A heroic struggle to understand the risk of cancers among workers in the electronics industry: the case of Samsung

In this issue of IJOEH, investigators in South Korea report a cluster of leukemia and non-Hodgkin lymphoma among workers in the electronics industry.1 These researchers have pursued their work heroically, against tremendous obstacles erected by the Samsung Group and the government of South Korea. The researchers, who benefit from extensive training and experience in occupational health, bridge academia and a non-governmental organization that aims to improve occupational health conditions for electronics workers (Supporters for the Health and Rights of People in the Semiconductor industry, SHARPS, which has mounted the International Campaign for Health and Labour Rights of Samsung Electronics Workers2).

Data presented in the article strongly suggest, but do not yet prove, a causal link between chemical exposures in the process of semiconductor production and the malignancies that workers have developed. A definitive study demonstrating this causal link conclusively would require access to information about the precise chemicals used in the production of Samsung semiconductors and about the characteristics of workers who have or have not developed such cancers. Samsung, the world’s largest information technology and electronics corporation (as measured by revenues),3 has refused to make public such data concerning the industrial processes that affect electronics workers and has impeded attempts by independent researchers to obtain essential information.1,4 The government of the Republic of South Korea, which Samsung profoundly influences as the country’s largest corporation, also has not facilitated such research and actually has appealed court rulings in favor of Samsung workers with these malignancies.5 On the other hand, during February 2012, the Korean government’s Occupational Safety and Health Research Institute announced findings from a 3-year investigation that showed multiple known carcinogens in the production process, including benzene, formaldehyde, arsenic, and ionized radiation, even though Samsung’s automation procedures had aimed to reduce workers’ exposure to those carcinogenic substances since 2000.6

The Samsung Group has emerged as one of the world’s largest and most powerful multinational corporations. In 2010, its total assets amounted to more than US$340 billion, with annual revenues of about US$220 billion and annual income of US$21 billion.7 Samsung focuses on electronics, but it also owns subsidiaries that deal with shipbuilding, telecommunications, construction projects, insurance and financial services, chemicals, retail stores, entertainment, clothing, and medical services.8

Samsung has received wide criticism from organizations concerned about public health, labor rights, the environment, and fair trade.9^–14 In particular, the company’s long-standing policy that prohibits union organizing has attracted critical attention.9 Samsung's overall corporate structure centralizes the policy making that governs the activities of its vast network of subsidiary corporations.8 This centralization of decision making has received critical assessment even from investors concerned about the Samsung Group's overall corporate efficiency.15 In addition to concerns about occupational health,10 Samsung’s construction subsidiary is taking the lead in the destruction of environmentally and culturally sensitive habitat on the South Korean island of Jeju.11 Samsung’s efforts aim to build a new naval base whose purpose apparently includes collaboration between South Korea and the USA in future containment efforts against China.12,13 Local communities of Jeju have not been granted a right to disapprove or to modify this massive project, which will exert vast impacts on the ecosystem and on traditional ways of life in fishing and agriculture.11,16,17 In 2012, due to these and many other deleterious corporate policies and practices, Samsung ranked third in Public Eye’s survey on the world’s most dangerous corporations.18

Various reports of working conditions in semiconductor plants raise concerns that, in that context, Samsung is privileging profitability over workers' welfare. Samsung’s impunity in disregarding or blocking systematic research on health problems among its workers has become even more notable as a variety of reports have pleaded for urgent attention to these problems.1,4,19 Researchers in non-governmental organizations and academic institutions have documented these problems among Samsung workers.1,4,10,19 A report of a study that Samsung itself commissioned concerning these problems did not present data that could be evaluated independently.20 Although occupational health researchers and activists have called attention to clusters of leukemia and other cancers among Samsung’s electronics workers, Samsung has not cooperated meaningfully in attempts to resolve the scientific question of causality or in acknowledging its responsibility to compensate workers voluntarily.1,4,10,19,20 Although Samsung’s orientation may appear both flamboyant and archaic, given the standard protective practices that unions and public health activists have achieved through struggles in many countries, the structural contradiction between profit and safety remains an inherent impediment to occupational safety and health within many capitalist industries.21

