Work and the right to health Geneeskunde voor het Volk Médecine pour le Peuple

Inleiding Geneeskunde voor, door en van het volk DEEL 1: Gezondheidszorg is een basisrecht, en mag geen koopwaar zijn DEEL 2: Gezondheid, kwestie van maatschappelijk onrecht bestrijden. DEEL 3: Geneeskunde voor het Volk: De dagelijkse praktijk anno 2012

11 health care centres Established in 1971 Right to health Right to healthcare free and equal access for everyone (fee for service ↔ capitation) patient-centered care Multidisciplinary Struggle for healthy working and living conditions Empower patients International solidarity (anti-imperialist): TWHA What is Doctors for the People?

Inleiding Geneeskunde voor, door en van het volk DEEL 1: Gezondheidszorg is een basisrecht, en mag geen koopwaar zijn DEEL 2: Gezondheid, kwestie van maatschappelijk onrecht bestrijden. DEEL 3: Geneeskunde voor het Volk: De dagelijkse praktijk anno 2012

1. Focus on the working class, Why? Work as determinant of health Physical, biological, chemical, psychological… Ideology: Working people as the motor of change Creators of social security systems In case of social combat: improvement for the majority of the people e.g. Struggle for better wages  less inequality and poverty Strike as powerful weapon Especially in the biggest companies Trade unions = biggest social organizations in the country: 75 % of the Belgian employees is organized in unions

Inleiding Geneeskunde voor, door en van het volk DEEL 1: Gezondheidszorg is een basisrecht, en mag geen koopwaar zijn DEEL 2: Gezondheid, kwestie van maatschappelijk onrecht bestrijden DEEL 3: Geneeskunde voor het Volk: De dagelijkse praktijk anno 2012

2a. Focus on the working class, How? Health care centers in worker’s neighbourhoods, often nearby big companies close connection to the working class work-related health problems in the doctor’s office In progress: registration projects for profession Better view on labour risks + scientific investigations in the future

Work-related diseases in PHC Approximately 1/3 patients that are consulting a GP think their problem might be work-related “Blind spot” at the diagnostic & therapeutic level? What kind of work-related diseases do GPs see? Percentage of diagnosed work-related diseases in primary care Hussey L, Turner S, Thorley K, McNamee R, Agius R. Work-related ill health in general practice, as reported to a UK-wide surveillance scheme. British journal of General Practice Sep;58:

Society changes… and so do work-related diseases 1975: Miner’s lung, lead poisoning, : stress, RSI, depression,... suicide

Intensification of work Question Does your job involve working at very high speed? 49,0%54,5% Does your job involve working to tight deadlines? 38,8%59,4% Three or more determinants of work pace (work done by colleagues, demands from people, production or performance targets, speed of a machine, direct control of a boss) 26,6%33,2%  Intensification of work by reducing non-productive time  Results from the European Working Conditions Survey (interviewed 4000 Belgian workers ): Work intensity ↑

Audi Cars “At the assembly line workers have 93 seconds to do their job. Not so long ago this was 98, and in a few month it will be 88”

2b. Focus on the working class, How? Solidarity delegations to strikes etc.

2c. Focus on the working class, How? Medical expertise for work-related health problems: Research on working conditions and their impact on health Documenting: books, brochures, leaflets… Defending employees in case of a professional disease or an industrial accident

Campaigns of the last years Langer werken Gevolgen van de crisis Werkstress RSI’s

1) Economic crisis and health Suicidal ideation in the last 12 months

2) Health and delayed retirement Age 55-64: 2477 patients 3/4: 1 chronic diseases 1/3: 3 or more chronic diseases => women = most vulnerable group Age (year) Patiënt with chronic disease (%) Number of chronic diseases

3. Addressing work as a SDoH Participatory Action Research (PAR) Principles – Participation Workers as co-researchers Acknowledge worker’s knowledge and priorities ‘Shared decision making’ – Research – As an instrument for action – Action – For social change – Empowerment Possibilities – Collective and holistic approach – From ‘patient-centred’ to ‘community-centred’ – Address power relations – Collaboration between GP = ‘health advocate for patients’ and trade union = ‘health advocate for workers‘ 18

3) PAR in supermarket chain (Antwerp) 1) Employees with musculoskeletal complaints (last 12 months) 2) Cashiers 19 Adjusted ORp-value Neck4,350 (1,701 – 11,120)0,002 Shoulders2,535 (1,076 – 5,975)0,033 Elbows2,578 (1,026 – 6,477)0,044

3) Major psychosocial and organisational problems  Shortage of personnel  Low autonomy  Working at high speed/workload  Flexibility (working hours/ workplace) => problems with work-life balance 4) High number of musculoskeletal complaints associated with: 20 adjusted OR (95%CI)p-value High work stress3,748 (1,372 – 10,233)0,010 High speed/workload3,150 (1,031 – 9,629)0,044 Monotonous job4,057 (1,482 – 11,105)0,006 Low autonomy3,306 (1,167 – 9,370)0,024 “ OVERLOAD ” Individual factors Psychosocial factors Work organization Stress Physical factors Musculo- skeletal diseases

3. Addressing work as a SDoH RSI as occupational disease # of RSI recognised (in 2007) per inh.

Conclusion Evolutions in working conditions & work-related diseases Within the consultation room = limitations Need to address work as a social determinant of health Importance of power relations

Conclusions Many health problems are work-related → Health professionals: be aware! Workers have the power to change the society → Health sector activists: work together!

(dutch/french) “Hidden behind workplace walls, they are invisible to society. Everyone knows-and suffers-their own working conditions, but is unaware of those of others. So, they are situations experienced by all but as the daily routine of the masses they escape the observer. They happen behind closed doors and are always guarded like an industrial secret" Asa Cristina Laurell

DEEL 3 Geneeskunde voor het Volk: De dagelijkse praktijk anno 2012 Werkomstandigheden, beroepsziekten en arbeidsongevallen Bloemenhulde Boek: Dokter in Overall. Over de werkomstandig- heden van interimmers in de Antwerpse haven.

DEEL 3 Geneeskunde voor het Volk: De dagelijkse praktijk anno 2012 Langer werken en gezondheid Onderzoek: gezondheidsstatus bij patiënten Tussen 50-55jaar: 1150 patiënten  2/3 heeft 1 chronische ziekte.  ¼ heeft 3 of meer chronische ziekten.  vrouwen zijn de meest kwetsbare groep. De meerderheid van mensen boven de 50 hebben één of meer chronische ziekten. Zonder mogelijkheid op voor vervroegd pensioen zullen er serieuze gevolgen zijn op hun gezondheidsstatus.

Inleiding Geneeskunde voor, door en van het volk DEEL 1: Gezondheidszorg is een basisrecht, en mag geen koopwaar zijn DEEL 2: Gezondheid, kwestie van maatschappelijk onrecht bestrijden DEEL 3: Geneeskunde voor het Volk: De dagelijkse praktijk anno 2012