Iran Occupational Health Journal

fa اثرات توسعه صنعت انرژی بر سلامت ساکنین منطقه ویژه اقتصادی انرژی پارس: دیدگاه های میانجیان مردم The Effects of Energy Industry Development on the Health of Residents of the Pars Economic Energy Zone: viewpoints of people’s mediator مطالعات کمی و کیفی Qualitative and quantitative studies پژوهشي Research   چکیده: زمینه و هدف: منطقه ویژه اقتصادی انرژی پارس دومین منبع گاز در جهان و پایتخت انرژی کشور ایران است. صنعت نفت و گاز از طرق مختلف بر سلامت ساکنان منطقه تأثیرگذار است.  در جوامع پیرامون این مناطق تولید و توسعه این صنعت، سبب بروز موارد استرس زای عمده شامل آلودگی هوا و آبهای سطحی و زیرزمینی، ترافیک وسایل نقلیه سنگین، آلودگی صوتی، تصادفات و اختلالات عملکردی و نیز تنش های روانی-اجتماعی که همراه با تغییرات اجتماعی هستند، می شود(4و5و6). درمنطقه ویژه نیز مطالعات نشان داده است که وضعیت سلامت جسمی، روانی و اجتماعی کارگران و کارمندان و نیز بومیان و خانواده های آنها از وضعیت مطلوبی برخوردار نیست. با توجه به اهمیت ویژه این منطقه در تأمین مالی برنامه های توسعه کشور، تأمین و حفظ و ارتقاء پایدار سلامت آن از اهمیت راهبردی برخوردار است هدف از این مطالعه بررسی چالشها و راهکارهای ارتقای سلامت مردم از دیدگاه میانجیان مردم منطقه است. روش بررسی:  این مطالعه با رویکرد کیفی انجام شد. روش نمونه گیری هدفمند بوده و به جهت تکمیل فهرست شرکت کنندگان روش گلوله برفی به کار رفت. در مجموع از 20 نفر میانجی مردم نظرخواهی شد. روش جمع آوری اطلاعات، انجام جلسات بحث گروهی متمرکز بوده و سپس تحلیل محتوا و دسته بندی درون مایه ها انجام شد. پس از شناسایی شبکه ها، طی مکاتبه رسمی از آنها خواسته شد تا نماینده آگاه و علاقمند به شناسایی و رفع چالش های سلامت منطقه را معرفی نمایند. در جلسه ای دو ساعته که در سالن سازمان منطقه پارس جنوبی باحضور اعضای تیم تحقیق برگزار شد به روش بحث گروهی متمرکز نظرخواهی از آنان انجام شد. در این جلسه پس از خوش آمد گویی و معرفی افراد، بیان اهداف و توجیه حاضران و اطمینان از رعایت محرمانگی اطلاعات گردآوری شده و ثبت و ارایه آنها بدون نام افراد  توسط مجری طرح انجام گرفت. سپس پرسشنامه کتبی بین آنها توزیع شد و پس از پاسخدهی طی مدت 15 دقیقه، به صورت چرخشی نظرات افراد نسبت به مشکلات منطقه و راهکارها به صورت شفاهی نیز اخذ و توسط یکی از اعضای تیم تحقیق به دقت یادداشت شد. یافته ها: اشتغال زایی، توسعه عمرانی، فرهنگی و آموزشی از جمله منافع صنعت است. آلودگی هوا و آب و خاک و دریا، تنشهای فرهنگی، فاصله عمیق بین شرکتها و مردم و ورود خرده فرهنگها در فرهنگ اصیل مردم و افزایش جرائم از مضرات صنعت بوده است. نقص امکانات و زیرساختهای درمانی با توزیع عادلانه، شیوع بیماریها به علت آلودگی محیط و بیکاری جوانان سه مشکل اصلی عنوان شدند. توجه به مراکز بهداشتی درمانی و خانه های بهداشت، بهداشت آب شرب و مشارکت دادن مردم در تصمیمات منطقه از جمله راهکارهای بهبود سلامت مردم پیشنهاد شد. نتیجه گیری: بهبود وضعیت سلامت منطقه در گرو تعامل سه گروه مردم، حاکمیت دولت محلی -مانند فرمانداری ها-  و صنعت نفت است. پیشنهاد می شود پس از مرحله به کارگیری نظرات مردم و تدوین برنامه جامع سلامت، شورای سلامت منطقه با مشارکت نمایندگان مردم تشکیل شود. Abstract: Background and aims: Pars Special Energy Economic Zone is the second largest source of gas in the world and Iran’s energy capital. The oil and gas industries in many respects affect the health of the inhabitants of the region. The creation and development of this industry creates major stressors in the communities around these areas; include air pollution, surface water and groundwater pollution, heavy vehicle traffic, noise pollution, accidents, functional disorders, and psychosocial stresses associated with social change. Studies conducted in this area have shown that the physical, mental and social health status of workers and employees and their families is not good. Due to the special importance of this region in financing the country's development programs, providing, maintaining and promoting its sustainable health is of strategic importance. Community participation in health issues has many benefits in terms of health care and development; because it increases problem-solving skills in communities so that they take responsibility for their health and well-being as much as possible and ensure that the needs and issues of the community are properly addressed. There are different patterns for people's participation. However, in a wide and public participation, the use of people's representation has been emphasized, which accelerates the participation of the people. These representatives could be the leaders and elders of the target community, official and legal representatives of the people, non-governmental organizations, self-help groups, volunteers, popular people in the community and special groups.  