Employment precariousness in Spain: prevalence, social distribution, and population-attributable risk percent of poor mental health.

As a consequence of labor market flexibilization, nonstandard employment has expanded and standard employment has declined. In many cases, these transformations are best described as an evolution toward precarious employment, which is considered a major determinant of health and health inequalities. Using the Employment Precariousness Scale (EPRES), this study aims to determine the prevalence of precarious employment in the waged and salaried workforce in Spain, to describe its distribution across social groups defined by occupational class, gender, age, and immigrant status, and to estimate the proportion of cases of poor mental health potentially attributable to employment precariousness. Data are from the Psychosocial Work Environment Survey conducted in 2004-5 on a representative sample of the Spanish workforce. Findings indicate a high prevalence of employment precariousness, affecting nearly 6.5 million workers, with almost 900,000 of them exposed to high precariousness. These estimates are higher than the proportion of fixed-term employment reported in regular statistical sources but may today be an underestimation, given the current economic crisis. Additionally, a significant proportion of cases of poor mental health are potentially attributable to employment precariousness. Both the proportion of cases of poor mental health attributable to and the prevalence of employment precariousness were highly unequally distributed across the study sample, indicating that this may be a significant contributor to social inequalities in mental health.

The Employment Precariousness Scale (EPRES): psychometric properties of a new tool for epidemiological studies among waged and salaried workers.

BACKGROUND: Despite the fact that labour market flexibility has resulted in an expansion of precarious employment in industrialised countries, to date there is limited empirical evidence concerning its health consequences. The Employment Precariousness Scale (EPRES) is a newly developed, theory-based, multidimensional questionnaire specifically devised for epidemiological studies among waged and salaried workers. OBJECTIVE: To assess the acceptability, reliability and construct validity of EPRES in a sample of waged and salaried workers in Spain. METHODS: A sample of 6968 temporary and permanent workers from a population-based survey carried out in 2004-2005 was analysed. The survey questionnaire was interviewer administered and included the six EPRES subscales, and measures of the psychosocial work environment (COPSOQ ISTAS21) and perceived general and mental health (SF-36). RESULTS: A high response rate to all EPRES items indicated good acceptability; Cronbach's alpha coefficients, over 0.70 for all subscales and the global score, demonstrated good internal consistency reliability; exploratory factor analysis using principal axis analysis and varimax rotation confirmed the six-subscale structure and the theoretical allocation of all items. Patterns across known groups and correlation coefficients with psychosocial work environment measures and perceived health demonstrated the expected relations, providing evidence of construct validity. CONCLUSIONS: Our results provide evidence in support of the psychometric properties of EPRES, which appears to be a promising tool for the measurement of employment precariousness in public health research.

Extending a model of precarious employment: A qualitative study of immigrant workers in Spain.

BACKGROUND: Since the 1980s, changes in the labor market have modified power relations between capital and labor, leading to greater levels of precarious employment among workers. Globalization has led to a growth in migration, as people leave their countries in search of work. We aimed to describe the dimensions of precarious employment for immigrant workers in Spain. METHODS: Qualitative study using analytic induction. Criterion sampling was used to recruit 129 immigrant workers in Spain with documented and undocumented administrative status. Data quality was ensured by triangulation. RESULTS: Immigrant workers reported that precarious employment is characterized by high job instability, a lack of power for negotiating employment conditions, and defenselessness against high labor demands. They described insufficient wages, long working hours, limited social benefits, and difficulty in exercising their rights. Undocumented workers reported greater defenselessness and worse employment conditions. CONCLUSIONS: This study allowed us to describe the dimensions of precarious employment in immigrant workers.

Methods for the study of employment relations and health inequalities in a global context.

