http://orcid.org/0000-0002-6232-6706
ABSTRACT
The neoliberal reforms of the early 1990s in Colombia, mainly labour and social security reforms, transformed capital-labour relations and contributed to the erosion of working conditions and health protection at work, with devastating impacts on workers’ health. In the context of these dramatic changes, Colombian workers mobilised around collective identities that have shaped new forms of workers’ struggle and resistance. Since 2006, associations of workers suffering work-related illnesses have been active in Colombia. The associated workers engaged in collective actions have demanded from employers, the Ministry of Work, occupational risk administrators, disability rating boards and the judicial system the recognition of certain diseases as being of occupational origin and that these entities guarantee corresponding labour, economic and social security rights. This paper describes and analyses the dynamics of the struggle for the right to health at work undertaken by these associations in Colombia, adopting an analytical perspective inspired by collective action theory.
Introduction
As an expression of collective action and struggles for the right to health and safety at work in Colombia, numerous associations of workers and ex-workers with work-related illnesses have been created since 2006 (Asolaborales, Citation2016; Torres-Tovar, Luna-García, & Ruiz-Vallejo, Citation2016). The creation of such associations is directly linked to the existence of workers with work-related injuries, disabilities and illnesses that have not been recognised or adequately treated and also relates to the recognition of the problem being of collective rather than individual nature.
Although the creation of associations of sick and disabled workers is not a new phenomenon and there are records of such associations, particularly of workers exposed to asbestos, since the 1970s at the international level (Barraza, Jansen, van Wendel de Joode, & Wesseling, Citation2013; Carrera, Citation2014; Fry, Citation2010, Citation2013; Hopkins, Citation2010; International Ban Asbestos Secretariat, Citation2017; Judkins, Citation1982, Citation1990, Citation1993; Knight, Citation1971; Silva & Ordúñez, Citation2014; Tello & Grau, Citation2015; Trabanino, Aguilar, Silva, Mercado, & Merino, Citation2002; Zavestoski, Citation2009), this constitutes a new phenomenon in Colombia.
We argue that this form of workers’ mobilisation and social organisation is a consequence of changes related to neoliberal labour, health and social security reforms that have been undertaken since the early 1990s in Colombia as well as to technical and entrepreneurial changes in the production processes since the beginning of the nineteenth century (Davolos, Citation2012; Luna-García, Castro-Fraume, & Villamizar, Citation2016; Torres-Tovar, Luna-García, Parra, & Shell-Sparling, Citation2016). These changes had repercussions on work-related health and safety, particularly as they came along with a loss of decent and safe work due to the fragility of public policies and the lack of business strategies to protect workers’ health. Several actors contributed to the deterioration of the workers’ and their families’ lives, including the tendency of the financial sector to assume an intermediary role in health and labour risk insurances; the absence or weakness of health services and the decay of health promotion and prevention at the workplace further contributed to the situation, as well as limitations in organisational processes and the participation of workers, as reflected in the difficulties faced by trade unions and workers’ associations and none or only limited participation in business decisions (Corredor Jiménez, Citation2004; Luna-García, Citation2009; Muntaner, Benach, Quinlan, Solar, & Santana, Citation2010; Niño Chavarro & De Lafont De León, Citation2013; Schnall, Dobson, & Rosskam, Citation2011; Standing, Citation2011).
Yet another dimension of the problem is evident in the way labour risks have been characterised or ‘qualified’. In this regard, the occupational origin of pathologies associated to working conditions is often has not been recognised and occupational risk administrators (ORA) as well as disability qualification boards have qualified work-related illnesses as being of common origin. As a result, many sick workers have been fired and lost labour and social protection rights (Torres-Tovar, Luna-García, Parra, et al., Citation2016).
