Epidemiology of migrant workers’ occupational health: a perspective from three regions : Current Opinion in Epidemiology and Public Health

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OCCUPATIONAL EPIDEMIOLOGY: Edited by Alessandro Godono and Yohama Caraballo

Epidemiology of migrant workers’ occupational health: a perspective from three regions

Salmen-Navarro, Acrana; Samant, Yogindrab; Seneviratne, Mahindac

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Current Opinion in Epidemiology and Public Health 1(1):p 25-31, November 2022. | DOI: 10.1097/PXH.0000000000000007
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Abstract

INTRODUCTION

It is estimated that the number of people living outside of their country of origin reached 281 million worldwide in 2020 and approximately 169 million are working or actively seeking for a job. Work is the primary drive for those who voluntarily migrate to increase their income and provide for their families in their home countries. Those who are forced to migrate immediately seek means of income to sustain themselves through a precarious process, as recently demonstrated in the consequences of war in Ukraine, in the Middle East and the economic crisis in Venezuela and Sri Lanka. Migrant workers are at considerable risk of work-related diseases and injuries, and their health needs are critically overlooked in research and policy (Hargreaves et al.[1]). Unfortunately, migrant workers are globally known to predominantly work in ‘4-D jobs’ – dirty, dangerous, and difficult and discriminatory; the fourth D was recently added to acknowledge the discriminatory aspect and other social determinants of health migrant workers face in their host country (Salmen-Navarro and Schulte [2▪▪]; Salmen-Navarro [3▪]). For this matter, migrant workers are at a higher risk of work-related diseases and injuries – especially musculoskeletal because of the nature of the manual handling labor they perform and the ergonomic hazard they are exposed. As we recognize the Universal Declaration of Human Rights from the United Nations, ‘Everyone has the right to work, to free choice of employment, to just and favorable conditions of work and to protection against unemployment’, it is vital that we understand the statistical data with the contributing factors behind this phenomenon. Considering no human life is dispensable, and a well tolerated and healthy working environment is a fundamental principal and right at work (https://www.ilo.org/global/topics/safety-and-health-at-work/areasofwork/fundamental-principle/lang--en/index.htm), we must protect the life of migrant workers from structural discriminatory process that undervalue their occupational safety and health (OSH), livelihood and the significant contribution these workers bring to their host countries.

This article aims to provide a broad perspective on the epidemiology of migrant workers from three different regions with a critical review of recently published studies. 

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Box 1:
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MIGRANT WORKERS IN THE AMERICAS

Approximately 45 million migrants lived in the United States in 2019, constituting 13.7% of the total US population, a figure that remains short of the record high of 14.8% in 1890.

In Fig. 1, we can demonstrate a constant growth of migrants in the country with a notable spike since the 1970s but at the same time, a stable migrant share of the US population of approximately between 10 and 15%.

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FIGURE 1:
Number of immigrants and their share of the total US population, 1850–2021. Sources: Migration Policy Institute (MPI) tabulation of data from U.S. Census Bureau, 2010–2019 American Community Surveys (ACS), and 1970, 1990, and 2000 decennial census.

In 2018, it was reported that roughly 11.2 million migrants living in the United States were from Mexico, accounting for 25% of all United States migrants, followed by China (6%), India (6%), the Philippines (4%) and El Salvador (3%) (Migration Policy Institute (MPI) [4]).

About 29 million migrants were working or looking for work in the United States, making up approximately 17% of the total civilian labor force. Lawful migrants made up the majority of the migrant workforce, at 21.2 million. An additional 7.6 million migrant workers are unauthorized migrants, less than the total of the previous year and notably less than in 2007, when they were 8.2 million. They alone account for 4.6% of the civilian labor force, a dip from their peak of 5.4% in 2007 (https://www.pewresearch.org/fact-tank/2020/08/20/key-findings-about-u-s-immigrants/).

Migrants are projected to drive future growth in the US working-age population through at least 2035. As the Baby Boom generation heads into retirement, migrants and their children are expected to offset a decline in the working-age population by adding about 18 million people of working age between 2015 and 2035 (https://www.pewresearch.org/fact-tank/2020/08/20/key-findings-about-u-s-immigrants/).