The authors describe the major methods and sources of information used in the EMCONET study for researching global, employment-related health inequalities. A systematic review of the literature provides valuable knowledge for research in this area. However, the limited number of studies, the poor quality of methods used, and a lack of theories or concepts have produced inconsistent results. To minimize bias from these limitations and to reach a comprehensive understanding of the complexity and health effects of global employment conditions, this article outlines key strategies for a synthetic, comprehensive, participatory approach: adapting transdisciplinary knowledge acquisition, building a theoretical model, employing multiple sources for data collection, and using a variety of methods (qualitative/ quantitative studies and narrative knowledge). This approach provides solutions to important research and policy needs regarding the global context of key employment relations, social mechanisms, and health inequalities. The strategies are adapted to synthesize input from several disciplines (epidemiology, sociology, and political science), social actors, and institutions. The study's main sources of information are a variety of digital, bibliographic databases; the authors reviewed the scientific literature from 1985 to 2008 and books, reports, and other documents from 2000 to 2008.

Is precarious employment more damaging to women's health than men's?

Current global economic trends in both developed and developing countries, including unregulated labor markets, trade competition and technological change, have greatly expanded a complex labor market situation characterised by many employees working under temporary work status, job insecurity, low social protection and low income level. Although the health of women is disproportionately affected by workplace flexibility, this has been largely ignored. The main purpose of this paper is to draw attention to this relevant but neglected topic.

La formalización del trabajo doméstico remunerado en Uruguay y Argentina: aprendizajes y desafíos para la salud pública / The formalization of paid domestic work in Uruguay and Argentina: lessons and challenges to public health

Resumen En América Latina, el 15% de las mujeres son trabajadoras domésticas remuneradas. Esta ocupación se realiza casi en el 80% de los casos bajo la informalidad, por lo que se trata de una ocupación sin protección social ni derechos laborales. A su vez, la salud de las trabajadoras domésticas debe considerarse, al menos, bajo una triple determinación: la precarización del empleo, las desigualdades de clase social, y las de género. Es importante generar marcos normativos que reduzcan las desigualdades en salud de los/as trabajadores/as precarios/as, en este sentido, Argentina y Uruguay promovieron la promulgación de leyes laborales sobre trabajo doméstico remunerado. En el presente artículo se describen las experiencias entre ambos países sobre los alcances e impactos en la salud del proceso de regularización de este empleo. Sin embargo, se observa un impacto limitado de la formalización del empleo en el trabajo doméstico remunerado, con dificultades para aplicar el modelo de protección del trabajo asalariado tradicional. La legitimación de los derechos también puede llevar a la salud pública y a la salud de los/as trabajadores/as hacia nuevos desafíos y tensiones, que se agravan en el contexto de la pandemia por covid-19.

Abstract In Latin America, 15% of women are paid domestic workers. Being a job without social security or labor rights, almost 80% of this work is done informally. In this sense, the health of these domestic workers should be considered at least under three aspects: precarization of work, social inequality, and gender inequality. Before the need for regulatory frameworks aimed at reducing health inequalities among informal workers, Argentina and Uruguay promoted the enactment of labor laws regarding paid domestic work. This study describes the experiences of both countries, considering the scope and impact of this formalization process on health. The results indicate that formalizing paid domestic work had but a limited impact, with difficulties in applying the traditional model of paid work protection. This legitimation of labor rights may also pose more challenges and tensions for public health and occupational health, which are worsened in the context of the covid-19 pandemic.

O futuro do trabalho após a COVID-19: o papel incerto do teletrabalho no domicílio / The future of work after the COVID-19, the uncertain role of teleworking at home / El futuro del trabajo tras la COVID-19: el papel incierto del teletrabajo en el domicilio

