Exploring priority occupational diseases in vulnerable workers and reasonable accommodations
1. Dr. Turusbekova Akshoola Kozmanbetovna
2. Udayveer Singh
(Teacher, International Medical Faculty, Osh State University, Kyrgyzstan
Student, International Medical Faculty, Osh State University, Kyrgyzstan)
Abstract
This comprehensive research report evaluates the critical intersection of occupational health and worker vulnerability, specifically focusing on pregnant, adolescent, older, and migrant populations. Through a systematic analysis of global occupational safety and health (OSH) frameworks, literature appraisal, and hazard identification, the study delineates the priority diseases and injuries disproportionately affecting these cohorts. The report maps these findings against the International Labour Organization (ILO) standards, including the Occupational Safety and Health Convention (No. 155) and the List of Occupational Diseases (Recommendation No. 194). Key findings highlight the prevalence of "3D" jobs (dirty, dangerous, and demanding) among migrants, developmental risks for adolescents, and the physiological and discriminatory barriers faced by pregnant and older workers. The analysis concludes that reasonable accommodations—ranging from ergonomic redesign and native-language training to flexible organizational structures and heat action plans—are essential for aligning workplace practices with international human rights and OSH mandates.
Keywords: Occupational Safety and Health (OSH), Vulnerable Workers, ILO Standards, Migrant Labor, Pregnant Workers, Adolescent Health, Aging Workforce, Reasonable Accommodations, Recommendation No. 194.
Introduction: Theoretical Foundations of Occupational Vulnerability
The global landscape of labor is increasingly defined by the participation of demographic groups that fall outside the traditional profile of the "standard" worker. These vulnerable populations face unique health trajectories dictated by the interaction between their physiological profiles and the socio-economic conditions of their employment.1 Occupational safety and health (OSH) is fundamentally a component of "decent work," yet for these cohorts, decent work deficits are frequent.1
The International Labour Organization (ILO) provides the primary normative framework for addressing these disparities. Since its inception in 1919, the ILO has utilized Conventions and Recommendations to establish international treaties and guiding principles that bind member States to specific health and safety outcomes.3 The significance of these standards lies in their practical application: they reflect feasible social progress while pointing toward a future where the workplace is inherently a site of health promotion.3 However, the reality for many of the world's 164 million migrant workers is a persistent exposure to risks that lead to a higher incidence of occupational injuries compared to their non-vulnerable peers.1
Section 1: Literature Search and Methodological Critical Appraisal
Evaluating the Quality of Occupational Health Research
A critical appraisal of the available literature reveals significant heterogeneity in study design. Occupational health literature frequently fails to adequately identify the specific characteristics of migrant groups, such as their legal status or language proficiency, which are essential confounders for health outcomes.6 Most existing research is concentrated in middle- and high-income regions, leaving a substantial gap in the understanding of risks in developing economies where informal sectors and loose regulations are more prevalent.5
When assessing the health of vulnerable workers, researchers utilize several methodological approaches, each with inherent strengths and weaknesses:
● Registry-Based Studies: Longitudinal nature with objective data, but they lack context and may use "crude" proxy variables.7
● Survey Studies: Tailored for the purpose of the study, yet subjective due to self-reporting and potential lack of trust from respondents.7
● Qualitative Studies: Provide a deeper understanding of phenomena and include marginal communities, though analysis is time-consuming and harder to maintain scientific rigor.7
The Expert System for Identification of Occupational Diseases
To bridge the gap between exposure and diagnosis, the ILO proposes an "Expert System" for identifying occupational diseases.8 This methodology utilizes an algorithm that integrates four primary vectors:
1. Industry and Occupation Identification: Identifying the specific task.8
2. Exposure Estimation: Quantifying the frequency and magnitude of exposure to physical, chemical, or biological agents.8
3. Clinical Evidence: Recording physical findings and utilizing specialized tests, such as lung volume or enzyme levels.8
4. Confounder Management: Accounting for non-occupational causes like family history or environmental factors.8
Section 2: Priority Occupational Diseases in Migrant Workers
The "3D" Job Phenomenon and Health Disparities
Migrant workers represent 4.7% of the global workforce and are disproportionately represented in "3D" jobs: dirty, dangerous, and demanding.6 These occupations inherently expose workers to higher environmental hazards and precarious employment conditions. Epidemiological evidence indicates that migrants face a significantly higher risk of injury; in 73% of countries where data is available, fatal occupational injury rates are higher for migrants than for native-born workers.6
Mapping Priority Diseases for Migrants
According to ILO estimates, over 75% of work-related deaths are attributed to chronic diseases rather than acute accidents.6
● Circulatory Diseases: Responsible for 31% of work-related deaths globally.
● Malignant Neoplasms: Responsible for 26% of work-related deaths globally.6
● Respiratory Diseases: Accounts for 17% of work-related deaths.
● Musculoskeletal Disorders (MSDs): Extremely frequent due to manual, physically demanding tasks and maintained upright positions.6
● Mental Health Disorders: Migrants experience higher levels of anxious-depressive and psychotic disorders due to migration trauma and discrimination.6
A recent meta-analysis of 7,260 international migrant workers found a pooled prevalence of at least one occupational morbidity at 47%.
