Protection of workers’ health

Data and numbers

• In many countries, more than half of workers are employed in the informal sector, where they lack social protection for health care and there are no mechanisms for applying occupational health and safety standards.
• Occupational health services tasked with advising employers on improving working conditions and monitoring workers’ health mainly cover large companies in the structured sector, while more than 85% of workers in small companies, from the informal sector, the agricultural sector, and migrants worldwide do not have any type of occupational health coverage.
• Some occupational hazards such as trauma, noise, carcinogens, airborne particulates, and ergonomic hazards represent a significant portion of the disease burden from chronic illness: 37% of all back pain cases; 16% hearing loss; 13% of chronic obstructive pulmonary disease; 11% asthma; 8% of trauma; 9% of lung cancer; 2% leukemia; and 8% depression.
• Annually, 12.2 million people, mostly from developing countries, die of working age from non-communicable diseases.
• In most countries, work-related health problems cause losses ranging from 4 to 6% of GDP. Basic health services to prevent occupational and work-related diseases cost an average of $ 18 to $ 60 (purchasing power parity) per worker.
• Approximately 70% of workers lack any type of insurance that could compensate them in the event of occupational diseases and injuries.
• Research has shown that workplace initiatives can help reduce sick absenteeism by 27% and healthcare costs for businesses by 26%.

Primary health care centers can provide some essential interventions to protect the health of workers, especially advice to improve working conditions, detection of occupational diseases, and surveillance of workers’ health, although, in most In countries, the focus is still on medical treatment, rather than prevention.

What determines the health of workers?

Economically active people spend about a third of their time in the workplace. Employment and working conditions have considerable effects on health equity. Good working conditions can provide protection and social status, opportunities for personal development, and protection against physical and psychosocial risks. They can also improve the social relationships and self-esteem of employees and produce positive health effects.

Workers’ health is an essential prerequisite for family income, productivity, and economic development. Therefore, restoring and maintaining work capacity is an important function of health services.

Health risks in the workplace, including heat, noise, dust, dangerous chemicals, unsafe machines, and psychosocial stress cause occupational illnesses and can exacerbate other health problems. Conditions of employment, occupation, and position in the workplace hierarchy also affect health. People who work under pressure or in precarious employment conditions are likely to smoke more, exercise less, and have an unhealthy diet.

In addition to general health care, all workers, and particularly those in high-risk professions, need health services that assess and reduce exposure to occupational risks, as well as medical surveillance services for the early detection of occupational diseases and injuries related to work.

Chronic respiratory diseases, musculoskeletal disorders, hearing loss caused by noise, and skin problems are the most common occupational diseases. However, only a third of the countries have programs to address these issues.

Non-communicable work-related diseases, as well as heart disease and depression caused by occupational stress lead to increasing rates of illness and prolonged sick leave. Noncommunicable diseases of occupational origin include occupational cancer, chronic bronchitis, and asthma caused by air pollution in the workplace and radiation.

Despite the incidence of these diseases, in most countries, doctors and nurses are not adequately trained to deal with work-related health problems and many countries do not offer graduate training in occupational health.

Workers’ health coverage

In most countries, work-related health problems cause losses ranging from 4 to 6% of GDP. Approximately 70% of workers lack any type of insurance that could compensate them in the event of occupational diseases and injuries.

Universal health coverage combines access to the services necessary to achieve good health (health promotion, prevention, treatment, and rehabilitation, including services related to the determinants of health) with adequate financial protection to prevent ill health from leading to impoverishment.

There are effective interventions to prevent occupational diseases. These interventions include, for example, isolation of sources of contamination, ventilation, noise control, the substitution of hazardous chemicals, improvement of furniture, and organization of work.

The task of specialized occupational health services is to assess these risks and make recommendations aimed at preventing occupational and work-related diseases. Workers exposed to risks should undergo periodic medical examinations to detect any health problem at an early stage, in which treatment and modification of the workplace can help to avoid permanent damage.

Currently, specialized occupational health services are available to only 15% of workers worldwide, mainly in large companies that offer health insurance and occupational injury benefits. In the context of the current global unemployment crisis, more and more people are looking for work in the informal sector, where they do not have any type of insurance coverage or occupational health services.

Furthermore, many of these workers often work in hazardous conditions and suffer work-related illnesses, disabilities, and injuries. In many communities, when the breadwinner becomes ill, the whole family suffers from a lack of social protection.

Primary care centers can provide some basic occupational services to the informal sector and small business workers in the community. Often, staff from these centers visit workplaces, make recommendations for improvements, periodically perform medical examinations and diagnostic tests, and report work-related illnesses.

Primary care centers could also train and collaborate with volunteers and those responsible for workplace safety to implement simple occupational disease prevention measures and advise on safer working methods. The costs of these services vary between US $ 18 and US $ 60 (purchasing power parity) per worker. Its advantages would include:

• improvements in the workplace, even after the first visit,
• detection and management of work-related health problems at an early stage, and
• provision of information to the worker communities and their participation in the protection of their health.

Research has shown that workplace initiatives can help reduce sick absenteeism by 27% and healthcare costs for businesses by 26%.

WHO response

Resolution WHA60.26 of the World Health Assembly entitled “Workers’ health: global action plan” urges the Member States “to do their utmost to ensure full coverage of all workers, including those in the non-health sector structured, those of small and medium-sized enterprises, agricultural workers and migrant and contract workers, through essential interventions and basic occupational health services aimed at the primary prevention of work-related diseases and injuries ”.

The strategy proposed by WHO to improve health coverage for workers, including those in small businesses and the informal sector, is to work with countries in the following strategic directions:

• Strengthen the training of primary care providers (general practitioners, nurses, environmental and public health specialists, and community health workers) to provide basic occupational health services, such as advice on improving working conditions, monitoring the health status of workers, and detecting the most common occupational diseases among workers in small businesses, rural areas, farms, the informal sector, and migrants.
• Expand coverage and improve the quality of specialized occupational health services in large and medium-sized companies and in industrial areas, with particular attention to the evaluation and reduction of occupational risks; surveillance and improvement of the environment, organization, machinery, and work equipment; early detection and rehabilitation of occupational diseases; Health promotion; and provision of first aid in the workplace.
• Establish links between occupational health services and primary care centers, in order to facilitate the care of workers suffering from chronic diseases and their return to work after long periods of sick leave.
• Developing healthy initiatives, tools, and methods in the workplace so that companies and other work environments can better deal with health without being overly dependent on professional health services.
• Include occupational health in the training, both prior to entry into service and in-service, of all front-line healthcare providers and some medical specialists in oncology, dermatology, pulmonology, neurology, and disorders of the musculoskeletal system.
• Develop roadmaps to strengthen workers’ access to essential interventions and services defined at the national level and aimed at preventing and controlling occupational and work-related diseases. This includes monitoring coverage and setting realistic goals compatible with human and financial resources for health and local traditions.