Work, stress and health in the era of COVID-19 pandemic: experiences from Taiwan

(Presentation in the conference of KSOEM)

1.     Good morning, I am Yawen Cheng, a member of the Taiwan OSH Link and also professor in public health at the National Taiwan University. I am delighted to have this opportunity to share with you Taiwan’s experiences on work, stress and health in the era of COVID-19 pandemic.

2.        The talk consists of three parts. First, I’d like to give you an overview of OSH and related health outcomes in Taiwan, including occupational fatality, occupational diseases and suicide mortality. Secondly, I will briefly review the distribution of working hours, shift work and workplace violence, and point out issues to be concerned regarding the impacts of COVID-19 pandemic on workers’ safety and health. Thirdly I’d like to share the experiences from Taiwan OSH Link, considering our strategies and actions to deal with occupational safety and health.

3.        This slide shows occupational fatality in selected countries, based on workers’ compensation insurance statistics. It shows that both Korea and Taiwan have high workplace fatality rates. The rate of Taiwan could have been underestimated, because the workers’ compensation insurance is not mandatory for workers employed in small enterprises with fewer than 5 people, and many self-account workers are not covered either. There are also problems of under-reporting. In other words, the true number of Taiwan could be higher.

4.        While occupational fatality rate is high, numbers of occupational diseases have been low as compared to other countries. This slide compares the numbers of compensated occupational diseases in Japan, Korea and Taiwan during the period from 1970 to 2016. It shows that there were many occupational diseases in Japan back in the 1970s, but the number declined steadily, that could be attributed to the improvement of working conditions, and to the relocation of dangerous industries to other countries. In Korea, a slight increase of occupational diseases was observed in the early 1980s, and since 1998, more and more occupational diseases have been increasingly compensated. In contrast, much fewer occupational diseases were recognized in Taiwan, except a small spike observed in the late 1990s, mainly coal miner’s pneumoconiosis cases. It was due to the success of retired coal miners who pushed the labor insurance bureau to modify regulations concerning disability benefits.

5.        An international comparison of compensation rate of occupational diseases, taken into account the size of the population, is presented in this figure. As shown, Taiwan recognized 706 cases in 2016, i.e., 6.9 cases per 100,000 insurers. The compensation rate of Taiwan is much lower as compared to Japan, Germany, UK, Korea and most of the European countries.

6.        Same data is presented in this Table, for your information.

7.        What are the major types of occupational diseases being recognized and compensated in Taiwan? As mentioned earlier, the spike observed around 1999 was due to the changes in regulations concerning disability benefits of miners’ pneumoconiosis. Beside this, major occupational diseases compensated by the labor insurance bureau include: musculoskeletal disorders, which accounted for more than 60% of all ODs, and work-related CVDs.

8.        This slide shows the numbers of work-related CVDs in recent years. As shown, a total of 679 cases were compensated, among them, 236 cases were fatal, accounting for 34.8%. (approval rate was 36% in 2018).

9.        In contrast to Japan and South Korea where work-related mental disorders have been increasingly recognized and compensated as occupational diseases, Taiwan recognized much fewer cases. This table summarizes the numbers of cases over the past 9 years. A total of 36 cases were compensated, including 7 fatal cases. We did not have statistics concerning the types of mental diseases, but it is believed post-traumatic stress disorders and major depression accounted for a large share. (approval rate was 27% in 2018). 

10.    It is unclear how severe work-related suicide might be in Taiwan, but we suspect that this problem might not be as severe as in Japan and South Korea, as the population’s suicide mortality of Taiwan were lower than that in Japan and Korea, for both men and women.

11.    However, working hours are quite long in Taiwan, ranking among the tops in many statistics.

12.    Which groups are prone to long working hours in Taiwan? Findings from various surveys showed that the following groups have long working hours, and those marked in red have additional risks of irregular or night shifts. Both long working hours and irregular work shift are known to increase the risks of cardiovascular diseases.

