Why Inequality in the Workforce Is Bad for Your Health

Sharan Burrow May 3, 2017

In a virtuous circle, unions make workplaces fairer, which makes the union voice stronger, which makes workplaces safer and healthier. (Photo by Mohammad Asad/Corbis via Getty Images).

This arti­cle was first post­ed by Haz­ards magazine.

When Bab­ul Khan lost two of his four sons in an infer­no at Gadani ship­break­ing yard on Novem­ber 1, 2016, it was a tragedy but it wasn’t a sur­prise. Like all the 26 work­ers who were killed when an oil tanker was blast­ed apart at Pakistan’s largest ship­break­ing yard, 18-year-old Ghu­lam Hyder and 32-year-old Alam Khan were inse­cure work­ers. Dis­pos­able workers. 

The yard was shut in the imme­di­ate wake of the deaths. Soon, though, it was busi­ness as usu­al — and that meant, inevitably, more deaths. At least five work­ers died in a fire on a liq­ue­fied petro­le­um gas (LPG) con­tain­er ship at the ship­break­ing yard on Jan­u­ary 9, 2017. The yard was mak­ing mon­ey; a steady stream of hor­rif­ic fatal­i­ties was just col­lat­er­al damage.

Who lives and who dies at work is not an acci­dent of chance. The emer­gence of increas­ing­ly pre­car­i­ous forms of employ­ment in con­vo­lut­ed sup­ply chains was as delib­er­ate as it was dead­ly. It cre­ates a work­ing world where the bad actors set a wage, con­di­tions and employ­ment rights bench­mark which sucks down con­di­tions across the glob­al economy.

Main­tain­ing a sys­tem of inde­cent work has always required an extra ingre­di­ent — a divid­ed work­force. Where work­ers do not have a col­lec­tive voice and where jobs are by design seg­re­gat­ed by gen­der, race or class those divi­sions can per­pet­u­ate dis­ad­van­tage and leave the most exploit­ed work­ers pow­er­less while under­cut­ting the con­di­tions of the rest.

All this comes at a price. At the top of the work­place peck­ing order, those mak­ing the deci­sions don’t just receive mul­ti­pli­ers more in income and perks, they get to live many years longer to enjoy them.

Don’t look, don’t find

Thumb through the clas­sic occu­pa­tion­al med­i­cine text­books, and you get a pic­ture of work relat­ed dis­ease dom­i­nat­ed by expo­sures in mines, mills and fac­to­ries. Male expo­sures. Dust dis­eases like pneu­mo­co­nio­sis and the pol­lu­tion and the phys­i­cal strains haul­ing large weights over long hours had a dev­as­tat­ing impact on the lives of the men stud­ied, dra­mat­i­cal­ly cur­tail­ing life expectancy.

Women worked, but were treat­ed as con­found­ing fac­tors” in research. Like­wise black and minor­i­ty work­ers. It was a bias that per­sist­ed through much of the 20th cen­tu­ry, and it per­pet­u­at­ed a vision of indus­tri­al health prob­lems that was white and male.

It was a big white lie. Women work­ing in the car­ing pro­fes­sions and as super­mar­ket cashiers can lift more in a shift than a con­struc­tion work­er or a min­er, and fre­quent­ly com­bine their work with a sec­ond unpaid shift of domes­tic work. From tea plan­ta­tions to brick kilns to flower fields world­wide, women do ardu­ous work, fre­quent­ly with young chil­dren in tow. 

A study pub­lished in the Sep­tem­ber 2016 issue of the Jour­nal of Occu­pa­tion­al and Envi­ron­men­tal Med­i­cine con­clud­ed the total hours bur­den borne by women who put in long hours for the bulk of their careers led to alarm­ing increas­es“ in life-threat­en­ing ill­ness­es, includ­ing heart dis­ease and cancer. 

Yet even today, the occu­pa­tion­al expo­sures in female dom­i­nat­ed trades like car­ing and clean­ing are under-researched and under-appre­ci­at­ed.

