Occupational health in Ecuador: a comparison with Latin-American surveys on working conditions

Abstract

Introduction:

Ecuador has recently implemented its First Working Conditions Survey.

Objective:

to describe working and employment conditions and workers’ health status in Ecuador in a sample that allows comparison with previous Latin American surveys.

Methods:

a sample of 1,713 workers was drawn from the First Working Conditions Survey in Ecuador. Prevalence and a 95% confidence Interval (95%CI) were calculated and compared with previous Latin American surveys in Colombia, Argentina, Chile, Central America, and Uruguay.

Results:

men were more often exposed to hazardous working conditions, with noise (81% of men and 69% of women), and repetitive movements (56% and 48%, respectively) being the most frequently reported. About 31% of men and 19% of women worked more than 40 hours per week. Almost 11% of both women and men reported poor self-perceived health status. The prevalence of occupational injury was the highest in the region: 15% for men and 8.4% for women.

Conclusions:

this is a first approach to the working and employment conditions and workers’ health status in Ecuador. To harmonize and improve Working Conditions Surveys in Latin America should be a priority goal for enhancing regional occupational health surveillance.

Keywords:
occupational health; health information system; working conditions; health status; Ecuador

Resumo

Introdução:

o Equador realizou recentemente seu primeiro inquérito sobre condições de trabalho.

Objetivo:

descrever as condições de trabalho e emprego e o estado de saúde dos trabalhadores equatorianos em uma amostra que permita comparação com inquéritos latino-americanos anteriores.

Métodos:

uma amostra de 1.713 trabalhadores foi selecionada do primeiro inquérito sobre condições de trabalho no Equador. Prevalências e intervalos de confiança de 95% (IC95%) foram calculados e comparados com inquéritos anteriores na Colômbia, Argentina, Chile, América Central e Uruguai.

Resultados:

homens foram frequentemente mais expostos a trabalho em condições perigosas, sendo as mais relatadas trabalho com ruído (81% dos homens e 69% das mulheres) e com movimentos repetitivos (56% dos homens e 48% das mulheres). Cerca de 31% dos homens e 19% das mulheres trabalhavam mais de 40 horas por semana. Quase 11% das mulheres e dos homens relataram uma autopercepção de saúde ruim. A prevalência de agravos ocupacionais foi a mais alta da região: 15% para homens e 8,4% para mulheres.

Conclusão:

este é um primeiro levantamento das condições de trabalho e emprego e do estado de saúde de trabalhadores no Equador. Harmonizar e aperfeiçoar os Inquéritos sobre Condições de Trabalho na América Latina deve ser uma meta prioritária para melhorar a vigilância em saúde do trabalhador na região.

Palavras-chave:
saúde do trabalhador; sistema de informação em saúde; condições de trabalho; estado de saúde; Equador

Resumen

Introducción:

Ecuador ha realizado recientemente su primera encuesta sobre las condiciones de trabajo.

Objetivo:

describir las condiciones de trabajo y empleo y el estado de salud de los trabajadores en Ecuador en una muestra que permita la comparación con encuestas anteriores en América Latina.

Métodos:

se seleccionó una muestra de 1.713 trabajadores de la Primera Encuesta de Condiciones de Trabajo en el Ecuador. Se calculó la prevalencia y el intervalo de confianza del 95% (IC95%) y se comparó con las encuestas anteriores realizadas en América Latina - Colombia, Argentina, Chile, América Central y Uruguay.

Resultados:

hombres se exponen con mayor frecuencia a condiciones de trabajo peligrosas, siendo las más frecuentes el ruido (81% de los hombres y 69% de las mujeres) y los movimientos repetitivos (56% y 48%, respectivamente). Alrededor del 31% de los hombres y el 19% de las mujeres trabajan más de 40 horas por semana. Casi el 11% de las mujeres y de los hombres reportaron mala salud autopercibida. La prevalencia de lesiones ocupacionales fue la más alta de la región: el 15% para los hombres y el 8,4% para las mujeres.

Conclusiones:

este es un primer acercamiento a las condiciones de trabajo y empleo y al estado de salud de los trabajadores en el Ecuador. Armonizar y mejorar las Encuestas de Condiciones de Trabajo en América Latina debería ser un objetivo prioritario para mejorar la vigilancia de la salud ocupacional en esta región.

