In the past decade, Spain has experienced dramatic growth of its immigrant population. In 1991, the national census counted 350 000 foreign nationals living in Spain, a number that jumped to over 1 500 000 in 2001.¹ The most recent municipal registry data suggest that this growth is continuing in the present.²

However, this growth and the resultant heightened public consciousness has not been accompanied by more abundant or enriched information regarding the circumstances in which these new arrivals find themselves in Spain. In contrast with other European countries, Spain has comparatively little experience with managed migration. Between February and May of 2005, the ruling government took a significant step, permitting the normalisation of almost 700 000 immigrants who, although they did not have normalised immigration status, could prove residence in Spain and had a labour contract.³

Given the magnitude of this immigration, and its possible social and occupational consequences, it is important to have more concrete information on the workplace conditions this population experiences. In 2003, the most recent year for which data are currently available, the Ministry of Labour and Social Issues added the variable nationality to its registry of occupational injury for those affiliated with the Social Security system (insured workers). This variable permits, for the first time, the comparison of workplace injury and death between Spanish national and foreign workers, one key element in understanding the conditions of workers.

METHODS

We obtained records of the non-fatal and fatal occupational injuries notified to the Ministry of Labour and Social Issues for the year 2003⁴ as Spanish, or those born in Spain, and foreign workers, for anyone with a nationality other than the Spanish. Furthermore, each registry was then examined for sex and age. We estimated the population at risk from data from the Social Security Affiliation Registry as of 31 December 2003.⁵ We calculated the incidence rates and relative risks, and their confidence intervals at 95% within each population group, using Spanish workers as the base reference.

RESULTS

In women and in men, and in every age group, foreign workers had an increased risk of both non-fatal and fatal occupational injury when compared with Spanish workers. These differences were especially notable in foreign women workers, who showed a risk over five (95%CI 5.38 to 5.48) or six (95%CI 3.62 to 9.62) times higher of non-fatal and fatal injury, respectively, than their Spanish counterparts. Additionally, older workers, especially those in the 55 and older age group, seem to have especially dangerous experiences, reaching risks of non-fatal injury (95%CI 14.65 to 15.22) and fatal injury (95%CI 10.46 to 20.82) almost 15-fold higher than Spanish workers of the same age (table 1).

DISCUSSION

The results of this study show considerably higher risks for occupational injury and death for foreign workers in Spain than for their native counterparts, and show the urgent need for improvement in relevant data collection and study of the factors involved in creating these differences. Our results are similar to those found in other contexts using nationality or ethnicity.^6–9

This study was limited by the fact that our data include only insured workers, which surely excludes many foreign workers in informal working positions. Additionally, because of data limitations, we were not able to examine occupational injury or death by area of origin, occupational sector, or by sex within each age group, which would have added nuance to the information garnered.

Despite these limitations, this study is important in that it can serve as a reminder that Spain’s immigration situation, in a context of continued global migration, requires information to drive appropriate actions that meet the needs of foreign workers. Such knowledge is currently limited by available data in Spain. Previous studies in other contexts have suggested that foreign workers are disproportionately represented in the most dangerous jobs,^6,8 and that within those jobs are often relegated to the most hazardous tasks.^6,7 One study found that the number of occupational injuries and deaths in foreign workers diminished with time of residence in the new country and approached that of native workers.⁹ This may suggest that language abilities and workplace and host society culture play a part in injuries at work, both in relevant safety training and in day to day communication at the job site.⁹ It could also suggest that with time, foreign workers can move on from the most dangerous jobs.

It seems logical to believe that such migrant specific factors could help to describe the experiences of foreign workers in Spain and thus the startling differences found in this study. However, we lack information on length of time of residence, language skills, and education, ethnic characteristics, work duties, salaries, and use of health programmes and services. When this information is collected, it is often not uniform across different information sources, which impedes its use. Furthermore, we have almost no information about unrecorded foreign workers. Because good public policy depends of good information, such dependable data and reporting mechanisms are vital to our ability to properly advocate for and meet the needs of foreign workers within a public health framework.

Occupational health in general deserves a more central place in our thoughts about health, but it seems that the health of foreign workers requires even more attention than that of native populations. Permitting normalisation and work permission for immigrants, as the Spanish government did this year, is a step forward, but it is not enough. At the very least, these workers should not work at heightened health risk compared with their Spanish coworkers. As Dong⁷ points out, excess occupational injury and death tend to involve known hazards with acceptable controls; the challenge is then to make those controls work in a complex, multicultural framework. Scandalous differences in occupational injury and death like the ones suggested in this study must occupy a larger portion of the public health and social welfare debate. After all, an improvement in the occupational health of foreign workers contributes to overall population health, the goal toward which all of us work.