Resumo Introdução: o teletrabalho no domicílio, uma das medidas adotadas para controlar a pandemia de COVID-19 e, ao mesmo tempo, manter o emprego, tem aumentado em vários países. Objetivo: refletir sobre o significado, a magnitude e as tendências do teletrabalho no domicílio, antes e durante a pandemia, enfatizando seus potenciais efeitos na saúde do trabalhador. Discussão: a precedente Convenção 177/1996 da Organização Internacional do Trabalho (OIT) sobre trabalho a domicílio e o acordo sobre teletrabalho entre agentes sociais na União Europeia, em 2002, apontam a dificuldade de regulamentar essa nova forma de organização do trabalho e da prevenção de possíveis lesões e doenças associadas, especialmente transtornos mentais e distúrbios musculoesqueléticos. São necessários estudos sobre os efeitos na saude dessa modalidade de trabalho para fornecer evidências científicas que embasarão normas em nível nacional e global. A inclusão de questões específicas e bem definidas, como as que a OIT propõe, em futuros levantamentos sobre as condições de trabalho, emprego e saúde poderá auxiliar tal objetivo e proporcionar uma oportunidade para observar os efeitos do teletrabalho no domicílio na saúde do trabalhador, bem como avaliar o impacto de uma necessária e urgente regulamentação.

Abstract Introduction: teleworking at home, one of the mitigation measures adopted to control the COVID-19 pandemic, while attempting to maintain employment, has increased in many countries. Objective: to reflect on the meaning, magnitude and trends of teleworking at home, before and during the pandemic, focusing on its potential effects on the health of workers. Discussion: the precedent of Convention 177/1996 of the International Labour Organization (ILO) on home work, and the agreement on teleworking between social agents in the European Union of 2002, underscore the difficulties of regulating this new form of work organization, and the prevention of possible injuries and associated diseases, especially mental and musculoskeletal disorders. The investigation of its effects on health is a priority to base its regulation at the national and global level on scientific evidence. The incorporation of specific, well-defined questions, such as those proposed by the ILO, in questionnaires of future surveys on working conditions, employment and health may help in this objective and provide an opportunity to monitor the effects on health of teleworking at home, as well as evaluating the impact of its necessary and urgent regulation.

Resumen Introducción: el teletrabajo en el domicilio, una de las medidas adoptadas para controlar la pandemia de COVID-19, y al mismo tiempo mantener el empleo, se ha incrementado en diversos países. Objetivos: reflexionar sobre el significado, la magnitud y las tendencias del teletrabajo en el domicilio, antes y durante la pandemia, focalizando en sus potenciales efectos sobre la salud de los trabajadores. Discusión: el antecedente del Convenio 177/1996 de la Organización Internacional del Trabajo (OIT) sobre trabajo a domicilio, y el acuerdo sobre teletrabajo entre agentes sociales en la Unión Europea de 2002, muestran la dificultad de regular esta nueva forma de organización del trabajo, y de la prevención de las posibles lesiones y enfermedades asociadas, especialmente los trastornos mentales y musculoesqueléticos. La investigación de sus efectos sobre la salud es una prioridad para fundamentar en evidencias científicas su regulación a nivel nacional y global. La incorporación de preguntas específicas, bien definidas, como las que propone la OIT, en cuestionarios de futuras encuestas sobre condiciones de trabajo, empleo y salud podrán ayudar en este objetivo y propiciar una oportunidad para monitorizar los efectos del teletrabajo en el domicilio sobre la salud, así como evaluar el impacto de su necesaria y urgente regulación.

Análisis descriptivo de la enfermedad profesional por COVIDD-19 en trabajadores de la salud, Argentina,2020 / Descriptive analysis of occupational COVID-19 disease in health workers, Argentina, 2020

