Monday, August 15, 2016

Relieving chronic work-related pain and job insecurity

- Marselle Bredemeyer

A Curbside Consultation article in AFP’s July 15th issue highlights the difficulties that immigrants working in low-wage jobs experience when it comes to addressing workplace hazards without the support of advocates and health care professionals. This challenge is not unique to immigrants, although they are disproportionally affected; underreporting of workplace injuries is a widespread problem. The Occupational Safety and Health Act, which was passed in 1970, covers persons working in nearly all sectors and protects all employees regardless of immigration status.

The Occupational Safety and Health Administration (OSHA), formed to enforce elements of the labor act, has its weak points, however. In a response to recent requests that sought reduced production line speeds at poultry plants, an OSHA representative cited “limited resources” as one factor precluding the implementation of definitive rules from being considered. The expectation for employers is broad, in any sense—they have a “general duty” to ensure a safe workplace.

Where does this leave patients like the one in the Curbside Consultation article? Although workers can’t anticipate that there are explicit regulations applying to individual aspects of their job, such as the amount of weight they are permitted to lift, there are actions that can be taken—like those described in the article commentary—to prevent long-term injury from repetitive motion.

Unlike the legal right to work in a safe environment, immigration status has a huge bearing on a person’s access to health care. In the case scenario described in the journal feature, the patient’s Cuban origin ensured her Medicaid eligibility for a temporary time. Many immigrants who are legally present are ineligible for Medicaid for five years after arrival, however, and those who are undocumented cannot shop for private coverage on the Patient Protection and Affordable Care Act’s (ACA) exchanges. Refugees and asylees, along with other select groups, whether from Cuba or dozens of other countries, have immediate access to health care assistance for at least eight months.

There are still a number of questions that researchers need to tackle regarding occupational health among immigrants. How can employers reduce the undue risk of harm migrants face in the workplace? Why does this disparity exist? Fear of job loss is, unfortunately, all too often well founded. Family physicians who are aware of existing labor protections and legal and community resources can not only guide the treatment of occupational disorders, but also empower patients who choose to take steps to improve workplace safety. Without a physician to take a directed history in the first place, connections between acute and chronic illnesses and workplace conditions will remain in the dark.

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