Protección de accidentes del trabajo y enfermedades profesionales: vacíos, contrastes y perspectivas. 1a Parte: Mirada Epidemiológica

Abstract

The purposes of this paper is to analyse inequalities affecting in Chile working people, and the consequences upon health conditions, particularly through working categories a groups, type of enterprise, and gender, expressed as morbi-mortality of productive population. In spite of a massive underdiagnosis and a significant lack of access to statistical information on occupational accidents and diseases, we worked on the elaboration of an epidemiological profile of morbidity and mortality and association with the conditions of work. This profile is characterized by a marked impact on certain categories of workers, which is consistent with inequalities in the determinants of social class and gender. This process tends to shape a regressive evolution in health, which translates into marked gradients for the different occupational categories of damage measured as premature mortality (YPLL) rate and severe morbidity measurable by the use sickness leave diagnoses. The YPLL rate gradients are maintained at a high le- vel of 8 and 7 times more premature mortality in “worker” than “employer”, in the years 2004 and 2014 respectively; while the gap is accentuated for the same occupational categories in men of 8 to 11 times, and is attenuated in women of 5 to 4 times between “worker” and “employer” in the same period. In terms of morbidity causing medical leave, accessibility bias according to socioeconomic level, measuring a mental and muscular-skeletal disease severity index by “manager”, “pro- fessional-technician-white collar” and “blue-worker” occupational groups. There is an excessive burden of injury in terms of “tenosynovitis” and “severe depression” in “blue-worker” occupational category, and in companies with a recognized occupational risk profile and anti-union practice. The information systems implemented by the Superintendency of Social Security in the Commission of Preventive Medicine and Disability, currently under review, lack the option of registering medical sickness-leave for occupational ac- cidents and diseases, a situation that complicates workers at the moment of requesting the coverage of the Law N°16,744 of Accidents and Profesionnal Disease and, what is undoubtedly the source of cross-subsidies for the benefit of the “non-profit” private Employers’ Mutuals.