Work is definitively a social determinant of health. The underlying causes of injuries and illnesses that businesses fail to prevent in the workplace create health and economic pressures on workers and consumers, and their families and communities. People spend most of their time working – and the work environment directly shapes physical, mental and economic well-being across a person’s life. Physical and psychosocial hazards at work dictate how people are able to spend their free time, and work-related chronic health conditions place physical and financial strains on individuals and their families. Family members often must stop working to become caretakers instead of contributors to the local and global economies.
Work is a significant source and cost of the burden of disease. Globally, 2.9 million deaths – 2.6 million from disease alone – and 180 million disability-adjusted life years are attributable to work. This burden has increased 25% to 45% in the last five years alone. It represents an economic loss equal to nearly 6% of global gross domestic product from occupational cancers, respiratory and skin diseases and others; psychosocial factors are increasing this loss.
The impact on the workforce, our communities and systems is enormous. Social protection systems such as workers’ compensation benefits cover only a fraction – in some estimates, one-fifth – of the actual costs of a workplace injury or illness, including lost wages, medical expenses and rehabilitation. The shifting burden onto social security, disability, health care and other systems cannot fully compensate or make workers whole.
Regulatory systems prevent disease by raising the floor for businesses that cut corners to make labour cheaper, faster and more disposable. Yet occupational health protections and workers’ rights are a primary target of a new wave of deregulatory efforts.
Race to the bottom
In the United States, current deregulatory efforts are removing employers’ responsibilities to maintain a safe and healthful workplace, in the name of job creation and productivity. Other countries may consider following suit.
But the deregulatory label is a bait and switch – it is not actually about fewer rules to promote growth and innovation. Instead, deregulation is about shifting costs and rigging the economy for the rich and powerful at the expense of workers’ health, economic security and well-being, regardless of the number of rules. It is about eliminating regulations that have been grounded in science and real-world evidence, based on public and expert input from all corners, and have been effective and achievable for decades.
Recent moves we are facing in the United States include weakening workplace chemical standards and heat enforcement; eliminating worker medical evaluations; ‘as low as reasonably achievable’ standards, which have driven down radiation exposures for decades; and government coverage for ‘inherently risky’ occupations and ‘obvious hazards’. Despite the International Labour Organization’s and World Health Organization’s global programme to eliminate silicosis by 2030, the US government is rolling back silica protections for mineworkers and prioritising efforts to shield manufacturers of dangerous engineered stone products from liability, rather than protect the workers harmed by them.
Deregulatory efforts are also removing domestic workers from minimum wage laws, weakening child labour standards, creating steep financial barriers for immigrant workers to be legally employed, making it easier to misclassify workers under employment schemes and targeting labour unions.
Dismantling standards and undermining these systems unleashes a cascade of uncontrollable problems.
Prioritising public health, not corporate wealth
Unions around the world have long been instrumental in fighting for regulatory safeguards that prevent disease from work, including banning asbestos, regulating chemicals such as carcinogens and reprotoxins, and addressing psychosocial factors that lead to burnout and stress. We have always bargained over new technologies and are now confronting attacks from corporate use of unchecked artificial intelligence tools.
We still fight for regulations against silica, asbestos, extreme heat and other climate-related hazards, and the right to organise and bargain over these protections. Unions support strong regulatory systems because they save lives, spur innovation, increase economic fairness, uphold democracy and create a pathway for social progress. Labour unions level the playing field so that the economy grows equitably.
Regulation is not perfect, but weakening systems that benefit working people will not benefit public health or the economy. Every market has rules, and if strong rules are not established by the government, then they will be eroded by powerful economic actors who will benefit at the expense of others.
No one thrives unless everyone thrives. The future of disease prevention rests in the political will to prioritise people’s health over excessive corporate wealth.
