Accepted Manuscript Competing conceptualizations of decent work at the intersection of health, social and economic discourses Erica Di Ruggiero, Joanna E. Cohen, Donald C. Cole, Lisa Forman PII:

S0277-9536(15)00170-7

DOI:

10.1016/j.socscimed.2015.03.026

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Social Science & Medicine

Please cite this article as: Ruggiero, E.D., Cohen, J.E, Cole, D.C, Forman, L., Competing conceptualizations of decent work at the intersection of health, social and economic discourses, Social Science & Medicine (2015), doi: 10.1016/j.socscimed.2015.03.026. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Manuscript Number: SSM-D-14-00281R2

Manuscript Title: Competing conceptualizations of decent work at the intersection of health, social and economic discourses

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Order of Authors:

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Erica Di Ruggiero, MHSc, RD, PhD (c) 1 Joanna E. Cohen, PhD 2 Donald C. Cole, MD, MSc 1 Lisa Forman, LLB, MA, SJD 1,3 Dalla Lana School of Public Health, University of Toronto

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Johns Hopkins Bloomberg School of Public Health

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Munk School of Global Affairs, University of Toronto

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Corresponding author:

Acknowledgments:

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Erica Di Ruggiero, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College St., Toronto, Ontario, Canada M5T3M7.

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We would like to thank the key informants in our study who suggested documents that informed this discourse analysis. Thanks also to the peer reviewers for very helpful comments on an earlier version of the manuscript.

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Abstract According to the International Labour Organization (ILO), decent work is critical to economic and social progress and well-being. The ILO's Decent Work Agenda outlines four directions

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(creating jobs, guaranteeing rights at work, extending social protection, promoting social

dialogue) (ILO, 1999a). While the Agenda's existence may imply consensus about its meaning, we contend that several conceptualizations of decent work exist in the global policy arena.

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Different institutional perspectives must be negotiated, and political, economic, social and health considerations balanced in its pursuit. This paper reports findings from a critical discourse

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analysis of 10 policy texts that aimed to reveal different health, economic, and social claims about decent work and how these are shaped by the work policy agendas of the ILO, World Health Organization, and World Bank. Themes emerging from the discourse analysis include the: challenges and realities of promoting "one" agenda; complex intersection between decent

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work, health and health equity concepts; emphasis on economic and pro-market interests versus the social dimensions of work; and, relative emphasis on individual versus collective responsibility for decent work. To our knowledge, this is a first attempt to contrast different

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conceptualizations of decent work involving these institutions. Our findings suggest that decent work is a contested notion, and that more than one "agenda" is operating in the face of vested

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institutional interests. Broader discourses are contributing to a reframing of decent work in economic, social and/or health terms and these are impacting which dimensions of work are taken up in policy texts over others. Results show how the language of economics acts as a disciplinary and regulatory power and its role as a normalizing discourse. We call for research that deepens understanding of how a social, economic and health phenomenon like work is discursively re-interpreted through different global institutional interests.

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Acronyms International Labour Organization

WHO:

World Health Organization

WB:

World Bank

DWA:

Decent Work Agenda

DW:

Decent work

UN:

United Nations

CDA:

Critical discourse analysis

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ILO:

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Key words: decent work, health equity, discourse, economic, policy

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Introduction Work is central to economic and social progress and societal well-being. The ILO defines decent work as the sum of people’s “aspirations for opportunity and income; rights, voice and

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recognition; family stability and personal development; and fairness and gender equality” (ILO, 1999b). The ILO Decent Work Agenda (“Agenda”) delineates four strategic directions– creating jobs, guaranteeing rights at work, extending social protection and promoting social dialogue

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(ILO, 1999c). While the Agenda’s existence may imply consensus about “decent work”, global efforts to improve working conditions remain stalled with profound implications for workers’

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health (Heymann & Earle, 2009a). About 1,000 workers mostly in poorer countries are estimated to die daily because of unsafe working conditions and another 5,000 from work-related diseases (Benach et al., 2007a). Growing societal inequalities are reinforced by economic policies that result in unfair distribution of and access to health and social resources such as decent working

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conditions (WHO, 2008; Ottersen et al. 2014a). We contend that the lack of consensus about what decent work means can partially explain this limited progress in improving global healthy working conditions. A critical discourse analysis (CDA) can reveal how asymmetries in power

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relations shape different conceptualizations of decent work.

