The World Health Organization has recognized health as a right of migrants and refugees, who are entitled to responsive healthcare policies, due to their particular social determinants of health. Migrants’ and refugees’ health is not only related to transmissible diseases but also to mental health, sexual and reproductive health, and non-communicable diseases, such as diabetes. Historically, however, migration has been linked to the spread of diseases and has often artificially served as a scapegoat to local shortcomings, feeding on the xenophobic rhetoric of extremist groups and political leaders. This approach fosters the criminalization of migrants, which has led to unacceptable violations of human rights, as demonstrated by the massive incarceration and deportation policies in developed countries, for example, the United States under the Trump administration.
In Latin America and the Caribbean, in particular, there have been legal developments, such as pioneering national legislation in Argentina in 2004 and Brazil in 2017, which suggest some progress in the direction of human rights, although in practice drawbacks abound in the form of countless barriers for migrants to access and benefit from healthcare services in the context of political turmoil and severe socioeconomic inequality. The COVID-19 pandemic has exposed and enhanced the effects of such inequality in the already frail health conditions of the most disenfranchised, including low-income migrants and refugees; it has both caused governments in Latin America to handle the crisis in a fragmented and unilateral fashion, ignoring opportunities to cooperate and shield the livelihoods of the most vulnerable, and served as a pretext to sharpen the restrictions to cross-border movement and, ultimately, undermine the obligation to protect the dignity of migrants, as the cases of Venezuela and the U.S.-Mexico border illustrate. Still, it could represent an opportunity to integrate the health of migrants to the public health agenda as well as restore cooperation mechanisms building on previous experiences and the existing framework of human rights organizations.
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Migration, Migrants, and Health in Latin America and the Caribbean
Deisy Ventura, Jameson Martins da Silva, Leticia Calderón, and Itzel Eguiluz
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Monitoring Migrants’ Health Risk Factors for Noncommunicable Diseases
Stefano Campostrini
Noncommunicable diseases (NCDs) have become the first cause of morbidity and mortality around the world. These have been targeted by most governments because they are associated with well-known risk factors and modifiable behaviors. Migrants present, as any population subgroup, peculiarities with regard to NCDs and, more relevantly, need specific information on associated risk factors to appropriately target policies and interventions. The country of origin, assimilation process, and many other migrant health aspects well studied in the literature can be related to migrants’ health risk factors. In most countries, existing sources of information are not sufficient or should be revised, and new sources of data should be found. Existing survey systems can meet organizational difficulties in changing their questionnaires; moreover, the number of changes in the adopted questionnaire should be limited for the sake of brevity to avoid excessive burden on respondents. Nevertheless, a limited number of additional variables can offer a lot of information on migrant health. Migrant status, country of origin, time of arrival should be included in any survey concerned about migrant health. These, along with information on other Social Determinants of Health and access to health services, can offer fundamental information to better understand migrants’ health and its evolution as they live in their host countries. Migrants are often characterized by a better health status, in comparison with the native population, which typically is lost over the years. Public health and health promotion could have a relevant role in modifying, for the better, this evolution, but this action must be supported by timely and reliable information.
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Newborn Mortality
Li Liu, Lucia Hug, Diana Yeung, and Danzhen You
As under-5 mortality declines globally, newborn or neonatal mortality is becoming increasingly important. Depending on measurement and empirical data sources, calculation of the magnitude and trend of all-cause and cause-specific neonatal mortality ranges from direct methods to model-based estimates. From 1990 to 2019, the global neonatal mortality rate decreased by 52%, though wide regional variations persist, with sub-Saharan Africa (SSA) consistently experiencing the highest neonatal mortality rates, followed by Southern Asia, accounting for 79% of the 2.4 million total newborn deaths in 2019. Globally, most deaths in 2019 are due to preterm birth complications (36%), intrapartum-related events (24%), congenital abnormalities (10%), pneumonia (8%), and sepsis (7%). Since 2000, in low- and middle-income regions like Central Asia and South Asia and SSA, most deaths were avoided through declines in intrapartum-related events (3.4% and 1.9% AARR [average annual rate of reduction from 2000 to 2019], respectively) and preterm birth complications (2.9% and 1.9% AARR, respectively); whereas high-income regions like Europe, Northern America, Eastern Asia and South-Eastern Asia were more rapidly able to reduce deaths due to congenital abnormalities (2.8% and 3.2% AARR, respectively). More investment is urgently required to improve data collection and data quality, as well as to leverage supporting empirical data with statistical modeling to improve the validity of neonatal mortality and cause-of-death estimates.