In 2021, foreign-born workers in the United States were more likely than native-born workers to be employed in service occupations; natural resources, construction and maintenance occupations; and production, transportation and material moving occupations. Foreign-born workers were less likely than native-born workers to be employed in management, professional, and related occupations and in sales and office occupations (www.bls.gov/news.release/pdf/forbrn.pdf) (BLS; see Table 1).

Table 1 - Employed foreign-born and native-born persons 16 years and over by occupation and sex, 2021 annual averages (percentage distribution)
Foreign born Native born
Occupation Total Men Women Total Men Women
Total employed (in thousands) 26 431 15 245 11 186 126 150 65 584 60 566
Occupation as a percentage of total employed
 Total employed 100 100 100 100 100 100
 Management, professional, and related occupations 35.2 33.1 38.1 43.9 39.7 48.5
 Management, business, and financial operations occupations 13.8 13.9 13.6 19.2 20 18.3
 Management occupations 9.4 10.6 7.8 13.1 14.6 11.4
 Business and financial operations occupations 4.3 3.3 5.8 6.1 5.4 7
 Professional and related occupations 21.4 19.2 24.5 24.7 19.7 30.2
 Computer and mathematical occupations 5.7 7 3.8 3.3 4.8 1.8
 Architecture and engineering occupations 2.5 3.4 1.2 2 3.3 0.7
 Life, physical, and social science occupations 1.3 1.2 1.4 1 1 1
 Community and social service occupations 1 0.7 1.4 2 1.2 2.8
 Legal occupations 0.5 0.3 0.8 1.3 1.2 1.5
 Education, training, and library occupations 3.8 2.2 5.9 6.3 3.1 9.8
 Arts, design, entertainment, sports, and media occupations 1.4 1.1 1.7 2.2 2.1 2.3
 Healthcare practitioners and technical occupations 5.4 3.2 8.3 6.5 3 10.3
 Service occupations 21.2 14.7 30 14.9 12.3 17.7
 Healthcare support occupations 4.1 1.1 8.3 3 0.9 5.3
 Protective service occupations 0.7 1 0.3 2.2 3.2 1.1
 Food preparation and serving related occupations 6 5.3 7 4.6 3.9 5.4
 Building and grounds cleaning and maintenance occupations 7.6 6.3 9.3 2.8 3.4 2.1
 Personal care and service occupations 2.7 1 5.1 2.3 1 3.8
 Sales and office occupations 14.2 10.7 18.9 20.9 15.2 27.2
 Sales and related occupations 7.1 6.3 8.2 9.9 9.5 10.3
 Office and administrative support occupations 7 4.3 10.7 11.1 5.7 16.9
 Natural resources, construction, and maintenance occupations 14.2 23.1 2 8.1 14.7 0.9
 Farming, fishing, and forestry occupations 1.5 2 0.9 0.5 0.8 0.3
 Construction and extraction occupations 9.8 16.2 0.9 4.3 8 0.3
 Installation, maintenance, and repair occupations 2.9 4.8 0.2 3.2 5.9 0.3
 Production, transportation, and material moving occupations 15.3 18.5 10.9 12.1 18 5.8
 Production occupations 6.8 7.2 6.3 4.9 7 2.5
 Transportation and material moving occupations 8.5 11.3 4.6 7.2 10.9 3.2
Updated population controls are introduced annually with the release of January data. Effective with January 2020 data, occupations reflect the introduction of the 2018 Census occupational classification system, derived from the 2018 Standard Occupational Classification (SOC). No historical data have been revised. Data for 2020 are not strictly comparable with earlier years. Source: https://www.bls.gov/news.release/forbrn.t04.htm#.

The United States and Canada receive many migrants but they have different immigration policies and health and social support systems. Although economic development through labor market participation is articulated as a priority of Canadian immigration policy, new migrant workers continue to find themselves in low-paying, precarious, high-hazard workplaces without access to resources to protect themselves.

