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Trust, Conflict, and Engagement in Occupational Health: North American Epidemiologists Conduct Occupational Study in Communities Affected by Chronic Kidney Disease of Unknown Origin (CKDu)

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Purpose of Review

Science has been used as a tool of colonialism, and aspects of science privilege researchers in the global North (USA and Europe). The environmental justice and worker health movements in the USA and globally have influenced aspects of how occupational and environmental health research is conceived and conducted so that it is more equitable. This review provides a case example of research in the area of chronic kidney disease of unknown origin (CKDu).

Recent Findings

In the present work, the author describes aspects of community-based participatory research and anti-colonial research that influence a current occupational epidemiology study of CKDu in Mesoamerica among workers in agriculture and non-agricultural industries. The research includes investigators from numerous countries in the global North and South and funding from the US government and corporations.


The role of industry in science and the misuse of science by corporate interests remain substantial threats to research integrity. The ability of researchers to navigate potentially conflicting interests with industry and workers, and establish trust within and outside the scientific community, is essential for sustained engagement in longitudinal studies. Trust is about human relationships. It takes time and effort to build and is essential for creating equitable, empowering research relationships.

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Thank you Kate Applebaum, David Ozonoff, Les Boden, and Mike McClean for edits and input. Discussions and experience with Juan Jose Amador, Daniel Brooks, David Friedman, Ramon Garcia-Trabanino, Emmanuel Jarquin, Jessica Leibler, and Damaris Lopez contributed to my thinking on this topic.


Funding sources referred to in the manuscript include the National Institute of Environmental Health Sciences of the National Institutes of Health, Award Number R01ES027584 and the Azucareros del Istmo Centroamericano (AICA), an association of sugar producers in Central America who gave a gift to Boston University. The author was also supported by a JPB Environmental Health Fellowship from by the JPB Foundation and managed by the Harvard T.H. Chan School of Public Health.

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Correspondence to Madeleine K. Scammell.

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Scammell, M.K. Trust, Conflict, and Engagement in Occupational Health: North American Epidemiologists Conduct Occupational Study in Communities Affected by Chronic Kidney Disease of Unknown Origin (CKDu). Curr Envir Health Rpt 6, 247–255 (2019).

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