Content analysis method was used to summarize the obtained information. The completed questionnaires and oral comments recorded in the group discussion sessions were manually coded and then were classified as the main themes Includes the benefits, disadvantages, main problems and strategies for improving health and how to operationalize the role of people.This study is aimed to examine the challenges and strategies for health promotion of the people from the viewpoint of the mediators of the region. Methods: This is a qualitative study with intentional sampling which the snowball method was used to complete the list of participants and 20 mediators participated in this study. First, a list of popular networks was prepared using purposive sampling method. After identifying the networks, they were asked in an official letter to introduce an informed and interested representative to identify and address the health challenges of the region. After identifying the networks, they were asked in an official correspondence to introduce an informed and interested representative to identify and address the health challenges of the region. Then, in a two-hour meeting with the presence of the introduced representatives, a poll was conducted on them through a focused group discussion method. In this meeting, while stating the goals and ensuring the confidentiality of the collected information, a written questionnaire was distributed among them and after answering within 15 minutes, people's opinions about the problems of the region and solutions were taken orally. Finally, the draft prepared by the research team was reviewed and the necessary amendments were made with the opinion of the majority of members. Results: According to the mediators, the existence of industry in the region has led to the benefits such as job creation, cultural and educational development and extending urban services. Moreover, gas extraction and the creation of the country's economic capital have led to the acquisition of knowledge and skills comparable to other countries.  Disadvantages of industry are including air, watersoil and sea contamination. The usable lands have been destroyed and the traditional jobs such as agriculture, animal husbandry and fishing have been destroyed. Following the entry of subcultures into the original culture of the people, cultural tensions have occurred and a deep gap has been created between people and companies;and crimes have increased. The three main problems were lack of facilities and medical infrastructure with equitable distribution; high prevalence of diseases due to environmental contamination and Unemployment. Consideration of health centers and health houses, drinking water health and people engagement in regional decision making have been suggested. Conclusion: In this study, the maximum effort of researchers has been made to involve people's representatives and mediators, which is one of the preconditions for the development of the region and one of the most obvious requests of the mediators. The use of a focused group discussion method not only led to researchers gather the views of different groups of people but also made the mediators themselves interacted more effectively and were aware of each other's view points.  In conclusion, people's opinions refer more to the roots and causes and indicate that the trust between the people and the officials in the region has been severely damaged, however, they are grateful and aware that they should be empowered to improve their situation. Interaction between these three groups is essential to improve the region's health: people, the oil industry and sovereignty of the local government. It is recommended that the health council of the region is formed with the participation of people's representatives after the process of applying people's opinion and designing a comprehensive health plan منطقه ویژه اقتصادی انرژی پارس, ارتقای سلامت, صنعت نفت و گاز, میانجیان مردم Pars Special Energy Economic Zone, health promotion, oil and gas industry, community participation. 489 498 http://ioh.iums.ac.ir/browse.php?a_code=A-10-3360-3&slc_lang=fa&sid=1 behzad damari بهزاد دماری bdamari@gmail.com 13600319475328460038110 13600319475328460038110 No Associated Professor, Department of Governance and Health, Neuroscience Research Center, Tehran University of Medical Sciences, Tehran, Iran. دپارتمان حکمرانی و سلامت، پژوهشکده علوم اعصاب، دانشگاه علوم پزشکی تهران، تهران، ایران ahmad hajebi احمد حاجبی hajebi.ahmad@gmail.com 13600319475328460038111 13600319475328460038111 No Professor, Research Center for Addiction and Risky Behavior ( ReCARB ), Psychiatric Department, Iran University of Medical Sciences, Tehran, Iran. مرکز تحقیقات اعتیاد و رفتارهای پرخطر، دپارتمان روانپزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران habib emami حبیب امامی emamihabib@yahoo.com 13600319475328460038112 13600319475328460038112 No Assistant Professor, Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran مرکز کنترل و پیشگیری از دخانیات، مؤسسه ملی تحقیقات سل و بیماریهای ریوی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران ail akbar zeinaloo علی اکبر زینالو zeinaloo@tums.ac.ir 13600319475328460038113 13600319475328460038113 No Professor, Department of Pediatrics, Pediatric Center of Excellence, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. مرکز پزشکی کودکان، دانشگاه علوم پزشکی تهران، تهران، ایران abbas vosoogh moghadam عباس وثوق مقدم a_vosoogh@yahoo.com 13600319475328460038114 13600319475328460038114 Yes Assistant Professor of Research in Commuity Medicine,Secretariat of Supreme Council for Health and Food Security, Ministry of Health and Medical Education, Tehran, Iran. دبیرخانه شورای عالی سلامت و امنیت غذایی کشور ، تهران ، ایران mohammadhosein salarianzade محمد حسین سالاریان زاده mhsalarianzadeh@yahoo.com 13600319475328460038115 13600319475328460038115 No Management Development and Transform Center, Ministry of Health and Medical Education, Tehran, Iran. وزارت بهداشت درمان وآموزش پزشکی، تهران، ایران