Pan American Health Organization

Health Status of the Population

Workers’ health situation

Workers’ health is determined by (1) their working conditions (risk factors and hazards related to the nature of their work and the processes involved); (2) social determinants (employment, contract conditions, salary, social protection, education, housing, etc.) (); (3) behavioral risk factors (related to individual habits); and (4) their access to health services and occupational health services.

In 2016, the workforce in the Region of the Americas was composed of 661 million people (), of whom 422 million (66%) were in Latin America and the Caribbean (LAC) and 239 million (33%) in North America (not including Mexico). Inequities in conditions of employment and working conditions impact workers’ health, quality of life, and equity, as well as their productivity. Although in 2015 there was a worldwide upward trend in productivity and employment (72%), and precarious work declined in middle-income countries (workers living in homes where each person lives on less than 2 US dollars a day are considered to have precarious work) (), regional and national productivity decreased and there were major inequalities. Since 2013, unemployment rates have increased, rising from 6.6% in 2015 to 8.1% in 2016, the highest in the decade () (Figures 1a and 1b). Growth in LAC has stalled, more so in South America than in Central America and Mexico (). Informal work persists and informal employment has increased (). Vulnerable employment persists in 16 countries in the Region (Figure 2) and 53.8% of non-agricultural workers are in the informal sector (). Gender gaps reflected in employment and participation rates have been reduced, but female unemployment remains high, with higher employment and participation rates for men, and gaps in access to protection and social rights for women, creating further inequities (). Working women also face other problems, including (): (1) segregation in the workplace; (2) lack of opportunities and unstable labor conditions; (3) persistent glass ceilings (barriers that prevent them from rising in the workplace); (4) low pay or no pay; (5) sexual, psychological, or random harassment; and (6) multiple jobs. Poverty limits women’s access to education and to improving their work skills, and on average, women earn 77% of what men earn.

Figure 1a. Latin America and the Caribbean (24 countries): principal labor indicators at the national level, 2006–2016 (percentages)

Figure 1b. Latin America and the Caribbean: Regional employment rate, by sex, 2006–2016 (average annual rates)

Source: ILO Labor Panorama 2016 ().

Figure 2. Annual indicators of employment in the informal sector in 16 countries in Latin America and the Caribbean, 2011

Source: Adapted from ILO, Statistical update on employment in the informal economy ().

It is difficult to determine the magnitude of exposure to workplace hazards due to the limited development of occupational hygiene services (). Surveys carried out in some countries on working conditions and health have identified certain patterns of exposure to multiple hazards (chemical, physical, biological, ergonomic, safety, and sanitation), as Figure 3 shows. These exposures could explain patterns in morbidity, accidents, and mortality, although much of the Region lacks official registries of occupational diseases (). This limits preventive interventions while pointing out deficiencies in the systems for surveillance, detection, and reporting of occupational diseases in different countries.

Figure 3. Proportion of workers exposed to different work hazards in five LAC countries 2007–2009

Source: Argentina: González, J. “Las Encuestas sobre condiciones de trabajo y salud son un instrumento para planificar y evaluar las políticas en salud laboral.” IV Congreso de Prevención de Riesgos Laborales en Iberoamérica Nuevos Tiempos para la Prevención 2010; Colombia: Ministerio de Protección Social. 2007. Primera Encuesta Nacional de Condiciones de Salud y Trabajo en el Sistema General de Riesgos Profesionales; Guatemala: Consejo nacional de Salud y Seguridad Ocupacional (CONASSO), OIT. 2007. Encuesta Nacional sobre Condiciones de Trabajo, Salud y seguridad ocupacional; Nicaragua: Programa Salud y Trabajo en América Central (SALTRA). Perfiles de salud ocupacional en Centroamérica. 2009; Chile: ENETS CHILE 2010.

Exposure to workplace hazards underlies the silent global epidemic of occupational diseases: the World Health Organization (WHO) estimates some 140 million new cases every year. In 2013, the International Labour Organization (ILO) estimated that 2.4 million accidents and occupational fatalities occur every year. In 2007, PAHO estimated at least 7.6 million occupational injuries (20,825 a day) in the Region–occurring more frequently in men–causing 11,343 deaths, 5,232 in LAC alone (). Construction, mining, agriculture, and transportation were the economic sectors with the greatest number of fatal injuries (). Available data from selected countries between 2000 and 2010 are shown in Figure 4. These figures do not reflect the complete Regional panorama, due to exclusion of the informal sector and high under-reporting in each country ().