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Occupational Health Challenges for Immigrant Workers
Emily Q. Ahonen
Occupational health and safety concerns classically encompass conditions and hazards in workplaces which, with sufficient exposure, can lead to injury, distress, illness, or death. The ways in which work is organized and the arrangements under which people are employed have also been linked to worker health. Migrants are people who cross borders away from their usual place of residence, and about one in seven people worldwide is a migrant. Terms like “immigrant” and “emigrant” refer to the direction of that movement relative to the stance of the speaker. Any person who might be classified as a migrant and who works or seeks to work is an immigrant worker and may face challenges to safety, health, and well-being related to the work he or she does. The economic, legal, and social circumstances of migrant workers can place them into employment and working conditions that endanger their safety, health, or well-being. While action in support of migrant worker health must be based on systematic understanding of these individuals’ needs, full understanding the possible dangers to migrant worker health is limited by conceptual and practical challenges to public health surveillance and research about migrant workers. Furthermore, intervention in support of migrant worker health must balance tensions between high-risk and population-based approaches and need to address the broader, structural circumstances that pattern the health-related experiences of migrant workers. Considering the relationships between work and health that include but go beyond workplace hazards and occupational injury, and engaging with the ways in which structural influences act on health through work, are complex endeavors. Without more critically engaging with these issues, however, there is a risk of undermining the effectiveness of efforts to improve the lot of migrant workers by “othering” the workers or by failing to focus on what is causing the occupational safety and health concern in the first place—the characteristics of the work people do. Action in support of migrant workers should therefore aim to ameliorate structural factors that place migrants into disadvantageous conditions while working to improve conditions for all workers.
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Preventing Falls Through Service Innovations: Institutional and Hospital Settings
Keith Hill
Falls in hospital and residential care settings are common events that can have major impacts for the older person, their families, and staff and also at an organizational level. They are a major trigger event for those with chronic health problems to advance to greater levels of care because they often result in traumatic injuries while they provide a signal event for declining health that may have gone unobserved before injury. Falls among older people in hospital and residential care settings are often caused by a complex mix of risk factors and have proved difficult to prevent. There is growing research evidence that a mix of universal falls prevention interventions that are applied to all patients or residents, as well as targeted interventions addressing one or more identified personal and environmental falls risk factors (often based on a falls risk factor assessment and environmental assessment) can help to reduce risk of future falls in hospitals and residential care. Preventing falls among older people in hospitals and residential care settings requires a complete staff and organizational focus.
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Prevention of Suicide
Danuta Wasserman
Around 700,000 people take their lives each year worldwide. Suicide accounts for approximately 1.3% of all deaths and therefore represents a major public health problem. The global age-standardized suicide rate is 9 per 100,000 population, yet there are large variations among genders, ages, countries, and world regions. The stress–vulnerability model of suicidal behaviors has been proposed to explain how a diathesis, developed through the influence of genetic and neurodevelopmental factors in relation to perinatal, postnatal, and life experiences, interacts with different risk and protective factors that either decrease or enhance the individual’s level of resilience to stress and suicidal risk. Public health suicide prevention strategies include suicide means restriction, reducing harmful substance use, promoting responsible media reporting, public-awareness campaigns, gatekeeper trainings, school-based interventions, crisis helplines, and postvention. Mental health strategies comprise identification, treatment, and rehabilitation of persons in distress and at risk for suicide. Multicomponent strategies that use a combination of evidence-based methods from public and mental health sectors are recommended. Future work should aim at enhancing the quality of epidemiological data, improving the research on protective and ideation-to-action factors, expanding the quantity and quality of data coming from low- and middle-income countries, and evaluating the cost-effectiveness of different suicide prevention strategies.
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Productive Engagement of Older Adults
Nancy Morrow-Howell and Peter Sun
Population aging has largely been approached as a problem. Demographic shifts toward aging societies have been viewed from a deficit perspective. Certainly, the remarkable extension of human life has created challenges to individuals, families, healthcare and social care systems, and income security policies. Yet, the “age-drain” approach fails to recognize the vast heterogeneity of the older population and the growing human capital among older adults. The productive-aging perspective is an alternative to the age-drain perspective that can shape social approaches to population aging. The concept of productive aging was introduced by Dr. Robert Butler in 1985, and he called for the redirection of attention from the dependencies associated with later life to the actual and potential contribution of older adults. Further, he suggested that society could not afford to dismiss the growing capacity of the older population. From the productive-aging perspective, the capacity of older adults to contribute to families and communities through working, volunteering, and caregiving is highlighted. It is likely that societies will need more people in these roles longer into the life course, and it is possible to facilitate engagement in these roles to maximize positive outcomes for older adults and society.