INTRODUCCIÓN: Los trabajadores y las trabajadoras de la salud (TS) poseen la mayor exposición laboral al contagio SARS-CoV-2. El aumento de la infección y la mortalidad afecta a los sistemas sanitarios. El reconocimiento transitorio de la enfermedad COVID-19 como enfermedad profesional (EP) fue una medida de protección fundamental. El objetivo de este artículo es realizar una descripción de la EP por COVID-19 entre los TS durante los primeros 10 meses de la pandemia. MÉTODOS: Se solicitaron datos no publicados a la Superintendencia de Riesgos del Trabajo sobre TS con EP según sexo, edad, ocupación y provincia de residencia. Se calcularon la incidencia, la mortalidad y la letalidad entre TS mediante el análisis de 49 307 registros. RESULTADOS: La incidencia acumulada en el Sistema de Riesgos de Trabajo fue de 1479,6 infectados y 6 muertes por cada 10 000 asegurados. La incidencia entre los TS triplicó a la de la población general en edad de trabajar. Durante 2020 se produjeron 171 EP por día y una muerte cada dos días. El 69% de las infecciones afectaron a mujeres, mientras que el 66% de las muertes fueron en hombres. El personal de enfermería tuvo el 54% de las infecciones y el 58% de las muertes, mientras que en el personal médico estas cifras fueron de 28% y 32%, respectivamente. DISCUSIÓN: El 21% de TS no habrían notificado su infección como EP, pero el problema de notificación debe buscarse en las provincias. La incidencia para los TS en Argentina fue mayor que la informada en la bibliografía. Es necesario investigar la determinación ocupacional en los TS. La legislación debe incorporar definitivamente la COVID-19 al listado de EP.

Descriptive analysis of occupational COVID-19 disease in health workers, Argentina, 2020 / Análisis descriptivo de la enfermedad profesional por covid-19 en trabajadores de la salud, argentina, 2020

RESUMEN INTRODUCCIÓN : Los trabajadores y las trabajadoras de la salud (TS) poseen la mayor exposición laboral al contagio SARS-CoV-2. El aumento de la infección y la mortalidad afecta a los sistemas sanitarios. El reconocimiento transitorio de la enfermedad COVID-19 como enfermedad profesional (EP) fue una medida de protección fundamental. El objetivo de este artículo es realizar una descripción de la EP por COVID-19 entre los TS durante los primeros 10 meses de la pandemia. MÉTODOS : Se solicitaron datos no publicados a la Superintendencia de Riesgos del Trabajo sobre TS con EP según sexo, edad, ocupación y provincia de residencia. Se calcularon la incidencia, la mortalidad y la letalidad entre TS mediante el análisis de 49 307 registros. RESULTADOS : La incidencia acumulada en el Sistema de Riesgos de Trabajo fue de 1479,6 infectados y 6 muertes por cada 10 000 asegurados. La incidencia entre los TS triplicó a la de la población general en edad de trabajar. Durante 2020 se produjeron 171 EP por día y una muerte cada dos días. El 69% de las infecciones afectaron a mujeres, mientras que el 66% de las muertes fueron en hombres. El personal de enfermería tuvo el 54% de las infecciones y el 58% de las muertes, mientras que en el personal médico estas cifras fueron de 28% y 32%, respectivamente. DISCUSIÓN : El 21% de TS no habrían notificado su infección como EP, pero el problema de notificación debe buscarse en las provincias. La incidencia para los TS en Argentina fue mayor que la informada en la bibliografía. Es necesario investigar la determinación ocupacional en los TS. La legislación debe incorporar definitivamente la COVID-19 al listado de EP.

ABSTRACT INTRODUCTION : The HCWs have the highest occupational exposure to the contagión of SARS-CoV-2. The increase in infection and mortality affects health systems. The recognition of COVID-19 as an Occupational Disease was a fundamental protection measure. The objective of this article was to make a description of OD due to COVID-19 among HCWs during the first 10 months of the pandemic. METHODS . Unpublished data were requested from the Superintendency of Occupational Hazards (SOH) on HCWs with OD according to sex, age, occupation y province. Incidence, mortality and lethality were calculated among HCWs. The number of records analyzed was 49,307. RESULTS . The Accumulated Incidence in the Occupational Hazard System (OHS) was 1,479.6 infected and 6 deaths, for every 10,000 insured. The incidence among HCWs is double that of the general working- age population. During 2020 there were 171 OD per day and 1 death every other day. 69% of the infections affected women, while 66% of the deaths were men. Nursing accounted for 54% of infections and 58% among deaths, while among physicians they were 28% and 32%, respectively. DISCUSSION . 21% of HCWs would not have reported their infection as OD, but the notification problem must be sought in the provinces. The incidence for HCWs in our country was higher than that reported in the bibliography. It is necessary to investigate the occupational determination in the HCWs. Legislation must definitely incorporate COVID-19 into the list of OD.