Figure 4. Insured population and occupational injury rate (per 100 workers) in selected countries of the Region of the Americas, 2000–2010

Source:
1. Canada: Association of Workers Compensation Boards of Canada (AWCBC). Annual KSM Standard Report 2000–2009. Available from: https://aoc.awcbc.org/KsmReporting/KsmSubmissionReport/2.
2. Mexico: Instituto Nacional del Seguro Social (INSS). Información sobre Accidentes y Enfermedades del Trabajo Nacional 2000–2010. Available from: http://www.stps.gob.mx/bp/secciones/dgsst/estadisticas/Estado%20de%20M%C3%A9xico%202001-2010.pdf.
3. Argentina: Superintendencia de Riesgos del Trabajo, República de Argentina. Anuarios Estadísticos años 2006 y 2009.
4. Venezuela: Dirección de Epidemiología e Investigación, Instituto Nacional de Prevención, Salud y Seguridad Laborales (INPSASEL). Registro de accidentes laborales años 2006 y 2008. Ministerio del Poder Popular para el trabajo y la Seguridad Social.
5. Chile: Superintendencia de Seguridad Social, Ministerio del Trabajo y Previsión Social. El cálculo incluye los datos de Mutuales. Available from: http://www.suseso.cl/OpenDocs/asp/pagDefault.asp?boton=&argInstanciaId=205&argCarpetaId=341&argTreeNodosAbiertos=&argTreeNodoActual=341&argTreeNodoSel=341.
6. Costa Rica: Instituto Nacional de Seguros. División de Seguros Solidarios. Instituto Nacional de Estadística y Censos. Encuesta de Hogares de Propósitos Múltiples, años 2000 y 2007. Ministerio de Planificación Nacional y Política Económica (MIDEPLAN), Costa Rica.
7. Nicaragua: Instituto de Seguridad Social de Nicaragua. Anuarios Estadísticos años 2006 y 2008.
8. Brazil: Ministerio de Previsión Social. Estadísticas de Previsión Social. Anuário Estatístico de Acidentes do Trabalho – AEAT 2006–2009; Anuário Estatístico da Previdência Social 2005-2009. Available from: http://www.mpas.gov.br/conteudoDinamico.php?id=423.
9. Colombia: Ministerio de la Previsión Social. Estadísticas de Riesgos Profesionales 2006–2009. Available from: http://www.minproteccionsocial.gov.co/estadisticas/default.aspx.
10. Ecuador: Instituto Ecuatoriano de Seguridad Social. Estadísticas de AT, anos 200-2008.
11. European Union: Health and safety work statistics [Internet]. Available from: http://epp.eurostat.ec.europa.eu/portal/page/portal/health/health_safety_work/data/main_tables.

Occupational diseases tend to be underreported due to their long latency and the difficultly in identifying them, and they remain hidden in noncommunicable disease registers. In 2007, a mixed profile of occupational pathologies was recognized, of which only 1–5% are reported (). A comparative estimate was made using results from surveys conducted in five countries among workers formally affiliated with the social security system, and compared with figures for the European Union (Figure 5). This comparison gives an idea of the low level of reporting, due partly to the precariousness of the occupational health and safety services (<30%); the invisibility of the informal sector and rural workers; the exclusion of workers who are not affiliated with the social security and workers' compensation systems; the lack of knowledge on the part of health professionals (especially in LAC); and the deficiencies in terms of information, surveillance, and reporting systems (). As well, the 2013 study of the global burden of disease () showed an increase in the exposure to occupational risks (11th leading cause of deaths among men and 13th among women), increasing the number of years of disability-adjusted life years (DALYs) between 1990 and 2015. Figure 6 shows that occupational risks continued to contribute to DALYs for both sexes and all ages in 2015. Furthermore, the WHO Global Health Observatory () has estimated that occupational risks contribute nearly 15% of the total burden of disease. Table 1 shows the exposures to occupational risks that can contribute to noncommunicable occupational diseases. When exposures are simultaneous, the burden of mortality is even greater, as can be seen in Table 2. The Plan of Action on Workers’ Health 2015-2025, approved in 2015 by the Directing Council of PAHO, addresses both groups of diseases in order to prevent and control them in the workplace.