In Latin America, since 2015, a significant exodus of Venezuelan nationals has occurred, mainly to Latin American countries. These people often have traveled by foot, walking as far as Chile ‘Los caminantes’. This massive and sudden migratory flow of more than six million Venezuelans due to political and financial crisis created many challenges for the region. Most migrants arrive in their host countries desperate for work and a source of income, which often results in immediate occupational vulnerability and precarious working conditions (Schulte et al.[5▪▪]; Ramos et al. [6▪]; Salinas and Salinas [7▪]).

Although this diaspora has increased the numbers of informal work in their host counties, the current Venezuelan crisis has also resulted in an unprecedented ‘brain drain’, which benefits host countries by the brain gain’ of often-overqualified individuals performing basic work. These workers have benefitted from the approval of specific legislation in the region, allowing legal relocation and often providing access to healthcare and other benefits resulting in millions of residence permits and work permits issued. A similar phenomenon happens in low–middle-income countries in Asia and Africa where the gain happens in their own former colonial powers (Schulte et al.[5▪▪]; Ramos et al. [6▪]; Salinas and Salinas [7▪]).

MIGRANT WORKERS IN THE EUROPEAN REGION

According to the International Labor Organization (ILO) [8] estimates, about 24% of the total 169 million global migrant worker population is found in the Northern, Western and Southern European regions . According to the intra-EU labour motility report in 2019 there were 1.5 million cross-border workers within the EU-28.

The pandemic excerbated the overrepresentation of migrant workers in low-skill jobs in high-hazard sectors like workers in cleaning, construction, mining, farming, food processing, and transport, including personal care workers (Fassani and Mazza [9]). In general, migrant workers in Europe perform jobs that were nonamenable to teleworking, given the essential nature of sectors that employ them requiring in-person manual handling tasks. Thus, these workers remained at the sharp end of the risk in terms of infectious exposure. Consequently, it is not surprising that several studies showed that low-skill, high-risk occupations like waiters, cleaners, care workers, and taxi drivers who tend to employ a large number of migrant workers sustained higher coronavirus disease 2019 (COVID-19) infection rates as the pandemic progressed (Magnusson et al.[10], Beale et al.[11], de Gier [12]). The vulnerability of the migrant workers in Europe vis-à-vis occupational health risks remains an under-profiled area in the epidemiological literature, partly because of tenuous data and in parts because of a lack of policy and research interest in this topic. EUROSTAT, the European agency that publishes statistics for accidents at work has not published any data or study on this topic, in particular. However, even before the current pandemic, several European studies had indicated the higher occupational health risks sustained by migrant workers compared with native workers (Sterud et al.[13], Arici et al.[14], Giraudo et al.[15], Ronda-Perez et al.[16]).

The essential services sector in Europe has largely been uninterruptedly functioning during the pandemic, so societies in Europe have been able to have some semblance of stability and predictability. This was possible not only because of the workers in the health sector but also other essential services where migrant workers are employed. Migrant workers have significant numbers in construction, transport (drivers), food processing, mining, cleaning, and recycling [7▪] (Fassani and Mazza [9]). These sectors are recognized as high-hazard sectors regarding injuries because workers are exposed to working at heights, electrical hazards, traffic accidents, hazardous machinery, confined spaces, and violent customers and clients. Studies from Spain and Italy seem to dominate the European literature on occupational injuries and migrant workers [Ronda-Perez et al.[17], Ahonen and Benavides [18], Ronda-Perez et al. [19], Salvatore et al.[20]). Perhaps, because of the large migrant populations that these two countries harbor. Studies from other European countries like Ireland, Denmark, and Norway also indicate similar findings in injuries of migrant workers (Ronda-Perez et al.[16], Biering et al.[21], Langeland [22], Davidson and Orr [23]).

Fragmented working arrangements (temporary and precarious work), noncompliant employers, willingness to work in less-than-optimal working conditions, inadequate social protection in host countries, lack of reporting because of fear of retaliation, and language barriers are among many factors associated with a higher risk of injuries among migrant workers.