This problem has been recognised by studies drawing attention to the suffering and negative consequences of unclear and prolonged routes of attention, recognition and rehabilitation of occupational diseases (Buitrago Echeverri, Abadía-Barrero, & Granja Palacios, Citation2017). These bureaucratic itineraries, that is, obligatory administrative, financial and judicial demands that the Colombian social security system has imposed on patients and their families to access health services or receive adequate medical attention have been found to cause suffering due to access and quality limitations and problems regarding integrity and timely attention (Abadía-Barrero & Oviedo, Citation2009). Furthermore, research suggests that despite labour stability regulations, which are constitutional guarantees that protect workers who have suffered a decline in their ability to work either by illness or accident, to avoid unemployment, many workers have been dismissed (Asolaborales, Citation2016; Buitrago Echeverri et al., Citation2017; Torres-Tovar & Torres-Echeverry, Citation2017).
This situation is compounded by the role played by the Ministry of Work, which is the governing entity of the general system of labour risks and by the Directorate of Labour Risks and the Territorial Labour Directorates is in charge of the inspection, supervision, and control of the system, yet has not played a relevant role in this problem. This situation viewed from the perspective of workers has allowed violations of labour, health and social security rights (Asolaborales, Citation2016; Buitrago Echeverri et al., Citation2017; Torres-Tovar, Luna-García, Parra, et al., Citation2016). Given this context, this article describes and analyses the Colombian workers’ and ex-workers’ struggles for the right to health at work, adopting an analytical perspective inspired by collective action theory.
Methodology
We conducted multi-method participatory action research using quantitative and qualitative methods and directly engaging in the political-organisational dynamics of the workers’ illness associations. The researchers’ engagement with the organisations implied supporting the consolidation of the Federation of Associations and further entailed the organisation of workshops with several associations where the results of this research were presented to strengthen their action and respond to specific technical-political demands of the associations and the Federation.
The research involved a scoping review of national and international literature on the situation of associated workers and former workers with occupational diseases as well as a survey, semi-structured interviews and focus groups with members of the associations in all five macro-regions of Colombia (Caribbean, Northeast, Coffee Region, Center and South). All interview partners and participants of the focus groups gave their informed consent to use audio recordings of these activities for the purposes of this research. The data collection was carried out during the first semester of 2016 and the respective analysis and reports were elaborated during the second semester of the same year. Part of the results presented in this article were published in the Culture and Work Review of the National Trade Union School.
Results
Workers’ Illness associations in Colombia
Since 2006, associations of workers suffering work-related illnesses, so called workers’ illness associations, have emerged as an expression of collective action and the struggle for the right to health at work in Colombia (Asolaborales, Citation2016; Torres-Tovar, Luna-García, & Ruiz-Vallejo, Citation2016). This phenomenon is on the rise and today there are fourteen workers’ illness associations (see ). Apart from these associations, several trade unions have incorporated demands related to the recognition of illnesses as being of occupational origin and the guarantee of social security rights, as well as corresponding economic benefits. These associations operate in different regions of Colombia, including the Caribbean Coast (Santa Marta, Riohacha, Cartagena, as well as processes located in the departments of Córdoba and Cesar), Northeast (Santander and Arauca), Eje Cafetero, Centro (Cundinamarca and Bogotá) and the South (Huila and Meta).
Table 1. Worker’s associations with work-related illness 2006–2016.
Characterisation of association members
A survey applied to 548 members of the workers’ illness associations (Asolaborales, Citation2016), allowed for a characterisation of their sociodemographic characteristics, their epidemiological or morbidity profile, changes in the family structure and the process of affiliation to the association.
It was found that most of the associates are adult men with technical schooling and complete secondary education, belonging to economic strata 1 and 2, married or in common-law marriage, heads of household in charge of two or more people. Most of the associates work or primarily worked in the mining-energy, agro-food or construction sector, with at least five years of experience. The socio-demographic profile of the associates reflects a population group with economic limitations and precarious living conditions, which worsened upon falling sick and lacking labour, health and social security rights, with many families facing financial ruin.
