Perspectives for Workplace Health Promotion in Latin America and the Caribbean

Abstract

The Latin American and Caribbean region is witnessing the emergence of discussion on workplace health promotion (WHP). The authors propose WHP as an equitable collective action targeting primarily work hazards and their determinants. It has its economic-political “macro” level and a downstream “micro” level. On the macro level, neoliberalism, privatization, and deregulation threaten equitable health and labor issues. Effective labor and health legislation and a fair degree of social redistribution of resources support WHP. Micro-scale WHP is important for contextual reasons and social diffusion, and can literally save lives. Worker involvement, free association of workers, public health affiliation, the precautionary principle, sensitization and training, employer responsibility for healthy working conditions, coalitions between workers and health professionals, and preference for reduction of direct work hazards over modification of personal lifestyles are basic tenets of WHP.     

Social context for workplace health promotion: feasibility considerations in Costa Rica,Finland, Germany,Spain and Sweden

We constructed a simple, flexible procedure that facilitates the pre-assessment of feasibility of workplace health promotion (WHP) programmes. It evaluates cancer hazards, workers' need for hazard reduction, acceptability of WHP, and social context. It was tested and applied in 16 workplace communities and among 1085 employees in industry, construction, transport, services, teaching and municipal works in Costa Rica, Finland, Germany, Spain and Sweden. Social context is inseparable from WHP. It covers workers' organizations and representatives, management, safety committees, occupational health services, health and safety enforcement agencies, general health services, non-government organizations, insurance systems, academic and other institutions, regulatory stipulations pertaining WHP, and material resources. Priorities, risk definitions, attitudes, hazard profiles, motivations and assessment methods were highly contextual. Management preferred passive interventions, helping cover expert costs, participating in planning and granting time. Trade unions, workers' representatives, safety committees and occupational health services appeared to be important operational partners. Occupational health services may however be loaded with curative and screening functions or be non-existent. We advocate participatory, multifaceted WHP based on the needs and empowerment of the workers themselves, integrating occupational and lifestyle hazards. Workforce in irregular and shift work, in agriculture, in small enterprises, in the informal sector, and immigrant, seasonal and temporary workers represent groups in need of particular strategies such as community health promotion. In a more general framework, social context itself may become a target for intervention.     

A new occupational health agenda for a new work environment

At the beginning of the 21st century, the emergence of new forms of work organization are transforming what had become standard types of work arrangements in industrialized countries. In this new labor market environment, new firms, types of workers, and risk factors are powerfully emerging. Contrary to common belief, emergent occupational health hazards should not be approached only as "technical" or "economic" value-free problems. Instead, many of the challenges faced by occupational health policy makers are predominantly related to professional values and to the political ideologies and economic interests of key stakeholders in the decision-making process. In this paper some of the key principles leading to efficient and equitable occupational health policies in the new work environment are discussed. An alternative is also proposed for dealing with the conditions and settings needed to meet the new challenges related to establishing an effective occupational health policy.     

Workplace health promotion and employee health in Swedish municipal social care organizations

Aim

The aim of this explorative study was to investigate the employers’ management characteristics, their provision of workplace health promotion (WHP) measures, and employee satisfaction with WHP in relation to employee health in Swedish municipal social care organizations.

Subjects and methods

A cross-sectional design was used, and questionnaires were sent to top managers (representing the employer) and employees in a nationwide random sample of 60 of the 290 municipal organizations for the social care of elderly and disabled people in Sweden. The questionnaire data from the 60 managers were linked to aggregated employee data concerning self-rated health and satisfaction with WHP from a representative sample of 8,082 employees in the same organizations. All analyses were performed at the organizational level using independent t-test, Spearman’s rank correlation and multiple linear regression analysis.

Results

In the multivariate analysis, the organizational WHP index (i.e. local WHP projects and WHP coordinators), individual WHP index (i.e. health profile assessment, fitness activities and medical check-up), and the level of employees’ satisfied with WHP were associated with employee health (F?=?9.64, p?<?0.001, adjusted R ²?=?0.48). General organizational and management characteristics were, however, not statistically related to employee health.

Conclusion

The results suggest that the provision of individual-directed and organizational-directed health-specific measures were related to employee health in Swedish municipal social care organizations and, therefore, can be part of a comprehensive approach to address WHP.     

