Objectives
Few Canadian data sources allow the examination of disparities by ethnicity, language, or immigrant status in occupational exposures or health outcomes. However, it is possible to document the mechanisms that can create disparities, such as the over-representation of population groups in high-risk jobs. We evaluated, in the Montreal context, the relationship between the social composition of jobs and their associated risk level.

Methods
We used data from the 2001 Statistics Canada census and from Quebec's workers' compensation board for 2000–2002 to characterize job categories defined as major industrial groups crossed with three professional categories (manual, mixed, non-manual). Immigrant, visible, and linguistic minority status variables were used to describe job composition. The frequency rate of compensated health problems and the average duration of compensation determined job risk level. The relationship between the social composition and risk level of jobs was evaluated with Kendall correlations.

Results
The proportion of immigrants and minorities was positively and significantly linked to the risk level across job categories. Many relationships were significant for women only. In analyses done within manual jobs, relationships with the frequency rate reversed and were significant, except for the relationship with the proportion of individuals with knowledge of French only, which remained positive.

Conclusions
Immigrants, visible, and linguistic minorities in Montreal are more likely to work where there is an increased level of compensated risk. Reversed relationships within manual jobs may be explained by under-reporting and under-compensation in vulnerable populations compared to those with knowledge of the province's majority language. Am. J. Ind. Med. 53:875–885, 2010. © 2010 Wiley-Liss, Inc.

Are immigrants, ethnic and linguistic minorities over-represented in jobs with a high level of compensated risk? Results from a Montréal, Canada study using census and workers' compensation data.

Background Workers’ compensation systems are among the most generous disability insurance systems in North America, although they are also known to be potentially adversarial and may have iatrogenic effects on claimants. This article examines issues to be considered to ensure fair compensation provided in a way that respects the dignity of workers. Methods An overview of the literature on characteristics and effects of workers’ compensation systems is followed by an analysis based on classic legal methods, including those of comparative law, complemented with interview data to examine three models of disability compensation. Results The first part of the article identifies cross cutting issues to be considered in the examination of the equity of compensation systems and the protection of the dignity of claimants. These include three underpinnings of workers’ compensation: the links between a ‘‘no-fault’’ system and the adversarial process, the appropriate use of medical and scientific evidence in the determination of compensability and the application of appropriate measures for promoting return to work. The second part looks at accident compensation in New Zealand, where compensation is available regardless of the cause of the accident, and disability insurance in the Netherlands, where compensation is available regardless of the cause of the disability. It then describes a composite of characteristics favorable to equity drawn from the thirteen workers’ compensation systems in Canada. Conclusion Systems that succeed in reducing opportunities for adversarial interactions and that provide substantive protection could better promote the dignity of claimants. Am. J. Ind. Med. 55:519–536, 2012. 2012 Wiley Periodicals, Inc.

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Preserving Workers' Dignity in Workers' Compensation Systems: An International Perspective

Shenzhen’s rapid growth and urbanisation has attracted a large, mobile, migrant working population. This article explores health protection through the means of social health insurance between migrants and registrants and their point of access to healthcare. A cross-sectional questionnaire survey was conducted in Shenzhen, with a random sample of 793 registered and 750 non-registered residents. Chi-square test and multivariate logistic regression were applied to analyse the association between health insurance coverage with Hukou registration status and healthcare utilisation. Amongst 1543 respondents, 43.1% of non-registered residents were uninsured. Being non-registered strongly predicted for no insurance (OR = 5.00; CI 3.53,7.07) and have purchased additional/ private insurance (OR = 2.99; CI 1.66,5.37). Migrants who self-reported chronic health conditions were also more likely to utilise health services in general (OR = 2.77; CI 1.18,6.52). Inadequate health insurance coverage for migrants as observed in Shenzhen remains a challenge for the Chinese health reform. Our results suggest that the current insurance system must seek to include migrants in order to achieve universal coverage and improved health protection for its population.

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Health insurance and healthcare utilisation for Shenzhen residents: a tale of registrants and migrants?

Purpose: The purpose of this comprehensive literature review it to explore cross-cultural issues in occupational rehabilitation and work disability prevention. Method: A literature review on cross-cultural issues was performed in medicine, health sciences, and social sciences databases (PubMed, Ingenta, Canadian Centre for Occupational Health and Safety, Ergonomics Abstract, Google Scholar, OSH Update and the Quebec Workers’ Compensation Board data base). A total of 27 documents published until 2010 in English or French were selected and analyzed. Results: Cross-cultural issues in occupational rehabilitation show that representations of pain, communication and therapist–patient relationship and intercultural competence could be presented as the major topics covered in the selected literature. As for the general topic of immigrant workers and OSH, barriers were identified revealing personal, relational, contextual and structural levels that put immigrant and minority workers in situation of vulnerability (...

