Occupational health surveillance of artisanal fishermen in the Baía de Todos os Santos: from invisibility to the proposal of public policies for the Unified Health System (SUS)

Abstract Introduction: fishermen are one of the largest and most traditional categories of workers in the world. In order to address the knowledge gaps in health problems related to this activity, and to develop actions together with the Unified Health System (SUS), in 2006 a set of studies and activities aimed at artisanal fishermen and shellfish gatherers was initiated, involving 13 municipal districts in Baía de Todos os Santos, Bahia, Brazil. Objective: to discuss results achieved in interventions and studies carried out with the purpose of subsidizing actions concerning fishermen’s occupational health surveillance (Visat). Methods: we discuss and refer to qualitative and quantitative studies developed through community-based participatory research. Results: studies and interventions revealed artisanal fishermen’s working conditions and occupational risks, especially those related to repetitive movements leading to high RSI/RMSDs prevalence. The results also contributed to the analysis of the workers’ quality of life, organization of diagnostic services, adaptation of the RSI/WRMSDs clinical protocol, and training the Family Health Strategy Teams operating in fishing territories. Conclusion: the studies and interventions indicate the possibility of reproducing this experience within the framework of Visat at SUS.

引言：渔民是全球规模最大、最具传统代表性的劳动者群体之一。为填补该职业相关健康问题的研究空白，并与巴西统一卫生系统（Unified Health System, SUS）协同推进干预举措，研究团队于2006年启动针对手工渔民与贝类采集者的系列研究与实践项目，覆盖巴西巴伊亚州托多斯奥斯桑托斯湾的13个市辖区。

研究目的：探讨针对渔民职业健康监护（Visat）的干预措施与研究成果，为相关工作提供实践支撑。

研究方法：本研究依托基于社区的参与式研究方法，对所开展的定性与定量研究结果进行分析与梳理。

研究结果：相关研究与干预措施明确了手工渔民的作业环境与职业危害，尤其是与重复性动作相关的风险——该类动作导致重复性劳损（Repetitive Strain Injury, RSI）/重复性运动障碍（Repetitive Motion Disorders, RMSDs）的患病率居高不下。研究成果还助力了劳动者生活质量分析、诊断服务体系优化、职业性肌肉骨骼疾患（Work-Related Musculoskeletal Disorders, WRMSDs）临床诊疗方案的适配调整，以及针对渔业作业区域的家庭健康策略团队的培训工作。

研究结论：本次研究与干预实践表明，该经验可在巴西统一卫生系统的职业健康监护（Visat）框架内进行复制推广。