[Basic questionnaire and methodological criteria for Surveys on Working Conditions, Employment, and Health in Latin America and the Caribbean]. / Cuestionario básico y criterios metodológicos para las Encuestas sobre Condiciones de Trabajo, Empleo y Salud en América Latina y el Caribe.

This article aimed to present a basic questionnaire and minimum methodological criteria for consideration in future Surveys on Working Conditions, Employment, and Health in Latin America and the Caribbean. A virtual and face-to-face consensus process was conducted with participation by a group of international experts who used the surveys available up until 2013 as the point of departure for defining the proposal. The final questionnaire included 77 questions grouped in six dimensions: socio-demographic characteristics of workers and companies; employment conditions; working conditions; health status; resources and preventive activities; and family characteristics. The minimum methodological criteria feature the interviewee's home as the place for the interview and aspects related to the quality of the fieldwork. These results can help improve the comparability of future surveys in Latin America and the Caribbean, which would in turn help improve information on workers' heath in the region.

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.

[Social classes and poverty]. / Las clases sociales y la pobreza.

Social classes and poverty are two key social determinants fundamental to understand how disease and health inequalities are produced. During the 90's in Spain there has been a notable oscillation in the inequality and poverty levels, with an increase in the middle of the decade when new forms of social exclusion, high levels of unemployment and great difficulties in accessing the labour market, especially for those workers with less resources, emerged. Today society is still characterized by a clear social stratification and the existence of social classes with a predominance of high levels of unemployment and precarious jobs, and where poverty is an endemic social problem much worse than the EU average. To diminish health inequalities and to improve the quality of life will depend very much on the reduction of the poverty levels and the improvement of equal opportunities and quality of employment. To increase understanding of how social class and poverty affect public health, there is a need to improve the quality of both information and research, and furthermore planners and political decision makers must take into account those determinants when undertaking disease prevention and health promotion.

Employment precariousness and poor mental health: evidence from Spain on a new social determinant of health.

BACKGROUND: Evidence on the health-damaging effects of precarious employment is limited by the use of one-dimensional approaches focused on employment instability. This study assesses the association between precarious employment and poor mental health using the multidimensional Employment Precariousness Scale. METHODS: Cross-sectional study of 5679 temporary and permanent workers from the population-based Psychosocial Factors Survey was carried out in 2004-2005 in Spain. Poor mental health was defined as SF-36 mental health scores below the 25th percentile of the Spanish reference for each respondent's sex and age. Prevalence proportion ratios (PPRs) of poor mental health across quintiles of employment precariousness (reference: 1st quintile) were calculated with log-binomial regressions, separately for women and men. RESULTS: Crude PPRs showed a gradient association with poor mental health and remained generally unchanged after adjustments for age, immigrant status, socioeconomic position, and previous unemployment. Fully adjusted PPRs for the 5th quintile were 2.54 (95% CI: 1.95-3.31) for women and 2.23 (95% CI: 1.86-2.68) for men. CONCLUSION: The study finds a gradient association between employment precariousness and poor mental health, which was somewhat stronger among women, suggesting an interaction with gender-related power asymmetries. Further research is needed to strengthen the epidemiological evidence base and to inform labour market policy-making.

Cuestionario básico y criterios metodológicos para las Encuestas sobre Condiciones de Trabajo, Empleo y Salud en América Latina y el Caribe / Basic questionnaire and methodological criteria for Surveys on Working Conditions, Employment, and Health in Latin America and the Caribbean / Questionário básico e critérios metodológicos para as Pesquisas sobre Condições de Trabalho, Emprego e Saúde na América Latina e Caribe

