Transcript Diapositiva 1

Research, Policy and Practice With Regard to
Work–Related Mental Health Problems in Chile:
A Gender Perspective
Ximena Diaz, Amalia Mauro, Julia Medel, Elisa Ansoleaga
CENTRO DE ESTUDIOS DE LA MUJER, CHILE
Katherine Lippel, Caroline Couillard
CRC in Occupational Health and Safety Law, UNIVERSITY of OTTAWA, CANADA
Michel Vézina, Karen Messing, Stephanie Bernstein
Teasdale-Corti Program Symposium
1 – 3 October 2012
OTTAWA
www.proyectoaraucaria.cl
Presentation outline
 Chilean context and the research questions
 Working conditions in Chile: why did we seek to do
this project?
 The research team: how we worked together
 Definitions
 The research accomplishments
 Empirical work in Chile
 Comparative regulatory analysis in sixteen
countries
 Role of research users
CHILE: a case of unequal development with
an aging population
 Population: 16.572.475 people, 51.5% are women; 87% live in
urban areas
 Life expectancy: 75 years for men, 81 years for women
 Fertility rate 1.87 children born per woman (birthrate is 14,28
born per 1000 inhabitants)
 Employed population: 7.637.393. Female participation in the
labour market is 42.7%
 71% of the employed population are salary earners
(employees)
 Unequal distribution of income: 10% of the richest households
earned 35.6 times what the poorest 10% earned
Workers’ mental health: a public health problem in
Chile
In Chile, mental health problems are the first reason for sick leave*.
The rate is similar for men and women even though fewer women
are in the work force
 In 2005 "emotional and behavioral disorders" were the third leading
cause of sick leave
 In 2010 they were the first cause of sick leave and represented 24% of
the total number of leaves requested that year.
 68.6% of sick leaves for that reason are requested by women
*Type 1 Sick leave : common diseases, account for more than 90% of the total
number of sick leaves (non professional leaves)
Few studies had examined work-related mental health
issues and far fewer have used a gender lens
Invisibility of mental health problems as
occupational diseases
 In Chile, mental health problems are legally recognized as
occupational diseases in theory but in practice few claims
are accepted
 Most of the diseases of workers, both men and women,
are labeled as common diseases, although they have often
been caused or aggravated by work.
 Mutuales reported 4,171 cases of occupational disease in
the year 2009, in an insured population of 3.593.299, a
rate of approximately 1.6 per 1000 workers insured
Program Research Objectives
 Axis 1: To undertake a Chilean study to identify occupational
factors that affect mental health, particularly in light of new forms
of work organization, taking into account the differential and
unequal gender division of work, both paid and unpaid.
 Axis 2: Comparative study of law, policy and interventions on
psychosocial hazards, mental health and work, analysed through
a gender lens:
 provide an international overview of regulatory instruments in
a variety of countries that were designed to reduce exposure
to psychosocial hazards and ensure compensation for
disability attributable to work-related mental health problems.
 document best practices in their implementation.
Program capacity building and knowledge
transfer objective:
To expand knowledge of all team members
(researchers and research users) with regard to
technical, political and institutional issues in order to
promote better monitoring of working conditions that
are a risk for mental health, to influence public
debate and the elaboration of policy and standards
on labour, gender and mental health, while providing
scientifically valid evidence that takes into consideration social
and gender inequality
The team: researchers
Researchers from
Canada and Chile
with a long research
experience in the
themes of the
program, from
different disciplinary
perspectives.
 Gender studies
 Sociology
 Law
 Ergonomics
 Occupational
Medicine
 Psychology
The team: researchers
Researchers
from Canada
and Chile, from
different
institutional
perspectives.
Universities: Ottawa, Laval,
UQAM, Diego Portales
(UDP)
Women’s Studies Center
(Centro de Estudios de la
Mujer)
Government institutions:
Instituto de Salud Pública,
Institute of Public Health,
Chilean Ministry of Health
The team: research users
From the beginning the program integrated a wide range of
research users representing:
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Unions: Health workers, Retail workers, workers of
the manufacturing industry, civil servants,
temporary agricultural workers
Civil organizations: Fundación SOL, Observatorio
Equidad de género en salud
Government institutions: Instituto de Salud Pública
y Departamento Salud Ocupacional de la Región
Metropolitana del Ministerio de Salud, Dirección del
Trabajo
Two axes of research
Axis 1
 Empirical study of
working conditions in
relation to
psychosocial hazards,
from a gender
perspective
 In Chile
Axis 2
Policy analysis of
regulatory protections
for workers’ mental
health from a
comparative
perspective:
16 countries, including
Chile and Canada
Key words to be unpacked
Gender filters in policy and practice
 Whose gender?
 Workers
 Supervisors
 Colleagues
 Institutional actors
 Union representatives
 What issues?