It may be that women, often under-rep­re­sent­ed in haz­ardous trades like con­struc­tion and min­ing, are less like­ly to fea­ture in the occu­pa­tion­al fatal­i­ty sta­tis­tics. But occu­pa­tion­al dis­ease deaths dwarf the work fatal­i­ties total, and there is good rea­son to sup­pose women are every bit as vul­ner­a­ble to these dis­eases. The chem­i­cals are there, the mus­cu­loskele­tal haz­ards are there, and the stress­es are there. It is just the stud­ies and the give-a-damn that is missing.

Take can­cer. We know about the lung and oth­er can­cer risks fac­ing men employed in dusty trades, and this has been recog­nised for many years and is some­times state compensated.

In women, the biggest occu­pa­tion­al can­cer killer is like­ly to be breast can­cer, caused by shift­work and work­ing in a tox­ic soup” of hor­mone dis­rupt­ing chem­i­cals in agri­cul­ture, plas­tics, food pack­ag­ing, met­al man­u­fac­ture and oth­er jobs. Is breast can­cer a uni­ver­sal­ly recog­nised and com­pen­sat­ed occu­pa­tion­al con­di­tion? No. 

We know women’s wages are low­er than men’s, not because women’s work is worth less, but because of glass ceil­ings and gen­der tram­lines that keep women in their place.” If soci­ety places less val­ue on women’s work, makes few­er efforts to assess its effects and takes less care in mit­i­gat­ing its con­se­quences, then that will, inevitably, be reflect­ed in unrecog­nised but sub­stan­tial work relat­ed ill-health.

At a disadvantage

It is easy to think of car­cino­gens like asbestos and sil­i­ca as equal oppor­tu­ni­ties killers — if you are exposed, then you may get the can­cer. But there’s not much asbestos fly­ing around board­rooms, and while con­struc­tion work­ers might be pre­dom­i­nant­ly male, they are also pre­dom­i­nant­ly work­ing class.

Occu­pa­tion­al can­cer, like all occu­pa­tion­al con­di­tions from stress, to der­mati­tis to lung dis­ease, is a blue col­lar ail­ment. Not the old blue col­lar of the fac­to­ry and the mine, but one that also includes toil in gar­ment fac­to­ries and food pro­cess­ing, clean­ing, car­ing and a mis­cel­lany of oth­er trades. And with­in the work­force, cer­tain groups face the bulk of the risk.

Like gen­der, race has been treat­ed his­tor­i­cal­ly as a con­founder” in occu­pa­tion­al health research, so the lit­er­a­ture on racial inequal­i­ties in occu­pa­tion­al health is thread­bare. But as occu­pa­tion­al risk increas­es the low­er you go down the social class lad­der, race as sure­ly com­pounds this.

In the ear­ly 1970s, the U.S. government’s occu­pa­tion­al health research body NIOSH inves­ti­gat­ed the risks to work­ers on the coke ovens fuelling steel works and fac­to­ries. It was appar­ent coke oven work­ers faced a great­ly increased risk of lung can­cer. But on clos­er inspec­tion it became clear black work­ers were far more like­ly to be giv­en the worst jobs with the high­est expo­sures, at the top of the coke oven. 

With­out this obser­va­tion, it would in all prob­a­bil­i­ty have been assumed the increased lung can­cer rates in black work­ers was to do with race, rather than exposures.

This isn’t an his­tor­i­cal arte­fact. In 2011, NIOSH not­ed: African-Amer­i­can, His­pan­ic, and immi­grant work­ers are dis­pro­por­tion­ate­ly employed in some of the most dan­ger­ous occu­pa­tions. African-Amer­i­can males are twice as like­ly as non-His­pan­ic white males to work in ser­vice occu­pa­tions and as labour­ers, fab­ri­ca­tors, and oper­a­tors, yet are half as like­ly to be in man­age­r­i­al or pro­fes­sion­al spe­cial­ty occupations. 

The result is that the African-Amer­i­can injury rate is about a third high­er for both African-Amer­i­can males and females com­pared to white non-His­pan­ic workers.”