13.    Workplace violence has been one of major concerns of occupational health policies in Taiwan. Several studies showed that medical violence was prevalent, including the forms of physical violence, verbal abuse, bullying and sexual harassment. In December of 2013, a nurse was slapped on face by a local councilor. This event was publicized in the media, leading to a widespread anger among health care workers, because similar events occurred from time to time, as patients were upset by long waiting. Later, in response to social pressure, the Legislative yuan (the Parliament) amended the Medical Care Law in 2014, by raising the penalty on the perpetrator of medical violence. Around the same time, the Legislative Yuan also passed the amendment of Occupational Safety and Health Act, by imposing a duty on employer to prevent workplace violence.

14.    This is one of the studies which we have made and found the workers were at high risks of workplace violence with following work characteristics: night or rotating shifts, longer working hours, greater workloads, greater physical loads, job insecurity and lower workplace justice.

15.    These two tables show the prevalence of workplace violence in different types by gender. We can see that the major type of violence reported by our participants was verbal violence followed by psychological violence, psychological harassment or workplace bullying. We’ve compared the overall prevalence to the prevalence in health care sectors, and the prevalence was much higher in healthcare sectors.

16.    Then, we stratified by type of occupation and the finding showed that among the male participants, certain type of occupation was at high risk of workplace violence including security personnel, manual workers. Among the female participants, those who are in healthcare sectors, finance and commercial sectors, consumer services, and sales who are at high risk of workplace violence. We examined it by psychosocial work conditions, and found the risk factors including night or rotating shift, long working hours, psychological job demands, high physical job demands, job insecurity, and low workplace justice were related to high workplace violence.

17.    We also examined the association between the experiences of workplace violence and their health outcomes with adjustment of some other factors. And it showed that the experience of workplace violence had an effect on a number of the health problems, including poor sleep quality, poor health status, emotional distress and low job satisfaction. Among the four types of the workplace violence which we studied, it showed that the psychological type appears to have the strongest association with poor health.

18.    Based on survey data in a nation-wide were conducted in years 2010 and 2013, our finding showed that the workplace violence has been increasing in this study period.

19.    Many countries have been affected severely by COVID 19 pandemic this year. In Taiwan, the cases of COVID-19 deaths and of infections were considered quite low. Despite the success in containing the spread of COVID-19, the economy of Taiwan has been affected and been struggling with rising unemployment. Like many other countries, Taiwan also experiences the economic recession and the COVID-19 employment crisis. As unemployment rate remains high, some people are turning to the platform economy. In many Asian countries, people rely on the Information and Community Technology heavily, therefore this kind of situation helps lead to new form of working patterns. During the pandemic, we have observed the platform economy grows, such as food delivery and work relies on ICT. This type of work patterns has a lot of implications in terms of workers’ safety and health.

20.    Recently we are studying how the innovation of ICT influences on the forms of production, service delivery, consumption patterns and work arrangement. Our group is currently doing some surveys and interviews with people who are engaged in platform economy. We are trying to understand how the new form of work arrangement might have affected their employment status, the physical work environment, psychological work conditions, and their safety and health problems.

21.    Lastly, I would like to introduce our group. We are from the Taiwan OSH Link, the organization was established in 2013. We have two full staff members and many volunteers and consultants from different disciplines. Our main tasks include provide consultation, assistance to injured workers and their families. We also conduct researches and monitor occupational safety and health policies. We promote social awareness on occupational safety and health through publication, presentations, education and other social campaigns.

22.    These activities include holding workshops, speeches and study groups on variety of issues, such as overwork problems, sleep deprivation, asbestos problems and drivers’ overwork problems.

23.    We hold the press conferences to raise a social awareness on the issues from time to time.

24.    And we also make publications. The books we have published including the booklet about the Worker Compensation Insurance policy, the book island of Overwork” is about overwork in Taiwan. Deadly Dust: Asbestos-related diseases, a major occupational disease epidemic in the history of industrialization is a book about the asbestos-related diseases in Taiwan. The book Aftermath: Meanings, Challenges and Prospects of Workers' Compensation published in 2019, was about the direction of workers’ insurance reform. Besides, we published several booklets to address occupational diseases related issues.

25.    We hope that, by reforming the OSH systems, all workers can be guaranteed with safe and healthy work conditions. By strengthening the workers’ compensation systems, injured workers can return back to the workplace with dignity and sufficient protection. By promoting safety culture, the risks of occupational injuries and diseases can be reduced.

26.    Thanks for listening