Globalization and workers' health

The global integration of economies worldwide has led to increased pressure for "labor flexibility". A notable aspect of this trend has been the rise in non-standard work arrangements, which include part-time work, temporary agency-based work, fixed-term contingent work, and independent contracting. Although non-standard work arrangements are convenient for employers, they are often associated with poor pay, absence of pension and health benefits, as well as lack of protection from unions and labor laws. Studies have begun to address the question of whether these "precarious" jobs pose a health hazard for workers. The challenge for causal inference is that precarious workers are likely to differ from non-precarious workers in a variety of characteristics that also influence health outcomes, i.e. there is confounding and selection bias. However, even after taking account of these biases--through propensity score-matched analysis--there is evidence to suggest that non-standard work may be damaging to workers' health. Policies modeled after the European Union's Directive on Part-Time Work may help to mitigate some of the health hazards associated with precarious work.     

A cultural economy approach to workplace health promotion in Australian small and medium sized workplaces: a critical qualitative study

Workplace health promotion (WHP) is advocated to progress the health and well-being of employees. However, research findings on its uptake and impacts are equivocal, particularly in smaller workplaces. This paper describes managers’ and workers’ responses to a WHP programme in the Australian Capital Territory. Informed by a cultural economy framework, in-depth interviews were conducted with 44 workers and managers from 10 small to medium sized enterprises (SMEs). Examining their availability and acceptability to workers and managers, we found a limited array of health promotion activities were adopted; a caring environment, provision of healthy foods, occasional health checks and health advice. Physical activity programmes during work hours were unlikely to be accepted by managers due to time costs, and workers were reluctant to spend their non-paid time on them. Casual workers were often excluded from WHP activities because their work times did not synchronize with other employees’ hours. This study illuminates how WHP is shaped by a complex of employment regulations that stress individual performance, associated limits on employer and worker time and resources, and organizational, cultural norms and practices regarding healthy work environments. We conclude that SMEs are implementing a limited array of behaviour change initiatives reflecting a particular view of health promotion. While organizational change may expand adoption of health practices during the workday, there are impediments to workers adopting wholesale changes in their health practices given a national culture of long hours, and intense job demands embedded in Australia’s neoliberal employment system.     

Leaving it up to the workers: sociological perspective on the management of health and safety in small workplaces.

Small workplaces present particular challenges for the promotion of occupational health and safety. However, little is known about the social organization of work in such settings and how it relates to matters of health and safety. The research on which this article is based relates patterns of occupational health behavior to the nature of social relationships within the workplace. From a qualitative analysis of interviews with 53 small business owners, the author describes the most common approach to managing workplace health and safety: leaving it up to the workers. This posture is explained in terms of the owners' perception of risk, particularly their understanding of workplace hazards, and their assessment of the social costs of ignoring or addressing such issues. Owners tended to discount or normalize health hazards, and to believe that management intervention in employee health behavior was paternalistic and inconsistent with prevailing patterns of labor relations and norms respecting individual autonomy. Many owners understood health and safety not as a bureaucratic function of management but as a personal moral enterprise in which they did not have legitimate authority. The conceptualization of the owners' responses in terms of "social rationality" has implications for addressing problems of health and safety in small workplaces.     

Zielgruppenorientierung und betriebliche Gesundheitsförderung

Background

In research regarding workplace health promotion (WHP), the employees’ perspective has so far been a neglected issue. Thus, employees’ potential opposition towards WHP due to perceived program-related barriers regarding information as well as program design has also received little attention. The latter is the focus of this study.

Methods

Preliminary hypotheses regarding WHP program-related barriers as well as proposals for their reduction were created on the basis of problem-centered interviews. These interviews were conducted with 19 employees in three organizations, four persons in charge of WHP within these organizations, and nine health experts.

Results

From the employees’ perspective, individual criteria such as the perceived utility of the WHP program, social aspects such as the internal acceptance of WHP, and organizational prerequisites such as access conditions potentially create barriers to the implementation and use of WHP programs.

Conclusion

On the individual level, barriers related to program design can be reduced by, for example, stressing certain topics. On the interpersonal level, offering activities with a strong group orientation is a possibility. On the organizational level, creating attractive organizational conditions represents a favorable intervention.     

