Fault lines exposed

Fault lines exposed

As COVID-19 uncovers deep inequities in the social determinants of health – including the conditions in which people work – reinforcing the linkages between decent work and good health has never been more important

The COVID-19 pandemic has been a wake-up call about safeguarding and promoting everyone’s health. And when we think about the social determinants of health – the conditions in which people are born, grow, live, work and age – we understand the crucial importance of decent work, including decent employment and working conditions that are productive and deliver adequate income, safety and health at work, adequate social protection, and the promotion of workers’ rights and social dialogue for improving health outcomes and reducing health inequities. Decent work provides people with the freedom to express their concerns, organise and participate in the decisions that affect their lives, and equality of opportunity and treatment for all women and men.

There is clear, consistent evidence of strong links between employment, decent work and health. The income security, social status and physical and psychosocial well-being brought about by decent employment can break the cycle of intergenerational poverty, improve health and reduce health inequities, which are needed to reach three Sustainable Development Goals 1, 3 and 8. Yet despite significant progress, there is still a long way to go to achieve them. Only 27% of the world’s population has adequate social security coverage and approximately 4 billion people lack any coverage at all. At least half the world’s population still does not have full coverage of essential health services, and 12.7% of the population spend more than 10% of their household budget on health care, thereby incurring significant poverty risks due to a lack of adequate health coverage.

Investing in health and well-being empowers people to achieve the highest attainable standard of health, to develop their potential and achieve their objectives. At the same time, it contributes to fostering productivity, enhancing wages and incomes, creating positive macroeconomic effects and fostering sustainable development. Therefore, investing in health is a policy choice for decent work.

Human and economic costs

A safe and healthy working environment and good working conditions are vital to attaining good health. Yet for millions of workers the reality is very different. According to the most recent global estimates released by the International Labour Organization, 2.78 million work-related deaths are recorded every year, of which 2.4 million are related to occupational diseases. In addition to the immense suffering of workers and their families, the associated economic costs are colossal, representing around 3.94% of the world’s annual gross domestic product. The ILO works together with governments and social partners to strengthen national occupational safety and health systems and, in particular, to implement occupational safety and health management systems and improve services to address this unacceptable situation. These systems are also the foundation of preparedness and response plans in times of a global health crisis, such as the COVID-19 pandemic.

Accelerating progress towards universal health coverage is indispensable for improving health outcomes and decent work. In promoting a rights-based approach, social health protection plays an important role at the intersection of health and social protection policies to ensure financial protection and effective access to healthcare services, thereby preventing impoverishment and encouraging preventive behaviour. This includes solidarity-based mechanisms to guarantee effective access to health care without financial hardship, such as social health insurance, national health services or a combination of both. It also includes sickness benefits that ensure income security during sickness, quarantine or when caring for sick family members and that contribute to protecting people’s own health and that of others, not only in times of a pandemic.

More broadly, social protection systems are critical for reducing inequalities, including health inequities. For example, access to social protection and income security explain about one-third of the inequity in self-reported health between the most and least affluent quintiles of adults within European countries. COVID-19 has reminded the global community of the urgency of building strong and resilient health and social protection systems, including floors. In this uniquely challenging moment, it is crucial to uphold and to promote the rights to health and social security enshrined in human rights instruments and international social security standards, in particular the principles of universality, solidarity, non-discrimination, safe and healthy working conditions, social inclusion, social justice and equity.