Palabras clave:
salud laboral; sistemas de información en salud; condiciones de trabajo; estado de salud; Ecuador

Introduction

Employment and working conditions are heavy health determinants for workers and their families¹. Growing scientific evidence shows that poor working and employment conditions, such as job insecurity and precarious employment, create adverse health effects, sickness absence, occupational injuries and produces health inequities among the population^{2), (3}.

Global competition and the increased need for cost-containment have put pressure on “labor flexibility,” affecting workers’ safety and health^{4), (5}. Additionally, as globalization allows outsourcing, this health cost is generally transferred to low- and middle-income countries, where the lack of policies and control exposes workers to poor working and employment conditions. In fact, high-income countries have five times fewer fatal and non-fatal occupational accidents than the world’s average and six times fewer the Latin American and the Caribbean average⁶.

In low- and middle-income countries, the scarcity of reliable information on working and health conditions is one of the major barriers to establish appropriate public policies^{7), (8}. Several international health and development programs have recognized the improvement of occupational health information systems as a priority goal^{9), (10}.

In this regard, working conditions surveys (WCS) have been consolidated as a reliable tool to monitor working, employment, and health conditions¹¹. Over the last decade, several Latin-American countries have carried out their first WCS¹². The purpose of these surveys is to subsidize their national policies. These efforts have also allowed the first cross-country comparisons in the region, offering better evidence for policy-makers¹³.

Recently, Ecuador has implemented its first WCS, providing a first glance at working and health conditions from the worker’s perspective. The objective of this study is to describe working and employment conditions and the health status of non-agricultural employees covered by the social security system in Quito and Guayaquil, in a sample that allows comparison with previous Latin-American surveys (Colombia, Argentina, Chile, Central America, and Uruguay).

Methods

The data used was obtained from the First WCS in Ecuador (I-ECSST, by its Spanish acronym), carried out in Quito, the capital city, and in Guayaquil, the most populated city in the country, between April 2016 and January 2017.

I-ECSST is a cross-sectional survey based on a sample of paid workers aged 18 or older, registered in the social security system, from all economic activity sectors and living in Quito or Guayaquil. In total, a representative sample of 1,790 was selected (741 from Quito and 1,049 from Guayaquil) through a multistage random sampling procedure stratified by neighborhood and based on the 2010 Ecuadorian Population and Housing Census. The face-to-face questionnaire was filled in at the workers’ home; only one worker per household was interviewed. Details of the survey are available on the official report¹⁴.

In order to compare the results of I-ECSST with previous WCS from Colombia (2007) ⁽¹⁵, Argentina (2009) ⁽¹⁶, Chile (2009-2010) ⁽¹⁷, Central America (2011) ⁽¹⁸, and Uruguay (2012) ⁽¹⁹, as it was done in a previous study¹³, we selected a subsample of employees who were registered in the social security system, aged between 18-64 years, and engaged in non-agricultural activities. The final sample was composed of 1,713 workers from Quito and Guayaquil (848 women and 865 men).

The variables that allowed comparison between I-ECSST and other Latin American WCS were: gender, age (grouped into 18-34 years, 35-49 years, 50-64 years), educational level (categorized into primary, secondary, university), economic sector (categorized into industry, construction, service) and occupational categories (categorized into managers, professionals, technicians, clerical support workers, services and sales workers, skilled manual and unskilled manual workers).

Regarding working conditions, we selected: noise, vibrations, handling, and breathing of hazardous chemicals, biological agents, manual handling, and repetitive movements. Following the same criteria of the previous study, responses were dichotomized into “exposed” and “non-exposed,” in which any different response to “never” means “exposed.” For employment conditions, it was only possible to select weekly working hours (< 30 hours, 30-40 hours, > 40 hours).

Regarding health outcomes, two variables were selected. Self-perceived health status was obtained by asking the respondents to describe their general health as “excellent,” “very good,” “good,” “fair,” “poor” or “very poor.” The responses were merged into two categories, where the answers “fair,” “poor” or “very poor” indicated poor self-perceived health. Occupational injuries were assessed by asking the respondents whether they had or not suffered a work accident in the previous 12 months.

The prevalence of exposure, and a 95% confidence interval (95%CI), to poor employment and working conditions, and health-related problems were calculated for each country. All analyses were stratified by gender and carried out with the statistical software package SPSS23.

