Health inequities and paid work in latin america and the caribbean
- Autores: Michael Silva Peñaherrera
- Directores de la Tesis: Pamela Merino Salazar (dir. tes.), María López Ruiz (codir. tes.), Fernando García Benavides (codir. tes.)
- Lectura: En la Universitat Pompeu Fabra ( España ) en 2021
- Idioma: español
- Tribunal Calificador de la Tesis: David Gimeno Ruiz de Porras (presid.), Mireia Utzet Sadurni (secret.), Alejandra Vives Vergara (voc.)
- Programa de doctorado: Programa de Doctorado en Biomedicina por la Universidad Pompeu Fabra
- Materias:
- Enlaces
- Tesis en acceso abierto en: TDX
- Resumen
Background: The Latin America and the Caribbean is the most inequitable region in the world. Many people in LAC lack access to basic health care, but also the access to scientific and technical advances in health services is mostly determined by income level. These unjust differences produce huge inequalities in population health and contradict the human right that everyone has to enjoy the highest attainable standard of health and well-being in their society. The size of these gaps is much bigger than is perceived by the population in general, and examination of the full impact of this inequity in the population's health in the region has been limited by the lack of reliable data.
Working and employment conditions have an important effect on global population health and health inequalities, especially in low-income countries. In these countries, there is a lack of policies and controls that expose workers to poor working and employment conditions, with a high proportion of workers in the informal economy. In Latin America and the Caribbean more than half of the workers are engaged in informal employment. Informal employment is not regulated, and workers are not protected by labor regulations and social security. In many cases, this employment may be the worst form of precarious employment. Preliminary studies have found that is associated with poor mental health, self-reported health, poor quality of life and occupational injury.
In this context, decent work is a key element to reduce health inequities. Decent work based on four pillars: promoting productive and freely chosen employment, guaranteeing rights at work, extending social protection, and creating social dialogue. Occupational health can contribute to public health, so to the welfare state, through the prevention of injuries and illnesses, and the promotion of the health of working people. However, social protections, healthcare, among other public health components are also necessary to support a safe and healthy work. In general, decent work is both a condition and a consequence of welfare state policies.
The welfare state policies set parameters for social protections, health services, pensions, and other worker benefits. In this sense, some regimes are better able to regulate employment arrangements and the negative impact of working conditions on population health than others. However, the complex relationship that may exist between worker´s health inequities and the welfare state policies has not been thoroughly studied in the Latin America and the Caribbean countries.
This thesis pursues to improve and deepen our knowledge about occupational health inequities in Latin America and the Caribbean. We want to light on the true magnitude of the inequality gaps and their impact on undesirable outcomes that are afflicting all members of society and not just the most disadvantaged groups.
Objective: To examine health inequities in the working population of Latin America and the Caribbean (LAC) according to sex, age, level of study, occupation, and formality or informality in employment.
Methods: It is a surveillance study, the base population of which is the entire workforce in LAC, and the main research topics are working, employment conditions and health. We collected microdata from the most recent national working conditions surveys, national health surveys, official registries, and national statistics institutes, as well as data from international organizations. We harmonized and recoded datasets in order to make data comparable between countries, to the extent possible. We estimated health inequity gaps by means of simple and complex measures of inequity calculating absolute and relative values. All analyses were stratified by sex.
Results: We found wide health inequities between occupational and educational groups in LAC. No evidence of progress in closing the health inequity gap over time was found. The wider health inequity gap was observed between countries. Informal employment negatively impacts population health, which is buffered by welfare state regimes.
Conclusions.
Addressing informal employment could be an effective way to improve population health in LAC. The welfare state is an important macro-level determinant of health that buffer the negative effects of poor working conditions on population health. Strengthening the occupational health surveillance system in LAC countries is a priority, with a view towards informing policy. These results could raise awareness of social members, local governments and international organizations, providing valuable information and motivating them to take urgent local and regional actions to address the problem of health inequities in the most unequal region on the planet.
