Fair and Ethical Trade in Health: Lessons from Surgical Instruments

Abstract

The NHS spends £20 billion on procuring a wide range of medical goods every year. Worldwide, the amount traded in products for health care runs into trillions of dollars. With such large sums of money we quite rightly ask about value for money as well as the quality of the goods we buy. But in addition to quality we should, but don't, ask about the conditions under which those goods are made. Unfortunately, recent research has found that some of the products we are using to promote health in the UK may actually be damaging health elsewhere, through unethical labour practices in their manufacture.

Instruments of health and harm: how the procurement of healthcare goods contributes to global health inequality

“…The limited available evidence indicates that in the manufacture of surgical instruments in Pakistan, musculoskeletal problems and injuries are common, sometimes leading to significant impairment, including loss of limbs [5]. There are serious dangers at various stages of the manufacturing process, including exposure to heavy machinery, hazardous electrical wiring, toxic and corrosive chemicals, metal dust and deafening noise-levels in grinding rooms [5,18]. When unmanaged, these occupational hazards can cause cuts and burns to hands and feet, repetitive strain syndrome, trauma to the eye, noise-induced hearing loss, visual loss, electric shocks, chronic obstructive pulmonary disease, or lung cancer [22].…”

“…However, as employers are able to freely curb collective-bargaining rights with anti-union policies [18], disempowered workers in need of an income often operate machinery that is not regularly checked without any personal or collective protective equipment [18]. Further, workers' wages are insufficient even by Pakistan's own household income standards [5] and therefore do not permit regular contributions to social insurance mechanisms that could enable workers access to healthcare or disability benefits.…”

“…Over a decade ago, it was revealed that the provision of goods to healthcare systems in high income countries (HICs) often involves products manufactured under precarious labour conditions, including surgical instruments and medical gloves [4,5]. While some procurers and buyers have made efforts towards addressing this, they represent a very small proportion of global healthcare purchasing [6].…”

“…The most notable examples are the Pakistani surgical instruments and Malaysian gloves manufacturing industries. In Pakistan, the manufacture of surgical instruments is associated with non-compliance with local labour laws with regard to minimum wage and excessive overtime, unfair contractual obligations, widespread child labour, and an absence of health and safety protections[4,5,18]. In Malaysia, the gloves industry is associated with ad-hoc employment, poor remuneration, compulsory overtime, insufficient health and safety provisions, anti-union activities and bonded labour of migrant workers involving illegal retention of passports[17].…”