Perspectives for workplace health promotion in Latin America and the Caribbean

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.     

Gendered Bodies: Recruitment,Management and Occupational Health in Northern Thailand's Electronics Factories

SUMMARY

This paper explores workers' experiences and understandings of occupational health hazards in the electronics industries of northern Thailand. Women form the bulk of the lower-level workforce as operators responsible for assembling the parts that make up microchip components. Drawing data from 16 months of research in workers' dormitories, formal and informal interviews and questionnaire surveys, in this paper I explore how gender relations are central to the organization and experience of work in these industries. I identify “work process” health hazards resulting from the physical working environment, and “workplace” health hazards relating to the organizational and social pressures of the working environment. Musculoskeletal pain, eye strain, chemical exposure, stress, improper use of safety equipment and accidents all impact upon women workers' health. Additionally, risk behaviors such as amphetamine and alcohol use, and unprotected sex, are associated with the social context of factory work.     

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.     

Academic-Practice Partnerships in Practice Research

Summary

Academic-practice partnerships in practice research support health social workers in engaging in research that is embedded within their practice. This shift in culture enables social workers to join in a health service discourse that is increasingly data-driven and focused on effective practice and demonstrated quality of care for patients. The mentoring model is described as enabling practitioners to superimpose research skills onto existing practice skills. An academic-practice research collaboration can reduce the distance between research and practice, contribute to a body of knowledge for health social work and promote health social workers as “research focused practitioners.”     

Comparison of occupational health problems of employees and self-employed individuals who work in different fields

Abstract

We used a representative sample of the working population of Korea to compare the occupational health problems of employees and self-employed individuals who performed different types of work. The Korean Working Conditions Survey (KWCS) of 2014 was used to compare the working conditions and occupational safety and health (OSH) issues of employees and self-employed individuals performing different types of work. Relative to paid employees, self-employed individuals were older, more likely to perceive their health as bad, and had less education, longer working hours, more exposure to workplace ergonomic hazards, more musculoskeletal problems, and poorer mental well-being. Relative to those performing “mental work” or “emotional work”, individuals performing “physical work” were more vulnerable to OSH problems. In conclusion, self-employed individuals in the sample were more vulnerable to OSH problems.     

Integrated Primary Care and Behavioral Health Services for Latinos: A Blueprint and Research Agenda

ABSTRACT

Disparities in Latino utilization of mental health services have been documented for some years. Factors such as stigma, low rates of health insurance, paucity of culturally competent providers, and linguistic inaccessibility have contributed to this underutilization. The documented tendency of many Latinos to experience the mind and body as a unified whole, often referred to as “non-dualism,” provides a unique opportunity to address these disparities in utilization. This article advocates a specific model of engagement of Latinos into a continuum of needed behavioral health services via the primary care clinic, and suggests a variety of clinical and administrative outcome measures for evaluating the effectiveness of the model. The model centers on the inclusion of a behavioral health specialist who is “nested” within the primary care team. The preparation and perspectives of clinically trained social workers make them ideal for this role.     

Child Labor Issues in the International Setting

SUMMARY

Internationally, children are working in situations where there are exposures to many occupational hazards, lack of basic worker rights and, sometimes, forced employment. Many of the child workers are involved in family-based agriculture, cattle tending, crop harvesting, commercial plantation work, and the cleaning and packing of food. Many severe forms of child labor are found in the commercial agriculture of Latin America and the Caribbean. The International Labor Organization states that “few human abuses are so unanimously condemned, while being so widely practiced as child labor… working children, all over the world, deserve better.”¹     

Desarrollo de un instrumento de evaluación formativa del agente comunitario de salud