The number of epidemiological studies on migrant workers and occupational injuries during the pandemic in Europe is as expected somewhat limited (Ramos et al.[24], Urrego-Parra et al.[25▪], Shepherd et al.[26▪], Martínez-Rojas [27]). The published literatures seem to focus largely on the agricultural and construction sectors. These studies indicate that migrant workers continue sustaining a higher risk for occupational injuries compared with native workers, which is consistent with the data from the prepandemic periods. A review published by Urrego-Parra et al. in 2022 reports the susceptibility of migrant workers to occupational injuries and accidents (Davidson and Orr [23]). This review asserts that migrant workers remain prone to occupational injuries in Spain and Italy. The most frequently reported injuries were falls from a height, followed by injuries with cutting/piercing instruments, insect, and snake bites, falls from the same level, and injuries with machinery; in addition, the main risk factors identified for suffering an accident or injury at work were the lack of knowledge about occupational safety and avoiding risky practices at work. A review conducted by Shepherd et al. in 2021 in the construction sector attributed the higher risks of injuries to, among others: increased use of subcontractors; dilution of safety standards down the supply chain; pressure to breach safety regulations on site; differing safety-related attitudes and behaviors due to national cultural differences, language barriers, and issues relating to training (Ramos et al.[24]). Almost a decade earlier, an epidemiological study from Norway (2010) found a higher risk for occupational injuries among migrants than the native population (Ohm et al.[28]). This study attributed the higher rates of occupational injuries among migrants to a higher risk of exposure to occupational hazards (overrepresentation in high-hazard sectors), combined with language barriers and inadequate safety training.

Unfortunately, there remains a glaring paucity of epidemiological data and studies on occupational injuries and migrant workers. The pandemic has thrust the migrant workforce in Europe into a more precarious situation, especially those in essential services, as they continued to work in lockdowns with limited resources, time pressures, precarious working conditions, and quarantine. As Europe attempts to emerge from the pandemic, we hope that more epidemiological data and studies will be conducted to create more evidence, which will reveal the effect of the pandemic on the risk of injuries to migrant workers. There is no conclusive data on the subject of migrant workers and occupational injuries during the pandemic. We will likely see an exacerbated risk of injuries during the pandemic among the migrant workers because of the cumulative effect of known risk factors along with the precarious working conditions precipitated by the pandemic.

MIGRANT WORKERS IN THE ASIA-PACIFIC REGION

The Asia-Pacific region consists in several of the world's largest workforces that are major sources of both internal (domestic) and international migrant workers. Disturbing scenes such as the postlockdown ‘long march’ to home villages by domestic migrant workers in India (Mohan and Mishra [29]) drew attention to the unequal impact of COVID-19 pandemic on migrant workers. Internal migrants themselves are a significant worker population in the region, especially in India and China. However, analysis on how the pandemic exposed migrant workers in the region more vulnerable to health and safety risks at work is limited, for example, to unsatisfactory accommodation for low-skilled migrant workers in Singapore (Koh [30]).

An International Organization for Migration (IOM) review of global data sources on occupational fatalities (Brian [31▪▪]) reported that migrants who consist most of national labor forces in the Gulf region of West Asia, suffer a majority of workplace fatalities. Some of the statistics from the IOM report are alarming and indicate a disturbing prevalence that has been largely overlooked. Existing government data showed that approximately 16 Indian workers died each day on average (authors’ emphasis) in the Gulf region between 2014 and 2019 and two Nepali workers abroad died each day on average every year since 2008. Over 37000 bodies of Bangladeshi workers were repatriated back home since 2000. A review by Sweileh [32] in 2018 showing the low global research output on the health of migrant workers noted this limitation was critical in the Arab region, which hosts 11% of the international migrant workforce.

National data on accidental injuries at construction sites in Korea between 2010 and 2019 showed higher severity among migrant workers (Kim et al.[33]). An analysis of over 40 000 occupationally injured migrant construction workers of Chinese nationality in Korea identified that policies on their prohibition in changing workplaces was a risk factor for the significantly higher occupational fatalities (Lee and Cho [34]).