Leadership in workplace health promotion projects: 1- and 2-year effects on long-term work attendance

BACKGROUND: Despite the acknowledged role of leadership in the psychosocial work environment, few studies focus on how leadership qualities and strategies may act as key processes of importance to positive effects of workplace health promotion (WHP). The aim of this study was to increase knowledge about how leadership qualities and strategies in WHP projects influence employees' long-term work attendance. METHOD: The 1- and 2-year effect of leadership on the prevalence of long-term work attendance among municipal human service workers (n = 3 275) was analysed using 3-year register-based data on sick leave, questionnaires and a qualitative categorization of each unit. RESULT: Increased leadership qualities, especially where leaders used rewards, recognition and respect, were associated with higher prevalence of work attendance at follow-up [PR 1.42 (1.20-1.69)]. Leaders' strategies and views on work-related health had a significant impact on increased work attendance in projects that had goals clearly focusing on changeable factors [1.36 (1.11-1.67)], in multi-focused projects [1.60 (1.24-2.04)] and in projects aimed to increase employees' awareness of their health. Workplace health promotion strategies with a single focus on strengthening individual, professional or organizational resources were negatively associated with work attendance. A higher proportion of employee work attendance was also seen in units whose leaders viewed the organization or the society (rather than individual workers) as responsible for the high rate of sick leave. CONCLUSION: Leadership, WHP strategies and leaders' attitudes towards employee work-related health have importance for implementation processes, as well as affecting employee work attendance. In this study, multi-focused WHP interventions had the largest effect on work attendance.     

某钢铁企业女职工生殖健康状况及需求调查

目的 了解钢铁企业女职工生殖健康状况, 以及她们对国家女职工劳动保护政策和生殖健康知识的知晓情况, 以保障和促进女职工生殖健康。
方法 采用横断面调查的方法, 选取某钢铁企业机关后勤和五个主要生产部门2 120名女职工作为研究对象。对女职工进行妇科体检, 发放调查问卷, 内容涉及对国家女职工劳动保护政策的了解、自身岗位接触有毒有害因素的知晓、对生殖健康知识的了解和需求。体检包括妇科常规检查、乳腺检查、白带检查、妇科B超和液基薄层细胞学检查。
结果 本次实检1 790人, 总受检率为84.43%。妇科检查发现乳腺小叶增生(检出率61.56%)、宫颈炎(检出率36.20%)和子宫肌瘤(检出率24.69%)是女性的多发妇科疾病, 乳腺小叶增生、子宫肌瘤的检出率有随年龄增高而增高的趋势(P < 0.05), 宫颈炎的检出率有随年龄增高而降低的趋势(P < 0.05)。接触职业病危害因素的生产部门女职工妇科体检的各项阳性率均高于机关后勤女职工, 其中乳腺小叶增生、子宫肌瘤、宫颈炎、阴道炎检出率的差异有统计学意义(P < 0.05)。液基薄层细胞学检查阳性率为4.70%。超过一半(占56.87%)的女职工知晓自身岗位的职业病危害因素, 但对国家有关劳动保护法律法规和女职工应享有的基本权利知晓率不高。女职工对本年龄段妇科常见病关注度较高, 基本在70%以上。49.16%的女职工选择手机网络获得生殖健康有关的知识。
结论 接触职业病危害因素会对女职工的生殖健康产生不利影响, 该企业女职工对国家有关女职工劳动保护法律法规了解不够。企业应加强相关法律法规培训, 根据不同年龄段的女职工需求, 普及生殖保健知识, 定期进行常规妇科疾病的普查, 切实保障女职工的生殖健康。
     

Development and process evaluation of the participatory and action-oriented empowerment model facilitated by occupational health nurses for workplace health promotion in small and medium-sized enterprises

The objective of this study is to develop an available empowerment model for workplace health promotion (WHP) in small and medium-sized enterprises (SMEs) and to evaluate its applicability and feasibility. Semi-structured interviews with employers and workers in SMEs were conducted to assess their actual requirements for support. The structure of our new empowerment model was discussed and established through several rounds of focus group meetings with occupational safety and health researchers and practitioners on the basis of results of our interviews. We developed a new participatory and action-oriented empowerment model based on needs for support of employers and workers in SMEs. This new model consists of three originally developed tools: an action checklist, an information guidebook, and a book of good practices. As the facilitators, occupational health nurses (OHNs) from health insurance associations were trained to empower employers and workers using these tools. Approximately 80 SMEs (with less than 300 employees) were invited to participate in the model project. With these tools and continued empowerment by OHNs, employers and workers were able to smoothly work on WHP. This newly developed participatory and action-oriented empowerment model that was facilitated by trained OHNs appears to be both applicable and feasible for WHP in SMEs in Japan.     