Using the ILO definition of decent work (DW) and its Agenda as reference points, we first depict the global institutional context and possible conceptualizations of decent work by reviewing relevant work and health and economic literatures. We then outline the research questions, methods, theory and findings from the CDA of 10 policy texts, and critically reflect on their implications for improving working conditions.

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Background Global institutional context

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Global institutions operate within a dynamic context shaped by economic, political, technological and socio-cultural forces (Lee, 1999; Szlezák N et al. 2010), and by their own mission, and culture. Different institutional perspectives must be negotiated in planning decent

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work policy, with various rules and norms governing power relations between institutions

(Szlezák et al. 2010). These contextual influences affect an institution’s ability to promote “one”

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agenda while facing other vested interests (Stone, 2008).

The ILO was established in 1919 with a commitment to social justice, and tripartite representation from employers, workers and states (Weindling, 1995). This specialized agency

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operates within the United Nations (UN) multilateral system, which involves more than 30 affiliated institutions including the World Health Organization (WHO). In 1999, the ILO launched the Agenda to encourage “decent work-oriented approaches to economic and social

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policy with the principal institutions and actors of the multilateral system and the global

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economy” (ILO, 1999c). The Agenda’s directions address: job creation in the name of reducing poverty and income inequality; guaranteeing rights at work through relevant conventions and labour standards as means of protecting workers’ rights; social protection through social security coverage and dignified work for personal growth and development; and, social dialogue (through tripartism involving governments, employers, workers, collective bargaining and worker participation) (ILO, 1999d).

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Since 1948, the ILO and WHO have cooperated on matters such as joint health and safety guidelines for workers (ILO/WHO, 2010) and the ILO-UN Social Protection Floor Initiative (2010). The ILO and World Bank have collaborated more recently. While not formally part of

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the UN system, the World Bank (WB) was established in 1944 by Allied Nations as the

International Bank for Reconstruction and Development to support development and poverty reduction (WB Group, 2013). Created along with the International Monetary Fund as part of the

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Bretton Woods System, the Bank shapes global labour policy through its financing, research and technical assistance functions (WB Group, 2013). These institutions operate in a politicized

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global policy space connected by “sets of informal and formal rules that prescribe roles, constrain activity, and shape expectations” (Szezak et al., 2010b: 2). In summary, an understanding of the global institutional context is central to discourse analysis as texts are constructed out of the context in which they are produced (Fairclough, 2001a). We assert that it

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is at the intersection of power relations between these global institutions that decent work is discursively shaped. We argue that work is a contested notion, and turn to the literature and

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institutional texts to guide analysis.

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Different conceptualizations of decent work Work is an inherently social, economic and health phenomenon. The ILO decent work concept is rooted in the principles of human rights, gender, social, and health equity, including the right to enjoy the highest attainable standard of physical and mental health. We use the following widely cited definition of health equity: it is created when everyone can reach their full health potential and not be disadvantaged from reaching this potential as a result of age, gender, race/ethnicity,

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social class, socioeconomic status or any other socially determined circumstance (Whitehead & Dahlgren, 2006a). Health equity is grounded in notions of fairness, social justice and human rights (WHO, 2008). It is embedded in the Agenda - it calls for work that is safe, secure and that

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provides a livable income and social protection should a worker become ill. Decent work is also associated with improved health and lower levels of disease and injury (Benach et al., 2007b). Yet the achievement of DW for many workers remains unattainable because they face material

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deprivation and discrimination on the basis of gender, social class, ethnicity and/or race (ILO, 2010). We contend that the elusive nature of achieving DW stems in part from the privileging of

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economic interests over considerations of equitable access to working conditions.

