Legislation for advancing women's leadership in the health sector in India and Kenya: a 'law cube' approach to identify ways to strengthen legal environments for gender equality.

OBJECTIVES: This paper examines the availability of legal provisions, or the lack thereof, that support women to progress equitably into leadership positions within the health workforce in India and Kenya. METHODS: We adapted the World Bank's Women, Business and Law framework of legal domains relevant to gender equality in the workplace and applied a 'law cube' to analyse the comprehensiveness, accountability and equity and human rights considerations of 27 relevant statutes in India and 11 in Kenya that apply to people in formal employment within the health sector. We assessed those laws against 30 research-validated good practice measures across five legal domains: (1) pay; (2) workplace protections; (3) pensions; (4) care, family life and work-life balance; and (5) reproductive rights. In India, the pension domain and related measures were not assessed because the pension laws do not apply to the public and private sector equally. RESULTS: Several legal domains are addressed inadequately or not at all, including pay in India, reproductive rights in Kenya and the care, family life and the work-life balance domain in both countries. Additionally, we found that among the Kenyan laws reviewed, few specify accountability mechanisms, and equity and human rights measures are mainly absent from the laws assessed in both countries. Our findings highlight inadequacies in the legal environments in India and Kenya may contribute to women's under-representation in leadership in the health sector. The absence of specified accountability mechanisms may impact the effective implementation of legislation, undermining their potential to promote equal opportunities. CONCLUSIONS: Government action is needed in both countries to ensure that legislation addresses best practice provisions, equity and human rights considerations, and provides for independent review mechanisms to ensure accountability for implementation of existing and future laws. This would contribute to ensuring that legal environments uphold the equality of opportunity necessary for realising gender justice in the workplace for the health workforce. PRIMARY SOURCE OF FUNDING: Bill & Melinda Gates Foundation (INV-031372).

Protecting and promoting the rights of the 'reserve army of labour': a policy analysis of structural determinants of migrant worker health in Pakistan and Qatar.

Labour migrants who travel overseas for employment can face deep health inequities driven in large part by upstream social and structural determinants of health. We sought to study the 'labour migrant health ecosystem' between one sending country (Pakistan) and one host country (Qatar), with a focus on how the ecosystem realizes the rights of labour migrants when addressing the social and structural determinants (e.g. housing, employment law, etc.) of health. Study objectives were to (1) undertake an in-depth review of policies addressing the structural and social determinants of the health of labour migrants in both Pakistan and Qatar, analysing the extent to which these policies align with global guidance, are equity-focused and have clear accountability mechanisms in place, and (2) explore national stakeholder perspectives on priority setting for labour migrant health. We used a mixed methods approach, combining policy content analysis and interviews with stakeholders in both countries. We found a wide range of guidance from the multilateral system on addressing structural determinants of the health of labour migrants. However, policy responses in Pakistan and Qatar contained a limited number of these recommended interventions and had low implementation potential and minimal reference to gender, equity and rights. Key national stakeholders had few political incentives to act and lacked inter-country coordination mechanisms required for an effective and cohesive response to labour migrant health issues. Effectively addressing such determinants to achieve health equity for labour migrants will depend on a shift in governments' attitudes towards migrants-from a reserve army of transient, replaceable economic resources to rights-holding members of society deserving of equality, dignity and respect.

Promoting labour migrant health equity through action on the structural determinants: A systematic review.

BACKGROUND: Labour migrants, who represent over sixty per cent of international migrants globally, frequently have poorer health status than the population of host countries. These health inequities are determined in a large part by structural drivers including political, commercial, economic, normative and social factors, including living and working conditions. Achieving health equity for migrant workers requires structural-level interventions to address these determinants. METHODS: We undertook a systematic review of peer-reviewed literature designed to answer the question "what is the evidence for the effectiveness of interventions to address the structural determinants of health for labour migrants?" using the Ovid Medline electronic database. FINDINGS: We found only two papers that evaluated structural interventions to improve the health of labour migrants. Both papers evaluated the impact of insurance - health or social. In contrast, we found 19 evaluations of more proximal, small-scale interventions focused on changing the knowledge, attitudes and behaviours of labour migrants. INTERPRETATION: Despite the rise in international migration, including for work, and evidence that labour migrants have some higher health risks, there is a paucity of research addressing the structural determinants of health inequities in labour migrants. The research community (including funders and academic institutions) needs to pay greater attention to the structural determinants of health - which generally requires working across disciplines and sectors and thinking more politically about health and health inequities. FUNDING: Wellcome Trust (208712/Z/17/Z).

Implementing workplace health promotion initiatives: who should we target?

BACKGROUND: With recent increase in focus on population-based interventions in workplaces, targeting lifestyle risk factors for chronic disease, there is a need to ensure that interventions maximise total reach while still reaching more disadvantaged groups within the workforce. This requires assembling information on NSW workforce and health risks data in a way that is useful to guide planning in health promotion. This paper aims to describe the NSW workforce by employer size, industry divisions, occupation classification, geographic location and risk factor prevalence. METHODS: Data from a unique combination of public and non-publicly available data sets was used to describe the NSW workforce by demographic, setting-specific variables and risk factor prevalence. RESULTS: NSW represents 31% of Australia's workforce. Large employers represent 1% of businesses but employ 33% of the NSW workforce. Reaching large numbers of NSW workers can be achieved by targeting large employers in metropolitan regions; however, a high proportion of workers with multiple health risks are located in non-metropolitan areas and industries that have a high proportion of small employers. CONCLUSIONS: The workplace as a setting for population based health promotion interventions provides a number of challenges due to the fragmented nature and dispersed distribution of the workforce.