Workers Deserve the Right to Mental Well-beings: A New Battle on Occupational Health and Safety
Labour Action China
February 3, 2021
"Mental health has become an urgent priority for companies as a result of the COVID-19 crisis. The uncertainty and stress created by the pandemic, and increased isolation due to large-scale remote working, have put pressure on workforce mental well-being." (The Davos Agenda 2021, World Economic Forum, January 25-29, 2021) 
Mental health has become an urgent issue in the global economy. World economic leaders make a unison voice aloud about how mental distress due to work has made adverse impacts on the world economy today. “The global cost of mental-ill health through lost productivity, absences and staff turnover is estimated to be around US$2.5 trillion annually”.
Business experts also go beyond the fact that mental health is a matter of personal well-being only. It is a global structural issue indeed and closely related to the global poverty and socio-economic development. The solution is finally upon the political priority of governments and the international community. The people in the poor economies clearly suffer more from mental and emotional illnesses than those in wealthy economies do so. Katharine Rooney, a business journalist observes,
1. Depression and anxiety are up to three times as likely for those on low incomes.
2. 55% of women report a significant impact from COVID-19-related income loss.
3. Unemployed people are less mentally and physically resilient than those in work .
Similar alarm has been voiced out by the World Health Organization (WHO) before the outbreak of the pandemic. To the WHO, “mental health is an integral and essential component of health”. Mental health is more than just the absence of mental disorders or disabilities. In its constitution, WHO declares,
"Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."
Mental health at work is a key component for the whole mental health of a person and the work-related stress has become a key issue. WHO classifies the risks of stress-related hazards at work into two categories, risks at work content and risks at work context.
Risks at work content include
1. job content (monotony, under-stimulation, meaningless of tasks, lack of variety, etc.); 
2. workload and work pace (too much or too little to do, work under time pressure, etc.);
3. working hours (strict or inflexible, long and unsocial, unpredictable, badly designed shift systems); and
4. participation and control (lack of participation in decision-making, lack of control over work processes, pace, hours, methods, and the work environment).
Risks at work context include
1. career development, status and pay (job insecurity, lack of promotion opportunities, under- or over-promotion, work of low social value, piece rate payment schemes, unclear or unfair performance evaluation systems, being over- or under-skilled for a job); 
2. the worker’s role in the organization (unclear role, conflicting roles); interpersonal relationships (inadequate, inconsiderate or unsupportive supervision, poor relationships with colleagues, bullying/harassment and violence, isolated or solitary work, etc.);
3. organizational culture (poor communication, poor leadership, lack of behavioural rule, lack of clarity about organizational objectives, structures and strategies); and 
4. work-life balance (conflicting demands of work and home, lack of support for domestic problems at work, lack of support for work problems at home, lack of organizational rules and policies to support work-life balance).
These two categories are also adopted by a pioneering research in Hong Kong co-conducted by Hong Kong Public Opinion Research Institute and Hong Kong Christian Industrial Committee in last January 2021. It is one of the several city-wide (if not the first) studies on mental health at work in Hong Kong. The result generally follows the trend in many studies on mental health at work in other countries. 35% of the 4,538 interviewees feel mentally distressed because of work. As estimated, there are 1.74 million workers find mental distress at work.
In the research, however, the risks of stress-related hazards are grouped into three categories, work content, work context and work ethics (one more dimension than that of the WHO). The dimension of work ethics covers the tension between work and personal beliefs, professional ethics and political orientation. It is especially serious in Hong Kong today [1]. The dimension of work ethics makes the study more holistic on risk factors of metal health at work.
On the World Mental Health Day in 2020 (October 9, 2020), Guy Ryder, International Labour Organization (ILO) Director-General, underlines the importance of looking after our mental health at a time when stresses are rising because of the COVID-19 pandemic. He states,
"These past few months many workers have felt helpless in the face of the profound changes they have experienced. Teleworking has brought new stresses, as workers find themselves isolated or juggling family and professional responsibilities while experiencing blurred lines between their work lives and personal lives. Those who cannot telework have felt unjustly exposed to the risks of the pandemic, with all the anxiety it has brought."
In his article, Guy Ryder proposes more comprehensive recommendations than those made by world economic leaders and the WHO. WHO sees mental health as an issue of public health. It aims to restore a personal health and to help a person cope with the difficulties s/he encounter at work. So the issue to the WHO is usually reduced as a matter of personal psychological adaptability. How to strengthen a person’s ability to adapt him/herself in the face of the risks of work-related stress.