Some­times the process is more bla­tant. In Decem­ber 2009, the Studsvik Mem­phis Pro­cess­ing Facil­i­ty in Ten­nessee, a U.S. com­pa­ny that process­es nuclear waste, agreed to set­tle com­pen­sa­tion claims with black employ­ees who were assigned to jobs with high­er radi­a­tion expo­sures but who then had their dose meters doc­tored to show low­er expo­sure levels.

In India, the work­ers employed infor­mal­ly as man­u­al scav­engers—remov­ing by hand human excre­ment from homes — are drawn exclu­sive­ly from the per­se­cut­ed low caste” Dalit com­mu­ni­ty. The health con­se­quences — con­stant nau­sea and headaches, res­pi­ra­to­ry and skin dis­eases, anaemia, diar­rhoea, vom­it­ing, jaun­dice, tra­choma, and dead­ly asphyx­ia—are lim­it­ed entire­ly to this community.

A 2017 study on racial and eth­nic dif­fer­ences in acci­dent rates warned about dis­crim­i­na­tion-based dis­par­i­ties in work­place injury risk. It not­ed: Based on our find­ings, pol­i­cy­mak­ers and reg­u­la­tors may need to review whether employ­ers are sys­tem­at­i­cal­ly assign­ing peo­ple of dif­fer­ent races and eth­nic­i­ties dif­fer­ent jobs or job tasks accord­ing to the risk.”

Dis­tress­ing work

Any notion that knowl­edge and enlight­en­ment is cre­at­ing a work­ing world that is by incre­ments get­ting safer and health­i­er is mis­guid­ed. Instead ordi­nary” jobs, not com­mon­ly asso­ci­at­ed with exces­sive dan­gers, are dri­ving many work­ers to a state of per­pet­u­al and some­times dead­ly desperation.

Review­ing evi­dence of a sharp spike in death rates among white work­ing class Amer­i­can males, occu­pa­tion­al health spe­cial­ists at the Uni­ver­si­ty of Mass­a­chu­setts Low­ell iden­ti­fied job inse­cu­ri­ty, dis­crim­i­na­tion and a lack of con­trol at work behind an increase in dis­eases of dis­tress“ — alco­hol and drug-relat­ed dis­eases and suicides.

Stud­ies in France have esti­mat­ed the annu­al work-relat­ed sui­cide toll — which has risen sharply in recent years — at sev­er­al hun­dred and pos­si­bly thou­sands of deaths each year. Reports in the Unit­ed States, Aus­tralia, France, Japan, Chi­na, India and Tai­wan and the UK all point to a steep rise in work-relat­ed sui­cides. There is a clear social class asso­ci­a­tion evi­dent and a com­mon set of work­place abus­es wit­nessed time again.

An offi­cial March 2017 report in the UK not­ed indi­vid­u­als work­ing in roles as man­agers, direc­tors and senior offi­cials — the high­est paid occu­pa­tion­al band — had the low­est risk of sui­cide. Among cor­po­rate man­agers and direc­tors the risk of sui­cide was more than 70 per cent low­er for both sex­es. Con­trast that with con­struc­tion where low skilled male labour­ers, had a three times high­er risk of sui­cide than the nation­al average.

These deaths should not dis­missed as a last cry for help. They are a last cry of protest. At the core of the prob­lem is a sys­tem where work­ers are treat­ed increas­ing­ly as just anoth­er com­po­nent, a vari­able on a busi­ness spread sheet to be cut, squeezed or extend­ed beyond oper­a­tional capacity. 

The increas­ing­ly con­tin­gent” work­force — part-time, tem­po­rary, zero hours and con­tract work­ers — favoured in the dereg­u­lat­ed glob­al work­place face high­er rates of occu­pa­tion­al injuries and ill­ness­es. In the UK, the gov­ern­ment safe­ty reg­u­la­tor found inse­cure employ­ment is cre­at­ing an army of dis­pos­able work­ers, too scared to take sick leave and who are fired when they can no longer perform.

But work­ers with, osten­si­bly, per­ma­nent jobs are also harmed. A study of the impact of the recent Great Reces­sion” dis­cov­ered just watch­ing peo­ple lose their jobs all around you will make you sick, even if you held onto your own.