 Differential exposures
 Working conditions
 Employment conditions
 Messing & Östlin,2006
 Differential consequences
 Employer representatives
of poor policy
 NGOs
 i.e. Work/family balance
 Labour inspectors
 Policymakers
 Decision makers
EQCOTESST, 2011
 Differential perceptions of
psycho-social hazards
 Salin, 2008
What psychosocial hazards?
 Job strain
 Different communities
 Iso strain
of practice
 Effort-reward
 Different scientists
imbalance
 Inadequate protection
of work-family balance
 Occupational violence
 Employment strain
 Different “consultants”
 Different professionals
 Different institutional
actors and allies
 Different «business
case»
Institutional and workplace actors
 What
institutions/which legal
frameworks?
 Labour & social
security law
 OHS Prevention
 Workers’
Compensation/social
insurance
 Minimum Standards
 Constitutional law
 Which actors
 Labour inspectors
 Public Health officials
 Judges
 NGOs
 Which countries?
 Answers to all previous
questions vary
jurisdictionally
 Sometimes prevention but
not compensation,
sometimes compensation
but not prevention
What role for precarious
employment?
Precarious
contractual
arrangements
Job insecurity
Precarious
employment
Informal sector
Employment
insecurity
Axis 1. Methodological approach:
1) Research program; 2) capacity building
1) Research program

Two-step study on employment conditions, psychosocial
risks, mental health and gender in Chile
o
A qualitative study (2008-2009) using three data collecting
strategies: Observation of workplaces; In-depth interviews;
and Discussion groups
o
A quantitative study (2011). A survey with 77 closed-ended
questions applied to a nationally representative probabilistic
sample of salaried workers: 1,486 women and 1,524 men
What issues?
 Employment conditions: type of contract, subcontracting, wages,
unemployment, working hours, social security
 Psychosocial hazards: demand-control-social support, job strain,
iso strain (Karasek and Theorell’ Model); effort, rewards, effortreward imbalance (Siegrist Model)
 Occupational violence: sexual harassment; psychological
harassment; verbal and physical violence
 Gender: domestic unpaid work load; interference family-work,
workplace composition by gender
 Mental health: distress, depressive and anxiety symptomatology,
psychotropic consumption, hazardous alcohol consumption
Women and men workers perceive:
 high psychological demands
 little control over his/her work and opportunity to
exercise abilities
 low social support from their peers and superiors
 high imbalance between efforts and rewards
 high levels of work-family interference among women
More women than men perceive high demands, low
control, high effort/reward imbalance
The survey showed a strong association between the quality
of employment and exposure to psychosocial risk at work
 Workers with the poorest quality of work are the most exposed to
psychological tension: unskilled workers (of services, agriculture,
industry and transportation sectors)
 Workers with the best quality of work are less exposed to
psychological tension: managers, professionals and technicians
 The perception of imbalance is higher in those with poor quality
of employment
More women than men report imbalance and the differences are
higher in management positions (68% women, versus 40%
men), and in unskilled workers (75% women versus 56% men)
 More women than men report symptomatology associated with
mental health problems: high depressive symptomatology, high
distress, and psychotropic drug consumption
Mental health outcomes by sex
Prevalence of depressive symptoms, distress and
psychotropics consumption is significantly higher
in women than men:
 5% of men and 15% of women report high
depressive symptomatology
 15% of men and 24% of women report high
distress
 10% of men and 20% of women report
psychotropic drug consumption
Psychosocial hazards and mental health
problems
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Exposure to psychosocial risk at work is associated
with psychological health of working population in
Chile
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Workers exposed to:
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psychological demands (OR:1,91)
low social support (OR:1,77)
Job strain (OR:1,83)
Isostrain (OR:2,19)
high effort (OR:1,54)
low rewards (OR:2,11) and
effort-reward imbalance (OR:2,06)
have an increased risk of depressive symptoms
than those not exposed
Axis 2:Methodological approaches
 Transdisciplinary approach to the problem
 Analysis of relationship between prevalence of hazards in a given
jurisdiction and regulatory frameworks
 Québec (EQCOTESST)
 Chile (Araucaria survey)
 Classic legal analysis
 Law governing mental health and work
 Prevention of psychosocial hazards
 Compensation for disability attributable to work-related mental health
problems
 Comparative law: 16 countries (+ EU), 38 jurisdictions + EU
 Teasing out system effects
 Teasing out and contextualizing best regulatory practices
 Analysis of regulatory effectiveness
 Brazil, Chile, Québec…
 Role of research partners and community input
Impressionist policy portraits
Best regulatory/intervention models
 Various jurisdictions provide models of interesting
legal and policy tools that allow inspectorates, public
health officials and unions to intervene for the
prevention of psycho-social hazards.