World economic leaders notice that mental health is deeply rooted in the global poverty in the world. They also promote financial support to poor families, especially the people who are unemployed or suffer from lack of job security. It becomes a matter of social protection. 
Guy Ryder, from the labour respective, promotes the measures on mental health protection in the following four areas,
1. legal and social measures against all forms of discrimination attacking the vulnerable groups in employment, 
2. social protection for the unemployed or those who suffer from job insecurity and re-distribution of global wealth,
3. family support and personal mental relief, and
4. occupational protection at work. 
But Ryder does not state clearly what and how to do occupational protection of mental health at work.
Three “I” problems of work
ILO's study in 2000 provides a very comprehensive measures in promoting mental health at work and preventing the potential damages . However, it seems that the measures proposed do not meet the diagnoses of new rising problems by both economic leaders and the ILO as quoted above. Although their analyses underlie the difficulties workers are facing during the pandemic, but the root causes of the difficulties have existed for a long time. In its research, BP, a leading oil company in the world, identifies four kinds of problems workers encounter at work during the pandemic.
1. increased anxiety around job security (56%), 
2. stress due to changes in work routines and organization (55%), 
3. feel lonely or isolated working from home (49%), or 
4. have difficulty achieving a work-life balance (50%)
Guy Ryder’s analysis is corresponding to BP’s points 1, 3 and 4. The rapid change in telework makes aged workers uneasy to be adaptive to the new development. They are worried about the job security. Telework facilitates work from home, but the workers feel isolated and lonely. Work from home blurs lines between workers’ work lives and personal lives, so that workers “have difficulty achieving a work-life balance”. 
In the last three decades, the innovation of information technology speeds up communication among individuals and communities and has crashed down the boundaries of work, in terms of place and time. Work from home and work dispersed all over the world become possible and have prevailed in many industries, like IT, finance, banking, design, etc. This trend has brought three crucial changes in work, individualization of work, informalization of work and irregularity of work (3 “I”s of work).
Work from home or work dispersed all over the world enforce and enhance the flexibility of work, but weaken physical solidarity and emotional support among workers. It makes workers easily feel lonely and isolated and become frustrated and helpless when facing difficulties.
Work from home or work dispersed all over the world speed up and intensify the informalization of work although it is not necessarily the result. On many occasions, workers, particularly young workers, like to be free from formal work relationship, but worry about job insecurity. They are also deprived of all kinds of labour protection.
Loss of distinction between work life and personal life due to work from home and informalization of work makes workers work in an unregulated situation and the work pattern becomes irregular. Long hour work is usually the symptom.
These three “I” issues have existed in the last 10-15 years due to rapid change in telecommunication. They exist before the pandemic, but the pandemic makes the situation worse. In the past, these three “I” problems were more confined to business executives, IT technicians and financial experts. They are a group of professional or highly educated community. But recently, these three “I” problems have emerged among rank-and-file workers due to telecommunication advancement. 
Delivery industry as a fast-growing industry
E-commerce is fast-growing in the last decade in the world and the delivery industry has absorbed a huge number of working force, particularly the younger generation, with highly flexible work. Moreover, the work itself does not require high education and skilled techniques. It is easy for people to get in and to earn relatively attractive income by long hour work. It is especially true during the COVID-19 pandemic. E-shopping and food order online have prevailed in many modern cities. Due to keen competition, speed for product delivery is almost the only assessment criteria of the success of the business. The average time of food delivery in China dropped from 38 minutes in 2016 to 26 minutes in 2019. Under great work pressure, workers complained about common headache at work.
Long hour work or “workaholics” is common in the digital industry everywhere. It is not limited in Silicon Valley, but also in Mumbai, Seoul, and Shenzhen, Shanghai and Beijing today. But now, long hour work is also common in rank-and-file industries, such as delivery, logistics, retailing, etc. In China, long hour work (both voluntary and involuntary) is regarded as a kind of honour of workers.
A Chinese e-commerce giant, Jack Ma, a founder of Alibaba, called long work hours “a huge blessing.” Richard Liu, who runs the Alibaba rival, said people who frittered away their days “are no brothers of mine” . The “996” working practice (a person works from 9am to 9pm every day and 6 days a week) is highly promoted in China. It is popular not only to business executives, IT technicians, financial experts, but also to rank-and-file workers. 
More cases about overwork death or suicide due to overwork have been reported. In Seoul, a 48-year-old delivery worker died in October 2020. The death was suspected due to excessive workload. The worker, who worked as a delivery person for 20 years, had to work for more than 14 hours a day, starting from 6:30 a.m. to around 10 p.m. This suspected overwork death is marked as the eighth case in Seoul in 2020.