Australia is a major high-income host country in the Asia-Pacific region for migrant workers but has sparse epidemiological studies on workplace fatalities or injury and illness among its diverse migrant workforce. Patterns of deaths and hospital admissions from work-related injuries among foreign-born workers were reported to have reversed in recent decades because of changes in migration demography (Reid et al.[35]) but this conclusion must be treated with caution. Coroners’ reports and hospital admissions overlook the higher incidences of injury and illness among migrant workers evident from on-field sources in certain occupations and industries.

A position paper by Aktas et al.[36] in 2022 that analyzed two recent systematic reviews on the occupational health of migrant workers identified a lack of longitudinal studies and recommended targeted research with mixed methodology (surveys, registries, qualitative studies).

Workplace fatalities, injuries, and illness in the Asia-Pacific region prior to the pandemic itself are alarming, despite the limited data and lack of comprehensive research approaches. Would this prevalence gain serious political and regulatory attention in any country, if the victims were native born workers?

Global labor shortages are making unprecedented demand for workers from low-income countries to fill low skilled, precarious jobs in higher income countries. This crisis should be an impetus for government agencies and researchers in host countries to give much needed attention to the health and safety of migrant workers and ensure that it is not acceptable to exploit vulnerable workers because they do not ‘belong’.

CONCLUSION AND RECOMMENDATIONS

This article looked at several recent reports on injuries and fatalities among migrant workers in the Americas, Europe, and the Asia-Pacific region. It provided some perspectives on the challenges, as well as the apparent indifferences, in documenting the epidemiology of these vulnerable workers.

The unprecedented impact of the COVID-19 pandemic on migrant workers provided a greater focus on their plight globally. We call international agencies and government policy makers to commit resources and build partnerships on the following areas to improve the health and safety at work, which is a principal driver international and the less visible, domestic migration.

Research

Reliable and efficient data collection on OSH of migrant workers and the inclusion of their perspectives in academic health programs will foster mainstreaming analysis and knowledge generation. This will give the basis to inform OSH policymakers and practice in the long-term contributing to the future of decent health.

Countries should increase and prioritize the funding opportunities for research to close gaps, create scientific evidence and have reliable data to be used for preventive measures in practice and create policy that would protect migrant workers.

Policy

Policy should have a global view of implementation addressing all phases of migration.

The hierarchy of controls must be applied at the workplace to achieve the highest possible preventive effect, with policies that prioritize the collective safety measures over the focus on individual capacities.

Efforts should be made globally to create realistic pathways to a legal status for migrants, in order to facilitate data registry that will foster more research on migrant populations.

Practice

Migrant workers usually perform the most precarious 4-D jobs available, with very high prevalence of diseases and injuries, regardless of their education level or abilities back in their country of, for example, demolition, agriculture, and garbage collection. Although there is dignity in every job done, employers and lawmakers must provide the minimum required protection and preventive measures to guarantee healthy and dignifying workplaces.

Active inclusion of migrant workers’ perspectives in broadening tripartite dialogue will facilitate better profiling of their OSH issues as stakeholder dialogue in many countries rarely has the representation of vulnerable groups.

Employers must consider linguistic and cultural diversity in their health and safety training.

Language-neutral means to communicate OSH should also be a primary consideration. The example of Napo, the hero in a series of animated films developed by EU-OSHA, provides light-hearted and thought-provoking introductions to OSH topics and risk prevention, which has achieved remarkable global outreach.

Enforcing OSH law through inspections and interventions remains the most effective measure of improving OSH and protecting the health of workers. Labour inspectorates must, therefore, make a committed effort to protect and promote the health of migrant workers by providing necessary guidance and enforcing OSH legislation with good governance.

Acknowledgements

None.

A.S.-N.: ORCID No. 0000-0001-9391-4589.

Y.S.: ORCID No. 0000-0002-3975-4905.

Financial support and sponsorship

None.

Conflicts of interest

There are no conflicts of interest.

REFERENCES AND RECOMMENDED READING

Papers of particular interest, published within the annual period of review, have been highlighted as:

▪ of special interest

▪▪ of outstanding interest

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Keywords:

epidemiology; migrant workers; occupational health; precarious jobs; vulnerable workers

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