Results

Most non-agricultural employees covered by social security and living in Quito or Guayaquil (Table 1) were young, being 11% of women and 13% of men over 50 years of age, and the overwhelming majority had secondary and university education. Both women and men were engaged mainly in the service sector (89% and 82%, respectively), and their occupations were related to services and sales, and clerical support (67% and 57%, respectively).

Table 1
Socio-demographic characteristics of non-agricultural employees, by gender, in Quito and Guayaquil, Ecuador, 2016-1017 (n=1,713)

Variable		Women n=848		Men n=865
		%	(95%CI)	%	(95%CI)
Age
	18-34 years	52.5	(49.1-55.8)	45.1	(41.8 -48.4)
	35-49 years	36.9	(33.7-40.2)	42.2	(38.9-45.5)
	50-64 years	10.6	(8.5-12.7)	12.7	(10.5-14.9)
Educational level*
	Primary	5.8	(4.2-7.3)	6.7	(5.0-8.4)
	Secondary	36.8	(33.5-40.2)	46.0	(42.7-49.3)
	University	56.8	(53.5-60.2)	45.9	(42.6-49.2)
Economic activity
	Industry	7.9	(6.1-9.7)	9.0	(7.1-10.9)
	Construction	3.1	(1.9-4.2)	9.4	(7.4-11.3)
	Services	89.0	(86.9-91.1)	81.6	(79.0-84.2)
Occupational categories
	Managers	4.4	(3.0-5.7)	6.0	(4.4-7.6)
	Professionals	7.3	(5.6-9.1)	4.6	(3.2-6)
	Technicians	7.7	(5.9-9.5)	11.2	(9.1-13.3)
	Clerical support workers	25.1	(22.2-28.0)	12.6	(10.4-14.8)
	Services and sales workers	42.3	(39.0-45.7)	42.3	(39.0-45.6)
	Skilled manual worker	4.9	(3.5-6.4)	13.6	(11.4-15.9)
	Unskilled manual worker	8.3	(6.4-10.1)	9.6	(7.6-11.6)

• *missing data: women n=5; men n=12

Regarding employment conditions, in Ecuador 19.3% (16.7%-22%) of women and 31.4% (28.3%-34.6%) of men worked more than 40 hours per week, and this was the lowest percentage of the region (for example, when compared with Chile: 63.5% of women and 83.6% of men). In relation to working conditions, being exposed to noise was the most prevalent hazard among Ecuadorian workers: 81.2% (78.5%-83.8%) of men and 69% (65.9%-72.1%) of women, followed by repetitive movements: 56.1% (52.8%-59.4%) and 48.1% (44.8%-51.5%), respectively. In all countries, the frequency of exposure was higher among men (Table 2). Furthermore, those exposures were higher when comparing the results obtained in Ecuador with the results from other countries in the region; for example, in Central America, the exposure to noise was 54.1% for women and 62.0% for men; to chemical substances in the air was 30.8% and 39.4%, respectively, and to biological agents was 9.9% and 9.4%, respectively.

Table 2
Employment and working conditions and health status of non-agricultural employees aged 18-64 years, by gender, in Ecuador, Colombia, Argentina, Chile, Central America, and Uruguay

