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By 2011, the workforce in the Region of the Americas is close to 468 million1, out of which 60.2% (283 million) is located in Latin America and the Caribbean (LAC), and 39.5% (185 millions) is located in North America (NA). Labor and working conditions are considered to be determinants of health and quality of life for working people2, but are very varied within the Americas. As a result, there are many gaps and impacts on workers´ health and wellbeing affecting social justice and health equity3. The purpose of this presentation is to raise the level of awareness about these conditions, and to highlight the work that is being done to improve them.
1. Inequities of formal and precarious work in the regional socio-economic context
Despite the current economic crises in United States, LAC increased economical growth with relative stable growth rates (6%), and an approximately 25% GDP increase between 2002 and 20114. Effects of the global economic crises are few, and some advances were made on the equity agenda4,5. Nonetheless, economic and social outputs are widely heterogeneous, and some countries (Mexico/Central America) were left under the successful average.
Strengthening employment and human capital was not completely achieved. Most jobs created since 2009 were in the service sector (61.6%), less in the industrial sector, and even less in the agricultural sector, in which one of every six jobs were represented in the Region. Hiring in formal jobs reached only 49%, mostly in urban areas (59%) for males (63.7%)6. Additionally, the decrease caused by the 2009 crisis led 1 million people to unemployment and 12 million people to poverty7. Youth is greatly affected since unemployment rates increased 19% in 2010 for youngsters between 14—25 years old1. There are two reasons for this: the number and quality of jobs after the 2009 crises were not enough8; and, the weak human capital caused by low investment in human resources. Education levels remain low, low skilled workers prevail, and physical capital (machinery/technology) too7. Hence, economic growth rates are expected to decrease to 4.5% by the end of 2012. Precarious work expanded weakening labor relations, and affecting every day work life9, with the potential of generating direct and indirect deleterious effects on workers´ health as several countries have reported10.
2. Informal work
The recovery of economic growth has not affected the dynamics of the growing informal sector during the last decades in LAC and increased in NA. Part-time and voluntary jobs increased after the crises, leading many workers to the informal sector8. Informal economy leads to poor working conditions, low salaries, social exclusion and transgression of basic rights at work. LAC is one of the three global regions with the highest employment vulnerability8. Countries with the highest rates of informal work in 201111,12 are: Bolivia (75.1%, 52.1%), Honduras (73.9%, 58.3%), Peru (70.6%, 50.2%), Paraguay (70.7%, 37.9%), Nicaragua (65.7%, 54.4%), Ecuador (60.9%, 37.3%) and El Salvador (66.4%, 53.4%). Informal occupations are: self-employed or in informal enterprises; contributing to house hold income (women, elderly and children); members of informal associations and employees within formal or informal enterprises, or caregivers and domestic workers11. Rural informality is not registered.
3. Child labor
Protection aimed to avoiding child work remains to be achieved in the entire Region. It is present in all economic activities, with/without subordination, salary, full or part-time, occasional, seasonal, regular, legal or illegal work13. Trends indicates that work rates of children aged 5-17 have decreased from 20.6% (196 million) in 2004, to 19.3% (176 million) in 2008, although employment for youngsters 15 to 17 years old increased in 2 millions, completing 129 millions. Agriculture occupies most of working children (60%), followed by services (26%) and industry (7%). Boys are mostly in agriculture (62.8%) and industry (68.5%), while girls are in services (52.6%).
Children in the worst forms of work are the silent majority. In LAC 10.7 million children work (9% within 5 and 14 years of age) representing 1 out of 10 children. Countries with highest rates are: Peru (42.2%), Bolivia (27.4%) and Guatemala (21%). Average work hours per week are 18-30, and 9.4 million perform dangerous work (agriculture). Children in street work are exposed to multiple hazards, including extreme psychosocial risks, street violence, sexual abuse, authority prosecution, presence of drug dealers and minor trading14. Other forms of the worst work include: sexual exploitation, military or guerilla recruitment, and even traffic of young girls, boys and adolescents15. It is estimated that LAC in 2008 had close to 228 boys and girls sexually exploited per hour16,17.
