Migrant men's occupational health
Article Outline
Interest in men's health is growing, albeit not at the rate that is warranted. Throughout the world there is evidence that men live shorter lives than women and, with the exception of women-specific biological processes such as pregnancy and childbirth, much of the morbidity men experience is more complex and is associated with worse outcomes. In 2001, the number of Disability Adjusted Life Years (DALYs) lost by men continued to be disproportionately higher than that for women in all regions of the world other than South Asia [1]. In Europe and Central Asia, for example, the total DALYs for 2001 were 278.3 for men and 212.5 for women [1]. Despite these glaring disparities, health policies and programs specifically designed to redress this situation and improve the health of men remain poorly addressed.
Hopefully, as more work begins to be done on the theme of men's health, attention will also be given to a related and rapidly growing challenge, namely the health of migrant men. Throughout the world, the pace of migration is accelerating rapidly and it is becoming an important lifeline for both the sending and receiving countries. Poverty continues to be a key push factor everywhere, but the need by industrial and post-industrial countries to overcome labour shortages in industrial areas such as mining, construction and intensive agriculture has also become an important pull factor. The number of women who are moving, and doing so alone, is also growing and in 2005 it began to approximate and, in some cases, to outpace that of men. But the fact remains that migration as an avenue of improving family incomes is still seen in most parts of the world as primarily the responsibility of men as heads of households [2], and it is the men who are expected to move in search of work.
Migration, however, is rarely a simple or easy process. Even under the most ideal circumstances it can be psychologically debilitating. People typically have to leave close families and relatives and move into what are often ‘uncharted waters’, not knowing what their chances of finding work are going to be, and when or if they are going to be able to reunite with their families. In recent years the conditions surrounding migration have been made more problematic by the adoption by receiving countries of policies that seek to prevent men (or women) taking their families with them when they move [3]. The assumption behind these policies, that most migrant workers will not stay for long periods, has been shown to be highly flawed, but continues to be upheld by policymakers even at a time when the need for new labour resources and demographic replenishment is growing and when most economic sectors are looking for worker continuity. Even when this is not the case, the fact is that migrants, irrespective of their legal or recruitment status, find other jobs and end up staying gainfully employed for indefinite periods of time [4].
Coping with the implications of leaving partners and children behind is difficult and inevitably requires that migrants develop coping strategies to deal with the loneliness, homesickness and insecurity that surround much of contemporary migration. Some of these strategies bring serious implications for health in their wake. The abuse of alcohol and tobacco by migrant men, for example, has become a major problem and an important obstacle to reaching national goals of lowering smoking behaviour among men in general. In Europe, where the prevalence of male smoking is 56% compared to 17% in women ([5]: see table 46.1), migrant men are becoming the main contributors to the problem and are probably highly represented in the total number of tobacco-related DALYs lost in 2000 (12,407 for men and 2,686 for women) ([5]: see table 46.2) as well as deaths in Europe ([5]: see table 46.2). Policies designed to limit the movement of migrants with families have also contributed to the reliance of male migrants on sex-industries and prostitution [6] and it should not be surprising that in many parts of Europe, the rates of new cases of sexually transmitted infections, including HIV, among migrants are now surpassing those of many national host populations.
The occupational health of migrant men has also become a serious problem. For a variety of inter-connected reasons the entry of migrant men into the sphere of heavy industry has been poorly regulated and supervised, and today it is characterised by high rates of occupational diseases, accidents and serious disabilities [7]. In some European countries the rate of occupational accidents involving migrant men is between 5 and 7 times higher than that among non-migrant men [7], [8] and even this may well be a gross under-estimation of the true situation because good data are not available.