The tragedy is that job inse­cu­ri­ty isn’t an irre­sistible force of nature. It is a choice. Work can be decent and pro­duc­tive and prof­itable. But cor­po­rate boards are judged by this year’s bot­tom line and at this year’s AGM. Cor­po­rate social respon­si­bil­i­ty is fre­quent­ly lit­tle more than cyn­i­cal pub­lic rela­tions, not an oper­at­ing imperative.

Low pay, high risks

It is a per­ver­si­ty of work that the lan­guage of risks and rewards” is used to jus­ti­fy soar­ing board­room pay pack­ets and the grow­ing income inequal­i­ty at work. But the work­ers most fre­quent­ly com­pelled to take gen­uine risks — to life, to limb, to health — are those who receive the low­est finan­cial rewards.

Low pay is in all prob­a­bil­i­ty the most clear indi­ca­tor of the degree of health and safe­ty risk a work­er will face. Low pay affects your choic­es. It influ­ences whether you work more over­time, extra shifts, report an injury, take sick leave. And it leaves you in jobs that typ­i­cal­ly have the inse­cure, dirty and dan­ger­ous hall­marks of risky work. Or jobs that are mind­numb­ing­ly dull and depress­ing. Or scratch­ing a liv­ing from mul­ti­ple jobs.

The major White­hall II study of UK civ­il ser­vants showed that stress, sick­ness and heart dis­ease all went up as your employ­ment grade went down.

Whole cat­e­gories of work­ers are more like­ly to pop­u­late the low pay clas­si­fi­ca­tion, and have greater employ­ment and health vul­ner­a­bil­i­ty as result. Migrant work­ers, like the cap­tive labour from South Asia build­ing the glis­ten­ing sta­di­ums in Qatar, face unpo­liced, uncount­ed but shock­ing injury and ill-health risks. Perm in oth­er fac­tors — ill-health, dis­abil­i­ty, age — and a lack of employ­ment options trans­lates to few­er choic­es and few­er oppor­tu­ni­ties to just say no.

Work­ers need the added vol­ume of a col­lec­tive voice to make them­selves heard. And that is where unions come in.

The union effect

If you want bet­ter pay, more job secu­ri­ty, low­er injury and ill-health rates and bet­ter terms and con­di­tions at work, then unions have a proven track record. In a vir­tu­ous cir­cle, unions make work­places fair­er, which makes the union voice stronger, which makes work­places safer and health­i­er.

Wher­ev­er there is an active union pres­ence, this union effect is like­ly to be observed — and there are eco­nom­ic ben­e­fits too. 

A Sep­tem­ber 2013 study cov­er­ing 31 indus­tri­alised coun­tries, pub­lished in the jour­nal Social Sci­ence & Med­i­cine, con­clud­ed: Union den­si­ty is the most impor­tant exter­nal deter­mi­nant of work­place psy­choso­cial safe­ty cli­mate, health and GDP.” The paper added work­er health is good for the econ­o­my, and should be con­sid­ered in nation­al health and pro­duc­tiv­i­ty account­ing. Erod­ing union­ism may not be good for work­er health or the econ­o­my either.”

Unions nar­row work­place inequal­i­ties, with a con­comi­tant ben­e­fit to health. In a harsh eco­nom­ic cli­mate unions con­tin­ue to make work fair­er. The same col­lec­tive strength that deliv­ers bet­ter wages also makes work safer and healthier. 

It is an indict­ment of the eco­nom­ic and polit­i­cal process that glob­al­i­sa­tion has seen a frag­men­ta­tion of work and a dec­i­ma­tion of work rights, caus­ing inevitable harm to the pub­lic health.

But it does put in sharp relief the unde­ni­able ben­e­fits of trade unions. It’s not just about wages, or equal­i­ty or safe­ty. It is about dig­ni­ty and respect at work. 

The shame is that with­out unions this basic decen­cy is in increas­ing­ly short supply.

Sha­ran Bur­row is gen­er­al sec­re­tary of the Inter­na­tion­al Trade Union Con­fed­er­a­tion (ITUC).
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