Regarding the morbidity profile of the associates, the survey revealed a broad spectrum of pathologies related to working conditions. Associates that reported only one pathology represented 43%, while 57% reported multiple pathologies. Some even had eight work related conditions, simultaneously. The illnesses mainly involved the respiratory system, musculoskeletal system, auditory and cardiovascular systems. Furthermore, some associates suffered work accidents producing burns, sprains, fractures, spinal injuries and loss of corporal segments.
The association members indicated that the respective qualification boards qualified only 57% of these illnesses and recognise 79% of those qualified illnesses as being of occupational origin. Permanent disability was established in 53% of the cases and 47% of the workers were rated as temporarily disabled. Regarding the qualification percentage of the reduction in labour capacity, only 10% of the cases were rated with more than 50% of reduction and 28% of the pathologies were reclassified by the respective national boards establishing that only 62% of the pathologies were related to labour instead of originally 79%. The situation indicates that in the qualification or rating process a considerable number of cases lose their relation to work after requalification, which clearly complicates the conditions of the association members.
The survey results indicate that an important number of pathologies are associated with workplace hazards that cause permanent damages and disability. At the same time, the figures suggest that these health damages are often not recognised or qualified as disabilities and a significant percentage of pathologies originally recognised as being of occupational origin are later reclassified. According to the results of our survey, workers and former workers with work-related illnesses affiliate with two different types of association in order to protect their labour and health rights: the traditional ones led by trade unions and a new type of organisation that specifically brings together workers with work-related illnesses.
Collective action undertaken by the associations
In Colombia, the rising phenomenon of demands and mobilizations of workers who have seen their health affected by labour diseases and/or accidents can be analysed from the theoretical perspective of collective action. This perspective highlights various aspects related to the configuration of organisational forms, from the establishment of collective identities, the repertoire of collective action, the set of demands and the proposals that define alliances and opponents.
Organisational forms and collective identities
The situation of insecurity with regard to labour stability, health protection and social security, configured a collective social action framework to fight and enforce these rights and eventually led to the emergence of multiple expressions of social protests and organisation by workers and former workers with work-related illnesses, whose rights have not been granted by the responsible actors: corporations, governmental entities and occupational risk administrators (ORA). This situation forged closer social relations between the workers and generated organisational processes that culminated in the creation of Associations or the incorporation of the topic in the agendas of existing trade unions. This organisational dynamic is shaped by the construction of collective identities, which involves sharing experiences among workers with similar work-related pathologies, discussing the suffering inflicted by bureaucratic itineraries and feelings of pain, anger, frustration and injustice that are provoked by these conditions.
Some associations emerged due to the absence or inexistence of trade unions, as is the case for ASOTRADISNORT. In other cases, associations emerged although there were trade unions, as the topic did not receive adequate attention within them, as is the case for ASOTRECOL. Yet others emerged from trade unions, as is the case for Fundación Manos Muertas, and in some cases the trade union itself took up the problems, like Unión Sindical Obrera (USO). In this regard, different organisational modalities emerged: associations where there is no trade union, associations that emerged with the support of trade unions and finally modalities where the trade unions recognised the problem and no other association emerged.
According to our qualitative and quantitative data, the reasons for joining these associations are diverse, but are mostly related to the formation of collective identity, which allows workers to recognise that the guarantee of their rights depends on a collective and individual struggle, a process that is reinforced by psychological and moral support, solidarity, companionship, guidelines for treatment and rehabilitation, and legal advice, among other services offered to the members of the organisations. This is evident in the experiences of ASOTRECOL, ASORIESGOS, ASOTRADISCUNDINAMARCA and ASOTRADISNORT, which practically turned into support centres for workers whose rights have been violated (Asolaborales, Citation2016). Importantly, in Colombia, these organisational processes are novel and notable, considering the enormous difficulties trade unions and similar organisations have historically faced in the country.
The workers’ illness associations are either organised around the economic sector to which the workers belong or a specific region in the country. What is found today in Colombia is that these workers’ and former workers’ organisations are mainly from the mining, energy, food, agro-industrial, construction, tobacco and services sectors, and are primarily found in the central, coastal and north-eastern regions of the country.
