Insurance as Efforts to Control Risk Disease Caused by Benzene for
Home Industry Shoes Workers
Abdul Rohim Tualeka, Heru Fahrudi, Siti Asiah
Department Occupational Health and Safety, Public Health Faculty, Universitas Airlangga, Mulyorejo, Surabaya,
Indonesia
Keywords: Benzene, Excess cancer risk, safe duration, Insurance.
Abstract: This study aimed to determine the risk characteristics of workers exposed to benzene and their insurance as
an effort to control the risk of occupational diseases in the shoe home industry in Surabaya. The research
method was a descriptive study by describing the risk control with insurance based on the characteristics of
the exposure to benzene. The sample size was 20 shoe home industry workers. The data analysis used was
descriptive. The results showed that the highest benzene concentration was 7.44 mg/m
3
, the average intake
of benzene was 0.00363 mg/kg/day, and that the Excess Cancer Risk of the 20 respondents >10
-5
means that
the exposure to benzene was not safe for their health. The safe duration for the workers between 0,03 - 3.53
years means that the workers have a high risk of suffering from leukemia due to their exposure to benzene.
Because it is high risk, the workers must be insured. However, based on the research results, 100% of the
workers had no insurance (BPJS Ketenagakerjaan); the home industry had no Pos Upaya Kesehatan Kerja.
From the results of the study, it has been concluded that the workers have a high risk of exposure to
benzene. The workers had no insurance (BPJS Ketenagakerjaan) and no Pos Upaya Kesehatan Kerja so
there was no protection for the workers.
1 INTRODUCTION
Benzene is in the working environment of
shoemakers. Therefore it is an absolute necessity to
know the level of risk of the exposed groups. This
study has measured 8 work sites to determine the
broader picture of benzene concentration.
One of the UKMs in Indonesia is the informal
industry of shoe craftsmen. In the early 1990s, the
footwear industry became a major contributor to
Indonesia's Gross National Product as the third
largest national income after the wood and textile
industry. About 40 percent of Indonesia's shoe
exports are shipped to the US market, while 33
percent are shipped to Europe. The rest are exported
to African, Middle Eastern and South American
countries.
The efforts of shoemakers to maintain the quality
and existence of their products are often not matched
by the protection from the occupational risks
associated with harmful equipment and materials.
The use of hazardous materials or chemicals in shoe
crafting includes using glue as a material for the
process of making shoes. The process consists of
several stages of work, starting with making the shoe
design, preparing the tops of the shoes (patterning,
pattern cutting, stripping, decorating, sewing and
insoles), preparing the bottom of the shoe (outer
soles, gluing, coat, sewing, nailing) finishing
(cleaning, smoothing) and packing for subsequent
delivery to the consumer/market in the production
process using a variety of equipment (Maryiantari,
2016).
Shoe work is a risky job. Long working hours not
supported by a safe and comfortable workplace,
uncomfortable body position, and harmful
equipment. Equipment used in the production
process includes electric heating/ fire (oven), nails
and hammer, raw materials made of fabric, synthetic
leather or plastic materials. For the process of
gluing, the workers use two types of glue; yellow
glue Pro ARDico Brand, glue LK and white glue
PU-Weber brand, DS-Bond DNS 818. Yellow glue
is used to connect the openings so it is usually used
in the surface and finishing, while white glue is
282
Tualeka, A., Fahrudi, H. and Asiah, S.
Insurance as Efforts to Control Risk Disease Caused by Benzene for Home Industry Shoes Workers.
In Proceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 282-289
ISBN: 978-989-758-335-3
Copyright © 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved

generally used to patch the soles because of the
much stronger adhesion force. In a normal situation
(normal day), within a month they can use 30-40 kg
of yellow glue and white glue by approximately 30
kg. The use of the glue means that it is poured in to
small containers such as bottles, drinks with open
positions or directly from a container of 3kg glue
size (Maryiantari, 2016). Based on the research
conducted by Hendra, it stated that there is an
organic solvent in the glue in the form of benzene by
about 1-2%.
The various equipment and materials used in the
shoe making process is one of the high risk hazards
involved. The use of chemicals can be detrimental to
the health of the shoemakers. One of them is the use
of glue. In the process, there is an organic solvent
vapor contained in the glue that is very likely to
have an impact on health if inhaled continuously for
long periods of time (Lu, 2006).
Benzene, when inhaled, can cause aplastic
anemia and leukemia. Research conducted in
Europe, America and Mexico has shown a
significant relationship between elevated levels of
benzene in the air and increased rates of cancer and
local leukemia. In other studies in the United States,
it has been shown that inhaling benzene even at the
threshold can cause chromosomal abnormalities in
sperm cells.
Indonesian National Standard in 2005 refers to
Permenaker No. 13 of 2011 which contains the time-
weighted avarage of workplace-treated chemical
substances, with the number of working hours of 8
hours per day or 40 hours per week. It states that
benzene is included in the A2 group (Chemical
substances estimated to be human carcinogens) and
has a NAB of 10 ppm or 32 mg/m
3
benzene in the
air (SNI 2005).
The occurrence of health problems due to
benzene exposure in shoe workshop workers is
reported to occur in China, which is the largest shoe
manufacturer in the world. A restrospective cohort
study of 75,000 workers exposed to benzene from
1987 to 1991 in 12 Chinese cities found that 43
groups of workers were exposed to benzene. This
study suggests that the workers exposed to benzene
are at a higher risk of dying from leukemia with a
relative risk of 2.3 compared with the workers not
exposed to benzene (Chen and Chan, 1999).
Risk control is a preventive method that is done
in such a way that the risk does not occur. One effort
to control the risk of disease in workers is with
insurance. Health insurance is an insurance product
that provides a finance security guarantee to the
policy holder at the time of health problems due to
illness or an accident (Tualeka, 2015). By insuring a
company's property when there is a big risk, it
transfers the impact of the risk to the insurer.
Insurance will not reduce the risk probability but it
will reduce the impact of those risks.
2 METHOD
This research was a descriptive and observasional
study conducted in the home industry of shoes
workers in Tambak Oso Wilangon, Surabaya. While
in terms of time, the type of approach used in this
study was a cross-sectional research design using a
risk analysis paradigm by taking one component,
namely the risk assessment/risk assessment (NRC,
1983). Risk assessment was used to calculate the
extent of cancer incidence, and if the duration of
work (Dt) was safe. Participation in relation to
insurance was done by interview.
This research was conducted at 8 locations of
work with the research subjects totalling 20
respondents. The measurement of benzene
concentration in the work environment was done by
using the NIOSH 1501 measurement method with an
active carbon absorbent pipe (choarcoal) by using
the Gas Chromatography (GC) technique by a
trained officer from UPTK3 Surabaya. To know the
ownership of insurance, we used the interview
method.
3 RESULT
Benzene in the working environment of shoemakers
makes it an absolute necessity to know the level of
risk of the exposed groups. This study measured 8
work sites to determine the picture of benzene
concentration.
Insurance as Efforts to Control Risk Disease Caused by Benzene for Home Industry Shoes Workers
283

Table 1: Benzene Concentration Distribution in Working Environment of Shoemakers in Tambak OSO Vilagge Wilangun
Surabaya 2016
In Table 1, the concentration of benzene by as
much as 6 points (75%) is still below the
determined brick threshold value of 0.5 ppm or 1.6
mg/m
3
. The average benzene concentration is
1,6313 mg/m
3
. The lowest concentration level was
0.04 mg/m
3
and the highest concentration was 7.44
mg/m
3
.
The pattern of activities to be covered includes
exposure, frequency and the duration of exposure.
The working hours of each work location are not
the same. In addition to the working hours, other
variables that must be considered are the number
of working days and long working hours in the
home industry shoe of Tambak Oso Wilangun.
Table 2: Distribution of Descriptive Frequency of Pattern of Workers Activity of Shoemaker in Tambak Oso Vilagge
Wilangun Surabaya 2016
Info.
(tE)
Amount
(fE)
Amount
(Dt)
Amount
n % N %
N %
≤ 8 hours 1 5 ≤ 265 day - - ≤ 25 yea
r
10 50
>8 hours 19 95 > 265 da
y
20 100 > 25
y
ea
r
10 50
Total 20 100 20 100 20 100
Mean
hours
/day
10.55
day/year
346.75
year
24.93
Std. dev 3.086 30.680 10.957
Me
d
9.50 365 24.50
Min 6 260 3
Max 17 365 43
Table 2 illustrates the frequency distribution of
exposure time, exposure frequency, and the duration
of exposure. Exposure time (tE) is categorised into
two ie ≤ 8 hours / day and> 8 hours / day.
The result showed that 1 worker (5%) had an
exposure time of ≤ 8 hours / day and 19 workers
(95%) had an exposure time of > 8 hours/ day. The
average exposure time of 10.55 hours/ day shows
that each work location has a different exposure
time. The exposure frequency (fE) is categorised
into two, ie ≤ 265 days and> 265 days. The result of
the research is that all workers have an exposure
frequency > 265 days. The average worker in a year
works for 346.75 days. Exposure duration (Dt) is
categorised into two, i.e. ≤ 25 years and> 25 years.
The results showed a balanced result between the
two for each of 10 workers (50%). The average
duration of exposure was 24.93 years.
Based on the results of the interviews, it is
known that workers have worked for a long time
before, therefore this needs to be considered because
this can give the idea that they are always in an
environment that allows for exposure to benzene.
The result showed that one of respondents with
serial number 1 had a body weight of 51.4 kg (Wb).
Every day they worked 9 hours/day (tE) for 313
days (fE), and had worked for 34 years (Dt). With an
inhalation rate (R) of 0.6 m
3
/hr and the tavg for
carcinogenic substances was 10950 days. The result
of the benzene air measurement showed a
concentration of (C) 0.04 mg/m
3
, so the amount of
non-carsinogenic intake (intake) was:
Concentration Benzene
(NAB= 1,6 mg/m
3
)
N Percentage (%)
≤ 1.6 mg/
m
3
6 75
> 1.6 mg/
m
3
2 25
Total 8 100
Mean 1.3475
Median 0.6350
Std. Deviation 2.54762
Min-Max 0.04 - 7.44
INAHEA 2017 - 4th Annual Meeting of the Indonesian Health Economics Association
284

