Health Terminators in Working Children: A Critical Ethnography Publisher Pubmed



Jafari H ; Nayeri ND ; Brand S ; Fazeli N ; Nasrabadi AN ; Fomani FK ; Varaei S
Source: International Journal for Equity in Health Published:2025

Abstract

Background: Multiple factors influence the health of working children, including cultural, behavioral, and environmental determinants. Identifying and understanding these factors is essential for developing effective interventions. This study aimed to identify and critically analyze the factors—termed “health terminators”—that undermine the physical and mental health of working children, considering cultural, behavioral, and environmental influences. Methods: This study is the second part of a larger ethnographic research conducted in Tehran, employing a qualitative critical ethnographic design over four years. Data collection included prolonged participant observation in workplaces, homes, and schools, semi-structured interviews with children aged 10–18 and key informants, informal conversations, and analysis of documents and children’s drawings. Data were coded and analyzed following Carspecken’s framework, with triangulation, member checking, and peer debriefing used to ensure trustworthiness. Results: Analysis generated 3,057 low-level codes, with approximately one thousand assigned to the main theme “health terminators,” comprising five intermediate categories: cultural beliefs, self-harming behaviors, living in unhealthy environments, forgotten children, and social abandonment and vulnerability. Key issues identified included superstition, risky behaviors, neglect of preventive health measures, unsafe housing, educational and emotional neglect, and restricted access to health services. Conclusions: Working children face multifaceted health risks driven by cultural, behavioral, and structural factors. Comprehensive, equity-oriented policies addressing physical needs, cultural beliefs, health behaviors, and environmental conditions are essential. Interventions such as culturally sensitive health education, improved living conditions, health insurance coverage, and social support can reduce vulnerability and promote equitable health outcomes, contributing to health justice for marginalized children. © The Author(s) 2025.