To validate a formative evaluation instrument of the community health agent.DesignMethodological study with a quantitative approach.LocationCarried out in two municipalities in the South of Brazil.Participants40 nurses for 350 community health agents.ParticipantsThe instrument was developed based on a competency framework of the Ministry of Health. The principal component analysis method was used for factor analysis. Internal validity and reliability were measured by Cronbach's alpha. The intraclass correlation coefficient, the Student's t test for paired samples and the ANOVA analysis of variance were used.ResultsThe factor analysis produced a factor structure with six factors and the 52 competencies of the original instrument were maintained. The final version of the instrument was structured into six domains: “Micro-area monitoring” (12 competencies), “Health promotion” (nine competencies), “Prevention and monitoring of specific groups and morbidities” (10 competencies), “Prevention and monitoring of environmental and social risk” (nine competences), “Planning and evaluation” (seven competences), “Teamwork” (five competences). Cronbach's alpha coefficient was 0.981, the test and the new test was p = 0.851 by the Student's t-test, and the ICC was 1.0.ConclusionsThe validated instrument constitutes an important reference in the discussion of the work of the Community Health Agent in the current context of public health policies. In addition to supporting the role of nurses in the supervision/in-service training of these professionals.     

Profils et représentations professionnelles des agents en centre de santé au Burundi : des groupes socio-professionnels aux savoirs cloisonnés

BackgroundThe professional identities, profiles and representations of Burundian health workers remain insufficiently explored. Our twofold objective is to identify the different socio-professional profiles of first-line caregivers and to explore their respective representations of health workers and work.MethodsThe first study describes the overall population of the 1047 staff members employed in 2014–2015 in 62 health centers. The second is a cross-sectional survey conducted in April 2014. Using IRAMUTEQ© software, we conducted textology analysis of the structure and contents of 911 respondents’ representations via 3 free associations with regard to 6 questions on the “good worker” and the “what renders one capable of doing good work”.ResultsAt the normative level, among all categories of staff, a relational role is a foundation of professional identity, while technical or administrative functions remain marginal. At the positional level, responses differed according to initial qualification level but not as a function of their role with patients or their professional experience. Three socio-professional categories emerged. The most qualified category (one-quarter of the population) consists primarily of male caregivers, with a high turnover rate (4 years) associated with prospects for further training and career development. These persons present the most professionalized representations of the worker and work. The second quarter has an average level of qualification and turnover (10 years), and is mainly composed of female caregivers with limited professional perspectives. This group's representations are less technical and more patient-centered. Finally, the remaining half consists of relatively low-skilled staff members in charge of technical and logistical support, who are likely to spend their entire career in the same center (> 20 years). Largely disregarded by the health care system and its funders, they have few opportunities for training or advancement and despite their long experience, maintain profane representations of workers and work.ConclusionOur results shed light on the predicament of unskilled staff members whose expectations are rarely taken into consideration, even though they represent a significant proportion of the workforce, perform tasks essential to quality of care, and serve as bearers of the memory of their hospital center. These results also highlight the compartmentalization of practices and knowledge between categories of workers and underscore the failure of continuous training strategies targeting the unskilled.     

Equidad y autonomía del paciente en las estrategias de atención a personas con enfermedades crónicas en los servicios de salud de España

ObjectiveTo examine the chronic care models of the different Spanish health services and to discuss the ethical questions derived from implementing some of their components.MethodNarrative review of care strategies and programmes for chronic patients in the different Autonomous Communities, searching in official health departments’ web pages, using the terms “Programmes”, “Strategies”, “Chronic patients”, and “Chronicity”.Results15 programmes were found. Most of them include all components of the chronic care model, “decision-making support” being under-represented. The main conflicts in the autonomy of patients arise from the use of big data to stratify the population and from telemonitoring. The stratification of population does not consider the social factors that accompany the disease.ConclusionsChronic care strategies should consider the autonomy and privacy of patients in the use of clinical data and telemonitoring. In order to be equitable, they would have to provide an integrated health care system, incorporating measures to reduce the inequalities due to the social determinants that accompany the disease.     

