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Outsourcing is a growing trend, relieving business pressure to flex with the erratic work demands of a dynamic market. Practically speaking, when a process is fairly consistent across an industry, outsourcing seems to make sense, as long as one can sufficiently detail the work specifications. To be successfully outsourced, a project must be translated into logical steps, those steps communicated, and executed—it must be well managed.
Not surprising, the emigration of project management to low wage economies has economic motivation. For all the resistance against such business practice, the long term effect of outsourcing on community health is not obvious. While offering flexibility and diversity to workers and employers, its trade off is stability and many times, expertise. Still, outsourcing offers an opportunity to globalise worker standards.
Against this backdrop, the stage is set for the Forum Barcelona (http://www.barcelona2004.org). The world Forum is organised around three core themes: (1) cultural diversity, (2) sustainable development, and (3) conditions for peace. In fact, conversation has already begun via the web and pre-forum dialogues.
That commerce fosters cultural diversity is undeniable. Outsourcing to the majority of the world brings India and the UK in contact, Brazil and Japan, China and the USA. Within a country, we can see an intersection of cultures. Also undeniable is the conflict concomitant with diversity. It is difficult to understand another who does not speak your language; even for people who speak the same language, a word can connote vastly different meanings. It takes time to develop understanding and trust. We promote effective dialogue by accentuating the beneficial aspects of diversity while acknowledging the inherent conflict in disparity.
The business practice of contracting workers from low wage economies like the Far East and eastern Europe also frames the question of what kind of growth is sustainable, and how do we sustain healthy communities. The global workforce cries for global standards for health and safety. Whether jobs are local or shipped to far away shores, all workers deserve protection. Smart regulations surely do not hinder profitability—amidst the toughest regulation in industry, we see some of the most profitable companies. The conundrum of economic prosperity as a requisite for community health is based, in part, on the riddle of productivity. Can industry increase productivity with greater return on investment, and concurrently preserve worker security?
CONDITIONS FOR PEACE
Clearly, the social contract between employers and workers is under revision. Those with the advantage of wealth, power, or prestige may craft policies toward or away from greater social justice. One measure of success will be the degree to which we reconcile the well established links of health with a decent family income, adequate housing, early childhood development, and a good education.
HOW TO CREATE A HEALTHY WORKPLACE
Ours is not a unique situation. Social reformers have helped close sweatshops, end child labour, and give workers a fair wage for a days’ work in Western Europe, Scandinavia, and the USA. Today, with many workers in safe jobs, in comfortable offices, with reasonable pay, we are called to extend reform of unsafe working conditions globally. As health professionals, we can take a page from the theory of change management1:
Establish a sense of urgency—why is this change needed now?
Gather a coalition to develop a strategy—for direction and support
Communicate the strategy—where do we want to go?
Empower others to act—those closest to the fire must stoke it
Generate short term wins—celebrate successes publicly
Produce greater change.
While thoughtful discussion is valuable, more important is implementing effective solutions. Companies can harmonise existing health and safety standards or stipulate such practice when outsourcing to escape liability and so all are protected, especially those with low wages. To paraphrase one executive, we have the capacity to do more good, for more people, than any other generation on the planet. The question is: How do we respond?
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