There are two reports of a sudden death of a female worker and a suicide of a worker in Pinduoduo Inc. (拼多多), the largest agriculture-focused technology platform in China. Both deaths were also suspected due to excessive workload. Later, a worker in the company shared that he needed to work for around 300 hours a month. He worked from 11am to 11pm every day and 6 days a week. An online article illustrates that the reason of long hour work of workers is because Pinduoduo wishes to expand the market share. Short and on-time delivery has become a way to attract more business. But it is at expenses of workers’ health and lives.
Another report comes about the suspected overwork death of a food delivery worker of ELEME Inc., an online food delivery service platform (饿了么 []) under the Alibaba Group. Worse, the death is not regarded as an occupational injury because delivery workers do not have formal relationship with ELEME. The family of the worker was given RMB 2,000 only as a special relief. But four days later, under the great public criticism, ELEME increased the relief up to RMB 600,000.
The case is a good example to illustrate the three “I” issues.
1. The delivery worker worked as an individual alone without partners or colleagues (individualization).
2. He had no formal employment relationship with the delivery company (informalization).
3. He needed to work for very long hours for higher income (irregularity).
Mental health as an occupational health and safety issue
The three “I” problems of work are deeply rooted in the modern economic development with assistance of technological and telecommunication advancement. Therefore, the problems cannot be solved just by personal counselling or pressure relief, or financial aid as what the WHO and economic leaders recommended. The main cause of the three “I” problems of works comes from the business model and structure.
World economic leaders do not want to tackle this issue, but rather shift the focus on the ways to reduce the effects of depression and anxiety at work or due to job insecurity, although their own studies also point out the questions of business model and structure today.
In his article, Guy Ryder, from the labour perspective, identifies four areas to be addressed in protection of labour rights to mental well-beings. One of the four areas is occupational protection at work, but regrettably, he does not talk much about how the occupational protection should be done on mental health at work. But he re-shifts the focus back to the issue of labour relationship. Mental health at work is no longer a worker’s personal psychological issue, nor a matter of social support, but rather an occupational hazard, a matter of labour rights.
If the three “I” problems of work continue, mental distress at work will stay along and go worse. As a matter of labour rights, the issue should be solved by two traditional ways, collective bargaining and legal protection. In fact, legal dimension is an area of mental health at work to which little discussion has addressed directly so far. In the ILO mechanism, in spite of the fact ILO is not a legal body, its convention could encourage and push legal reforms of its member states. But ILO has yet to formally address the increasing need by clearly specifying any work-related mental conditions as occupational disease, except for PTSD. Instead, a ‘catch-all’ provision is adopted to allow member states a leeway to regulate mental diseases, clause 2.4.2 of the ILO List of Occupational Diseases (revised 2010) provides, 
"other mental or behavioural disorders not mentioned in the preceding item where a direct link is established scientifically, or determined by methods appropriate to national conditions and practice, between the exposure to risk factors arising from work activities and the mental and behavioural disorder(s) contracted by the worker. " [2]
This ‘catch-all’ formulation no doubt preserves the scope for member states to formally recognise mental diseases. However, it leaves two vital issues unsettled.
1. Under what circumstances is a psychiatric condition considered occupationally related? and
2. What is the standard required for workers to establish a “direct link” between mental diseases and work influence?
What is determinative in the diagnosis of work-related mental disorders appears to be workers’ exposure to “risk factors”. The provision, however, is silent on what factors amount to risk factors and the magnitude of exposure to the specified risks needed to be established.
Legal issue is crucial in protection of workers’ rights of mental well-beings. In the aforementioned survey on mental health at work in Hong Kong, Hong Kong Christina Industrial Committee (CIC) strongly promotes the change in the existing labour regulations through which mental illness due to work could be classified as a recognized occupational disease. It is immensely helpful to workers to make claims against employers in defending their rights to occupational mental health. CIC also urges that the Hong Kong Government should promote public education of prevention, remedies and rehabilitation of mental distress at work. It is a new battle of labour rights and occupational health and safety today.
[1] In fact, political orientation seems to be a significant variable to mental health at work. Simply speaking, pro-establishment voters tend to find mental distress more on the risk factors of work content and pro-democratic voters tends to be more worried about the risk factors of work context. There is not much difference on the risk factors of work ethics. See the whole report (in Chinese only). Hong Kong Public Opinion Research Institute, “‘We Hongkongers’” Panel Survey Latest Results”, January 29, 2021. 
[2] The emphases are added.
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