Psychosocial Work Environment Among Employed Swedish Dairy and Pig Farmworkers

ABSTRACT

The purpose of this study was to investigate the psychosocial work environment for employed dairy and pig farmworkers in southern Sweden and to identify potential risk factors related to the psychosocial work environment for the development of musculoskeletal disorders (MSDs). Thirty-seven workers on 10 dairy farms and 30 workers on 10 pig farms participated in the study. The study was based on a Swedish translation of the short version of the Copenhagen Psychosocial Questionnaire (COPSOQ) for analyses of self-perceived psychosocial work environment and the general Nordic questionnaire for analyses of self-perceived MSDs. In general, the psychosocial work environment was assessed as “good” by both the dairy and pig farmworkers. However, the dairy and pig farmworkers experienced lower work demands, poorer general and mental health, and poorer vitality (physical and mental strength, vigor, and energy) compared to other occupations. Furthermore, the results indicated that the quality of leadership, feedback, and social support at work were poorer at the dairy farms than at the pig farms. No significant risk factors related to the psychosocial work environment were identified for MSDs in “the back” and in the “upper extremities.” This study indicates that the psychosocial work environment for the dairy and pig farmworkers may well be improved in order to promote these workplaces as attractive and healthful. This especially seems to be the case concerning the quality of leadership, feedback, and social support at work for the dairy farmworkers. Furthermore, the present study suggests the probability that physical factors are more likely to lead to MSDs among employed livestock workers than factors related to the psychosocial work environment.     

Self‐employed individuals performing different types of work have different occupational safety and health problems

Introduction

We assessed the occupational safety and health (OSH) issues of self‐employed individuals in Korea.

Methods

The working conditions and OSH issues in three groups were analyzed using the Korean Working Conditions Survey of 2014.

Results

Among self‐employed individuals, “Physical work” was more common among males, whereas “Emotional work” was more common among females. Self‐employed individuals performing “Mental work” had more education, higher incomes, and the lowest exposure to physical/chemical and ergonomic hazards in the workplace. In contrast, those performing “Physical work” were older, had less education, lower incomes, greater exposure to physical/chemical and ergonomic hazards in the workplace, and more health problems. Individuals performing “Physical work” were most vulnerable to OSH problems.

Conclusion

The self‐employed are a heterogeneous group of individuals. We suggest development of specific strategies that focus on workers performing “Physical work” to improve the health and safety of self‐employed workers in Korea.

     

Theorizing eldercare work: An orders of worth analysis

ABSTRACT

Eldercare is often regarded as “dirty work” due to its association with dysfunctional, decaying, and diseased bodies. This paper focuses on eldercare work, and studies how current practices and organization of eldercare have been justified and legitimized in different and sometimes conflicting ways. Drawing on ethnographic fieldwork with workers in nursing homes for the elderly and homecare service, this paper examines eldercare work through the theoretical lens of “orders of worth.” The concept of orders of worth affords a moral political analysis of eldercare work that helps to explain those dilemmas and situations which eldercare workers encounter and negotiate. Through the analysis, the moral entanglements between individual practices, institutional logics, and the political economy of care labor are systematically revealed.     

Betriebliche Gesundheitsförderung in mittelständischen Unternehmen

Background

Various studies have found the profitability of small and midsize enterprises (SME) to be related to their ability to innovate. Investing in human and social capital can help these companies increase their ability to innovate.

Research question

This study looked at how the level and type of workplace health promotion (WHP) programmes differ among larger, leading SME when they are actively managed by the businesses’ owners and their competitors.

Method

Structured interviews were conducted with six owner-managed enterprises, as well as with four competitors from the chemicals and metal industry.

Results

All businesses offer WHP programmes. Two of the businesses participating in the study have enrolled an employee in an in-house WHP programme. The organizations taking part in the study spend around €83 per employee per year on WHP programmes. By comparison, owner-managed enterprises clearly spend less than their competitors. One weakness stands out: “Controlling” or “active management” of the WHP programmes was found in only two of the businesses taking part in the study. The differences between the owner-controlled businesses and the management-controlled businesses are, on the whole, minor. Innovative potential by the owner-managed businesses is indicated by the fact that they focus much more strongly on the needs of their employees, as well as possess a perceptiveness and responsiveness to certain groups of employees. In conclusion, it is highly recommended that all businesses enroll more staff and more actively manage their WHP programmes.     