Male migrant workers are also less likely than non-migrant men to seek help or to use whatever health and social services are, in principle, available to them. Sometimes they simply do not know what services exist or what their rights are in terms of health care and/or compensation. Because migrant men (and women) often work in non-unionised industries, job insecurity is a constant source of concern and seeking care or even taking time off to seek it calls for careful consideration [9]. Promoting and protecting the health of migrant men, however, is often made more difficult because many come from societies where, over the years, there has been an experiential and cultural adaptation to poverty, poor health and the lack of health care. As a result migrant men, at times, either have a more stoical attitude to pain and disease or are able to feign it and fail to seek help when it is most needed.
In the agricultural industry, chronic exposures to pesticides and insecticides have produced respiratory and neurological problems that have led to serious behavioural presentations as well as illnesses [10], [11]. Meanwhile in the construction industry, falls, muscular skeletal injuries and hearing problems are the major outcomes of migrant working situations that remain poorly defined and supervised [12]. In some industries employers remain reluctant to invest in the type of training and on-the-job safety supervision that migrant workers would ideally require, and argue that migrant workers are transient, speak difficult to understand or ‘hard to communicate in’ languages and do not have the same attitudes to safety. The reality is that many migrant men are expected to use or be close to technologies that, in fact, they are not familiar with and for which, again, there is little careful introduction [12].
The growing pace of migration and its implications for health has been largely ignored by the international community as well as by national governments. At its 122nd Executive Board meeting, however, the World Health Organization (WHO) placed migrant health on the agenda and the resultant resolution, EB122.R5, calling for attention to this domain of public health will be presented to the 61st World Health Assembly in May, 2008. At that time Member States will be called on to take more concerted action to address the problem and take more specific action to promote and protect the health and welfare of migrants. Addressing the gender differences in migrant health and acknowledging the role played by occupational diseases and accidents in migrant men's health will hopefully emerge as a key theme in the WHO's response.
References
- Buvinić M, Médici A, Fernández E, Torres AC. Gender differentials in health. p. 195–210 in Disease control priorities in developing countries, 2nd edition. New York: Oxford University Press; 2006. Available at: http://www.dcp2.org/pubs/DCP/10/FullText.
- . State of the world population 2006. A passage to hope: women and international migration. New York: UNFPA; 2006;Available at: http://www.unfpa.org/upload/lib_pub_file/650_filename_sowp06-en.pdf
- . Migration and diabetes: the emerging challenge. Diabetes Voice. 2006;51(2):31–33Available at: http://www.icmh.ch/WebPDF/2006/2006-007%20-%20Migration%20and%20Diabetes%20Article/Article%20as%20published.pdf
- de Melo J. Migration, remittances and the brain drain: a symposium in memory of Riccardo Faini - an introduction. World Bank Econ Rev 2007;21(2):173–76.
- Jha P, Chaloupka FJ, Moore J, et al. Tobacco addiction. p. 869–86 in Disease control priorities in developing countries, 2nd edition. New York: Oxford University Press; 2006. Available at http://www.dcp2.org/pubs/DCP/46/FullText.
- . Sexual behavior and the vulnerability of migrant workers for HIV infection. Culture, Health, Sexuality. 2002;4(4):459–473
- . Migration and health in the European Union. Trop Med Int Health. 1998;3(12):936–944
- . Risk of fatal and non-fatal occupational injury in foreign workers in Spain. J Epidemiol Community Health. 2006;60:424–426
- . The process of social insertion of migrants, refugees and asylum seekers in the context of access to and use of health and social services. Geneva: ICMH; 2004;
- . Occupational health problems among migrant and seasonal farm workers. West J Med. 1992;157(3):367–373
- . Occupational injuries among North Carolina migrant farm workers. Am J Public Health. 1991;81(7):926–927
- European Agency for Safety and Health at Work: European Risk Observatory. Literature study on migrant workers. Bilbao: European Agency for Safety and Health at Work. 2006; p. 1–58. Available at: http://osha.europa.eu/priority_groups/migrant_workers/migrantworkers.pdf.
PII: S1875-6867(08)00055-9
doi:10.1016/j.jomh.2008.02.006
© 2008 Published by Elsevier Inc.
