The massive and dramatic restructuring that is evident at the local, national and international levels has profound implications for the health of workers.

At the international level, a new global economy has emerged as both capital and labour have become increasingly mobile within and among countries. This new economy has been marked by the negotiation of trade agreements which simultaneously remove barriers among countries and provide protection from those outside their common markets. These agreements, such as the North American Free Trade Agreement (NAFTA) and the European Union, cover much more than trade issues; indeed they encompass the entire role of the state. Along with these agreements have come a commitment to freer markets, deregulation of the private sector and the privatization of many state enterprises.

In some cases, the agreements have led to common standards that raise the level of protection provided to workers in countries where previously such protection was minimal or absent. In other cases, the condition of membership or aid has been de-unionization and movement away from social services, rural agriculture and local enterprise. And in still other cases, unionized workers have successfully resisted efforts to change their conditions. In all cases, however, national boundaries, national economies and national governments have become less important in structuring work relations and in determining the location of work.

Although the new global economy is characterized by the continuing expansion of transnational corporations, it has not been accompanied by the creation of larger and larger establishments. Indeed, the opposite is the case. The prototype enterprise is no longer the giant car plant with thousands of employees producing a standard product by following a fixed production line. Instead, more and more corporations use niche production to provide customized goods and, increasingly, services. Rather than employ economies of scale they employ economies of scope, shifting from one product to another with the help of sub-contracting and equipment that can easily be reprogrammed.

In fact, at least part of the massive shift to the service industries and the rapid growth in small businesses can be explained by transnational corporations contracting out their work. In the work that continues to be done directly by the corporation, large inventories and buffer stocks are frequently replaced by “just-in-time” production, and firms see themselves as increasingly customer driven. More employers are demanding a flexible workforce, one that has a range of skills and a variety of work times. In this way, employees too can work “just-in-time” and at a number of work stations. This increase in contracting out and in multi-tasking, along with the move to “non-standard” forms of employment such as part-time and part-year work, make it difficult for unions to follow the traditional means of organizing workplaces.

Both the development of a global economy and the restructuring of work have been made possible by the new microelectronics technology. This technology makes niche production possible, because new equipment can be altered quickly and cheaply to accommodate new lines. Moreover, this technology not only creates inexpensive and instant communication throughout the world, independent of time zones or other barriers , but also allows the corporation to maintain control over remote enterprises of workers, because it can monitor output in other locations. It thus creates the possibility for production in the home with workers employed anywhere in the world at any time of the day or night.

At the same time, this technology helps to transform the kinds of skill required and the organization of work within enterprises. Increasingly, employers are talking about multi-skilling for workers who control and monitor a variety of machines and who must move between work stations. More and more workers analyse and apply the information generated, processed, stored and retrieved by the new technologies. Both kinds of worker may be organized in teams so that they can work together to continuously improve quality.

This continuous quality improvement is intended to put the focus on the work process as a means of eliminating error and waste. Much of this quality improvement is measured by the new technologies that allow employers and employees to monitor continually the time taken by each worker, the resources used and the amount and quality of the product or service. Managers, especially at the intermediate level, become less necessary because there are fewer supervisory tasks. As a result, hierarchies are flattened and there are fewer promotion routes to the top. Those managers who remain are more involved with strategic considerations than with direct supervision.

The technologies also make it possible for employers to demand a flexible labour force, not just in terms of skills, but also in terms of time. The technology allows employers to use formulas to calculate the precise amount of work time required for the job, and the hours when the work must be done. It therefore allows employers to hire precisely for the number of work hours required. Moreover, the technology can eliminate the traditional costs associated with hiring a variety of workers for short periods of time, because it can determine how many workers are necessary, call them to come to work, calculate their pay and write their cheques. Although the technologies make it possible to monitor and count in incredible detail, they also make transnational corporations more vulnerable, because one power failure, or a computer “glitch”, could delay or shut down the entire process.

All this restructuring has been accompanied by rising unemployment and increasing disparities between the rich and the poor. As companies become leaner and meaner, the demand for employees declines. Even among those who still have jobs, there is little employment security in the new global economy. Many of those with jobs are working very long work weeks, although some do so for only short periods of time as more and more work is done on a contract or piece-work basis. Shift work and irregular work hours have increased significantly as employers rely on a flexible workforce. With only irregular employment, fewer workers have employment-linked protection from unemployment and fewer are represented by strong unions.

This is particularly the case for women, who already form the majority of the casual labour force and of the non-unionized workforce. Governments are also reducing the provision of social services for those without work. Moreover, the combination of new technologies and new organizations of work often results in jobless growth, with both profit and unemployment increasing simultaneously. Economic development no longer means more paid work.

The implication of these developments for workers’ health are enormous, although often more difficult to see than those found in traditional industrial work organizations. Non-standard employment, like unemployment, can increase the health risks for workers. While workers can be quite productive in short work periods, irregular employment may have the opposite effect over the long term, especially if workers are unable to make plans for the future. It can lead to increased levels of anxiety and nervousness, to irritability and lack of confidence and an inability to concentrate. It also can have physical consequences such as high blood pressure and an increased incidence of illnesses such as diabetes and bronchitis. Moreover, irregular employment and non-standard work times can make it very difficult for the women who bear the major responsibility for child care, elder care and domestic chores to organize their work, and thus can significantly increase their stress levels. Furthermore, irregular employment usually means irregular income and often loss of work-related benefits such as dental care, pensions, sick leave and health care. These, too, contribute to the stress workers face and limit their ability to remain healthy or productive.