Cultural competence in healthcare in the community: A concept analysis

This study aims to conduct a concept analysis on cultural competence in community healthcare. Clarification of the concept of cultural competence is needed to enable clarity in the definition and operation, research and theory development to assist healthcare providers to better understand this evolving concept. Rodgers’ evolutionary concept analysis method was used to clarify the concept's context, surrogate terms, antecedents, attributes and consequences and to determine implications for further research. Articles from 2004 to 2015 were sought from Medline, PubMed, CINAHL and Scopus using the terms “cultural competency” AND “health,” “cultural competence” OR “cultural safety” OR “cultural knowledge” OR “cultural awareness” OR cultural sensitivity OR “cultural skill” AND “Health.” Articles with antecedents, attributes and consequences of cultural competence in community health were included. The 26 articles selected included nursing (n = 8), health (n = 8), psychology (n = 2), social work (n = 1), mental health (n = 3), medicine (n = 3) and occupational therapy (n = 1). Findings identify cultural openness, awareness, desire, knowledge and sensitivity and encounter as antecedents of cultural competence. Defining attributes are respecting and tailoring care aligned with clients’ values, needs, practices and expectations, providing equitable and ethical care, and understanding. Consequences of cultural competence are satisfaction with care, the perception of quality healthcare, better adherence to treatments, effective interaction and improved health outcomes. An interesting finding is that the antecedents and attributes of cultural competence appear to represent a superficial level of understanding, sometimes only manifested through the need for social desirability. What is reported as critical in sustaining competence is the carers’ capacity for a higher level of moral reasoning attainable through formal education in cultural and ethics knowledge. Our conceptual analysis incorporates moral reasoning in the definition of cultural competence. Further research to underpin moral reasoning with antecedents, attributes and consequences could enhance its clarity and promote a sustainable enactment of cultural competence.     

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。     

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.     

Systematic comparative content analysis of 17 psychosocial work environment questionnaires using a new taxonomy

Background: Many questionnaires have been developed to measure how psychosocial characteristics are perceived in a work environment. But the content validity of these questionnaires has rarely been questioned due to the absence of a reference taxonomy for characteristics of work environments.

Objectives: To propose an exhaustive taxonomy of work environment characteristics involved in psychosocial risks and to apply this taxonomy to questionnaires on workplace psychosocial factors.

Methods: The taxonomy was developed by categorizing factors present in the main theoretical models of the field. Questionnaire items most frequently cited in scientific literature were retained for classification.

Results: The taxonomy was structured into four hierarchical levels and comprises 53 categories. The 17 questionnaires analyzed included 927 items: 59 from the “physical environment” category, 116 from the “social environment” category, 236 from the “work activity” category, 255 from the “activity management” category, and 174 from the “organizational context” category.

Conclusions: There are major content differences among analyzed questionnaires. This study offers a means for selecting a scale on the basis of content.     

International Code of Conduct (Ethics) for Occupational Health and Safety Professionals

Abstract

This communication summarizes the available data on work-related determinants of health in Central America. The Central American working population is young and moving from agriculture toward industry and services. Ethnicity, gender, migration, subemployment and precarious work, informality, rural conditions, low-level educational, poverty, ubiquitous worksite health hazards, insufficient occupational health services, low labor inspection density, and weak unions define the constellation of social determinants of workers' health in Central America. Data are, however, scanty both for hazards and work-related illnesses and injuries. Governments and industries have the responsibility of opening decent work opportunities, especially for those facing multiple inequalities in social determinants of health. A first step would be the ratification and implementation of the ILO Convention (187) on occupational safety and health by the seven national governments of the region.