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 outlineChilean context and the research questions

Working conditions in Chile: why did we seek to do this project?

The research team: how we worked togetherDefinitions

The research accomplishmentsEmpirical work in ChileComparative 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 ChileIn Chile, mental health problems are the first reason for sick leave*.The rate is similar for men and women even though fewer womenare 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 studiesSociologyLawErgonomicsOccupational

MedicinePsychology

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:

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 1Empirical study of working conditions in relation to psychosocial hazards, from a gender perspectiveIn Chile

Axis 2Policy 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?WorkersSupervisorsColleaguesInstitutional actors

Union representativesEmployer representativesNGOsLabour inspectorsPolicymakersDecision makers

What issues?Differential exposures

Working conditionsEmployment conditions

Messing & Östlin,2006Differential consequences

of poor policy i.e. Work/family balance

EQCOTESST, 2011

Differential perceptions of psycho-social hazards

Salin, 2008

What psychosocial hazards?

Job strainIso strainEffort-reward

imbalanceInadequate protection

of work-family balanceOccupational violenceEmployment strain

Different communities of practiceDifferent scientistsDifferent “consultants”Different professionals

Different institutional actors and allies

Different «business case»

Institutional and workplace actors

What institutions/which legal frameworks?

Labour & social security lawOHS PreventionWorkers’

Compensation/social insurance

Minimum StandardsConstitutional law

Which actorsLabour inspectorsPublic Health officialsJudgesNGOs

Which countries?Answers to all previous

questions vary jurisdictionally

Sometimes prevention but not compensation, sometimes compensation but not prevention

What role for precarious employment?

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, effort-reward 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 employmentMore 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

Exposure to psychosocial risk at work is associated with psychological health of working population in Chile

Workers exposed to: 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 symptomsthan 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 analysisLaw 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, 2010Rasmussen, 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, 2010Lippel, 2011

Squelch & Guthrie, 2010

Where it exists, it is easier to make the “business

case” for preventionto 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:GenderLocal political and economic

contextPower 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 decision-makers

‘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 materialBilateral meetingTraining 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

Training labour and health inspectors: in collaboration with Dirección del Trabajo

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:

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 - 1All 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

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www.proyectoaraucaria.cl