New methods of organizing work also may be increasing the health hazards for those with more regular employment. A number of studies indicate that unhealthy or inappropriate job design and work organization can increase the risk of heart disease and stroke, as well as other work-related health concerns such as repetitive strain injury. The greatest stress is produced by jobs that offer workers little control over their work or work time, those which require few recognized skills and those that do not allow workers to determine which skills they use. These stress levels may be increased even more for the majority of women, who also have a second job at home.

Although the new work organizations based on teams and multi-skilling promise to increase both the range of skills workers employ and their control over work, in the context of continuous quality improvement they can have the opposite effect. The focus is usually on short-term, easily quantifiable increases in productivity rather than on the long-term results or overall health of the workers. Especially when team members are not replaced during sickness, when team quotas are set by management alone or when output is measured by detailed formulas, team structures may mean less individual control and little collective collaboration to establish individual contributions. In addition, multi-skilling may mean that workers are required to do a wide variety of tasks in rapid succession. Their range of skills is intended to ensure that every second is used, that there are no breaks created by the nature of the work or the transfer of tasks from one worker to another. Particularly in the context of less individual control, the pace set by such work can result in repetitive strain injury or a variety of stress-related symptoms.

Similarly, the new technologies that increase output and make flexible work schedules more possible also can mean loss of control for workers, increased work speed and more repetitious work. In allowing the precise calculation of both work time and output, the new technologies make possible continuous quality improvement and the elimination of waste time. But slack time also can be physical and psychological recovery time, and without such time, workers often experience higher blood pressure levels, increased nervous system activity and generally greater strain. In allowing the electronic measurement of workers’ activities, the new technologies also limit workers’ control, and less control means higher risk of illness. In eliminating many of the mental and manual aspects of the work previously done by a range of workers, the new technologies can also reduce the variety in jobs and thus make work more stultifying and less skilled.

At the same time that work is being reorganized, it is also being relocated both within and among countries. What may be called outwork or home work is increasing. New organizations of work make it possible for more and more production to be done in small workplaces. And new technologies make it possible for more workers to buy their own equipment and work at home. Today, many service jobs such as accounting and filing can be done at home, and even auto parts can be produced within households. Although work at home can reduce commuting time, can increase choices about work time, can make it possible for the disabled to take on paid employment and can allow women to care for their children or the elderly, it also can be dangerous to health. Health hazards in the home are even less visible to others than those in the new workplaces.

Any health hazards created directly by the equipment or the materials involved in the workplace can place the entire household at risk twenty-four hours a day. Without the separation of home and work, workers often feel pressured to work all the time at work that is never done. Conflicts can develop between the demands of children, the elderly and household chores that raise the levels of stress for the entire household. The isolation from other workers doing a similar job can make the work both less satisfying and less likely to be protected through union membership. Physical and mental assault problems remain hidden in the household. This may be the case particularly for the disabled, who then have less choice about working with others because the pressure on employers to make jobs in the market accessible for the disabled is reduced.

Although people in many countries throughout the world have long worked from their homes, the new global economy often involves a new kind of home work. This home work includes new work relations with a remote employer who can have a great deal of control over the home work. Thus, in spite of allowing workers to remain within their households far away from their employers, the new home work may decrease workers’ control over the nature and pace of their work without improving their work environment.

Those who live in many of the southern countries are drawn into the global economy as homeworkers for international corporations. These homeworkers are even more vulnerable to health risks than those in the north and even more likely to have less control over their work. Many are located in free trade zones where protection for workers is eliminated, often as a means of encouraging investment.

At the same time, in both the north and south, cutbacks in state services frequently mean a relocation and redistribution of work for women. With fewer services provided in the public sector, there are fewer paid jobs for women in the labour force. More services are expected to be provided by women, without pay, in the home. Although women bear most of the burden, this transfer of work to the home increases the strain on all household members and lowers their immunity. The increased responsibility at home also may increase the pressure on women and their children to do home work.

In some countries, the growth of both home work and small business means that many employers are no longer subject to state regulations that provide standards for pay, promotion, work hours, conditions and relations, standards such as those forbidding sexual harassment and arbitrary firing. In any case, the expansion of small businesses and home work makes it more difficult to enforce health and safety standards in these many and varied workplaces. Similarly, the growth in contract work often means that the worker is defined as self-employed and thus ineligible for protection from the person who pays for the work. What might be called a legal underground economy is emerging: an economy in which standards related to health and safety no longer apply and unions are more difficult to organize.

There certainly are still significant differences in economies throughout the world. And there are certainly large differences among workers both within and between countries regarding the kinds of work and pay they receive, as well as the protection they have and the hazards they face. However, the emerging global economy is threatening the protection many workers have gained, and there is a growing pressure for states to “harmonize down” in terms of less emphasis on protection and services as free trade increasingly becomes the goal.

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