What can public health do for the welfare state? Occupational health could be an answer

Waiting time from identification to recognition an occupational disease in Spain

OBJECTIVE

To estimate the waiting time since a suspected an occupational disease (OD) is identified, notified and recognized in Spain.

METHOD

A series of 34 patients attended at Occupational Diseases Unit (ODU) of Hospital del Mar in Barcelona were follow up since their identification until final resolution by the National Institute of Social Security (INSS). Median, and 25 and 75 percentiles (interquartile range [IQR]) were calculated in weeks by total time (n=27), ODU time (n=34), patient time (n=31) and INSS time (n=27).

RESULTS

Total time was 51 weeks (IQR: 33.6 and 122.6), of which 42 weeks (17.6-99.5) corresponded to the waiting period at the INSS.

CONCLUSIONS

The disproportionately long waiting time since INSS receives a case could impact on the under-recognition of OD. Urgent improvement of the administrative process is needed to reduce the patient waiting time for the recognition of OD.

Association between informal employment and mortality rate by welfare regime in Latin America and the Caribbean: an ecological study

OBJECTIVE

We aimed to estimate the association between informal employment and mortality in Latin America and the Caribbean (LAC) by comparing welfare state regimes.

DESIGN

Ecological study using time-series cross-sectional analysis of countries. Informality was estimated from household surveys by the Center for Distributive, Labor and Social Studies in collaboration with the World Bank, and the adult mortality rates for 2000-2016 were obtained from the WHO databases. Countries were grouped by welfare state regimes: state productivist, state protectionist and familialist. We calculated the compound annual growth rate for each country and performed linear regression between the informality and the adult mortality rates stratified by sex and welfare state regime.

SETTING

Seventeen countries from LAC with available data on informality and adult mortality rates for 2000-2016.

PRIMARY OUTCOME MEASURE

The association between informality and mortality by welfare state regime.

RESULTS

Between 2000 and 2016, mortality rates decreased an average 1.3% per year and informal employment rates 0.5% per year. We found a significant positive association between informality and mortality rates (women: R²=0.48; men: R²=0.36). The association was stronger among the state regime countries (women: R²=0.58; men: R²=0.77), with no significant association among the familialist countries.

CONCLUSION

Informal employment negatively impacts population health, which is modified by welfare state regimes. Addressing informal employment could be an effective way to improve population health in LAC. However, linkage with public health and labour market agendas will be necessary.