		Ecuador		Colombia		Argentina		Chile		Central America		Uruguay
Variable		%	(95%CI)	%	(95%CI)	%	(95%CI)	%	(95%CI)	%	(95%CI)	%	(95%CI)
Women		n=848		n=366		n=2646		n=1540		n= 1034		n=358
Employment conditions
Weekly working hours
	< 30h	5.4	(3.9-6.9)	-		21.8	(16.6-27.1)	5.2	(3.2-7.2)	12.4	(9.9-14.9)	17.5	(12.6-22.5)
	30-40h	75.2	(72.3-78.1)	-		29.0	(24.3-33.6)	31.3	(26.8-35.8)	27.1	(24.0-30.3)	41.4	(35.1-47.6)
	> 40h	19.3	(16.7-22.0)	-		49.2	(44.1-54.4)	63.5	(58.8-68.2)	60.5	(57-63.9)	41.1	(34.8-47.4)
Working conditions
	Noise*	69.0	(65.9-72.1)	23.3	(19.0-27.6)	14.9	(11.8-18)	22.5	(18.8-26.3)	54.1	(50.7-57.6)	22.3	(17.3-27.4)
	Vibrations$	12.0	(9.8-14.2)	6.8	(4.3-9.4)	5.5	(3.6-7.4)	11.2	(8.2-14.3)	25.1	(22.2-28.1)	7.9	(4.9-10.9)
	Handling of hazardous chemicals$	19.2	(16.6-21.9)	8.8	(5.9-11.7)	11.9	(6.7-17.1)	9.6	(7.1-12.2)	16.9	(14.4-19.5)	6.4	(3.7-9.1)
	Breathing chemical substances*	38.8	(35.5-42.1)	19.2	(15.2-23.3)	2.6	(1.6-3.6)	7.3	(4.8-9.7)	30.8	(27.7-34.0)	14.0	(9.7-18.2)
	Biological agents*	30.2	(27.1-33.3)	8.2	(5.4-11)	9.4	(6.5-12.3)	17.7	(14-21.4)	9.9	(7.8-11.9)	12.3	(8.3-16.2)
	Manual handling*	36.7	(33.4-39.9)	13.4	(9.9-16.9)	24.1	(19.9-28.3)	24.0	(20.1-27.9)	13.9	(11.5-16.2)	27.8	(22.3-33.4)
	Repetitive movements$	48.1	(44.8-51.5)	84.4	(80.7-88.1)	50.8	(45.6-56)	54.7	(49.9-59.5)	73.7	(70.7-76.7)	51.3	(45.0-57.8)
Health problems
	Poor self-perceived health+	10.8	(8.8-12.9)	5.5	(3.1-7.8)	-		33.4	(28.4-38.3)	24.3	(21.3-27.2)	-
	Occupational injuries++	8.4	(6.5-10.2)	3.8	(1.9-5.8)	-		7.4	(4.6-10.2)	4.5	(3.1-6.0)	-
Men		n=865		n=455		n=4402		n=2310		n=1632		n=498
Employment conditions
Weekly working hours
	< 30h	2.5	(1.5-3.6)	-		5.4	(3.4-7.5)	0.9	(0.2-1.5)	5.6	(4.0-7.2)	7.9	(4.6-11.1)
	30-40h	66.0	(62.8-69.2)	-		18.3	(15.6-21)	15.5	(12.8-18.2)	21.0	(18.6-23.5)	34.1	(28.4-39.8)
	> 40h	31.4	(28.3-34.6)	-		76.3	(73.1-79.4)	83.6	(80.9-86.4)	73.3	(70.6-76.0)	58.1	(52.1-64.0)
Working conditions
	Noise*	81.2	(78.5-83.8)	45.2	(40.6-49.7)	22.5	(19.7-25.2)	45.6	(41.1-50.1)	62.0	(59.2-64.7)	30.7	(25.6-35.8)
	Vibrations$	35.8	(32.6-39.0)	30.8	(26.6-35.1)	17.8	(15.4-20.2)	42.1	(37.6-46.5)	37.6	(34.79-40.4)	30.0	(24.8-35.2)
	Handling of hazardous chemicals$	22.2	(19.4-25.0)	22.1	(18.3-25.9)	12.5	(10.7-14.4)	19.1	(15.9-22.4)	18.4	(16.2-20.6)	18.3	(13.9-22.8)
	Breathing chemical substances *	57.5	(54.2-60.8)	50.9	(46.3-55.5)	11.9	(9.9-13.8)	32.9	(28.9-36.9)	39.4	(36.6-42.2)	31.4	(26.1-36.8)
	Biological agents*	31.7	(28.6-34.8)	8.2	(5.6-10.7)	6.2	(4.7-7.6)	9.2	(7.1-11.3)	9.4	(7.7-11.2)	15.1	(10.7-19.5)
	Manual handling*	58.6	(55.3-61.9)	34.4	(30.0-38.7)	44.9	(41.2-48.5)	39.9	(35.7-44.1)	36.6	(33.9-39.3)	45.5	(39.5-51.5)
	Repetitive movements$	56.1	(52.8-59.4)	76.9	(73.0-80.8)	62.8	(59.1-66.5)	60,0	(55.4-64.7)	77.3	(74.9-79.9)	58.6	(52.6-64.6)
Health status
	Poor self-perceived health+	10.9	(8.8-12.9)	4.2	(2.3-6.0)	-		16.6	(13.4-19.7)	19.1	(16.9-21.4)	-
	Occupational injuries++	15.0	(12.6-17.4)	9.9	(7.1-12.6)	-		6.5	(4.7-8.3)	4.9	(3.7-6.1)	-

• *: “always,” “very often,” “sometimes” or “rarely”; ^$: “yes”; ⁺: “fair,” “poor” and “very poor”; ⁺⁺: during the previous 12 months.

