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 Volume 5 - No.2 - 2000
Workers' Health in Latin America and the Caribbean:
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Can the international legal mechanisms and forums such as the Latin American Parliament, the Central American Parliament, the Andean Subregional Parliament, or the MERCOSUR Parliament correct the abuses of child labor? Or cope with the problems of the maquiladora, or assembly industry? Or pass laws to protect the massive movement of migrant workers?
In the last half-century, the Americas have transformed their agricultural and mining economies at different rates and with different levels of intensity. Most recently, globalization has had an impact on the fundamental economic structures of all the countries in the Region. This process has been especially dramatic in the developing economies of Latin America and the Caribbean.
The estimated population of the Americas during the last survey in 1996 was 781 million, and the economically active population (EAP)-or those who are buying and selling goods and services-was around 351 million, or about half of the total population. Broken down by region, this is about 201 million in Latin America and the Caribbean, plus another 150 million in the United States and Canada. By 2025, the EAP is expected to reach 270 million in Latin America and the Caribbean.
In Latin America and the Caribbean, there are 20 to 27 million work-related accidents annually, 90,000 of which are fatal. That is some 30 to 50 accidents a minute and 300 deaths a day, at a cost of 10 percent of the gross domestic product (for the entire Region), in terms of medical expenses and lost productivity.
Regarding wages, up to a third of the working population receives an income below the minimum necessary to cover the basic basket of household necessities.
Poverty, Malnutrition, and Anemia
Poverty is one of the principal factors that have pushed 25 million children of the Americas into the work force and compromised their right to an education.
In Latin America approximatively 20 million children work-or one of every five people under 18-with approximatively half of them between the ages of 6 and 14.
In the United States, between 4 and 5 million children work.
Women Lag Behind
In the mid-1990s, there were some 56 million women in the work force, generally in more precarious working conditions than men and receiving only 71 percent of male income.
Women frequently suffer a dual burden, forced to work at a job for pay and then come back to work in the home. This exposes them to greater physical and mental health risks.
Women are now expanding into jobs that are considered hazardous and will require the appropriate level of protection for this additional risk.
The People Behind the Statistics
Jorge Pinto Rojas is a seafood vendor who gets up at 3 a.m. and travels 4 hours to bring his fish to the Central Market in Lima, Peru.
"My children are studying at the National School, and I hope they specialize in computers, so they don't have to work this hard," Jorge said.
"If my fish is not sold in three days, it begins to spoil and I have to sell it for very little," he says. "On a good day, I might sell about 800 Soles of fish and the rent for my stall is 200 Soles. If I don't show up one day, my clients go somewhere else.
"But this is all I know how to do. We have no health insurance and I must meet the needs of my family with what little money I can make," he said.
The Consequences of Globalization
The International Labor Organization (ILO) states that the majority of the population in many developing countries, including wage earners in the informal sector and the self-employed, have no social security protection at all.
The case of Pinto Rojas is symptomatic of the times, the result of regional and worldwide globalization, which is producing a new labor phenomenon known as "informal work." This includes a large number of temporary workers and has created a whole new series of problems.
One is the lack of social security protection, especially health and social services for occupational injuries, adequate pensions, and a secure retirement.
Mónica Bolis, the Regional Adviser on Health Legislation at the Pan American Health Organization, addresses the re-gional problems of what is now being called flexible labor. "Temporary workers in Latin America do not have adequate protection, and the situation is growing more complicated as we move from informal work into what is now known as flexibility in the labor market.
"Informal workers are generally employed outside the mainstream. They are independents but work in poorly paid occupations, such as street vendors or home repairmen.
"In the new flexible labor market, contracts are signed that provide only partial benefits, leaving workers in this system without access to health or other social services."
On migrant workers, she says: "We go beyond occupational health and try to focus on the individual as a contributor to the economy and the ongoing development of the country. The ILO is trying to create different kinds of insurance, which can be applied preferentially to migrant workers, to confront the new consequences of globalization and the flexible labor market."