Reasonable Accommodations for Migrants
Protection is anchored in Conventions No. 97 and No. 143, mandating treatment no less favorable than that of nationals.1
● Language Accommodations: Safety training must move beyond simple translation to customize the format and use visual-heavy materials.10 Employers should use "teach-back" methods to confirm comprehension.11
● Housing Standards: For many migrants, work and living facilities are linked. ILO standards require a minimum of 198 cm by 80 cm for sleeping space and at least 203 cm of headroom for free movement.13 Facilities must provide one toilet, washbasin, and shower for every six persons.13
Section 3: Pregnant and Breastfeeding Workers - Reproductive OSH
Physiological Vulnerability and Obstetric Complications
The occupation of a woman during pregnancy can have profound impacts on fetal development.14 Exposure to hazards can lead to miscarriage, preterm birth, and hypertension.14 A cohort study found that women with more than two night shifts in a week had a 32% increased risk of miscarriage after the eighth week of pregnancy.15 High work stress is associated with a 4.85% prevalence of preterm birth compared to 4.82% in low-stress groups.15
Priority Hazards for Pregnant Workers
● Chemical: Anesthetic gases (miscarriage risk) and formaldehyde (oncogenic/infertility risk).16
● Physical: Noise above 85 dB (restricted intrauterine growth) and extreme heat (placental detachment and fetal malformations).16
● Biological: Zika virus (microcephaly), Rubella, and Toxoplasmosis (fetal death or birth defects).16
● Ergonomic: Heavy lifting over 5 kg and prolonged standing (musculoskeletal pain and sick leave).16
Global Standards and Accommodations
The Pregnant Workers Fairness Act (PWFA) requires accommodations for "known limitations" unless they cause "undue hardship".19
● Physical Modifications: Providing a stool to a pregnant cashier experiencing leg pain or swelling.20
● Organizational: Additional, longer, or more flexible breaks for water, nutrition, or restrooms.20
● Lactation Support: The PUMP Act requires reasonable break time and a private, non-bathroom space to express milk for up to one year.19
Section 4: Adolescent Workers - Protecting the Developing Body
Developmental Risks and ILO Mapping
Adolescents face higher susceptibility to accidents due to environments designed for adults and a lack of ossification in their musculoskeletal systems.8 The Minimum Age Convention, 1973 (No. 138) sets the minimum age at 15.23 The Worst Forms of Child Labour Convention, 1999 (No. 182) prohibits "hazardous work" likely to harm the health, safety, or morals of children.23
Reasonable Accommodations and Supervision
● Mentorship: Implementing a "buddy system" where an experienced adult guides the young worker.27
● Visual Identifiers: Issuing different-colored smocks so supervisors know who is not allowed to operate dangerous machinery.29
● Training: Providing "hands-on" training in periodic short sessions rather than one long class to maintain engagement and retention.28
Section 5: Older Workers - Sustaining an Aging Workforce
Physiological Challenges and R162
Aging is often accompanied by a decline in muscle mass and sensory acuity.31 The Older Workers Recommendation, 1980 (No. 162) promotes equality of treatment and modification of the work environment.32
Adaptive Measures
● Ergonomics: Adapting the job using technical means (e.g., elevators, lifting aids, increased lighting) to preserve health and maintain working capacity.31
● Remuneration: Transitioning from "pay by results" to "pay by time" to reduce the stress of speed.31
● Time Organization: Reducing daily and weekly hours for those in arduous or hazardous roles.31
Section 6: The ILO List of Occupational Diseases (R194)
The List of Occupational Diseases Recommendation, 2002 (No. 194), revised in 2010, includes internationally recognized diseases caused by chemical, physical, and biological agents.4
● Evolution: The 2010 revision specifically added mental and behavioral disorders, such as psychosomatic psychiatric syndromes caused by mobbing.36
● Open Items: R194 includes "open items" allowing for the recognition of diseases not explicitly named if a link to work activities is established.4
Section 7: Emerging Hazards - Heat and Digitalization
Extreme Heat Stress
Climate change has intensified heat risks. Drastic drops in productivity (2-3% per degree above 20C) and severe health impacts like chronic kidney disease (CKD) have been documented. Approximately 2.4 billion workers are exposed to excessive heat globally, resulting in over 22.85 million occupational injuries annually. Migrant workers face a three-fold higher risk of mortality from high temperatures in certain regions.
Digital Labour Platforms
The "digital precariat" faces novel psychosocial risks like "technology anxiety" and mental overload from constant availability requirements. Algorithmic management can restrict worker autonomy and increase stress. Recommendations include establishing a "right to disconnect" and designing "human-centric" algorithms.
Section 8: Economic and Social Benefits of Accommodations
Reasonable accommodations are not merely a legal duty but an investment.
● Cost Efficiency: 90% of employers use accommodations to retain employees, with 58% saving costs from reduced turnover.
● Productivity: 68% of employers reported increased productivity after implementing adjustments.
● Inclusive ROI: Organizations that invest in inclusion report better employer branding and lower workers' compensation claims.
Conclusion
This analysis of priority occupational diseases among vulnerable workers demonstrates that predictability and prevention are the cornerstones of modern OSH. From the pooled morbidity of migrant labor to the developmental risks of adolescents, vulnerable populations require targeted interventions aligned with ILO standards. Reasonable accommodations—whether providing stools for pregnant workers, native-language training for migrants, or heat action plans for an aging workforce—preserve the health and dignity of the global workforce while delivering significant economic benefits to employers and society.
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