Intercultural communication in health care: challenges and solutions in work rehabilitation practices and training: a comprehensive review

Many studies have emphasized the importance of medical, insurance, and workplace systems treating individuals fairly in work disability prevention (WDP) and return-to-work (RTW). However, ethical theories and perspectives from these different systems are rarely discussed in relation to each other, even though in practice these systems constantly interact. This paper explores ethical theories and perspectives that may apply to the WDP–RTW field, and discusses these in relation to perspectives attributed to dominant stakeholders in this field, and to potential differences in different jurisdictional contexts. Literature was sought primarily in biomedical ethics, business ethics, and public administration ethics. In biomedical ethics, four ethical principles are dominant: autonomy, beneficence, nonmalevolence, and justice. Business ethics involve theories on Corporate Social Responsibility (CSR), social contracts, and organizational justice. Public administration ethics focus on constitutional theory, citizenship, social equity, virtue, and public interest. Several concepts were identified as relevant for ethical analyses in the WDP–RTW field, including justice; individual autonomy; nonmalevolence; economic and social responsibility; and social contracts. These concepts provide a vocabulary that may be used to analyze stakeholders’ actions and interactions in RTW processes. It was also noted how the power balance between stakeholders will influence which ethical perspectives will influence RTW. Jurisdictional differences that influence RTW processes with regard to stakeholder responsibilities were identified, as well as varying beliefs as to who is the client in different compensation systems. A social contractual approach may inform an analysis of cultural and legal differences.

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Ethical Perspectives in Work Disability Prevention and Return to Work: Toward a Common Vocabulary for Analyzing Stakeholders’ Actions and Interactions

This paper examines the compensation process for work-related injuries and illnesses by assessing the trajectories of a sample of immigrant and non-immigrant workers (n = 104) in Montreal. Workers were interviewed to analyze the complexity associated with the compensation process. Experts specialized in compensation issues assessed the difficulty of the interviewees’ compensation process. Immigrant workers faced greater difficulties with medical, legal, and administrative issues than non-immigrants did. While immigrant workers’ claim forms tended to be written more often by employers or friends (58% vs. 8%), the claims were still more often contested by employers (64% vs. 24%). Immigrant workers were less likely to obtain a precise diagnosis (64% vs. 42%) and upon returning to work were more likely to face sub-optimal conditions. Such results throw into relief issues of ethics and equity in host societies that are building their economy with migrant workers.

Ethics and the compensation of immigrant workers for work-related injuries and illnesses.

Regle generale, presque tous les travailleurs du Quebec victimes de lesions professionnelles peuvent se prevaloir d’indemnites. Mais l’acces a l’indemnisation est difficile pour bon nombre d’entre eux dont les travailleurs immigrants. Cet article decrit le processus d’evaluation et les criteres ayant permis de juger des difficultes rencontrees par des travailleurs lors de leur parcours d’indemnisation. Trois groupes d’experts ont attribue des scores de difficulte a un echantillon de 104 travailleurs immigrants et non-immigrants de la region montrealaise victimes de lesions musculo-squelettiques. La comparaison des scores a ete faite sous trois angles d’evaluation (medical, juridique et administratif) et le resultat demeure le meme : les travailleurs immigrants ont des scores de difficultes superieurs aux autres travailleurs et particulierement lorsque l’analyse est faite sous les angles juridique et administratif. Les criteres retenus ciblent les dimensions humaines liees aux incomprehensions lors des procedures, des problemes de communication a lire la documentation ainsi qu’a completer les formulaires et a s’exprimer precisement lorsqu’il s’agit de decrire les evenements accidentels ou les circonstances entourant l’apparition de la lesion et les symptomes medicaux.

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Critères pour apprécier les difficultés d’accès à l’indemnisation des travailleurs immigrants victimes de lésions professionnelles

Occupational medicine, witness to the industrial and economic evolution of societies, has observed over time the link between diseases and occupational exposures. Nowadays, the transformation of societies brings out new risks, modulated by technical and organizational changes, and our knowledge of their impact on health is constantly evolving. The role of the occupational physician has not changed: he must question and observe in order to know and understand. Its purpose is the same, to prevent workers from falling ill because of their work. It remains essential to pay particular attention to the search for professional factors that may have influenced the disease since the identification and management of the cause is often the best treatment.La médecine du travail, témoin de l’évolution industrielle et économique des sociétés, s’est intéressée au fil du temps au lien entre les maladies et les expositions professionnelles. De nos jours, la transformation des sociétés fait émerger de nouveaux risques, modulés par les changements techniques et organisationnels, et nos connaissances de leurs impacts sur la santé sont en constante évolution. Le rôle du médecin du travail n’a pas changé : il doit questionner et observer pour connaître et comprendre. Son but reste le même, éviter que les travailleurs ne tombent malades à cause de leur travail. Il demeure primordial d’accorder une attention particulière à la recherche de facteurs professionnels ayant pu influencer la maladie puisque l’identification et la gestion de la cause représentent bien souvent le meilleur traitement. 

Louis Patry

Papers

Ethics and the compensation of immigrant workers for work-related injuries and illnesses.

Critères pour apprécier les difficultés d’accès à l’indemnisation des travailleurs immigrants victimes de lésions professionnelles

La médecine du travail : témoin de l’évolution sociale