Figure 5. Occupational diseases (OD) in selected countries of the Region of the Americas, 2000–2009

Source:
1. Argentina: Superintendencia de Riesgos del Trabajo, República de Argentina. Anuarios Estadísticos años 2000 y 2009.
2. Panama: Alvarado, J. s/f. Perfil de seguridad y salud ocupacional en Panamá Programa de salud y Trabajo en América Central (SALTRA).
3. Mexico: Instituto Nacional del Seguro Social (INSS). Información sobre Accidentes y Enfermedades del Trabajo Nacional 2000-2010. Available from: http://www.stps.gob.mx/bp/secciones/dgsst/estadisticas/Estado%20de%20M%C3%A9xico%202001-2010.pdf
4. Brazil: Ministerio de Previsión Social. Estadísticas de Previsión Social. Anuário Estatístico de Acidentes do Trabalho – AEAT 2006-2009; Anuário Estatístico da Previdência Social 2005-2009. Available from: http://www.mpas.gov.br/conteudoDinamico.php?id=423, http://www.mpas.gov.br/conteudoDinamico.php?id=1162
5. Colombia: Fondo de Riesgos Profesionales, Ministerio de la Previsión Social. Estadísticas de Riesgos Profesionales 2000-2010. Available from: http://www.minproteccionsocial.gov.co/estadisticas/default.aspx, http://www.fondoriesgosprofesionales.gov.co/documents/Infoestadistica/2011/ESTADISTICAS_SGRP_JUN2011.pdf
6. Chile: Informe Final Comisión Asesora Presidencial para la Seguridad en el Trabajo. Available from: http://www.previsionsocial.gob.cl/cst/wp-content/uploads/downloads/2010/12/Informe-Final-CST.pdf
7. Europe: Health and Safety Work Statistics. Available from: http://epp.eurostat.ec.europa.eu/portal/page/portal/health/health_safety_work/data/main_tables

Figure 6. Global Both sexes, all ages, DALYs per 100,000

Source: Global Burden of Disease Study 2015. Global Burden of Disease Study 2015 (GBD 2015) Results. Seattle: United States: Institute for Health Metrics and Evaluation (IHME), 2016. Available from https://http://vizhub.healthdata.org/gbd-compare/.
For terms and conditions of use, please visit http://www.healthdata.org/about/terms-and-conditions.

Table 1. Burden of noncommunicable occupational disease due to dangerous exposures in the workplace, GBD 2004

Dangerous
exposures
Diseases No. of deaths DALYs*
(1,000 per year) (1,000 per year)
Airborne particles Asthma, COPD, silicosis, asbestosis, anthracosis 457 6,751
Carcinogens Mesothelioma, lung cancer, leukemia 177.4 1,897
Ergonomic stressors Lumbar pain 0.9 898
Noise Hearing loss due to noise 0 4,509
Accidents Injuries 352 11,612
TOTAL 987.3 25,667

*DALYs = Disability-adjusted life years
Source: WHO, Ivan Ivanov, Workers’ Health, 2013.

Table 2. Burden of noncommunicable occupational disease due to dangerous exposures in the workplace, GBD 2004

Diseases Dangerous
exposures
Attributable deaths
(000 per year)
Mesothelioma Asbestos 59
Lung cancer Arsenic, asbestos, beryllium, cadmium, chromium, diesel fuel, nickel, silica 11
Leukemia Benzidine, ethylene oxide, ionizing radiation 7
Pneumoconiosis (silicosis, anthracosis, asbestosis) Crystalline silica, coal dust, asbestos 30
Chronic obstructive pulmonary disease Powder, smoke, and vapors 375
Asthma Airborne allergens 52
TOTAL 634

Source: WHO, Ivan Ivanov, Workers’ Health, 2013.

References

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Reference/Note:

Regional Office for the Americas of the World Health Organization
525 Twenty-third Street, N.W., Washington, D.C. 20037, United States of America