Hazardous! Occupational safety and health in the care economy during the pandemic

Protecting the health and safety of all workers in the care economy is essential, but for this to become a reality major changes are needed.

The coronavirus crisis has darkened the long shadow cast by austerity over the health and care systems across the European Union. Public-health and healthcare organisations and trade unions warned that the budget cuts after the 2008 economic crisis would lead to inequalities in health outcomes and increase risks to staff safety in the long term. This prediction has come true, with devastating consequences, in the Covid‑19 pandemic.

Health professionals have been committed to maintaining a high quality of service during the pandemic. But their workplaces are often understaffed and under-resourced, riddled with biological hazards and psychosocial risks. The risks arise from understaffing, excessive overtime, work overload, time pressure, a lack of training for the tasks being performed, insufficient breaks and days away from work, low wages and job insecurity—just to give a few examples.

Women and migrants

Occupational safety and health (OSH) inequalities, and work-related morbidity and mortality, are closely linked to demographic characteristics of the workforce, such as gender, age and ethnicity. With tens of thousands of health workers having been infected with Covid‑19 globally and hundreds dead, bear in mind that women comprise 75 per cent of those employed in human health activities in Europe and 90 per cent of nurses. A considerable proportion of health and care workers are also migrants. Inadequacies in work organisation compound these inequalities.

The SARS-CoV-2 virus requires specific OSH measures in the world of work, not least in health. Hazard-control systems are designed to prevent workers’ exposure: engineering controls place a barrier between the hazard and the worker, administrative controls aim to ensure appropriate work practices and policies, and personal protective equipment (PPE) protects against infectious substances. These measures can prevent and mitigate the biological hazard of the virus to workers to a certain extent.

But the world of work also includes psycho-social risks, which have intensified during the pandemic and need to be controlled too. Associated measures include adequate workforce planning, preventing the risk of third-party violence and harassment, and staff OSH training. Family support comes into this, including with childcare and the spin-off effects on domestic relationships of minimising contagion.

Underlying shortcomings

The pandemic has created new problems in OSH and working conditions in healthcare but it has also put a spotlight on underlying shortcomings in the systems. Health workers have ended up compensating for these through individual adjustments, sometimes to the detriment of their own health and lives—their right to safe work has been violated. The lack of PPE for health workers across the different occupational groups, in hospitals and the community, has been well-documented. But even the available PPE is not necessarily suitable for women, as the design of most equipment is based on the sizes and characteristics of men.

The capacity for testing health workers for Covid-19 meanwhile continues to be insufficient. Shortages of staff and resources, allied to social tensions, have increased violence against health workers. Staff are having to work longer hours, with higher workloads and in shifts amid increasing demand for health services, which can lead to fatigue, burnout and distress. In many countries junior staff have been placed in demanding new roles while retired personnel have been called back to duty.

Health workers also face a financial risk, vulnerable to a catastrophic loss of income due to insufficient social protections. As of April, only 13 EU member states had adopted new measures facilitating access to paid sick leave in the current crisis, and only a handful of countries recognise Covid-19 as an occupational disease—even in the health sector.

Immediate measures

Immediate OSH measures must focus on the availability of PPE and health workforce testing. Prevention of violence and harassment is essential, while measures to mitigate psychosocial risks are equally crucial. It is likewise important not to introduce any new and unforeseen risks to workers’ safety and health, including psychosocial risks related to work organisation or ergonomic and chemical risks.

Guidelines for safety and health in case of a pandemic, with appropriate training of staff, should hence be expanded and updated. But those who work in the care economy need to contribute to OSH planning—to ensure their experiences are drawn on when strategic decisions are taken related to their work. Democratic workplaces, where workers can exercise their rights and have their say, should be the norm in the care economy.

Treating Covid-19 as an occupational disease would provide some financial safety-net for workers. The inclusion of SARS-CoV-2 in the list of biological agents known to affect humans, set out in the European Commission directive (EU) 2019/1833 with a short transposition period, supports the protection of workers’ health.

Long-term vision

While short-term responses are rolled out, medium- and long-term measures should be developed in parallel, focusing on preventing OSH risks in the future. Structural shortages of health workers intensify psychosocial risks, and sufficient recruitment and retention must be planned and financed as part of a long-term vision.

Reducing public deficits should not come at the expense of healthcare systems, the suffering of patients or hazards for workers. On the contrary, an effective alternative to austerity is public investment in social infrastructure and the care economy. Robust national preparedness plans for public-health emergencies should be adopted and continually improved.

The care economy is systematically undervalued and structural gender inequalities are replicated in healthcare. For example, nursing suffers from an image of ‘low-skilled work’—which fails to match the reality of a professional life defined by high-level technical, emotional and cognitive skills—and so incurs the wage penalty for working in female-dominated occupations and industries.

Transformative changes

In addition to policies related to medical equipment and clinical research, transformative changes are required to address the root causes of the poor OSH and working conditions in healthcare and the care economy more broadly. Such changes would support gender equality and decent work, including:

• an EU gender pay transparency directive, enforcing the principle of ‘equal pay for work of equal value’;
• inclusion of gender in EU OSH legislation, with trade-union involvement in the design, implementation and evaluation of the post-2020 OSH strategy;
• a directive on psychosocial risks in the world of work;
• ratification and implementation by the member states of the International Labour Organization convention 190 and recommendation 206 on the elimination of violence and harassment in the world of work, and
• a strengthening of health workforce planning, with the aim of eliminating occupational inequalities from the care economy.

Gender-balanced representation of trade unions and health and social-care organisations in governance and decision-making structures will be crucial to ensuring the mistakes of the past are not repeated. Lives have been ruined, and even lost, during this pandemic because these well-known problems were not addressed in time. Our health workers deserve better protection—and the time to act is now.

This article is derived from a European Trade Union Institute policy brief by the author.