As for health problems, men from Ecuador were more prone to occupational injuries than women: 15% (12.6%-17.4%) vs. 8.4% (6.5%-10.2%), as it was reported in other countries, and they showed the highest prevalence in the region followed by Colombia (9.9% of men and 3.8% of women), Chile (6.5% of men and 7.4% of women) and Central America (4.9% of men and 4.5% of women). Finally, almost 11% of both women and men reported poor self-perceived health in Ecuador, a prevalence that was below Chile and Central America.

Discussion

This study is a first look at the formal workers’ working conditions and health in two of Ecuador’s most populated cities. It offers a first comparative perspective considering WCS previous results in Latin American countries.

Our sample shows a similar distribution to that observed in the region, with a small difference due to a greater proportion of workers engaged in the service sector: 81.6% of men from Ecuador versus 78.1% of men from Central America¹³. This difference could be explained because the Ecuadorian WCS was implemented in the two biggest commercial and administrative cities in the country.

In the region, Ecuador has the lowest percentage of men and women working more than 40 hours per week. The average working hours per week for the Ecuadorian formally employed population was 43.1 for men and 41.3 for women. Similar to the average 42 hours reported in 2013, in Latin America, based on national household surveys²⁰, although the formally employed population reported a lower average in others WCS of the region. This finding may be related to the laws in many countries of the region that allow longer weekly maximum hours than the recommended by the International Labor Organization²¹.

Regarding working conditions, we found that some exposures were higher in Ecuador than the ones observed in the other countries of the region. This high prevalence in Ecuador could have been overestimated given the criteria adopted to group the responses, where a five-point Likert scale was dichotomized and any response that was different to “never” meant “exposed.” However, it was also higher than Colombia, where a similar five-point Likert scale was used. Further research is needed to explain these differences.

Unlike Chile and Central America, we did not find gender differences related to poor self-perceived health. This could be related to the sensitivity of this measure to the cultural environment. For instance, in a European longitudinal study, substantial differences were not found in the self-perceived health by gender²². Anyway, the Ecuadorian percentage was above Colombia and below Chile and Central America.

Ecuador showed the highest prevalence of occupational injury in the region. These results were much higher than those reported by the Ecuadorian social security system²³, which barely reaches 0.62%. This discrepant result alerted us of a probable high sub-register in the official figures in the country. It is a problem in many countries⁶.

We should consider some limitations of this study. Firstly, the sample included only workers registered in the social security system, engaged in non-agricultural activities and living in Quito or Guayaquil. This may have introduced a selection bias because, although these two cities include the largest working population covered by social security (62%)²³, informal employment was not considered. According to the Ecuadorian 2017 labor report, informal employment represents 46% of the working population²⁴. It is a general problem in the region labor market, ranging from 83.1% in Bolivia to 40.5% in Chile²⁵. In fact, the previous comparison among Latin-America WCS also excluded informal employment. Secondly, differences among the questionnaires (concerning the items included and the response categories) used by Latin-American WCS limited the number of variables that we could compare. For example, we excluded psychosocial results in our study because question-wording and response categories have limited comparability.

Despite these limitations, this is the best information available in Ecuador so far, and it is a first step to diagnose health and working conditions in the country. This study also presents a preliminary comparison between occupational health in Ecuador and in other Latin-American countries. It provides basic information for the surveillance of health and working conditions in the country and enhances the regional epidemiological surveillance. Furthermore, it reinforces the need to harmonize and improve WCS in Latin America²⁶, as well as the global occupational health surveillance²⁷. This study also recognizes the need to establish appropriate occupational health public policies.

Acknowledgments

The authors thank Amy Murphy for proofreading the article.

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• This study was partially supported by the SEK International University of Ecuador and by the Universidad de Especialidades Espiritu Santo in the city of Guayaquil, Ecuador.
• The authors inform that the article was not based on a dissertation or thesis and that it was presented at the XXXVI Scientific Meeting of the Spanish Epidemiology Society and at the XIII Congress of the Portuguese Epidemiology Association, 2018, Lisbon, Portugal.

Publication Dates

• Publication in this collection
  21 Aug 2020
• Date of issue
  2020

History

• Received
  15 Feb 2019
• Reviewed
  03 May 2019
• Accepted
  23 July 2019