Occupational health outcomes among international migrant workers – Author's reply
Authors: Sally Hargreaves, Kieran Rustage, Laura B Nellums, Jon S Friedland, Cathy Zimmerman
Journal: The Lancet Global Health (2019)

We thank Kristine Husøy Onarheim and colleagues for raising the role of gender in the occupational hazards of migrant workers, and how gender influences health. We would like to strongly emphasise that, to date, female migrant workers remain invisible to society and to researchers. As such, the rights and protection of migrant women (and girls) are commonly ignored in discussions about occupational health. Our study1Hargreaves S Rustage K Nellums LB et al.Occupational health outcomes among international migrant workers: a systematic review and meta-analysis.Lancet Glob Health. 2019; 7: e872-e882Summary Full Text Full Text PDF PubMed Scopus (105) Google Scholar should serve to show that disaggregating results by gender will remain impossible until female workers are fully recognised by labour structures and by researchers. In fact, in most research studies, migrant workers are generally only included as a subpopulation of the wider pool in a cohort, and gender differences are rarely explored. Until there is greater recognition of migrant workers by governments and global policy makers more broadly, and of female workers in particular, their rights will continue to be violated, and their health and safety will remain at risk. We agree with Onarheim and colleagues about the absence of good gender-disaggregated data, and we strongly encourage future research to make the necessary efforts to identify those workers who are most vulnerable to harm, and to specifically focus on the role of gender in the occupational health risks of migrant workers. We appreciate Haiyan Yang and colleagues' careful review of our systematic review and meta-analysis1Hargreaves S Rustage K Nellums LB et al.Occupational health outcomes among international migrant workers: a systematic review and meta-analysis.Lancet Glob Health. 2019; 7: e872-e882Summary Full Text Full Text PDF PubMed Scopus (105) Google Scholar and the opportunity to respond to their queries about the data in figure 2. As the data from Acrury and colleagues,2Arcury TA O'Hara H Grzywacz JG Isom S Chen H Quandt SA Work safety climate, musculoskeletal discomfort, working while injured, and depression among migrant farmworkers in North Carolina.Am J Public Health. 2012; 102: S272-S278Crossref PubMed Scopus (90) Google Scholar Sandberg and colleagues,3Sandberg JC Grzywacz JG Talton JW et al.A cross-sectional exploration of excessive daytime sleepiness, depression, and musculoskeletal pain among migrant farmworkers.J Agromedicine. 2012; 17: 70-80Crossref PubMed Scopus (39) Google Scholar and Bener4Bener A Health status and working condition of migrant workers: major public health problems.Int J Prev Med. 2017; 8: 68Crossref PubMed Scopus (25) Google Scholar were not disaggregated to show how many morbidities each individual might be experiencing, we took the number for the most prevalent morbidity. For example, in the study by Acrury and colleagues,2Arcury TA O'Hara H Grzywacz JG Isom S Chen H Quandt SA Work safety climate, musculoskeletal discomfort, working while injured, and depression among migrant farmworkers in North Carolina.Am J Public Health. 2012; 102: S272-S278Crossref PubMed Scopus (90) Google Scholar the available data indicated that the 118 individuals with musculoskeletal pain also included those with depression or an injury. Thus, we determined that it was inappropriate to sum these numbers to avoid artificially inflating the prevalence of morbidity. We acknowledge the limitations of this approach, and recognise that the prevalence of morbidity reported in our systematic review1Hargreaves S Rustage K Nellums LB et al.Occupational health outcomes among international migrant workers: a systematic review and meta-analysis.Lancet Glob Health. 2019; 7: e872-e882Summary Full Text Full Text PDF PubMed Scopus (105) Google Scholar could in fact be an underestimation of the true prevalence (ie, in this instance, the prevalence of having at least one reported occupational health outcome). Despite this issue, and in light of the complexities involved in pooling heterogenous data from a diverse range of studies, which commonly require pragmatic decisions for data extraction, we believe that the findings are as robust as possible with the currently available data. Moreover, as this is the largest review on migrant workers to date (including 12 168 migrant workers; 3890 of whom were included in the meta-analysis),1Hargreaves S Rustage K Nellums LB et al.Occupational health outcomes among international migrant workers: a systematic review and meta-analysis.Lancet Glob Health. 2019; 7: e872-e882Summary Full Text Full Text PDF PubMed Scopus (105) Google Scholar we believe that, even with minor limitations related to the reporting of results in these three previous studies,2Arcury TA O'Hara H Grzywacz JG Isom S Chen H Quandt SA Work safety climate, musculoskeletal discomfort, working while injured, and depression among migrant farmworkers in North Carolina.Am J Public Health. 2012; 102: S272-S278Crossref PubMed Scopus (90) Google Scholar, 3Sandberg JC Grzywacz JG Talton JW et al.A cross-sectional exploration of excessive daytime sleepiness, depression, and musculoskeletal pain among migrant farmworkers.J Agromedicine. 2012; 17: 70-80Crossref PubMed Scopus (39) Google Scholar, 4Bener A Health status and working condition of migrant workers: major public health problems.Int J Prev Med. 2017; 8: 68Crossref PubMed Scopus (25) Google Scholar our findings, conclusions, and recommendations are accurate. At the same time, we encourage researchers to aim for more consistent data collection approaches in future studies of migrant workers. We declare no competing interests. This work was funded by the Wellcome Trust. Occupational health outcomes among international migrant workers: a systematic review and meta-analysisInternational migrant workers are at considerable risk of work-related ill health and injury, and their health needs are critically overlooked in research and policy. Governments, policy makers, and businesses must enforce and improve occupational health and safety measures, which should be accompanied by accessible, affordable, and appropriate health care and insurance coverage to meet the care needs of this important working population. Full-Text PDF Open AccessOccupational health outcomes among international migrant workersThe health of the 164 million migrant workers worldwide is understudied;1 only 6·2% of the literature on global migration published between 2000 and 2016 has examined the health of migrant workers.2 The important systematic review by Sally Hargreaves and colleagues (July, 2019),3 summarises the global prevalence of occupational morbidity in migrant workers and reports on employment sector, country of origin, country of employment, occupational health outcomes, and design of the studies included. Full-Text PDF Open AccessOccupational health outcomes among international migrant workersIn their systematic review and meta-analysis, Sally Hargreaves and colleagues1 investigated the prevalence of occupational health outcomes (defined as any injury, mortality, or physical or psychiatric morbidity due to an individual's work or workplace environment) among international migrant workers. The findings could help governments, policy makers, and businesses to enforce and improve occupational health and safety measures. However, after carefully checking the data in figure 2,1 we identified several issues that should be highlighted. Full-Text PDF Open Access