A systematic review of working conditions and occupational health among immigrants in Europe and Canada

According to the International Labour Organization’s estimates, there are 150 million immigrant workers throughout the world, almost half of whom are concentrated in two broad subregions, Northern America and Europe. In Europe, the proportion of foreign-born residents increased by more than 50% in the first decade of 2000 because of mobility and migration, and this group now represents about 10% of the European population [1]. Immigrant workers are commonly defined as all economically active immigrants because most of the data sources cannot define the reasons for migration and are likely to record only nationality or country of birth. Most immigrant workers throughout the world are engaged in the services sector and in industries such as manufacturing, construction, transportation and agriculture [2]. New European Union (EU) and national state policies to liberalize regulations have been introduced during the last decade to open up labour markets in Europe, to stimulate new supply- and demand-driven forms of labour migration, and to meet labour market demands and demographic outlook. Most of the immigrant workers from inside and outside of Europe work in low-skilled jobs [1]. Although both immigrant status and unskilled labour are thought to constitute particular risks of unsafe and unhealthy working environment, relatively little is known about working conditions and work-related health of migrants in host countries [3].

Paid work is important for quality of life because it provides a source of income and identity. The workplace offers opportunities for personal development and socializing [4]. However, not all jobs provide equal opportunities, and some are characterized by occupational hazards such as heavy physical work, risk of injury or exposure to toxic substances or poor psychosocial working conditions (e.g., excessive mental work load, low job autonomy or negative social interactions). It is well documented that such exposures can negatively affect workers’ health [5]. In destination countries, immigrant workers are reported to be over-represented in less desirable, low-skilled jobs and are thought to be more exposed to adverse working conditions than natives [6]. Greater difficulties in entering the labour market and in validating prior educational and technical training once in the host country, poor language skills, and a lack of workers in some unskilled occupations may contribute to the higher rate of immigrant employment in the most hazardous jobs. Hence, there are reasons to assume that work-related health among the immigrant population differs from that of the native population in various countries. Other factors such as the reason for migration, geographical origin, age at migration and residence time in the new country also likely contribute to differences in health status between immigrant groups and the native population [7]; however, these topics were considered to be beyond the scope of the systematic search in present study.

More than 10 years have passed since Ahonen and co-workers published the most recent review of research on occupational health among immigrant groups [8]. Their search strategy captured both original and overview articles relating to the topics of immigration, work and health in the PubMed database for the period 1990–2005. Nearly 90% of the included studies were conducted in the United States, Australia and Canada, while only a few were conducted in Europe. The most studied outcome noted in their review was occupational injuries, whereas studies of exposure and occupational health problems involved mainly specific populations (e.g., farm workers and textile workers). The authors reported that the studies included were highly heterogeneous and difficult to classify. Nevertheless, they concluded that all indicators together drew a worrying image of immigrant workers’ health.

Our objective here was to perform a systematic review of the research on both working conditions and occupational health among immigrant workers in Europe. We included studies from Canada because its immigration regime is similar to that of some European countries, especially the Scandinavian ones. We aimed to compare the relationship between working conditions and occupational health in immigrant and native workers. Our main research questions were as follows:

Research question 1: A) Do differences in working environment and conditions exist? B) Does the relationship between work-related exposure and health differ between these groups?

Research question 2: A) Do immigrant workers have more occupational health problems than native workers? B) Do differences pertaining to working conditions mediate differences in occupational health problems?

In this review, we defined “immigrant worker” in a general sense as a person who is foreign-born and economically active in the host country. We chose a wide definition to allow us to examine different aspects of work and health for diverse groups of immigrants or minorities in multiple contexts.

The search resulted in 3213 hits in the three databases after we had removed all duplicates. We excluded most of the studies (n = 3063) in the initial screening of titles and abstracts. In total, 151 articles were read in full, 92 of which fulfilled the initial inclusion criteria [10‐80]. In addition, 11 studies [81‐91] identified in the reference lists were included. The excluded studies that were read in full did not report data on working conditions or health-related outcomes in a defined working population (n = 53); three were duplicates, and two were historical studies of asbestos and mesothelioma [92, 93]. Twenty-one studies [94‐114] did not report relevant quantitative measures of exposure or health. Thus, 82 studies were included in this review (see the flow chart in Fig. 1).

Most studies were cross-sectional (n = 77), except for five with a longitudinal design [26, 45, 62, 70, 81]. Most studies were questionnaire-based surveys (n = 66), except for some register-based studies of sick leave or disability pension [22, 28, 37, 42, 45, 73, 81, 82] or work injury [16, 20, 26, 29, 40, 50, 59].

The studies were from Canada (n = 13), Czech Republic (n = 2), Denmark (n = 9), Finland (n = 5), Germany (n = 2), Greece (n = 1), Ireland (n = 5), Italy (n = 2), the Netherlands (n = 2), Norway (n = 7), Spain (n = 20), Sweden (n = 7), Switzerland (n = 2), the United Kingdom (UK) (n = 4), and Europe (n = 1).

The aim of the present paper was to use a systematic approach to explore the literature and determine whether working conditions and occupational health differ between immigrant and native workers in Europe and Canada.