4. Forced Labor
It is the extreme opposite of decent work, in which the victims are the less protected persons in society (women, children and youngsters, indigenous, migrants, and elderly). Close to 1.3 million people in LAC are under this condition18, and found in many economical activities, formal/informal, urban/rural. It relates to abusive forms of slavery, semi-slavery, servants or labor exploitation for debts or traffic of people, all violating human rights19.
5. Women and work
The increase of close to 20 million into the regional labor force is attributed to the continuous massive participation of women12, as proven by the sustained increment of occupation rates from 47.3 to 52.8% between 2000 and 201020. Global and regional research have made visible many of women’s problems at work, but the balance shows that improvement remains limited requiring stronger actions21. Stellman&Mejía’s22 categorization of women’s problems at work and recent research on gender equity within the Agenda of decent work20 ratify them23. In general, women still are under disadvantages in relation to social and development indicators, except in those countries of greater income21. Poverty impedes accessing education and skills training, and sexual division of work assigns them to the care of home, child and elderly in need, limiting access to better quality of work. Concealing and harmonizing responsibilities for both men and women from and within personal, family and work lives, remains to be a fundamental objective for achieving fair and human societies21; and invisible barriers are a work challenge to be concealed at enterprise level too.
6. Working conditions
Finding reliable and sufficient information about hazard exposures is difficult due to low access to industrial/occupational hygiene services and lack of national information systems that can provide it24. Information gaps are reflected directly in the low quantification of occupational injuries, diseases and fatalities. Several countries mix registration of injuries and diseases, making diseases invisible25. Other factors such as the lack of knowledge of healthcare services on OHS and social benefits given through workers’ compensation systems, the limited coverage of OHS services (< 30%), the increasing growth of informality and the invisibility of rural workers, reconfirm the fact that probably only 5% of the morbidity/mortality is reported26. National surveys also report lack of knowledge of workers and employers, negligence of employers to report, and intimidation of workers because of the fear to lose their jobs26. Consequently, effective implementation of hazard control and risk prevention is limited. Efforts for closing these gaps include: defining the inherent characteristics of work processes and exposure matrixes27,28, conducting national surveys for building hazard/risk profiles26; and organizing sub-regional/local OHS networks, research teams and expert groups29.
7. Occupational injuries, diseases and fatalities
Official statistics of the workers’ compensation systems in sixteen countries of the Region were used to estimate that at least 7,6 million occupational injuries (OI) occurred in 2007, with an average of 20,825 injuries per day30. Nonetheless, injury trends vary from country to country because of multiple sources of information; the lack of detection, diagnosis and registration; and the exclusion of informal workers in the statistics of each country25. Trends seem to have certain increase during the decade, but this is difficult to interpret because of huge differences in social security coverage varying from 12% to 87%25,30. Formal workers had close to 11,343 fatal OI in 2009, out of which 5,232 (3.2 x 100,000 workers) occurred in LAC, and 6,107 (8.9 X 1000,000 workers) occurred in Canada and USA31. For 2009, Occupational Diseases (OD) were estimated close to 281,389, probably having 770 new diagnosis daily30. Under-diagnoses has been studied by several academicians and institutions32, and even countries like Argentina and Colombia that have implemented plans to improving OD diagnoses33,34, show high levels of under-diagnoses.
8. OHS, Social Security and Primary Health Care services
Most of the countries relay upon their health care and public health systems and occupational health services available after health and workers’ compensations reforms occurring in the 90´s. After 15 years of implementation, universal coverage for both remains to be a challenge, basically because they are directly linked to formal work. Social protection coverage remains critical in low income countries: Bolivia (26.5%), Guatemala (28.1%) and Haiti (12%), in contrast with the highest achieved by Cuba (97.6%) and estimated in United States (85.3 %) that also varies between the States of the Union35. Hence, universal coverage seems to be utopia. Innovative solutions to complete coverage are required. Primary Healthcare Services policies and networks aiming to provide health for all are returning and promising, like those in Brazil36 and Colombia37 reaching informal workers...