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Worker’s Health

Underdiagnosis jeopardizes public policies

Project will quantify real incidence work accidents in Piracicaba

The official statistics have recorded a fall in the number of accidents at work in Brazil. In 1998, for example, 414,000 cases were notified, falling to 387,000 in 1999 and to 343,000 in 2000. But this apparently optimistic picture is contested by technicians and specialists who act in the area of Workers’ Health. They reckon that this decline in occurrences is a result of the increase in undernotification, because the official data collection system is inadequate. The technicians guarantee that the occurrence of accidents has undergone strong growth, above all in the informal job market, and they calculate that for each ten accidents, only one is notified.

The official statistics are supported by information gathered from the document called Communication of Accident at Work (CAT in the Portuguese acronym of the National Institute of Social Security used for the purposes of benefits payment. The result, these specialists argue, is that civil servants, the self-employed, domestic staff, owners and workers from the informal sector of the economy – which represent at least half of the workforce – remain outside this data collection, for not being included in the Social Security benefit plan. However, undernotification, they add, even occurs in the case of workers with a right to the benefit, since it is the companies that make the communication and, in a large number of cases, they omit the information and are not inspected. The estimate is that only one fifth of the accidents with workers under the regulations are notified.

“Incongruent data leads to underdiagnosis and can jeopardize the effectiveness of public policies implemented at the various levels of government, with the objective of preventing accidents and guaranteeing suitable work conditions”, warns Ricardo Cordeiro, from the Public Health Department of the São Paulo State University (Unesp) of Botucatu. He coordinates the project Diagnosis and Control of Accidents at Work in Piracicaba, a broad survey that intends to quantify and record the real incidence of work accidents in the municipality, to propose a policy for monitoring the occurrences and, at the same time, to supply input for implementing a more adequate national system for notification. This research, which also has the participation of the Methodist University of Piracicaba (Unimep), is financed by FAPESP’s Research in Public Policies Program and has the support of the Ministry of Labor and Employment.

Health Watch
The initiative for this research came from the municipal government of Piracicaba, a city with 318,000 inhabitants, in the interior of São Paulo. With 56,487 formally employed workers, the great majority occupied in industry (44.5%) and in the services sector (56.7%), the average of officially notified accidents was 51for each group of one thousand insured workers in 1997, far higher than the national average recorded in the same period, of 16 accidents for each group of one thousand insured workers.

On account of the high incidence of accidents, the municipal government implanted the Municipal Program of Workers’ Health, to monitor the occurrences and to develop programs of health watch. “There were cases of companies with an average of 40 accidents for each hundred employees”, says Rodolfo Vilela, the program’s coordinator. But undernotification, the lack of systematized information about the distribution and the characteristics of the accidents at work, and, above all, the absence of data on accidents in the informal economy, were endangering the proper conduct of the project. “We went to see Unimep and Unesp in Botutacu, the municipality where Cordeiro had already carried out similar research”, says Vilela.

The research into Work Accidents in Botucatu, coordinated by Cordeiro and also financed by FAPESP, in 1997, found that the social security records captured only 22.4% of the work accidents. “The system itself, however, undernotifies 80% of the accidents. Only the more serious ones are communicated”, explains Cordeiro. He reckons that this situation, which is likely to be repeated in Piracicaba, is strongly influenced by changes to the social security legislation, such the increase in the period not covered by the insurance from 2 to 15 days, which brought about an increase in the under-recording of minor accidents, or the exclusion of the self-employed and domestic employees from the insurance against accidents.

The survey carried out in Botucatu revealed that 51.3% of the victims of accidents were civil servants, the self employed and employees without a work contract, so that these occurrences were not notified. In Piracicaba, it is estimated that only half the municipality’s Economically Active Population (EAP) has a work contract and is part of the population insured by the INSS (Instituto Nacional da Seguridade Social- The National Institute for Social Security), through the Consolidation of Labor Laws (CLT). “We have no information at all on the informal job market”, explains Vilela.

Household survey
In Piracicaba, the research in the field began on May 15th. All the inhabitants over 10 years old will be consulted, from a total of 3,521 households spread over 450 points in the urban region of the municipality. In all cases, the place of work, the occupation and the kind of labor regulation will be identified, among other information that is crucial for identifying the types of accident that are most common in the formal and informal economies. In the interviews, detailed information will also be gathered on all kinds of work related accidents – typical accidents at work or when commuting, accidents at home, sporting or leisure activities, etc. – that took place in the previous 90 days. All the compulsorily notifiable accidents at work will be compared with the INSS records, in order to make it possible to observe the level of under-recording amongst workers with a right to benefits.

At the end of the three months of research, the project will be assessed by FAPESP’s Public Policies committee. If it is approved, the group of researchers will have a time limit of two years to conclude the work. Besides identifying the accidents at works with a greater incidence amongst the workers in the job market, formal and informal, the research project intends to point out the working environments to which priority should be given forconcentrating health watch activities, as well as the necessary measures for prevention. And identifying the magnitude of under-recording, another target of the project will provide input to correct the official indicators.

THE PROJECT
Informal Work and Work Accidents in Piracicaba
Modality
Public Policies Research Program
Coordinator
Ricardo Carlos Cordeiro – School of Medicine of Botucatu/Unesp
Investment
R$ 29,330.00

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