30 Dec Examining migration and work precarity: what is the added value (and potential downside) of a public health perspective?
by Nora Gottlieb
Public health is a scientific discipline and practice concerned with the distribution of health and disease in the population. To improve population health and mitigate health inequities, it examines risk factors and resources for health on different levels; e.g., on the level of the “social determinants of health” (the conditions in which people are born, grow, work, live, and age) and their “root causes” (differential power and resources, differential exposure, differential vulnerability, and differential consequences of being sick). In other words, public health research measures social inequalities by their health outcomes.
Public health research has shown disproportionally high rates of work-related physical and mental illness and injury among migrant workers. Adverse occupational health outcomes are consistently linked to intersecting migration-related, employment-related, and socio-economic precarity (alongside other instances of marginalization such as gender-related disadvantage). Further occupational risks – such as the delegation of dangerous job tasks, low safety culture, inadequate housing, and lack of access to social benefits and support – cascade from these root causes. However, the current body of evidence shows major blind spots and data limitations.
For example, precarity is often conceptualized as an atypical, temporary, and transient phenomenon. In fact, it is a systemic feature of many industries; and it is a permanent condition for many workers. As such, it is inscribed in their bodies as constant and accumulating illness and injury, and normalized as “slow death”. Given the lack of longitudinal studies, the long-term consequences of this “slow death” for individuals, their families, and their communities are barely known; and social protection schemes – if existing – may be ill-equipped to provide support.
What is the added value of a public health perspective on such issues? And what are the downsides? During the COVID-19 pandemic, it was often recited that “no one is safe until everyone is safe”. Thus, Public Health offers good arguments for universal health protection – albeit, only regarding infectious diseases. From the perspective of public health, prevention, protection and care are investments. They maintain workers’ productivity, mitigate social and economic burdens, and ensure the functioning of essential industries. Yet, the utilitarian character of the argument is problematic. Ultimately, it is worthwhile revisiting the discipline’s ethical and historical roots: From a public health ethical perspective, each person’s health is of equal worth, warranting equitable, impartial, and non-discriminatory protection and care. Social medicine, at its historical origins in the 19th century, coined what has been called “public health’s biggest idea” [1]: that health and disease are embodiments of the successes and failures of society as a whole; and that, therefore, improving health requires political action and social change. In other words, public health is a social science and, vice versa, “politics is nothing but medicine at a larger scale” [2].
Public health thus offers a set of pre-existing concepts, knowledge, tools, and arguments for researching and acting on social inequities. At the same time, public health research has many limitations and open questions about the links between migrant workers’ conditions and health. Inter- and transdisciplinary efforts that integrate a public health perspective to address migration and work precarity thus have great potential for mutual learning and cross-fertilization.
Notes:
1. Mackenbach JP (2009) Politics is nothing but medicine at a larger scale: reflections on public health’s biggest idea. Journal of Epidemiology & Community Health;63:181-184.
2. Ibid; see also https://en.wikipedia.org/wiki/Rudolf_Virchow
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