TEIKYO SDGs reportTacklingdiverse work styles and worker health
- Public health: examining society and making people healthier -
Mariko Inoue Associate Professor Graduate School of Public Health Teikyo Graduate School
After graduating from the University of Michigan Graduate School Master of Public Health (MPH), she worked in international cooperation in the Philippines. The unstable worker health problems he experienced at that time led him to pursue a career in research. After completing a doctoral program at the University of Tokyo's Graduate School Graduate School of Medicine, he has been teaching at Teikyo University since 2008. He has served as a visiting researcher at the International Labour Organization (ILO) and has been a Associate Professor at Teikyo University Graduate School Graduate School of Public Health since 2016. He specializes in social epidemiology, which focuses on social determinants of health in public health. In particular, we will focus on research on the health and safety of workers with new and diverse work styles, including non-regular employees, and address the health issues of workers in society as a whole.
To summarize this report ...
Public health encompasses an extremely broad range of fields, but its focus is on "people's health."
Health requires not only treatment but also prevention. Health is not only influenced by personal factors such as genetics and lifestyle habits, but also by social determinants of health.
Since the COVID-19 pandemic, and now in the midst of what is being called the Fourth Industrial Revolution, the number of gig workers and cloud workers has increased worldwide, and working styles have become increasingly diverse, but understanding of the industrial hygiene situation has not kept up.
In Japan, there is a history of small and medium-sized enterprises, sole proprietors, and the self-employed having difficulty being covered by the industrial hygiene safety net.
As our society becomes more complex, there is an urgent need to provide industrial hygiene support both at home and abroad that leaves no one behind.
Currently, efforts are being made to understand the social factors behind these problems, analyze their current situation, and develop policies to address them.
In terms of the SDGs, the health and sanitation of working people is an important theme, not only in developed but also in developing countries.
Solutions to industrial hygiene issues in Japan can be applied in other countries and may help improve the level of public health around the world.
Examining the changing society
Public health comes from the phrase "protecting the public's lives." It specializes in protecting people's lives, lifestyles, and being alive. Hospitals and other medical institutions are the most important places to protect people's lives, but that's not all. Various social efforts, such as creating a safe environment, laws and health care systems that support access to medical care, and providing correct knowledge, protect people's health. Public health is a field that focuses on "people's health" and seeks to understand and solve social issues surrounding health. Garbage problems and infectious disease control are easy-to-understand examples, but public health has a long history and humanity has accumulated various wisdom. For example, water and the environment were important even in ancient Greece, when viruses and bacteria had not been discovered. John Snow, the father of epidemiology who stopped the spread of cholera in the UK, also used the power of epidemiology to identify the cause as well water before the cholera bacteria were discovered, and contributed to infection prevention. Other examples include responses to pandemics that have occurred many times since history, both domestically and internationally. In Japan, the lessons learned from pollution and metal poisoning suffered by craftsmen due to the mercury used in the construction of the Great Buddha are well known. There was also a notable decline in infant mortality rates due to maternal and child health and the prevention of infectious diseases. In modern times, many things are being studied, from lifestyle-related diseases and stress caused by the advanced economic environment to the recent COVID-19 pandemic. Public health is also active everywhere, from medical economic perspectives to sending out easy-to-understand health messages. Society is complex, diverse in race and place of origin, and colored by countless relationships, including those between corporations and individuals. When technology evolves somewhere, society also changes rapidly. Every time this happens, public health also continues to evolve.
Although it is a very broad field, there are five main fields that are the basic areas of public health worldwide. In Graduate School of Public Health where I am enrolled, we focus our research activities on five fields: epidemiology, biostatistics, health administration and medical management, environmental and occupational health, and behavioral science and health education. In this field, I am interested in and conduct research on the social determinants of health, focusing on epidemiology, which aims to clarify the distribution of diseases occurring in society and factors that harm health, and to prevent them. This field is known as social epidemiology, and I have been researching the health of workers surrounding non-regular workers.
The health of workers is protected by the industrial hygiene system. It is a broad field that contributes to the health of workers and ultimately society as a whole through personal health management and improvements to the work environment. In Japan, there are professionals such as industrial physicians in the workplace, but I am focusing on the health of non-regular workers as a social determinant of health. Under what circumstances is working in an unstable position likely to damage health? In addition, the theme is to investigate and analyze whether preventive medical treatment is not accessible, and to seek solutions. The diseases covered range from lifestyle-related diseases to mental health. We investigate the causal relationship between diseases and people, and if a causal relationship or association is found, we report it as scientific evidence. Based on that evidence, how can we prevent it? We propose what kind of preventive methods and interventions are available to the field and, if possible, to national and local institutions, and consider solutions. In today's world where economic activity and life are closely linked, and due to the large working population in society, it can be said that the issues of industrial hygiene are directly linked to the "health of society."