The most robust result in the present analyses is the higher risk of work injuries in immigrant than in native workers in studies from different countries and with different designs (e.g., occupational injury records, national surveys and patient records) [14, 20, 29, 31, 40, 50, 65, 67, 71, 85, 88]. However, one study that compared immigrants and natives with similar jobs and work tasks (bus drivers) did not find a higher risk among immigrants [66]. Different study designs and the fact that many of the studies were based on patient samples without access to the population at risk make it difficult to compare the risk estimates in all studies. Register-based population studies are considered the gold standard for estimating injury rates in the general population; however, a common limitation in all the included studies was that these studies did not account for illegally employed workers, as well as legally workers, who were not found in the national registries. Nevertheless, our findings are consistent with the results from two previous reviews based primarily on studies from the United States (U.S.) [8, 14]. Preventing work injuries in immigrant workers should take a high priority at both the government and enterprise levels.

Across a large number of survey studies, our analyses consistently show that the prevalence rates of bullying [18, 43] and perceived discrimination [15, 19, 36, 41, 46, 48, 51, 86, 91] were higher in immigrants than in natives. However, the different definitions and measures of bullying and discrimination used in these studies rules out the possibility of comparing prevalence estimates. Immigrants do not generally appear to experience poorer psychosocial working conditions than natives within similar occupational groups, and psychosocial working conditions appear to be equally important for health in both immigrants and natives [17, 38, 44, 49, 54, 55, 87]. Nevertheless, results of studies of the general working population show that immigrants are more likely to be employed in jobs with a lower level of autonomy and opportunities for development [35, 39, 77, 80]. In addition, employment conditions such as temporary work [15, 21, 33, 73], lack of work contracts [33] and over-qualification [34] are prevalent and may be important work factors to take into account, especially in studies of recent immigrants [26, 72]. Further studies are needed to replicate these results in different countries and groups of immigrants.

Only a few studies have addressed the physical and chemical working environment of immigrant workers. We did not identify any studies of the health consequences related to physical and chemical exposures in the workplace. Such health consequences may manifest several years after the exposure and are therefore not straightforward to investigate, which may partly explain the lack of studies in this field. A previous review reported that studies of exposure and health problems tended to focus on specific exposure in specific occupational groups, such as pesticide exposure among agricultural workers [8]. However, these studies were conducted in the U.S. Thus, the present study shows that physical or chemical exposures among immigrant workers have been neglected in the European research literature. One possible explanation is that studies of exposure to physical or chemical factors at work may have focused on the exposure and effect in certain occupational groups, as in the U.S., without reporting other characteristics of the exposed groups, such as immigrant status.

Our study shows that immigrant workers report higher levels of poor SRH [21, 23, 25, 35, 47, 82] and mental distress [10, 25, 32, 35, 52, 55, 69, 84, 87, 89] than do natives, which is consistent with the findings of two previous reviews [115, 116]. Our analysis also showed that most [28, 37, 42, 45, 81‐83] but not all studies [23, 24, 73] have reported a higher risk of sick leave and disability pension among immigrants compared with natives. The evidence that occupational factors may partly contribute to the excess risk of sick leave and disability pension observed among immigrants is sparse, although a few Scandinavian studies support this observation [28, 42, 82]. However, differences pertaining to working conditions were reported to have a small or negligible impact on the increased risk of poor mental health or SRH among immigrants compared with natives in studies from Scandinavia [35, 84], Spain [25] and the Netherland [52].

The overall evidence to show that immigrant workers are more exposed to physical or chemical hazards and poor psychosocial working conditions than natives in Europe and Canada is very limited. Nevertheless, the prevalence of bullying and perceived discrimination is consistently higher among immigrant than among native workers. Immigrants have a higher risk of work-related injuries than do natives. The available evidence supports the inference that immigrant workers are disadvantaged in terms of self-perceived health and mental distress compared with the native population. However, the evidence to conclude that the working conditions are a potential mediator of the association between immigrant status and these health outcomes is very limited. Nonetheless, a few studies from the Scandinavian countries support the idea that controlling for occupational factors may partly mitigate the differences in risk of sick leave and disability pension between non-Western immigrants and natives.

Knowledge of the working conditions and occupational health of immigrant and ethnic minorities is important for initiating preventive and integrational efforts. However, this is challenging because of shortcomings in the available data, heterogeneity of immigrant populations, uncertainty about the validity of instruments and the lack of prospectively designed cohort studies. These challenges underscore the importance of collecting information on working conditions and health more systematically, particularly among groups that are presumed to be at greater risk of being employed in high-risk jobs.

To understand further the associations between working conditions, health and immigrant status, and to facilitate cross-country comparisons in the European context, large-scale studies that focus on different aspects such as immigrants’ cultural and socio-economic backgrounds, language skills and time lived in the host country are needed, as are investigations that are culturally appropriate and use instruments translated into the mother tongue of the target groups of immigrants. Tools and procedures that include immigrants and ethnic minorities in the existing data collection processes, such as censuses, national statistics and health surveys are also needed.

Many aspects of working conditions and occupational health related to immigrant movements remain to be investigated. There are indications of the over-representation of immigrants in low-skilled, high-risk manual jobs, which require confirmation through the analysis of valid empirical data. In addition, there is a lack of information regarding unsettled and undocumented immigrant workers. This matter is complicated by short-term, circular and return migration, which creates difficulties for data collection and reliable assessment of occupational health issues among immigrant workers.