Peter Vermeiren (sociologist)
The seventh of October was the international Day for Decent Work. Did anybody notice? Well, I didn’t. Until a friend told me about it and asked me to put some ideas to paper about ‘decent work’. Once I could set aside the frustration that a colleague political sociologist covering health policy had to remind me, a sociologist studying labour conditions in Belgium, about that campaign I wondered why I should bring this up in a blog on IHP. I didn’t have to think long. For the very simple reason that there is a direct connection between having decent work and being healthy and between labour policy and health policy.
When I was studying global health policies myself, some time ago, I often wondered why the global health community paid so little attention to the field of labour, not unlike the way other fields routinely ignore health policy. This is odd, because working, especially badly organised work, can make us very sick. And when we are sick, we can’t work very well or not at all. That’s not rocket science, especially in a week when the Nobel prizes are awarded. At the same time, the financing of our health system relies heavily on the contributions of working people – at least that’s the case in many European countries. Hence, health policy and health systems should pay more attention to the fight for decent work. Not only is decent work supposed to be justly paid work, which makes it possible to provide better health care for all, decent work can also prevent various work related diseases that lay a heavy burden on the health of people and therefore on the health system. In other words, asking for a stronger health system and demanding a labour market that provides decent work go hand in hand.
How about the condition of the labourers?
The International Day for Decent Work zooms in a lot on labour conditions, but what about the condition of the labourers? Trying to bring labour protection in emerging and developing countries to the level of rich countries is absolutely necessary, but how is the protection in these ‘rich’ countries actually ? Sure, compared to the sweatshops in Pakistan or Bangladesh the conditions in the West could look like heaven. But are they?
Our welfare system (including the health system) is under heavy pressure and struggles to be financially sustainable. One of the main conditions to maintain it, is that as many people as possible should have a job because the system is funded by contributions from wage earners. So the focus on putting people to work is logical, at least at first glance. But since a couple of years there is a trend to push unemployed people to work no matter what kind of work it is and no matter what the conditions or the wages are. All in the name of the sustainability of our welfare system (at least that’s the political explanation, in reality the politicians have simply run out of ideas of how to create new jobs, I’m afraid).
However, the wages in these ‘forced’ jobs are often so low, that they can hardly contribute financially to the welfare system. Also, more often than not, working conditions are lousy. And bad working conditions lead to health problems and increasing health problems lead to… yes, a burden on the health system. You don’t need to be an exploited worker in a Bangladeshi sweatshop to know that a bad organisation of work makes people sick, if not physically, then psychologically. Let’s face it, in many cases the work doesn’t fit the worker, but most employers keep on complaining that the workers don’t fit the work which creates an enormous amount of stress for the employees who try to fit in. Again, the effect on their health is clearly negative. The proof for that is overwhelming. And overwhelmingly swept aside.
The deteriorating labour conditions in the EU paradoxically make for a shrinking basis for solidarity. We can measure this by the success of the rightwing parties with anti-social policy suggestions. People have less, so they tend to reserve what they have for themselves or for their own national systems. It will be very difficult in that solidarity-hostile climate to find support from these workers-taxpayers for assisting in financing something like UHC in low income countries, especially when they are confronted with their own degrading welfare system. So when asking for decent work, maybe don’t take the European model too much as an example, at least not without questioning it at the same time.
Adam Smith tried to warn us, his followers try to fool us
Even before the global financial crisis, workers were first and foremost assessed in terms of their functioning in the production process. They are a tool to adapt to the production process instead of the other way round. This enormous flaw in the labour system has never been resolved since people started to work in industrial factories halfway the 18th century.
The physical conditions have obviously improved tremendously since, but in place came a mental burden that caused new kinds of health hazards. And it’s not like we didn’t see that one coming! Adam Smith already warned in 1776 for the mind numbing effects of a system of labour division where the worker is reduced to a part of machinery. As a matter of fact he did this in his famous book ‘An inquiry into the nature and causes of the Wealth of Nations’, the book free market followers and other neoliberal workaholics seem to love so much. I wonder if they ever read the following paragraph, especially the last phrase. I admit it is put in a rather paternalistic way, but then again, it was the 18th century.
“The man whose whole life is spent in performing a few simple operations, of which the effects are perhaps always the same, or very nearly the same, has no occasion to exert his understanding or to exercise his invention in finding out expedients for removing difficulties which never occur. He naturally loses, therefore, the habit of such exertion, and generally becomes as stupid and ignorant as it is possible for a human creature to become. The torpor of his mind renders him not only incapable of relishing or bearing a part in any rational conversation, but of conceiving any generous, noble, or tender sentiment, and consequently of forming any just judgment concerning many even of the ordinary duties of private life… But in every improved and civilized society this is the state into which the labouring poor, that is, the great body of the people, must necessarily fall, unless government takes some pains to prevent it.”
Seems the ‘hero of the free market’ didn’t trust the market very much in providing care for its workers and opted for the state to deliver that kind of help. Could it be that the neoliberals have a ‘revised’ or censored version of the book where that paragraph was deleted?
Decent work deserves more attention from the global health community
So, if the bad organisation of work makes us sick, and sick workers can’t contribute to the welfare system, and as such to the health system, why is it that, apart maybe from the people who take a close interest in the social determinants of health, in the vast amount of studies, reports, analyses on IHP, HSS etc…, so little is said about the need to provide decent work? How come the global health community fails to see that point? True, the international economic and labour community also often fail to see the importance of decent health services (although there has been some improvement there lately). But this silo mentality seems short-sighted, especially in an era of sustainable development and interdependence.
As my friend, ‘the political sociologist covering health policy’ (yes, he wants to remain anonymous, but you probably have a hunch) said, there’s more to this oversight, though. A part of the global health community, keen on establishing public-private partnerships and collaboration with philanthropic foundations and very much at ease when talking to people like David Cameron, does not seem to feel very comfortable with a rather political topic like ‘decent work’ that obviously has repercussions for countries in the North as well – see for example the pressure on the German government to introduce minimum wages when it became clear that people in e.g. the meat industry worked their asses off for only a Euro an hour or the abominable working conditions at Amazon (think twice before you buy a cheap book from them). Or take the Mc Donald’s workers’ strikes in the US recently.
Last but not least, but that’s just a not yet corroborated hypothesis of mine: could it be that many of the influential people in global health are workaholics themselves, working tirelessly towards a better world, answering thousands of emails a week, but failing to understand that in this world, unfortunately not everybody can work 60 or 70 hours a week for a cause they’re passionate about? Put more bluntly: could it be that many global health (and other) bigwigs die of a heart attack or another stress disease before they even realise it’s actually the work that’s killing them? … In case you wondered, the latter one was a joke, not a hypothesis (although, maybe there is somebody in health research who would like to test that one?)
In sum: safer and healthier working conditions and a better organisation of work in function of the worker can diminish substantially the number of people who need medical help AND contribute to a better financed health system. As such, decent work is in my opinion a corner stone of a stronger, better health system and therefore a topic that deserves much more attention from the Global Health Community. For example in the discussions on the post-2015 health agenda.