Resumen: El objetivo de este trabajo es presentar un cuestionario básico y criterios metodológicos mínimos, para ser considerados en futuras Encuestas sobre Condiciones de Trabajo, Empleo y Salud (ECTES) en América Latina y el Caribe. Para ello, se llevó a cabo un proceso de consenso, tanto virtual como presencial, con la participación de un grupo internacional de expertos que, para definir la propuesta, partieron de las encuestas disponibles en la región hasta 2013. El cuestionario final incluyó 77 preguntas agrupadas en seis dimensiones: características sociodemográficas del trabajador y la empresa; condiciones de empleo; condiciones de trabajo; estado de salud; recursos y actividades preventivas; y características familiares. Entre los criterios metodológicos mínimos destacan el domicilio de la persona entrevistada como lugar de la entrevista y los relacionados con la calidad del trabajo de campo. Estos resultados pueden ayudar a mejorar la comparabilidad de las futuras ECTES en América Latina y el Caribe, lo que contribuiría a mejorar la información en salud laboral en la región.

Abstract: This article aimed to present a basic questionnaire and minimum methodological criteria for consideration in future Surveys on Working Conditions, Employment, and Health in Latin America and the Caribbean. A virtual and face-to-face consensus process was conducted with participation by a group of international experts who used the surveys available up until 2013 as the point of departure for defining the proposal. The final questionnaire included 77 questions grouped in six dimensions: socio-demographic characteristics of workers and companies; employment conditions; working conditions; health status; resources and preventive activities; and family characteristics. The minimum methodological criteria feature the interviewee's home as the place for the interview and aspects related to the quality of the fieldwork. These results can help improve the comparability of future surveys in Latin America and the Caribbean, which would in turn help improve information on workers' heath in the region.

Resumo: O objetivo deste trabalho é apresentar um questionário básico e critérios metodológicos mínimos, para serem considerados em futuras pesquisas sobre Condições de Trabalho, Emprego e Saúde (ECTES) na América Latina e Caribe. Para tal, foi realizado um processo de consenso, tanto virtual como presencial, com a participação de um grupo internacional de expertos que, para definir a proposta, partiram das pesquisas disponíveis na região até 2013. O questionário final incluiu 77 perguntas agrupadas em seis dimensões: características sociodemográficas do trabalhador e a empresa; condições de emprego; condições de trabalho; estado de saúde; recursos e atividades preventivas; assim como características familiares. Entre os critérios metodológicos mínimos destacam-se o domicílio da pessoa entrevistada como lugar da entrevista e os relacionados com a qualidade do trabalho de campo. Estes resultados podem ajudar a melhorar a comparabilidade das futuras ECTES na América Latina e Caribe, o que contribuiria para melhorar a informação sobre saúde do trabalhador na região.

[Incidence of permanent disability in a cohort of social security-affiliated workers (2004-2007)]. / Incidencia de incapacidad permanente en una cohorte de trabajadores afiliados a la Seguridad Social, 2004-2007.

OBJECTIVE: To describe the incidence of permanent disability, both work-related and non-work-related, by several socioeconomic and geographical variables. METHODS: We performed a retrospective study of a cohort of 768,454 workers covered by the General Social Security Regimen, followed-up from 2004 to 2007. This study was based on the Continuous Working Life Survey. In the 4 years of follow-up, 7,749 cases in 1,937,921 workers-years were identified. Incidence rates and crude and adjusted rate ratios were estimated by Poisson regression models. RESULTS: The incidence of non-work-related permanent disability was 10 times greater than that of work-related disability (36.3 versus 3.7 per 10,000 workers-years). The incidences for both non-work-related and work-related disability were higher in men and increased with age and lower education level. For non-work-related permanent disability, the region with the highest incidence was Asturias and that with the lowest was Madrid (56.7 vs. 23.3). For work-related permanent disability, the highest incidence was found in Asturias and the lowest in Navarre (7.8 vs. 1.4). This differential was maintained for work-related and non-work-related permanent disability for Asturias, after adjustment was made by sex, age, educational level, company size and economic activity. CONCLUSIONS: In this study, we observed substantial differences in the incidences of permanent disability by demographic, social and geographical characteristics, which should be analyzed in greater depth, especially the differences observed by regions.