= 0,04 mg/m
3
x 0,6 m
3
/hours x 9 hours/day x 313
hours x 34 years
51.4 Kg x 10950 day
= 0,004084 mg/kg.day
The known benzene intake per day for the first
worker was 0.004084 mg/kg.day. As for the
calculation of the carcinogen intake using the
formula and value of the same variable, but using
the tavg for carcinogenic substances, the result was
25550 days. Here is the calculation of the
carcinogenic intake per day for the workers:
= 0,04 mg/m
3
x 0,6 m
3
/hours x 9 hours/day x 313 day x 34 year (1)
51.4 Kg x 25550 day
= 0,0018 mg/kg.day
The know benzene intake per day for the first
worker is 0,0018 mg/kg.day.
If ECR >10
-5
, then the concentration of
benzene exposure may cause a carcinogenic health
effect.
The risk characteristics for cancer effects can
be determined by multiplying the value of cancer-
causing substance intake with CSF values with the
following formula:
If ECR ≤10
-5
, then the concentration of
benzene exposure has not made the workers be at
risk of causing carcinogenic effects.
From the ECR calculation, it is known that the
ECR value for the current exposure is 5 years for the
30 workers with an ECR> 10
-5
. As many as 20
people (100%) are at risk of the health effects of
cancer.
After the risk assessment was done and got
results that are beyond the threshold value, the next
thing that was done was to conduct risk
management. This was done to minimise and even
eliminate the risk of danger posed by the hazard in
the workplace.
Table 3: Percentage of current Excess Cancer Risk (ECR) value, 5 th, 10 th, 15 th, 20 th, 25 th, and 30 th Shoemakers in
Tambak Oso Village Wilangun Surabaya 2016
.
Exposure ECR
Amoun
t
Total
N%
ECR
First
ECR ≤ 10
-5
00 20
ECR > 10
-5
20 100
ECR 5 th ECR ≤ 10
-5
00 20
ECR > 10
-5
20 100
ECR 10 th ECR ≤ 10
-5
00 20
ECR > 10
-5
20 100
ECR 15 th ECR ≤ 10
-5
00 20
ECR > 10
-5
20 100
ECR 20 th ECR ≤ 10
-5
00 20
ECR > 10
-5
20 100
ECR 25 th ECR ≤ 10
-5
00 20
ECR > 10
-5
20 100
ECR 30 th ECR ≤ 10
-5
00 20
ECR > 10
-5
20 100
In relation to carcinogens, the risk management
used is the value of ECR by applying the formula as
follows:
ECR = I
k
x CSF (3)
I
k
=


(4)


=


(5)
Based on the above calculation formula of
carcinogenic effect, it can be used to find the safe
value of C, t, and D safe as follows:
C safe =


(6)
tE safe =


(7)
Dt safe =


(8)
For the full calculation, the results can be seen
in the following table:
ECR=Intake Karsinogenik (I
k
) x CSF (2)
Insurance as Efforts to Control Risk Disease Caused by Benzene for Home Industry Shoes Workers
285