Working Conditions of Brazilian Immigrants in Massachusetts

Brazilian immigration to Massachusetts and other states in the US grew significantly in the last two decades. There is a lack of data about the working conditions and health and safety hazards faced by Brazilian immigrant workers. We surveyed over 500 workers in Eastern Massachusetts through a community-based participatory research project to explore occupational and immigration factors that may represent a risk to the health of Brazilian immigrant workers, who mostly work in the construction, housecleaning, and food services segments of the state labor force. Our pilot study suggests that Brazilian immigrant workers are exposed to chemical, ergonomic, physical, and psychosocial job hazards and have experienced a variety of health symptoms that may be associated with these work environment exposures. Since most Brazilian workers have not received proper training to recognize the hazards, there is an urgent need for the implementation of culturally adequate training programs and enforcement of safety and health regulations to prevent occupational injuries and fatalities.     

Work and health in the Mexican "maquiladora" industry: a dominant trend in dominated neoliberalism

This paper discusses health and working conditions of workers in the export-oriented "maquiladora" industry in Mexico. The work is intensive and performed mostly by women. It is the country's second largest source of foreign exchange. The "maquiladora" industry illustrates the effect of neoliberalism on working and health conditions, unveiling the impact of overall flexibilization of labor and growing technological changes. The situation for risks and demands is complex. Taylorist demands persist in work organization, with multiple chemical risks and probable effects beyond the workplace. There are also demands from repetition strain and uncomfortable positions. Effects on workers' health include high morbidity rates as reflected by demands on the social health/welfare services, some two to four times greater than for other industrial workers. There is a high percentage of stress-related illnesses as the reason for medical consultation. There are also effects on workers' families. Low birthweight is 2.8 times higher in women who work in the "maquila" than in other labor groups. Work-related accidents are common, the second most frequent cause for medical consultation in some cases. The analysis identifies some of the tendencies in which workers' health could be important in coming years for large contingents of workers.     

Health and labor-power: a theoretical investigation

In this historical materialist analysis of health and medical care, health is defined as a component of labor-power (capacity to work). Investment in health, including provision of medical services, represents part of the cost of maintaining the labor force. The primary determined of the level of health and medical care under capitalism is the tendency toward maximization of the rate of exploitation. The absolute level of health and medical care tends to decline as unemployment rises and individual workers become more "replaceable." Health differentials by socioeconomic status are similarly explained by the easier replacement of lesser-skilled workers. Medical care services in the context of the capitalist system constitute a drain on surplus-value. In periods of economic decline, attempts are made to conserve surplus-value through reductions in medical services ("social wages"). Institutional and ideological racism yields additional surplus-value savings and weakness public resistance to medical care retrenchment. The profits of health-related industries are shown to be merely partially recouped surplus-value losses. The social epidemiology of capitalism has been characterized as social murder. "Public health" measures appropriate to this systemic pathology are suggested.     

山东省和甘肃省制药行业女工职业健康现状调查

目的 了解制药行业女工的职业健康现状,分析其存在的主要职业健康问题,并提出保护其职业健康的对策。方法 选择山东省和甘肃省19个制药企业的2816名女工进行职业健康现状问卷调查。结果 73.1％的女工接触职业性危害因素,以有毒化学物质为主。制药行业女工的痛经发生率较高,达63.2％;有38.5％的女工患有生殖系统疾病,依次为：乳腺增生(44.1％)、宫颈糜烂(26.5％)、子宫附件炎(24.2％);17.1％的女工在工作中曾遭遇意外伤害,工作中出现腰背痛者占34.7％,自觉听力减退者占29.7％; 94.9％的女工希望得到职业健康或劳动防护方面的知识与技能培训。结论 加强对女工职业卫生监管,改善女工作业环境和提高女工职业卫生相关知识水平是目前改善女工职业健康现状的有效手段。     

Betriebliche Gesundheitsf?rderung f??r Berufskraftfahrer

Background

Because driving takes place outside of company premises, access for professional drivers to workplace health promotion (WHP) is hindered. In the following cross-sectional study, we surveyed WHP experiences and needs from the viewpoint of entrepreneurs in order to gain insight into necessary preventative measures.