Productive engagement is defined as engaging in activities that produce goods and services, whether paid for or not, including working, volunteering (formal and informal), and caregiving. In all these cases, monetary values have been assigned to the contributions made by people over a certain age, depending on the age selected by the researcher. Outcomes of productive engagement have been conceptualized at multiple levels, including well-being for older people, experienced person-power for organizations, relief to retirement income programs, and stronger civic society. Attaining these outcomes requires social policies and programs that increase opportunities for all segments of the older population. Since the conceptual beginnings, scholars have proposed that productive engagement be viewed as an outcome of extra-individual factors, distinguishing this perspective from the successful aging paradigm that focused more on individual determinants. To date, outdated programs and policies have constrained the engagement of older adults as workers, volunteers, and caregivers. Many innovations have been proposed, and promising interventions are being demonstrated. The aim is to transform work environments and employment policies to enable people to work longer, to increase opportunities to engage older adults in volunteer roles while helping organizations more fully utilize this talent pool, and to improve support for caregiving and other forms of care work in later life. The goal is to create opportunities and to facilitate engagement in productive roles—not to exploit or coerce older people or to exclude lower-resourced individuals who have been marginalized across their life course. Fundamentally, progress depends on changing attitudes about aging and dispelling current assumptions about older adults and aging populations.
Article
Psychosocial Aspects of Cardiovascular Disease in African Americans
Amy L. Ai, Hoa B. Appel, and Sabrina L. Dickey
Cardiovascular disease (CVD) is the leading cause of death in the United States, but the burden of CVD falls disproportionately on racial and ethnic minority populations. Blacks are especially impacted by CVD. Since the 2010s, mortality from CVD has declined and life expectancy disparity between White and Black males has decreased. However, the mortality rate in Blacks remains the highest among all racial and ethnic groups. For example, concerning survival differences between White and Black patients with acute myocardial infarction, 5-year mortality for Black patients is significantly higher than that for White patients. Also, hypertension or high blood pressure and stroke, two of the most disabling diseases, burden Blacks much more than other groups. Furthermore, several major CVD comorbidities or risk factors are linked with disparity in Blacks, especially diabetes, obesity, and chronic kidney diseases. Physical inactivity is a major risk factor. Blacks and Hispanics, as well as Asian American women, all have higher rates of physical inactivity compared with Whites.
The literature indicates the remarkable psychosocial and environmental issues that underlie CVD disparities in Black populations. Specifically, the social determinants of health (SDOH) have been shown to be significant indicators of CVD morbidity and mortality causing a disproportionate impact on racial and ethnic minorities and low socioeconomic status populations. These SDOH involving economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context provide a framework for a multifactorial approach to understand the impact of CVD on the Black community.
The Black community has a history of trauma from racism and discrimination, which is still evident in the existence of structural racism. Trust in the health care system within the Black community remains an ongoing issue and stems from the unethical Tuskegee Study. The lack of trust in the U.S. health care system by the Black community is evident in the limited number of Black participants in research and the excess of health disparities within the Black community. Utilizing SDOH provides a context for understanding the complexity of addressing health disparities among historically marginalized groups. A unifactorial approach will not suffice when there are a number of physical, psychosocial, economic, and environment factors that adversely impact the health of underserved and underrepresented groups such as African Americans. Stringent policies to address racism, discrimination, and adequate access to health care for the Black community must be implemented to decrease the presence of CVD as a health disparity. Without the presence of a social and physical environment that provides adequate resources, such as health care services, quality education to attain employment and be health literate, employment to afford access to health care, and the support to engage in preventive care, African Americans will continue to suffer from various health disparities, such as CVD, and have shorter life spans compared to other racial and ethnic groups.