Table 4: The result of calculating the value of safe exposure of benzene carcinogenic health effect on benzene shoes worker
in Tambak Oso Village Wilangun Surabaya 2016
No. Worker
C
(mg/
m
3
)
C safe
(mg/
m
3
)
tE
(hours/day)
tE safe
(hours/day)
Dt
(year)
Dt safe
(year)
1 0,04 0.004 9 0.93 34 3.53
2 0,04 0.005 15 1.88 20 2.50
3 0,04 0.004 17 1.79 16 1.69
4 0.06 0.003 8 0.40 40 2.02
5 0.06 0.002 14 0.58 36 1.49
6 0.06 0.008 10 1.40 17 2.39
7 0.06 0.006 8 0.74 30 2.77
8 0.06 0.053 8 7.06 3 2.65
9 0,15 0.007 8 0.36 25 1.12
10 0,15 0.009 6 0.37 24 1.46
11 1,12 0.002 13 0.02 43 0.08
12 1,12 0.016 12 0.18 8 0.12
13 1,12 0.003 9 0.02 43 0.12
14 1,27 0.003 15 0.04 23 0.06
15 1,27 0.007 8 0.04 20 0.11
16 1,27 0.005 10 0.04 27 0.10
17 1,27 0.004 9 0.03 31 0.11
18 2,91 0.007 10 0.02 25 0.06
19 7,44 0.008 14 0.02 20 0.02
20 7,44 0.017 8 0.02 14 0.03
From the above data, the researchers took the
safe value by choosing the safe cancer risk from the
calculation data most likely applied by the workers
of shoe craftsman in Tambak Oso Village Wilangun,
Surabaya. Safe was 0,003 mg/m
3
, t
E
safe equals 7.06
hours/ day and Dt Safe is 3.53 years.
Table 5: Have Known about JKK (Jaminan Kecelakaan
Kerja)
ECR Have Known about JK
K
Amount
Respondens Yes No
> 10
-5
5 15 20
(
25,00%
)
(
75,00%
)
(
100,00%
)
≤ 10
-5
0 0 0
(0,00%) (0,00%) (0,00%)
In Table 5 above, the respondents who are ECR>
10
-5
or are not carcinogenically safe 75,0% do not
know about JKK and 25,0% 25,0% have known
about JKK.
Table 6: Have Known about JKM (Jaminan Kematian)
ECR Have Known about JKK
Amount
Respondens Yes No
> 10
-5
5 15 20
(25,00%) (75,00%) (100,00%)
≤ 10
-5
0 0 0
(
0,00%
)
(
0,00%
)
(
0,00%
)
In Table 8 above, for the respondents who are
ECR> 10
-5
or are not carcinogenically safe 75,0% do
not know about JKM and 25,0% 25,0% have known
about JKM.
Table 7: Workers Insurance (BPJS Employment)
ECR Have BPJS
Amount
Res
p
ondens Yes No
> 10
-5
0 20
20 (100,0%)
(0,00%) (100,00%)
≤ 10
-5
00 0
(0,00%) (0,00%) (0,00%)
In Table 7 above, for the respondents who are
ECR> 10
-5
or who are not carcinogenically safe,
100% have no insurance with BPJS Employment.
Table 8: Pos Upaya Kesehatan Kerja (Pos UKK) / Post
Work Healt Effort
ECR
Responden
Has Pos Upaya Kesehatan
Kerja (Pos UKK)
Amount
Yes No
> 10
-5
0 20 20
0,00% (100,00%) (100,00%)
≤ 10
-5
00 0
(
0,00%
)
(
0,00%
)
(
0,00%
)
INAHEA 2017 - 4th Annual Meeting of the Indonesian Health Economics Association
286

