Employment and Working Conditions

An important category of risk during pandemic is an individual’s employment and working conditions. The type of employment, income security, access to health benefits (and hence a social safety net if an employee is sick or needs to stay home to provide caregiving), workplace exposure to the virus, workplace demands, and challenges associated with managing multiple role conflicts, all contribute to vulnerability and resilience in pandemic [8, 17, 26-38].

Essential service workers, in particular first responders (eg. EMS) and front line health care workers, are more widely recognized to be at increased risk during an influenza pandemic, particularly after the experience of the global outbreak of SARS in 2003 and concern about H5N1 (Avian Influenza) and H1N1 and their potential to become pandemic [36, 43, 80, 96-98]. In a recent publication from the WHO [2] there is an emphasis on the need and obligation of government and health care organizations to protect the health care workforce. In Canada, in response to the devastating effects of the SARS outbreak on health care workers, the federal government updated the Canadian Pandemic Influenza Plan and identified that it was specifically for the Health Care Sector. An accompanying psychosocial annex was developed to highlight some of the challenges and vulnerabilities for the health care sector [49, 59].

The Public Health Agency of Canada [49] estimates that in the peak two week period during pandemic of influenza, 20 to 25 percent of the population may be absent from work. Essential service workers, particularly those in health care settings or response organizations (eg. Paramedics) are particularly at risk for burnout, psychosocial stress, and exposure to the contagion [35-36, 96-98]. This psychological stress was observed during the SARS outbreak in 2003 [59, 80] and during the aftermath of Hurricane Juan [36] and Hurricane Katrina [32].

The H1N1 pandemic, which was mild compared to other strains of pandemic influenza, resulted in 9% absenteeism in November 2009, based on data from the Labor Force Survey [99]. The number of women who missed work as a result of their own flu-like symptoms or those of their family members was higher than men (10.5% and 7.6%, respectively), although there was no difference in the average number of hours of missed work [99]. Health care workers put in more than 2.0 million additional work hours during the month of November in 2009, in response to the H1N1 pandemic [99].

One population that is especially at risk during pandemic in both the U.S. and Canada is migrant farmworkers. Steege et al. [58] describe how farmworkers are at risk because of their interactions with animals that may harbor the virus, as well as their non-citizen status and the social conditions under which they work and live. As many as 4.2 million seasonal and migrant workers are employed in the agricultural industry in the U.S. [58]. In Canada there are 18,000 to 20,000 migrant workers who live and work in precarious situations [100]. Furthermore, economic factors and substandard living conditions can exacerbate the situation. In an examination of 37 national pandemic plans, Garoon & Duggan [8] noted that needs of migrant workers and immigrants were addressed in only two. Historical studies have also shown that harsh and crowded working environments, such as coal mining, can also facilitate the spread of influenza [101], as well as occupations which include close contact with the public, such as the food and service industries and the sex-trade [9].

Additional concerns related to employment and working conditions include compliance with imposed quarantine measures and social distancing recommendations, which may result in lost income and job insecurity [17, 28]. Some people cannot afford to stay home and sacrifice their income. Others work in essential service positions and are required to ensure continuity of services for the community. Child care issues may be an additional challenge whereby parents may be forced to bring their children to group day care settings when they are sick or have been exposed to influenza [36]. Alternatively the parents may be forced to sacrifice income in order to stay home to care for sick children. Job security, flexible work arrangements, and income replacement strategies are recommended by government to reduce differential impacts of quarantine restrictions on disadvantaged populations when quarantine is in effect, however these interventions are not feasible for all employment positions. The following quotation from Baum et al. [28] is an important statement highlighting the need for policy makers to recognize vulnerabilities that can arise from the implementation of public health interventions during a pandemic:

Policy makers will need to ensure that vulnerable populations or other sub- populations do not shoulder unfair burdens or receive fewer benefits during a pandemic due to the implementation of social distancing measures. The financial struggles that many will face as a result of mandatory school or business closure during a pandemic, for instance, will be most pronounced for low-income workers and the least well-off in society. These groups will have fewer financial resources to sustain them during business or school closures, and may be at higher risk of job loss if they lack vacation or sick leave benefits. (p.11)