Repertoire of collective actions
The repertoire of collective action refers to the types of protest used by social actors (Tilly, Citation2004). The collective action literature suggests that organised actors dispute social order through two different repertoires of action: so-called non-contentious collective action or legal action, referring to action that uses institutional channels to resolve their demands, which is the case of petitions and other legal action, and what is referred to as contentious collective action or de facto, that is often used when non-contentious action is exhausted, including mass demonstrations, rallies, road closures, occupation of buildings and others.
Among the collective action that associations have taken to enforce their rights are a broad set of both individual and collective legal actions. Furthermore, the associations opted for traditional contentious collective action such as rallies, marches and the occupation of buildings and novel, more radical, action such as the indefinite occupation of public space with tents, hunger strikes (with sewed mouths), performance of burials and actions simulating crucifixion and with protesters tied up to recognised institutional buildings.
The demands ASOTREDP, UNECOL, ASOTRADISNORT and ASOTRADISMETA handed over to the Ministry of Work are an example of such forms of collective action, where the general situation and the workplace hazards are detailed and cases of individual workers who suffered injustice are outlined (Asolaborales, Citation2016; Saldarriaga, Citation2013). ASOTRECOL led more radical action including the performance of burials, hunger strikes and a simulation of crucifixions in front of the American Embassy in Bogotá (Torres-Tovar, Luna-García, Parra, et al., Citation2016), ASOTRADEIMENE promoted the chaining of several workers at the entrance of the company and ASOTREDP protested with ropes around the workers’ necks in front of the Ministry of Work (Asolaborales, Citation2016). The repertoire of collective action further includes international complaints and advocacy action, which seek to draw international attention to the problems the workers face in Colombia. These actions are mainly driven by workers and former workers from international companies.
When analysing the repertoire of these organisations, it can be observed that they replicate traditional repertories, both in contentious and non-contentious forms of action; but there are two facts that make a difference in the repertoire with respect to other mobilisation processes: First, the radical nature of non-contentious action, which reflects the enormous despair of the workers and former workers who found no answer to their problems in their interaction and negotiation with entrepreneurs, public institutions and social security institutions. Second, another distinctive feature constitutes the international perspective of several associations, that managed to put their demands on international agendas and thereby force national actors to attend and resolve their demands.
In relation to the cycle of protest, understood as a phase of intensification of conflicts and confrontation in the social system that includes a rapid diffusion of collective action from the most mobilised to less mobilised social sectors (Tarrow, Citation1997), in the case of these workers’ and former workers’ organisations with work-related illnesses, collective action has intensified since 2015. While this clearly reveals the lack of resolution of the workers’ demands, the intensification of collective action also drew attention to the problem, being recognised by public institutions and mass media.
Demands and proposals
The social dynamics driving the consolidation of organisations of workers and former workers with work-related illnesses is mainly a collective response to the repeated violation of labour, health and social security rights and reflect demands around the guarantee of these rights. In relation to the violation of their right to labour, the demands are aimed in two directions: one for those who kept their work and another for those who lost it. In the first case, demands focus on adequate processes of labour relocation that radically challenge the relocation of ill workers to marginal areas of work where they end up feeling useless. In the second case, the demands generally seek to achieve labour reincorporation with adequate rehabilitation processes, if required.
In relation to the violation of their right to health, the demands relate to the recognition of accidents and/or diseases, to adequate medical treatment and timely rehabilitation. Furthermore, the demands include re-adaptation measures that allow the worker to adequately perform his or her work, be and feel productive. In relation to the violation of their right to social security benefits due to illness or accidents, the demands focus on receiving adequate medical care for the health problems from both the employers and the social security institutions. It is demanded that work related illnesses are adequately qualified as such and that the percentage of impairment in working capacity is established in a reliable way, as the welfare and economic rights are calculated in accordance with these measures. Regarding the diagnostic and therapeutic itineraries that workers have to go through (Buitrago Echeverri et al., Citation2017), starting at the company and ending at the national disability qualification board, the central demand is that public institutions headed by the Ministry of Work, protect their occupational and health rights by intervening to oblige the companies to guarantee the rights. Furthermore, public institutions are called to protect the human rights of workers, forcing the Ministry of Work to assume leadership and push for appropriate action by companies, occupational risk administrators and disability rating boards.
