Nurses providing hospital care, delivery people delivering food to homes, domestic workers cleaning hotel rooms, office workers accumulating overtime hours, restaurant servers taking on two or three jobs to make minimum wage: no one would consider these to be dangerous occupations. And yet today, more than ever, they have become high-risk jobs.

In 2019, you no longer have to hang from scaffolding to risk your life on the job. Precariousness, stress, and overwork can also make you sick, and even kill you, at a much higher rate than accidents.

Of all of the work-related deaths recorded each day (7,500 according to the International Labour Organization, or ILO), less than 14 percent occur at the workplace. The vast majority (approximately 6,500) were the result of long-term physical (circulatory, respiratory, professional cancer) or mental illness.

We work in safer environments than we did 30 years ago but the physical and emotional health of workers remains fragile. Traditional risks persist – the European Union, for example, has seen a recent uptick in fatal accidents in the construction sector – while at the same time, emerging risks, psychosocial risks, and risks associated with the digital economy are increasing. These include stress, fatigue, and harassment related to the organization of work, working hours, demands, and uncertainty.

“Psychosocial risks are the great pandemic of this century and they are related to the precarious conditions of the labour market,” warns Ana García de la Torre, secretary of occupational health of Spain’s General Union of Workers (UGT).

The union’s latest prevention campaign focuses precisely on “invisible” threats such as overloading and hyperconnectivity. “They are not new, we’ve been suffering from them for a while, but they have definitely gotten worse.”

Today’s greatest workplace risk isn’t falling or infectious agents, which are more or less under control, but increasing pressure, precarious contracts, and working hours incompatible with life, which, bit by bit, continue to feed the invisible accident rate that does not appear in the news.

In today’s frenetic and competitive market, stress has become almost as common at the office as the coffee machine. It is the second most common workplace health problem and is responsible for half of all absences.

It is most common in the service and care sectors, jobs with a high percentage of female employees, where relationships with people can be exhausting. “The idea that the customer is always right has been very damaging to the wellbeing of many workers,” says José Antonio Llosa, PhD in Psychology at the University of Gijón. According to Llosa, at the other end of the spectrum, the most affected employees are highly skilled workers who face “serious levels of demand for excellence.”

Work-related stress is primarily the result of overwork and an increase in the use of technology. According to the ILO’s most recent health and safety report, 36 percent of the world’s employees work too much (more than 48 hours a week), and all of this overtime puts them at risk.

“There is a close correlation between excessive working hours and accidents at work,” the report warns. “Excessive working hours are associated with the chronic effects of fatigue, which can lead to cardiovascular disease, gastrointestinal disorders, high rates of anxiety, depression, and sleeping disorders.”

Ana Isabel Mariño, labour and social security inspector, acknowledges that these psychosocial risks, combined with ergonomic risks related to harmful movements and postures, are “the most serious today.” However, companies still fail to take preventative measures. “There are usually no protocols in place, just as there are no protocols for dealing with harassment and even sexual harassment,” says Mariño.

Measures are lacking for both raising awareness within companies and updating current legislation. According to UGT, “psychosocial risks are still not included in the catalogue of professional illnesses.” For this reason, many companies do not include them in their risk analyses and they are ignored in medical examinations.

Over the last year there have been some minor advances “such as the recognition of occupational burnout,” says Llosa. “However, we have to be careful with labels. It’s not the fault of the worker who doesn’t know how to deal with the stress,” she explains. The problem cannot be remedied with anti-anxiety drugs, exercise, or meditation but must be dealt with at the source by changing the way that work is organized.

Job insecurity, precarious contracts, and low wages have created a new category of working poor. Today, in addition to earning low wages, they are also more likely to become sick or injured.

“This flexibility and mobility, this extreme and constant obligation to leave your zone of comfort without any type of security results in extreme physical and emotional exhaustion. Job insecurity is linked to poor mental health outcomes with higher rates of depression, anxiety and despondency. It also impacts the way people organize their lives and frustrates their plans,” says Llosa.

Llosa, who is participating in a research project on precariousness and mental health, also warns of a direct link between job insecurity and drug consumption and between perpetual uncertainty and thoughts of suicide. “Obviously suicidal thoughts do not necessarily equate to attempts, but they are indicative of a very deep malaise.”

At the same time, precariousness has physical consequences. “The number of accidents has increased in absolute terms and in severity since 2013, coinciding with increased labor flexibility,” adds Mariño in reference to the figures for workplace accidents in Spain.

The most vulnerable workers are those employed on a temporary or casual basis, those subcontracted through agencies and the false self-employed. ILO data shows the rate of accidents for these employees to be much higher than for any others.

In addition, they are hired to do the most dangerous work, have less access to training, are more susceptible to harassment and generally have a harder time asserting their rights. They are consistently faced with a choice between health and work, between enduring pain or running the risk of not being called back.

The most striking example is that of workers for digital platforms and in particular delivery workers and messengers who are forced by multinational companies to declare themselves self-employed in order to receive a salary. This is why many of them lose their rights, including risk prevention, in a dangerous occupation.

“We receive photos of accidents every day. We drive for shifts of three, four, five hours at a time, the probability of having an accident is high and the company puts us under constant pressure to arrive on time. In addition, we don’t receive any training in risk prevention,” complains Nuria Soto, spokesperson for the labor union Riders x Derechos, which represents delivery people in Barcelona.

Last May, a courier in Barcelona, 23-year-old Nepalese national Pujan Koirala, lost his life while making a delivery. Koirala did not have a work visa and was working under the account of another rider. According to Soto, such arrangements are commonplace. “There are tons of undocumented migrants renting or borrowing accounts. The company is aware of this but it suits them. These workers are the last to claim any rights.”

According to Riders x Derechos, since Koirala’s death, six other delivery workers have died in Europe and Latin America “and in none of these cases have the companies taken responsibility.” That’s why they are demanding to be recognized as salaried workers (several courts in Spain have already ruled in their favor) so they don’t have to continue risking their lives on a job-to-job basis as part of a working model that belongs to the 19th century rather than the 21st.

Accidents not only negatively impact workers but also the companies that employ them and society in general. Bad health and safety practices cost around 3.94 percent of global GDP every year. “That’s why prevention has to be integrated into business operations early on,” says Alejandro Pérez, professor of occupational risks at the ICADE Business School in Madrid.

“I teach my students that they have to assess the risks, inform their workers, provide training, and monitor health. Illnesses have to be addressed as soon as they appear, including stress, so that anyone suffering from it can receive the same protection as someone with a twisted ankle. The problem is that we are still more reactive than preventative,” he adds.

The ILO recognizes that more effort is required in order to anticipate risks and strengthen international standards. In the coming decades, the world will have to face major challenges when it comes to occupational safety, including an ageing population, technological risks, the toxic potential of nanomaterials, and climate change, as well as fundamental changes to the way that work is organized.

There is no point in designing algorithms to predict accidents when the labor market itself has become the primary risk factor. As Mariño insists: “The key to improving prevention is slowing down processes, better regulating hours, and curbing this insane competition.” Protecting workers is impossible in a market that is unrestrained and insecure by nature.