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Racism and Indigenous Health
Yin Paradies
There are an estimated 300 million indigenous peoples worldwide. Although there is ample evidence of worse health and social outcomes for the majority of indigenous peoples, compared to their non-indigenous counterparts, there has yet to be a review of racism as a determinant of indigenous health using global literature. Racism constitutes unfair and avoidable disparities in power, resources, capacities, or opportunities centered on ethnic, racial, religious, or cultural differences that can occur at three levels: internalized, interpersonal, or systemic. For indigenous peoples this is closely related to ongoing processes of colonization. Available research suggests that at least a third of indigenous adults experience racism at least once during their lives and that about a fifth of indigenous children experience racism. For indigenous peoples, racism has been associated with a considerable range of health outcomes, including psychological distress, anxiety, depression, suicide, posttraumatic stress disorder, asthma, physical illness, obesity, cardiovascular disease, increased blood pressure, excess body fat, poor sleep, reduced general physical and mental health, and poor oral health, as well as increased alcohol, tobacco, and marijuana use and underutilization of medical and mental healthcare services. Disparities in medical care experienced by indigenous patients compared to non-indigenous patients have also been found. Existing studies indicate that avoidant and passive coping tends to exacerbate the detrimental health impacts of racism for indigenous peoples, whereas active coping ameliorates the ill-health effects of racism. Reducing individual and interpersonal racism can be achieved by (a) providing accurate information and improving awareness of the nature of racism and racial bias; (b) activating values of fairness, reconciling incompatible beliefs, and developing antiracist motivation; (c) fostering empathy and perspective-taking and confidence in regulating emotional responses; (d) improving comfort with other groups and reducing anxiety; and (e) reinforcing antiracist social norms and highlighting personal accountability. There are five key areas for combating systemic racism in organizations and institutions: (a) institutional accountability; (b) diversity in human resources; (c) community partnership; (d) antiracism and cultural competence training; and (e) research and evaluation.
Article
Rebooting Education: A Keystone to Ending Racial and Ethnic Minority Health Disparities
William A. Vega and Esther J. Calzada
Undermining educational attainment at any stage is a threat to life course health. A strong educational platform is required for adequate human development in the 21st century because it provides a foundation for lifelong knowledge, skills, and competencies that protect health. The importance of educational attainment for health has been acknowledged but remains understudied as an interdisciplinary issue. In US American society, unequal educational opportunity is a historical reality and is reflected in health disparities among African American and Latinx populations over the life span. Reform efforts have been initiated for decades, yet gains in educational attainment show limited progress and wide disparities in lifetime health persist. Educational attainment is a fundamental social determinant of health because it leverages higher income, improves the management of other social determinants of health, improves social skills, improves occupational life chances, and extends life expectancy. The reverse is also true. Low educational attainment that is intergenerational imperils human development by failing to prepare youth with the capabilities to overcome structural disadvantages and poverty, which themselves imperil development. African American and Latinx populations in the United States, who together represent nearly 100 million people and who will be the largest component of the majority-minority American population by the year 2046, confront a web of aversive social determinants, including poverty in de facto segregated communities, violence and trauma, toxic exposures, poorly compensated and often temporary employment, a lack of universal health insurance, racism, and sexism in their daily lives. Clearly, there are social, biologic, and psychological issues associated with the educational attainment and health gradient, and early childhood learning experiences represent a critically important opportunity for human potential by advancing cognitive performance, problem-solving ability, motivation to learn, and overall structural and functional brain development. Families from low educational attainment backgrounds experience the negative impacts of social determinants in their daily lives, and their children’s life chances are diminished by poorly funded schools with ineffective educational programs. Putative causes and potential responses to overcoming the historical problem of neglect have been identified, and there are promising efforts at educational system reform aiming to promote health with effective programs and comprehensive strategies that will close the gaps in educational attainment.
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Regional Studies of Indigenous Health: Europe and Russia
Peter Bjerregaard
The indigenous peoples of Europe and Russia comprise the Inuit in Greenland, the Sami in northern Norway, Sweden, Finland and Russia and forty officially recognized ethnic minority groups in northern Russia plus a few larger-population indigenous peoples in Russia. While the health of the Inuit and Sami has been well studied, information about the health of the indigenous peoples of Russia is considerably scarcer. The overall health of the Sami is in many aspects not very different from that of their non-indigenous neighbors in northern Scandinavia; the health of the Inuit is similar across Greenland and North America and far less favorable than that of Denmark, southern Canada and the lower 48 American states, respectively; the health of the indigenous peoples of the Russian north is poor, partly due to poverty and alcohol.