These demands from workers’ and former workers’ organisations with work-related illnesses reflect structural problems related to the guarantee of labour, health, social security rights in Colombia and further evince impediments to the freedom of association that seriously hamper several organisations in Colombia (Escuela Nacional Sindical, Citation2017) and in this case, particularly obstruct the workers to organise themselves and participate in the transformation of norms and policies that define their situation. Furthermore, the demands of the workers’ illness associations reflect the terrible impact on the quality and dignity of the population that generates the wealth of the nation.
In relation to the proposals that these organisations articulate, two types can be differentiated: some in relation to the previously discussed resolution of their demands and others of a rather organisational nature. As part of the organisational demands that are based on the understanding that a stronger organisation has a stronger capacity to influence and resolve their demands, workers and former workers created the Federación Nacional de Trabajadores y ex Trabajadores Enfermos de Colombia (FENATRAECO) in 2016. FENATRAECO aims to articulate current associations and increase the influence on companies, social security institutions, government, control agencies and judicial bodies. Demands include the creation of committees or associations in each occupational risk administration company to allow direct dialogue with insurers and promote the formation of new associations in companies with similar problems.
Field of political contentions: between alliances and opponents
The political contentions in the field of health and security at work are primarily expressed in the conflictual interaction between two groups of actors. The first group is composed by those who are responsible for the guarantee of working conditions that do not damage the workers’ health. Among them are the Ministry of Health and of Work (institutions representing the state), the entrepreneurs, the occupational risk administrators, and the disability qualification boards. The second group includes those who suffer the effects of the lack of protection at work, in other words the workers and former workers with work-related illnesses, their associations, and other social and academic actors that support demands for the guarantee and protection of the life and health of the worker. In this sense, the organisational processes of workers and former workers with work-related illnesses have defined the entrepreneurs, the occupational risk administration companies, the qualification boards and even the judicial system and state institutions represented by the Ministry of Work, as their opponents. At the same time, they have identified other workers, their families, some non-governmental organisations (NGO), other social and academic actors, and international social organisations as allies that support their claims. Political disputes in this field are currently won by the entrepreneurs and the occupational risk administration companies because they possess greater resources of power. The weakness of regulation and control by the Ministry of Work and the judicial system contributes to this result.
Achievements and learning
Nonetheless, the workers’ and former workers’ illness associations have made several achievements and went through several significant learning processes. Among the achievements, we highlight the visibilization of their health problems and the violation of their rights; the dialogue established between several social, institutional and political actors to resolve their problems; the emotional support and counselling between the association members; and benefits that were gained by the associations such as medical treatment and economic compensation for those who qualify. Furthermore, several companies have had to take managerial and technological action to protect the health of the workers and the associations have clearly become a reference to other workers in similar conditions that seek solidarity and counselling and serve as an example for the struggle and resistance that can be replicated in other contexts.
As for key learning processes, we highlight the importance of documenting cases of illnesses related to working conditions in order to facilitate the enforceability of rights. Additionally, we highlight the important role of communication to disseminate the allegations and complaints and also the work that is being carried out by the associations. Finally, we highlight the importance of lobbying national and international actors to become involved in workers’ struggles and we recognise persistence as a transcendental factor in the context of the wear and tear this type of collective action can generate.
ASOTRECOL offers an example of the achievements accomplished by associations to date. This association became a reference due to its persistent struggle symbolised by a tent in front of the American embassy in Bogotá over the course of 6 years. The online communication of the association has been decisive as it allowed for wide dissemination of the workers’ struggle. Furthermore, the associated workers and former workers recognise that the company saw itself in the need to provide medical treatment to the workers who had fallen ill and were further obliged to manage rehabilitation and relocalization of the affected workers as a direct result of international pressure. As a result, the company did not manage to lay off the workers and was forced to adopt technological changes with an ergonomic perspective to prevent illness in workers (Torres-Tovar, Luna-García, Parra, et al., Citation2016).