"There now are masses of people crossing borders to work in other countries, where they are often unprotected and paid low wages. We need to provide social coverage for these people and honor their right to health care-and we need to protect the State that receives these workers-so that they do not overwhelm the national health system."
The private sector also has responsibility in this matter, Bolis says. "From both a national and international perspective, the legal framework is very important. When large numbers of people move from one country to another, they can be exposed to many risks. Both the country of origin and the receiving country should assume the costs needed to guarantee adequate worker protection.
"The receiving countries are benefiting from the cheap labor, so we need to encourage the employer in the private sector to take on certain responsibilities for the workers. In effect, the public sector is, therefore, demanding that the private sector share some of the benefits of this cheaper labor with their workers."
"National and international agreements should not just be words on paper and so there is a great deal of importance in the legal framework for these arrangements of the migrant workers with the public and private sectors."
A major challenge this decade, she adds, "is how to restore these guarantees to the workers under the new paradigms and still be able to promote the economic and social development of the countries at the same time, since one is not valid without the other. The challenge of this century will be to consolidate sustainable human development in the environmental area, redistribute benefits back to the populations and foster an improvement in living conditions, so that everyone can compete on an even playing field."
When discussing the access of workers to health services in Latin America, Dr. César Vieira of the Division of Health and Human Services of the Pan American Health Organization said this will vary according to the level of individual income, the social protection in each country, and the state of the general economy.
Emphasizing only the market forces in health care would be likely to lead to a concentration of wealth and inequity, according to Dr. Vieira. In this area of public health, PAHO's Division of Health and Human Development and the Division of Health Systems and Services Development focuses on the public regulation of the health sector.
"Personally, I am optimistic, although there may be occasional setbacks as well as advances. There has been an inevitable redistribution of responsibilities among the state, the market, and civil society in health care."
"Moreover, many states are redefining their functions and transferring some of their responsibilities to the regional, departmental, provincial, and municipal level as the national central governments assume more of a regulatory policy, and steering role."
"In Europe, this transfer of functions to national and international entities is the same phenomenon that Latin America is experiencing."
"This implies entirely new frameworks for the operation of the health sector. We are learning-sometimes with great difficulty-but we are managing to develop instruments that will enable us to promote efficiency, effectiveness, and most importantly, equity in health systems," according to Dr. Vieira.
Dr. Luz Maritza Tennassee, Regional Adviser for Workers' Health in the Division of Health and Environment at PAHO, discussing occupational risks, said: "In Latin America and the Caribbean, working conditions, occupational risks, and the intensification of socioeconomic and health inequities among the working population increase the susceptibility to work-related illness, accidents, disabilities, and mortality-a phenomenon that mostly affects younger people because of their lack of experience."
Dr. Tennassee, who has done field work in Venezuela and Canada, became aware of workers' health issues as a pediatrician and established a link between the health status of children and the occupation of their parents.
"There is an epidemiological pattern, characterized by a combination of health problems and traditional occupational health pathologies, such as dermatitis, acute pesticide or heavy metal poisoning, and respiratory problems."
"We also find the emergence of work-related problems, such as occupational cancers, asthma, neurological deficits, and troubles with the immune system. There has also been the reemergence of endemic diseases that had once been controlled, but are now increasing due to changes in working conditions."
Regional Plan for Workers' Health
The rising leptospirosis epidemic in Central America, the growth of endemic malaria in the Amazon area, and the increase in risks as a result of a younger working population have made workers' health a priority. PAHO is collaborating with other national and international agencies, the civil societies, community organizations, and representatives of workers and private enterprise to develop an integrated initiative known as the Regional Plan for Workers' Health.
The program is promoting and increasing national capacities to identify and control occupational hazards; update the policies and legislation promoting workers' health; and take into account the major international changes that affect it - such as the introduction of flexibility into the labor market, globalization, the integration process and, state reform.
Information- a Vital Force
Information is vital for the identification and control of occupational risks. In the Americas, and in the Southern Hemisphere in particular, there are no systematic, permanent information systems for the collection of data to determine the nature, severity, and magnitude of occupational risks.