Even if Samsung eventually does succumb to pressure and begins to collaborate in a forthright way to investigate the impact of toxic exposures on its workers, methods to establish causality are not straightforward. In particular, the usual epidemiological methods to assess the impact of exposures on disease outcomes contain some inherent limitations. Even in case–control cohort studies, where workers could be followed from the onset of exposure until the development of disease and then compared in exposure history and other characteristics to workers who do not develop the disease, the numbers of cases required to reach statistical significance are substantial. In typical scenarios when clusters remain fairly small, as in the current report about Samsung workers, the lack of a statistically significant association with a toxic exposure may reflect an inadequate sample size to achieve the statistical power needed to reduce the probability of type II errors, which involve accepting the null hypothesis when false. Due to this methodological challenge of proving causality with small numbers of cases, clusters of cancer like those that have appeared among Samsung workers may not receive the urgent attention and action that they deserve.

In classical work on cancers among workers at IBM, Clapp and colleagues explored this methodological issue and determined that, for instance, the proportional mortality ratio proved much more sensitive than the standardized mortality ratio in detecting an excess occurrence of cancers among workers exposed to toxins in the manufacture of semiconductors.22,23 Activism and advocacy linked to the research by Clapp and colleagues have led to somewhat more stringent identification of, monitoring for, and protection against hazardous exposures for electronics workers based in the USA.24 Unfortunately, such advances have not yet benefited many electronics workers in other countries, even those at factories which are owned by or which supply components for US electronics companies.24

Even under favorable circumstances, the traditional quantitative methods favored in epidemiology do not lend themselves to an in-depth, multifaceted assessment of causal linkages. Although quantitative techniques obviously can prove very helpful, they remain limited, and the scientific community should recognize these limitations more explicitly. Missing from the admirable report by Kim et al. are the workers’ stories about their exposures, the efforts that they made to find out what caused their cancers, the history of attempts to organize unions in part to address occupational health threats, the relationships between the Samsung workers and the non-governmental organizations which have fought for their rights, and a host of similar qualitative data that could provide a rich and instructive context for the quantitative data in this report. Kim et al. hint at such narratives in their brief descriptions of work categories such as operators versus engineers, and in their allusion to gender-related processes that led to a predominance of these cancers among young women. There are excellent prior examples of multi-method research that has combined quantitative techniques with qualitative group interviews of workers exposed to toxins, for instance, in the petroleum industry. Most such work, however, has taken place in Europe and Latin America,12,25,26 and little of this extremely useful approach has filtered into the dominant occupational health literature published in English.27^–29

To address the horrendous impediments to occupational safety and health that Samsung has created, actions that go beyond research are urgently needed. Those who care about the health of electronics workers and workers in general need to consider ways to exert financial pressures on Samsung and to publicize these concerns in ways that compel Samsung to address fully workers’ health issues. To improve Samsung’s practices, one potential avenue for advocacy could be to target organizations that purchase Samsung products. Such an organization, Credo Mobile, buys Samsung cell phones that it provides “free” or sells to its subscribers. This collaboration with Samsung, which Credo Mobile highlights uncritically in its website and advertising, appears to contradict Credo Mobile’s “progressive” corporate policies that support labor rights, public health, and environmental justice.30 The occupational health community should call on Credo Mobile, publicly and privately, to use its economic leverage in encouraging Samsung's honest and open disclosure of information on workers' exposures, improved protection of Samsung's workers from toxic exposures in the production process, respect for workers' right to unionize, and facilitation of independent research on the carcinogenic effects of semiconductor production. Highlighting the urgency of such efforts is the recent death from cancer of a young mother with two small children — the 32nd worker at a single Samsung semiconductor manufacturing plant to die from cancer.31

The courageous work by Kim et al., deserves praise and international support. This work amply illustrates the classic contradictions and challenges of occupational health in the capitalist workplace. The efforts of Kim et al. stimulate us to reconsider the most effective ways to clarify the causal sequences that adversely affect workers’ health in the semiconductor industry and in other industries as well. This work also should motivate us to pressure Samsung to release data on workers' health and workplace exposures. Only by doing so can researchers and workers alike be sure that workers in the semiconductor industry are protected from preventable cancers, needless suffering, and premature death.

Disclosures: The authors report no conflicts of interest.