Industrial hygiene issues. The health of workers is linked to the health of society
The number of non-regular employees in Japan has increased rapidly since 2000. This was due to the long-term slump in the Japanese economy and deregulation, such as allowing temporary workers to work in a wide range of occupations. At that time, not only did the weak position and disparity of non-regular employees attract attention, but the burden on regular employees increased and long working hours became more serious, resulting in a wide range of impacts. In recent years, work style reform was announced in 2018, and laws were established to prohibit discriminatory treatment based on employment type. Since then, after the COVID-19 pandemic in 2020, working styles have become even more diverse, including working from home. There has been a sharp increase in cloud workers who use online cloud services to take on work in their spare time, and one-off/part-time workers who do not have an employment relationship, known as gig work. However, industrial hygiene support for the "health" of these people has been lagging behind. This year, the government also issued a policy to protect the health of freelance workers, but it remains to be seen how to create a system to continuously protect the health of workers who do one-off work. In 2023, we conducted an online health survey of current diverse workers, including non-regular employees and gig workers. We hope to report on health differences due to working style, identify related factors, and propose countermeasures.
In the first place, are all workers in Japan really protected? Not really. There is a law on industrial hygiene, and there is a provision that an industrial physician must be appointed in workplaces with more than 50 people on a regular basis. An industrial physician is a doctor who has extensive knowledge and experience, especially in the health and safety of workers. They are mainly active in large companies, but since small and medium-sized enterprises make up the overwhelming majority in Japan, there are many companies that do not meet the conditions. Therefore, people working in small business establishments are in a situation where it is difficult to fully benefit from industrial health. People working in large companies are protected by the industrial health system, including industrial physicians, but people working in companies with few employees and self-employed people tend to fall through the cracks. Currently, non-regular employment is increasing, and the number of people working in new styles is steadily increasing, and the situation is expected to become more complicated. Therefore, there is a clear division between those who will continue to be protected by the industrial health activities of companies throughout their working lives and those who are not. Although employment in Japan is moving in a fluid and diversity-oriented direction, it is no exaggeration to say that Japan's industrial health system is still stuck in the 20th century. There is an urgent need to respond, and related national agencies are taking various actions. However, it would take a lot of effort, time, and cost to truly provide an industrial hygiene umbrella to all workers in Japan. We therefore hope to make a contribution by presenting the results of our research on the health of workers with diverse working styles, who are particularly difficult to reach.
Rescue those left behind
When scientifically examining modern working environments, one major issue is the limitations of research. For example, here is an example. Even when comparing the health of regular employees working in a factory with those of fixed-term workers who work for a certain period of time, many regular employees stay on the job for a long time and can be tracked over a period of several years, whereas many non-regular employees leave the company after one or two years, making it difficult to track them continuously. This is why the actual situation of non-regular employees falls through the cracks of industrial hygiene.
Of course, society is not just sitting idly by. For small and medium-sized enterprises, there are attempts to set up and utilize local industrial health centers in the region, doctors and nurses from medical associations who support them, and experts working on industrial hygiene in small companies, and new ideas are beginning to emerge. The health of people, who are the productive population, is the very vitality of society, so I feel that there is a growing momentum to think about this as a society as a whole. On the other hand, in rural areas where the birthrate is falling and the population is aging rapidly, the labor force is steadily decreasing, and recruiting personnel is becoming an increasingly important issue. For young people and those who want to work in a variety of ways, an environment where they cannot benefit from industrial hygiene is a major disadvantage, and it may be that they will not choose this as a place of employment. However, there may be situations where people have limited options for work and have no choice but to choose unfavorable working styles.
A new topic called "side jobs" has also emerged. Naturally, some workers see these diverse work styles as an opportunity to further improve their skills and increase their income. In society, the increase in opportunities to utilize various wisdom will lead to increased productivity. As technology evolves and diverse work styles become possible, opportunities are increasing, such as people who have previously found it difficult to work even if they wanted to. That is why we want to take advantage of the positive aspects while investigating the causes of the issues and ensure that concerns about industrial hygiene do not become a barrier.
Changing society with public health ideas
From the perspective of the SDGs, public health can be said to be an attempt at the health of society. Society is carried out by each and every individual, and in a broader sense, the same can be said for corporations. If the health of each individual cannot be guaranteed, the health of society as a whole will not be possible. Pursuing public health is the very understanding of society, and is a method of solving problems that are common around the world. Naturally, research in Japan can also be applied to the rest of the world. The issue of non-regular employment and the diversification of working styles that I have talked about today is now also a global issue.
I believe that ideally, people should work to live healthy and happy lives. Therefore, it is upside down to work to harm one's health. In addition, working takes up a large part of our lives. It is very worrying that many diseases, including mental health, are caused by stress in daily life and the working environment. One of the main goals of my research is to change the current situation in which part of the cause is "work." People's health is linked to many causal relationships, and it is extremely difficult to grasp each of these threads, understand where they are connected, and what measures can be taken to bring about positive change. Nevertheless, public health experts are aiming for the causes that lie at the source and how to change society to make people healthier. Because public health is so broad and inconspicuous, it is often perceived as an elusive academic field. However, as you can see from the response to the current COVID-19 outbreak, public health is an incredibly dynamic field that is connected to the world and deeply involved not only in medicine but also in politics, economy, and life. In a world that is so interconnected, thinking about human health and "leaving no one behind" is the goal of all SDGs, and solutions are being sought all over the world. "Examining" the economy and society through the health of workers. Improving the possibilities and health of a new society. Researchers continue to take on the challenge of how the academic field of public health as a whole can contribute to building a new world.