Article
The Role of Historically Black Colleges and Universities in Advancing Health Equity
Orlando L. Taylor, Nicole L. Retland, Briana Jeffreys, Elaine Meredith, Melissa E. Wynn, and Pamela L. Carter-Nolan
The end of the Civil War marked a period when America’s medical practitioners considered the Black populace to be unworthy of proper health care on par with that of its White populace. Although slavery had officially ended, its vestiges remained prevalent in the lives of formerly enslaved persons. Indeed, lingering health issues permeated the generations that have followed, such that diseases that are highly treatable have often resulted in premature illness and death. Historically, the health-care industry has even blamed the formerly enslaved and subsequent generations for their own health conditions.
In the early post–Civil War years, state and local statutes legalizing segregation in the American South (known as the Jim Crow laws) cemented these views and perpetuated unfair and unequal health-care conditions. In more recent years, COVID-19 exacerbated an already dire situation, and a disproportionate share of illness and death has occurred among African Americans and other underrepresented masses. Historically Black colleges and universities (HBCUs) can lead the way in bringing some semblance of equality to this situation. Primarily increasing the fiscal resources of HBCUs so that they can further advance the education of a more diverse health-care workforce is a critical component for providing culturally sensitive health care for the nation.
HBCUs already play a disproportionate role in these efforts andwill likely continue their role to effect much-needed change in the prevalence of treatable illnesses and deadly diseases among America’s Black population. While continuing their historic mission to educate the Black populace of the United States, resulting from generations of racial exclusionary and discriminatory practices by predominantly White institutions, HBCUs continue to provide compassionate culturally sensitive education in the public health-care field. Moreover, they provide real-time testimony for the nation’s higher education enterprise on how to provide equality in health-care education.
Article
The Use of Appropriate Sanitation Technology in Low-Income and Informally Occupied Areas: A Case Study of EMBASA’s Experience With the Condominial Sewerage System in Salvador da Bahia, Brazil
Júlio Mota and Ivan Paiva
This article describes how the State of Bahia Water and Sanitation Company (Empresa Baiana de Águas e Saneamento [EMBASA]) expanded sewerage coverage in the city of Salvador, in the state of Bahia, Brazil. In 2021, the city had a sewerage network that served over 80% of its population, despite the fact that at least 70% of the city was composed of informal settlements. To overcome the enormous challenges of installing sewerage systems in areas with informal settlements, EMBASA decided to use the condominial sewerage model, a methodology that combines technical changes in the design of the collection systems coupled with a strong community participation component. The principal technical changes in the collection system were adapting the solution to local circumstances in each neighborhood, universalization of service, the use of the concept of microsystems (subbasins), and the use of the urban block as the basic collection unit. The methodology was first used during a program to expand the sanitary sewerage system of Salvador between 1995 and 2004, when household connections to the sanitary sewage system increased from 26% to 60% in the municipality. The condominial sewerage methodology was adopted because it was the only system capable of solving the enormous problems of informal occupation, community participation, and social inequality, among other things. With the success of the program, investments in sanitary sewerage were continued, and in 2021, the connection rate was 81%. Many challenges to increasing coverage remained, especially those related to the occupation of urban land, which continued in a disorderly manner; social inequalities; and changes in the sanitation regulatory framework.
Article
Traditional Medicine and Indigenous Health in Indigenous Hands
Gerard Bodeker and Kishan Kariippanon
An estimated 370 million Indigenous people reside in 90 countries and make up 5% of the global population. Three hundred million Indigenous people live in extremely disadvantaged rural locations. Indigenous people have suffered from historic injustices due to colonization and the dispossession of their lands, territories, and resources, thus preventing them from exercising their right to development according to their own needs and interests. Across the board, Indigenous people have poorer health outcomes when compared to their non-Indigenous fellow citizens.
Cancer, respiratory disease, endocrine, nutritional, and metabolic disorders, primarily diabetes, affect Indigenous people disproportionately. Newborns of Indigenous women are more than twice as likely to be of low birth weight as those born to non-Indigenous women. Indigenous rates of suicide are the highest in the world.
For public health to be effective, a social determinants approach, along with health interventions, is insufficient to create lasting health impact. Partnerships with Indigenous organizations, Indigenous researchers, and the professionalization of health workers is essential. Integration of traditional medicine and traditional health practitioners can enable the Western biomedical model to work in partnership with Indigenous knowledge systems and become more locally relevant and accountable.
