in Thomas, 1986). The follow-up period for several studies was very short (less than 10 years), and risks of fatal disease with long latent periods may have been underestimated.
A group of primary brain cancer deaths among workers at a Union Carbide petrochemical plant in Texas City, Texas was reported in 1980 (Alexander et al., 1980 as cited In Thomas, 1986). All of the decedents were less than age 66 at death and the best medical information available indicated that 15 of 18 tumors were glioblastoma multiforme. A cohort mortality study of workers at this plant showed a significant elevated SMR for brain tumors among white male hourly workers. A similar analysis by the company of the same data also indicated a significantly increased brain cancer mortality risk among workers who held hourly positions, but nested case-control analyses indicated no significantly elevated odds associated with exposure to any specific chemicals (Austin & Schnatter, 1983; Leffingwell et al., 1983 as cited in Thomas, 1986).
Operating engineers employed in the petrochemical industry in Texas and Louisiana had an elevated frequency of brain tumor deaths. This excess is primarily due to a significantly elevated PMR for brain tumors among persons employed as operators in oil refineries and petrochemical plants (Thomas, 1986).
A study of workers in a rubber plant in Ohio indicated an elevated brain cancer mortality risk among employees in the curing and tire-building department. Later studies in the same plant population also suggested that men employed in tire assembly and tire building had an increased brain cancer mortality risk, but brain cancer mortality was less than expected in the entire plant population (Monson & Fine, 1980 as cited in Thomas, 1986).
A cohort study from 34 plants examined the relationship between polyvinyl chloride exposure and the risk of cancer. Among persons who had worked for at least one year in a job involving exposure to vinyl chloride, the total number of brain cancers deaths observed was significantly greater than expected. Twelve brain cancer deaths observed during the study period included glioblastomas, two astrocytomas, one ependymoma, and five unspecified types (Thomas, 1986).
Conclusion
Through the different studies discussed above and upon initiatives of the UAE government and the general public, many areas and issues have been addressed and to provide the strategic plan necessary to deal with all the safety and health problems of the UAE population and the migrant workers. Full coordination and cooperation between the different sectors must be attained so that specific diseases and new viruses threatening the country now and shortly can be properly addressed. Loney et al. (2013) recommend effective surveillance and monitoring.
Health and safety issues are not only the concern of the internal government but a global concern because the spread of diseases and viruses can have rapid consequences if not dealt with quickly and effectively. The coverage in dealing with SARS and the MERS-Cov outbreak is an example of international cooperation and coordination.
The UAE issue has become an international issue because tourists and migrant workers are going there to visit or work. It is an attraction to the world, thanks in part to the government and the Emiratis themselves for making their country a model for economic diversification and development. The problem that this economic progress has brought up should be the concern of all. Even if the government and the UAE people are addressing it, there is not enough action and much has to be done.
Recommendations
It is recommended that consistent and effective longitudinal data be available for UAE strategic planning in health and safety programs. A portion of this has been achieved but there are still many things to be done.
The UAE government can use technology for safety in construction. An expert system is known as How safe was first developed by Levitt (as cited in Al-Kaabi, 2006), and could determine the strength and weakness of a construction firms organization and procedures. The system starts with a hypothesis and a series of fundamental goals helps to prove the hypothesis.
The technique in knowledge extraction in How safe is structured like an inverted tree where the top-level diagnosis is helped by three to four lower-level inferences or deductions which can be analyzed by the use at the end of each branch. Each leaf of the trees branches corresponds to a question to which the user chooses the degree of belief. The conclusion is reached with the inferred degree of belief in the top-level hypothesis in addition to the reliability of the conclusion given as a percentage (Al-Kaabi, 2006).
Furthermore, the UK Health and Safety Executive (HSE) developed the computerized expert system known as Estimation and Assessment of Substance Exposure (EASE), which simplifies dangerous substances exposure assessments. This system utilizes some rules to forecast a series of probable exposures or an end-point for a certain work situation (Cherie & Hughson as cited in Al-Kaabi, 2006). The safety regulations in the UK require that the maker of a new substance should notify the appropriate authority about it, and the authority will have to carry out a risk assessment. A computer-based system that addresses exposure to a substance in the workplace is effective.
References
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