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Ximena Diaz, Amalia Mauro, Julia Medel, Elisa Ansoleaga CENTRO DE ESTUDIOS DE LA MUJER, CHILE

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

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Ximena Diaz, Amalia Mauro, Julia Medel, Elisa Ansoleaga CENTRO DE ESTUDIOS DE LA MUJER, CHILE

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  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

  2. 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

  3. 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

  4. 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)

  5. 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

  6. 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.

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. Key words to be unpacked

  13. Gender filters in policy and practice • Whose gender? • Workers • Supervisors • Colleagues • Institutional actors • Union representatives • Employer representatives • NGOs • Labour inspectors • Policymakers • Decision makers • What issues? • Differential exposures • Working conditions • Employment conditions • Messing & Östlin,2006 • Differential consequences of poor policy • i.e. Work/family balance EQCOTESST, 2011 • Differential perceptions of psycho-social hazards • Salin, 2008

  14. What psychosocial hazards? • Job strain • Iso strain • Effort-reward imbalance • Inadequate protection of work-family balance • Occupational violence • Employment strain • Different communities of practice • Different scientists • Different “consultants” • Different professionals • Different institutional actors and allies • Different «business case»

  15. 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

  16. What role for precarious employment?

  17. Axis 1. Methodological approach: 1) Research program; 2) capacity building Research program Two-step study on employment conditions, psychosocial risks, mental health and gender in Chile A qualitative study (2008-2009) using three data collecting strategies: Observation of workplaces; In-depth interviews; and Discussion groups 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

  18. 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

  19. 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

  20. 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

  21. 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

  22. 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 symptoms than those not exposed

  23. 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

  24. Impressionist policy portraits

  25. 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

  26. 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

  27. 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?

  28. 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

  29. 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 learnedfrom community partners ourselves while providing them with the opportunity to increase their intervention capacity through participation in the research program.

  30. 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

  31. 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.

  32. 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.

  33. 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.

  34. 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

  35. 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.

  36. 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.

  37. 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

  38. Challenge - 2

  39. Thank you very much For more information: www.proyectoaraucaria.cl

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