In Table 8 above, for the respondents who are
ECR> 10
-5
or are not 100% carcinogenic in the
home industry of shoes in Romokalisari Surabaya do
not have Pos Upaya Kesehatan Kerja (Pos UKK) or
Post Work Health Effort.
Table 9: Why not have BPJS Ketenagakerjaan?
Why not have
BPJS
ketena
g
ake
j
aan
Respondens
Amou
nt
Yes No
No information
5 75 20
(100,0
%)
(0,00%) (100,00%)
No socialitation
20 0 20
(100,0
%)
(100,00%) (0,00%)
No enough
money
20 0 20
(100,00%) (0,00%)
(0,00
%)
In Table 9, for the 20 respondents, 100,0% said
that they had never been given information about
BPJS but 100,0% also said that they had never been
socialited by BPJS and had no enough money.
4 DISCUSSION
The measurement of benzene concentration was
done at 8 sampling points at the location of
shoemaker workers. Kelurahan Tambak Oso
Wilangun in Surabaya showed the highest
concentration of 2,333 ppm equal to 7.44 mg/m
3
and
the lowest was 0,0129 ppm equal to 0,04 mg/m
3
.
The measured benzene concentration at each point
was different. The high-measured benzene
concentration is due to several things including the
production of the shows and the glue used which
also follows the amount of shoes produced.
The exposure time describes the number of hours
worked per day in the work environment. The results
of the study showed that the lowest worker worked
at work for 6 hours per day, and the highest work for
17 hours per day. The results of the study above
show that the threshold value of normal working
hours the standard as 7 hours of work a day or 6
days a week, or 8 hours of work a day or 5 days a
week. The highest working time is 17 hours a day
due to high orders and fast production deadlines so
that the workers strive to meet the target order.
The frequency of exposure indicates the time that
the workers spend working in the shoe-making
industry within the space of 1 year. The results
indicate that the workers spend the least time or 260
days/year and the highest 365 days/year.
The calculation of the risk level of individual
cancers at the current time is that for up to 30 years,
as many as 20 people (100%) have the results of the
ECR calculation of > 10
-5
. The results explain that at
the present time, exposure of up to 30 years are all at
risk of cancer health and are in unsafe conditions
against benzene exposure.
The concentration of benzene exposure towards
the shoemaker workers in Tambak Oso Wilangun of
Surabaya is influenced by the air condition at the
worker's location as well as the materials in the form
of shoe glue which is used in the shoe production
process. From the calculation of the value of health
risk, control of non-cancer effects and the effects of
cancer on safe exposure of benzene to sharecropper
workers in Kelurahan Tambak Oso Wilangun in
Surabaya 2016 obtained a safe value of (C) of 0,003
mg/ m
3
, safe snack time (tE) of 7,06 hours/day,
exposure frequency (fE) of 322 days/year and an
exposure duration (Dt) of 3.53 years.
Based on the research results, 100% of the
respondents have no insurance.This can not protect
workers from exposure to benzene-causing cancer
because the ECR is greater than 10
-5
which means a
high risk with major consequences. In the United
States, ECR 10
-5
is established as a carcinogenic
limit for workers. In Shingga, workers working in
industries with an ECR larger than 10
-5
should be
protected, among others, by having medical
insurance.
According to Presidential Regulation of the
Republic of Indonesia No. 12 2013 on Health
Insurance, health insurance is a guarantee of health
protection for the participants so they can benefit
from health care and have protection in meeting
their basic health needs. A participant is any person,
including foreigners, who work for a minimum
period of 6 (six) months in Indonesia, and who have
paid the contribution. From the observation, it is
known that 100% of the workers do not guaranteed
Health Insurance. The workers exposed to benzene
have a high risk of leukemia because there is no
protection against their health.
According to Kountur 2008, in Tualeka, A.R.
(2016), the high risk control is because the
consequences are carried out with the transfer of
risk, among others, by the insurance. Thus, there is
the need to control the risk of exposure to benzene
workers such as insurance with BPJS Employment.
In addition, in the area, there must also be Post
Work Health Efforts. With insurance, it will not
reduce the probability of the occurrence of the risk
Insurance as Efforts to Control Risk Disease Caused by Benzene for Home Industry Shoes Workers
287

but it will transfer the risk of the impact of benzene
exposure from the workers to the insurer. Thus, the
workers are not harmed by the losses borne by the
insurer. According to the Ministry Menpower
Regulation RI No.1 2006 about Insurance for
Manpower in the informal sector who must have
insurance.
More of the manpower in the informal sector
have no BPJS insurance because the company has
never done any solicitation in the home industry, and
they have no money. Information about BPJS for the
manpower in the informal sector is important to
increase the knowledge about BPJS and to change
the behaviour so then the workforce become
members of BPJS.
5 CONCLUSION
Workers in the insecure home shoe industry are not
encountering enough carcinogenic ingredients to
encounter the high consequences of cancer. 100% of
the shoe industry workers do not have insurance so
they do not get protection due to their exposure to
benzene, which is a cause of cancer.
The lowest benzene concentrations were present
at work site 1 of 0.04 mg/m
3
and the highest
concentration was found at work site 8 of 7.44 mg
/m
3
.
For the calculation of the cancer risk rate (ECR),
most workers have an ECR value > 10
-5
, meaning
that at the time of the study, there were workers in
unsafe conditions due to benzene exposure. The safe
limits for the workers are as follows: safe
concentration (C) 0.003 mg/m
3
, safe travel time (tE)
7.06 hours/day, exposure frequency (fE) 322
days/year and exposure duration (Dt) 3.53 years.
The workers have a high risk of cancer because
the benzene safe exposure time of only 7.06
hours/day and the duration of safe work is only 3.53
years.
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