Material and methods

Managers of transport companies were asked for their opinion, knowledge, experiences and plans regarding WHP. Additionally, we obtained information about their willingness to participate in a pilot project. The 10% random sample was taken from the list of a statutory accident insurance association. The results were correlated with the likely predictor variables company size, engagement in long- or short-distance traffic and WHP experience.

Results

Of the responding entrepreneurs (n=598, =11% response rate), 22% had prior experience with preventative health measures for their workers; the rate depends on the company size. One third of the respondents signalled a general willingness to participate in a prevention project and detailed their preferences.

Conclusions

The current practice of WHP in transport companies is deficient. However, at least a small percentage of transport entrepreneurs are receptive to information campaigns and need-based WHP offers.     

Interrelationship Between Organizational and Relational Aspects and the Return-to-Work Process: A Case Study with Nursing Professionals at a Teaching Hospital in Brazil

Introduction The process of returning to work, especially for individuals with labor restrictions, impacts work teams and interferes with the labor reinsertion process. In this study, we aimed to understand the impact of these situations on a nursing team from both organizational and relational perspectives. Methods We conducted a qualitative research study at a university hospital in the municipality of São Paulo using three strategies: documentary analysis; semi-structured interviews with pairs of workers returning to a labor situation; and a focus group with nursing managers. Results Medical leaves of absence overburden the employees who remain working. Regarding the return to work, the participants reported both positive and negative aspects. One positive aspect reported was that those who return to work contribute to the division of labor, generating solidarity and cooperation. The negative aspects reported were related to the return of workers with labor restrictions who do not fully resume their activities, consequently generating conflicts within the work teams that interfere with the reintegration processes. The supervisors reported difficulties reorganizing work on a broad scale and assessing the workers’ diagnoses and symptoms and the workers themselves in terms of the necessity of their leaves and the validity of their labor restrictions. Conclusion The organization of labor and social relationships among peers and supervisors is a significant contributor to the success or failure of the work reintegration process and therefore should be considered. We aimed to address this issue by highlighting the complexity of the return-to-work process among health workers.     

Methods for recruiting white, black, and hispanic working-class women and men to a study of physical and social hazards at work: the United for Health study.

Despite research on work and health having a long-standing concern about unjust exposures and inequitable burdens of disease, there are few studies that document the joint distribution and health effects of physical and psychosocial hazards (e.g., noise, dusts, fumes, and job strain) and social hazards (e.g., racial discrimination and gender harassment) encountered at work. Also, there is a paucity of data on how these exposures, singly and combined, are distributed in relation to sociodemographic characteristics including race/ethnicity, gender, socioeconomic position, and nativity. This article presents a conceptual model for redressing these knowledge gaps and describes recruitment strategies and the characteristics of study participants in the United for Health study. Working with labor unions, the authors recruited 14 (67%) of 21 worksites from manufacturing, meat processing, retail, and transportation, and 1,282 workers (72% response rate), of whom 62 percent were men, 36 percent were women, 39 percent were black, 23 percent were Hispanic, 25 percent were white, 31% earned less than a living wage, 40 percent were below the poverty level, and 23 percent had less than a high school education.     

Assessment of feasibility of workplace health promotion

BACKGROUND: A simple empirically based method for assessment of the feasibility of workplace health promotion programs is described, focusing on cancer hazards (lifestyles, workplace hazards, deficient early detection). The basic components of feasibility are addressed: extent of hazards; needs of employees for hazard reduction and acceptability of WHP; and social context. METHODS: The procedure consists of six modules: guidelines on feasibility assessment; employee questionnaire; interview checklists for probing attitudes of management and partners (social context); data form; debriefing; and assessment of feasibility. Pretesting was completed in 16 workplace communities representing industry, construction, transport, telecommunications, health care, lodging and catering, teaching, and municipality jobs in five countries; a total of 1,085 subjects completed the employee questionnaire on health hazards, needs, and acceptability. RESULTS: The method demonstrated its utility in obtaining and summarizing the necessary data. Feasibility was assessed for the 16 test communities. CONCLUSION: The procedure can be customized; it has a high degree of face validity or understandability, and it is applicable in a wide variety of settings.