The Indigenous health workforce is increasingly using evidence-based, innovative approaches to address the shortage of health professionals as they move toward universal health coverage. Internet, mobile, and communication technologies are enhancing the mobilization of Indigenous health efforts and the support for health workers in rural locations. Presented are country examples of integrated medicine and Indigenous partnerships that effectively implement health interventions.
Article
Using Large Data Sets to Measure Health Status and Service Use of Older Adults
Kimberly E. Lind and Magdalena Z. Raban
Commonly used data sources for measuring health status and service use of older adults include national surveys and secondary data analysis of electronic data sources including healthcare claims data and electronic health records (EHRs). Depending on how the data are generated in EHRs and medical claims, and depending on how long people are observed for, the ability to measure prevalence or incidence of chronic conditions and the ability to measure incidence or a history of acute conditions will vary. Various data types spanning standardized data (diagnostic codes, procedure codes), medication administered or prescribed, unstructured free text such as clinical notes, and clinical assessment data can all be used to measure health status and service use. Different data sources and types of variables have different benefits and limitations depending on how data are generated and the incentives for those recording data (i.e., healthcare providers and billing staff) to be complete. Testing assumptions and exploring the validity of measures can be accomplished by approaches such as comparing agreement of measures (e.g., disease prevalence) across data tables within a data source, comparing agreement with linked data sources, and comparing rates of disease or service use to rates in data sources that have similar populations. Future directions for administrative data such as data linkage and natural language processing will improve the utility of administrative data. The information and concepts are broadly applicable, but for illustrative purposes, examples of how these approaches have been applied to electronic data from administrative records including EHRs and claims data to fill important knowledge gaps and measure health status and quality of care from Australia and the United States are presented.
Article
Using Lifestyle Interventions to Reduce Alzheimer’s Risk in African Americans
Robert L. Newton, Jr., George W. Rebok, Andrew McLeod, and Owen Carmichael
Currently, there are no pharmacological interventions that have been shown to reduce the risk of developing dementias such as Alzheimer’s disease. However, it is recognized that modifiable behaviors are associated with increased risk of developing dementias. Lifestyle interventions are designed to assist participants in changing these modifiable behaviors. Typical behaviors targeted include dietary intake, sleep patterns, and social, cognitive, and physical activities. It is hypothesized that these effects occur through physiological and biological pathways. African Americans have a high risk of developing dementias, and altering lifestyle behaviors may be effective for reducing risk in this population. Identifying these interventions is important, as effective interventions for a majority non-Hispanic White population do not necessarily translate into effective interventions for African Americans.
Article
Workers’ Health in Latin America and the Caribbean
René Mendes
In different countries and regions of the world—particularly in Latin America and the Caribbean—the term “workers’ health” may have different meanings. From a more traditional perspective, defined on economic and demographic bases, this term introduces a delimitation characterized by economically active people, usually over 10 years of age, of both sexes, and who are working, have worked at some point in their life, or are in search of work. This condition usually ceases in case of retirement or disability. Such a criterion, as can be imagined, is extremely imprecise, particularly in regions such as the ones analyzed here, since it includes great variability of situations, including work considered informal; the work of children and adolescents (prohibited or restricted in accordance with international labor standards); clandestine and illegal work; domestic work (sometimes not formally recognized); and slave and forced labor. It is not clear, either, when work activity actually ceases, especially when there are no social protection systems for elderly and disabled people. But even if this definition is adopted, it is already possible to foresee the complexity of the theme, both in the conceptual perspective and in the scope of health programs, as well as in the health and illness problems of this population.
However, in some countries, the term “workers’ health” (or “worker’s health”) goes beyond the economic or demographic delimitation, and includes a paradigm shift about the role of workers in the struggle for their health. This perspective, political and ideological, originates in the concepts and experience of the “Italian Labor Model”; brings in elements of the Marxist discourses and Liberation Theology; takes advantage of and improves the perspective of “Social Epidemiology” or “Social Medicine”; and, in our continent, can be considered as an unfolding of “Latin American Social Epidemiology.” This understanding of workers’ health also depends on social movements—such as unions and other forms of organizing workers—as well as on political leaders committed to the struggle of workers against precarious work, unemployment and the destruction of already established social rights, especially in the context of neoliberalism.
Therefore, workers’ health is a polysemic and complex concept, and its discussion is a living, dynamic, and extremely rich agenda.