Another example constitutes the international incidence and lobby work of the Asociación de Trabajadores, ex trabajadores y pensionados de la empresa Colombit, ASOTRECOL, Fundación Manos Muertas and ASOTREDP, who managed to draw international attention to the problem and mobilise political actors such as the Congress of the United States and the European Union, that eventually supported the activities and protected the organisational processes (Torres-Tovar, Luna-García, & Villamizar, 2016; Torres-Tovar, Luna-García, Parra, et al., Citation2016).
Conclusions
The deterioration of working conditions in the context of the labour and social security reforms of the 1990s created a field of political contention which generated social unrest and set the stage for the consolidation of associations demanding the protection of workers in hazardous working conditions and the guarantee of labour, health and social security rights as part of broader political demands related to health and social security policies in Colombia.
Our analysis here and previous publications on similar issues reveal a set of barriers that delay the recognition and guarantee of labour and health rights of workers who suffer work-related diseases and forced the workers to organise and act collectively to demand the guarantee of their rights. In this context, novel forms of collective action have developed in more traditional associations like trade unions and new collective actors, namely, workers’ and former workers’ illness associations emerged. The emergence of these new associations can be interpreted as an expression of the traditional trade union movement’s weakness in the context of neoliberal labour reforms (Isaza Castro, Citation2003; Niño Chavarro & De Lafont De León, Citation2013; Schnall et al., Citation2011), but also as a response to the fact that many trade unions were slow or did not incorporate the topic in their agenda (Luna-García, Citation2017).
The epidemic of work-related pathologies is an expression of neoliberal labour regimes characterised by overexploitation and flexibilization, which have exacerbated the contradictions between capital and labour, accumulation and accident, and between profit and lack of social protection (Abadía-Barrera, Pinilla, Ariza, & Ruíz, Citation2012). At the same time, they reflect the defeat of a health protection model at the workplace, which was subordinated by an emphasis on productivity and capital accumulation to the benefit of employers and occupational risk administration companies that have focused on the insurance business. Public institutions headed by the Ministry of Work have not properly fulfilled their regulation and inspection functions and the disability qualification boards have mostly failed to adequately assess the health situation of workers and assume neutrality, which eventually exacerbated a compensational or indemnity-oriented perspective rather than a preventive perspective.
The collective action undertaken by workers’ and former workers’ associations with work-related illnesses could lead to the configuration of a new political subject capable of transforming the poor working conditions and the lack of social protection that led to this type of social mobilisation. Nonetheless, this requires strengthening organisational processes, alliances between associations, trade unions and other allies, and further requires gaining space in society by raising awareness on the unacceptability of the violation of the workers’ rights.
As a direct result of the work done by the associations of workers and trade unions, workplace health issues are now on the public agenda and strategic demands regarding the establishment of a health protection system in multiple work scenarios in Colombia have been formulated, where the Ministry of Health and the financial superintendence assume their function and oblige companies and occupational risk administrators to grant the workers’ rights and involve all actors in the decision making processes, radically challenging business models and labour regimes that promote the accumulation of capital at the expense of the suffering, sickness and death of male and female workers.
Acknowledgments
We are grateful to the group of associations of workers with work-related illnesses who opened their spaces to be able to inquire about their collective processes. Likewise, we thank the People's Health Movement that contributed with resources of the project “The contribution of civil society to achievement of health for all” to did this research and to carry out the translation of this paper.
Disclosure statement
No potential conflict of interest was reported by the authors.
ORCID
Mauricio Torres-Tovar http://orcid.org/0000-0002-6232-6706
Jairo Ernesto Luna-García http://orcid.org/0000-0002-0885-7223
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