In the past three years, significant progress has been made, for example, in the development of software for the Occupational Risk Identification System with the support of the University of California, which is collaborating with Venezuela in its application.
This system already has been adopted and modified by Chile, Mexico, Cuba, and other countries, making it possible at the regional level to determine the basic principles for establishing adequate information systems in the protection of worker health. This program has found a receptive audience in large- and mid-size industries and in the region's ministries of health, labor, and social security.
With technical cooperation from Canada, PAHO has developed an electronic communications network in English, Spanish, and Portuguese, which will permit the establishment of a forum for the discussion of the most serious problems. In less than a year, the network has attracted 644 active subscribers and received an award from World Safety in England for The Best Electronic List in the Analysis of Occupational Health.
PAHO is also deeply involved in the Virtual Library on Workers' Health-and Brazil's Chamber of Industry has signed an agreement with PAHO for its promotion using the Healthy Workplace Approach.
Fourteen Brazilian companies have already signed the initiative, as have the eight countries in Central America-including the maquiladora and flower industries in Panama, Belize, and the Dominican Republic.
On the Two Sides of the Maquiladora Industry
"One of the results of globalization has been the appearance of new methods of production, such as the duty-free zones and the maquiladora, or assembly, industry. Several studies in Central America have shown that in some countries, maquiladoras are now among the leading generators of foreign exchange for the country, " Dr. Tennassee says.
"The emergence of this type of production is partly a response to the problem created by the obsolescence of the old labor model based on the exploitation of the primary sector. In the maquiladora industry, women and children constitute 90 percent of the work force because of the way in which the work is organized. Unfortunately, maquiladoras are often characterized by unstable jobs and work force, wages under the legal minimum, long hours, sexual harassment, temporary contracts, and subcontracting for outside work to be performed in the home," she adds.
"In this type of industry, production incentives are controlled by what we call 'timed work rhythms.' That is, wages in every phase of the process are based on the amount that a worker can produce in a certain amount of time and the final quantity of the finished product. From a public health standpoint, it is clear that the work is often repetitive, monotonous, and an excessive burden on the musculoskeletal system. Lack of adequate rest breaks can create arthritis and other problems with the ligaments and muscles.
"The postures that workers assume on the job often seem to go against their physiology. Some maquiladora workers report cases of cardiovascular and circulatory disorders, which have even been linked to an increase in spontaneous abortions among the workers. The problems are also psychosocial; for the work in maquiladoras is often monotonous and stressful.
"Maquiladoras usually recruit women from different rural areas of the countries, where political, social, and economic factors have created a scarcity of work, and this can contribute to their feelings of isolation and loneliness. There are also physical hazards, such as high temperatures, dust, and the use of chemicals like solvents and dyes.
"From another perspective, the maquiladora industry has created a rich new source of jobs. In Mexico, unemployment has fallen in direct proportion to the increase of these factories. There has also been significant technology transfers from an economic and social development standpoint; but this progress should be accompanied by a reduction in occupational risks," Dr. Tennassee adds.
"Likewise, there need to be adequate safeguards against the creation of environmental pollution from the wastes created by all of this new industry-much of it in cities and along waterways."
On Political Commitment
"With regard to the implementation of the Regional Plan in the next decade, there is a political commitment at all levels: from the government, nongovernmental organizations, the community, civil society, and international and local organizations.
"In the past, this was an area which enjoyed little social visibility and limited political commitment. We now expect it to be involved with integration and reform processes that will increase awareness and ensure that effective policies and legislation are actually implemented.
"The other priority is in human resources education, which has received limited attention in the field of public health. We need to recruit and educate more occupational experts in medicine, toxicology, nursing, epidemiology and psychology."
"Workers should have access to education and training programs, not only for their jobs, but to carry out the prevention programs required to identify and reduce occupational risks, not to mention protecting their own health and the welfare of their families," concludes Dr. Tennassee.
Eugenio Gutierrez, a Washington journalist in PAHO's Office of Public Information, was a former foreign correspondent for various Latin American newspapers and magazines.