 Quinlan, 2007 (restructuring and psycho-social hazards)
 Velasquez, 2010
 Rasmussen, 2011
 Moncada, 2011 (ISTAS 21)
 Vézina & Chénard, 2011
Links between compensation and
prevention
 Compensation for
disability related to
psychosocial hazards,
including occupational
violence, exists in
some jurisdictions and
not in others
 Lippel & Sikka, 2010
 Lippel, 2011
 Squelch & Guthrie, 2010
 Where it exists, it is
easier
 to make the “business
case” for prevention
 to ensure training and
voice for worker
representatives…but
what voice?
 to convince
policymakers of the
need for prevention
Objectives and impact
 To make a better
working world for men
and women workers
by understanding
differential exposures
to hazards and tools
for prevention and
compensation
 To better understand
the differential impact
of these tools
 Perspectives:
 Gender
 Local political and economic
context
 Power imbalances
 What regulation?
 What tools for
intervention?
 Applied by whom?
 To what end?
 With what effect?
Theory of change (Jones, 2011)
 Two approaches
 ‘inside track’: working
closely with decisionmakers
 ‘outside track’ : seek
to influence change
through pressure and
confrontation
 In Araucaria our
collaboration with
research users
allowed us to use both
approaches
Capacity building and knowledge transfer:
strategies to transfer research into practice and action, and to
promote change
- Through workshops, and educational material workers and labor
inspector now identify worker’s mental health as a priority and
recognize psychosocial hazards at work. (34 workshops, 715 trained
workers)
- Through Seminars, Conferences, participation in academic networks
the Program has contributed to strengthening critical academic thought
on the mental health of workers, incorporating new models and
analytical perspectives including gender lens
- Through participation in government institutions, has addressed
psychosocial hazards in its occupational health policy and the team is
recognized as a valid interlocutor in this field.
We adopted a systemic approach to capacity-building and learned from
community partners ourselves while providing them with the
opportunity to increase their intervention capacity through participation
in the research program.
Working with the research users
 Different types of research users: different ways
of working together
Workshops
Educational material
Bilateral meeting
Training the trainers
Participation in working groups and networks
Some examples
Asociación Nacional de Mujeres Rurales e
Indígenas (ANAMURI)
 Is a women’s group comprised of temporary agricultural
workers, rural and indigenous women.
 What have we done?
 Workshops to sensitize members of the organization on the
associations between mental health of women working in the
agricultural sector (seasonal) and their working conditions.
 Collaborative production of a booklet on mental health
problems related to work and to gender issues.
 Several meetings and workshops organized in various parts of
the country to disseminate and discuss the booklet.
Asociación Nacional de Empleados Fiscales
(ANEF) The largest association of civil servants in
the country
What have we done?
 Several workshops to promote the eradication of
discriminatory practices towards women (psychological
harassment, sexual harassment, schedules that are
incompatible with work-family balance etc.)
 Pamphlet on Code of Good Labour Practices in the State’s
Central Administration)
 Booklet on Moral Harassment
 Bilateral meetings to support the implementation of an
Observatory on gender discriminatory practices in the civil
service.
Conafutech: (Confederación Nacional de
Funcionarios Técnicos en Enfermería de Chile)
What have we done?
 Support to analysis and processing of a survey applied by the
union, on the daily workloads of nursing technicians employed by
the civil service in the VIIIth region of the country.
 Collaborative preparation of a project on daily workload of health
workers presented to the Oficina Panamericana de la Salud en
Chile and to the Wellcome-Trust (British agency which funds
projects to encourage the public appropriation of health
research).
 Workshops on work related mental health problems and gender
issues
 Training on measuring workloads and their effect on the mental
health taking into consideration women’s workload outside of
their employment.
Government Institutions: strategies to
influence policy
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Training labour and health inspectors: in collaboration
with Dirección del Trabajo
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Participation in working groups convened by government
institutions:
By SEREMI de Salud Metropolitana to promote a
permanent dialogue with civil society on occupational
health programs
By Ministry oh Health to participate in:
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the Consultative Council on Gender;
an Expert panel to adapt a Québec tool to identify
psychosocial risk at work;
a working group to elaborate a Psychosocial hazards
surveillance protocol
Conclusion-1
 In Chile, few studies had examined work-related
mental health issues and far fewer had used a gender
lens. The activities of our research team have
changed this portrait.
 The relationship between work and mental health,
seen from a gender perspective has been recognized
as a topic of interest and preoccupation by policy
makers, community and social organizations, and
academics.
 organizations have been encouraged to include these
topics and diagnostics in their institutional activities.
 The research team is recognized as a valid
interlocutor in this field.
Conclusion 2
 Researchers and workplace actors from many
jurisdictions around the world are now paying
more attention to psychosocial hazards and
the role of state actors and workplace actors
in their prevention.
 Policy makers and those responsible for their
implementation have access to up to date
analyses of best practices and challenges.
Challenge - 1
All of this to be done in a context of work
intensification and globalisation where
‘‘many of the factors that have contributed to the
declining influence [of workers’ representation on
health and safety] are the same ones that
contribute to the rise in psychosocial risks and their
effects at work’’.
Walters, 2011
Challenge - 2
Thank you very much
For more information:
www.proyectoaraucaria.cl