A second possible conceptualization of work is rooted in economic arguments. Markets are

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dynamic and range from the micro-level with a focus on local economies to national and multinational markets. They are influenced by different economic theories, which create “rival views of market society” (Blyth, 2013d:39). While the Keynesiani perspective reflects a pro-poor

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position by supporting the less fortunate so they will consume more to boost demand and consumption, the more dominant neoliberal view of the past few decades suggests giving

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resources to corporations to invest wisely. “Different economic theories empower, and disempower different political and economic constituencies.” (Blyth, 2013e) This matters because public policies dominated by neoliberal ideology can negatively affect health and human development through more restrictive state interventions in economic and social policies, and the deregulation of labour and financial markets (Navarro, 2007a).

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Heymann and Earle (2009b) identified claims from their research on labour laws in 190 countries countering the goal of acceptable working conditions for all. These include: a “bad” job is better than no job; labour laws and standards are irrelevant because they are seldom implemented; and

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lower income nations must endure poor working conditions until they “develop their

infrastructure, technology and productivity” (Heymann & Earle, 2009c:93). These economic arguments emphasize competitiveness and productivity at all cost. Contemporary pro-market

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approaches that result from the 1970’s revolution in macroeconomic theory from neoliberal economics (Blyth, 2013a) are grounded in two assumptions: individuals are self-interested agents

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who maximize the pursuit of those interests, and “markets clear”, meaning the supply and demand for something (jobs) is in perfect equilibrium with no excess supply or unfilled demand (Blyth, 2013b:41). This approach to economics employs discourses such as “markets are growth and productivity engines”, “markets as the best distribution mechanism for goods and services”,

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and “markets know what’s best because they reflect individual, optimal and efficient choices”

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(Blythe, 2013c; Fudge, 2007).

To identify whether the above conceptualizations of decent work were present in texts, we

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designed a discourse analysis to answer these questions: What are the health, economic, and social conceptualizations of decent work reflected in the work policy agendas of the ILO, WHO, and WB?; And, how do concepts, assumptions and claims in the ILO’s Agenda influence the work policy agendas of the WHO and WB?

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Methods We draw on CDA techniques, a process of studying how social relations, knowledge and power are constructed in written texts (Fairclough, 2001b). A CDA was the preferred method because

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of its applicability to examining how texts can be biased towards a certain ideology and how they are shaped by power relations (Johnstone, 2008; Fairclough, 2001c). Other scholars have used CDA techniques to analyze policy discourses (Garoon & Duggan, 2008; Teghtsoonian, 2009a;

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Moore, 2009a). A CDA “explores often opaque relationships between discursive practices,

events and texts and wider social and cultural structures, relations and processes… and [how]

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these arise out of and are ideologically shaped by relations of power and struggles over power” (Fairclough, 2001d: 93). Discourses include interrelated sets of texts and the practices of production, and reception by actors who bring a particular version of social reality into being (Fairclough, 1993a). CDA’s strength is not only to account for how often a concept is used but

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2005).

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also describe how concepts are reinforced in rhetoric (Atkinson & Delamont, 2005; Crowe,

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From a critical perspective, discourses and practices are contested and mediated by power relations between institutions. Our analytic framework was informed by Foucault’s conception of the dynamic relationship between power and knowledge in shaping social reality. Foucault argued that knowledge and discourses produce broader social and cultural structures, relations and processes that get reproduced and taken up in texts and social practices (Foucault, 1980b). We applied Foucault’s conception of governmentality (the ‘conduct of conducts’ or how practices are shaped at a distance), to identify the impact of various forms of procedural and

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institutional power on global actors (Foucault, 2007; Joseph, 2010). Global actors secure some form of social order through their interactions around policies, with potential negative health and social effects (Ottersen et al. 2014b). We examined policy texts from three institutions to

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contrast how discourses about decent work and the texts in which they are embedded carry traces of doctrines and beliefs that underpin dominant or emerging political, economic, or other

systems of thought (Foucault 1980a). We suggest that these texts carry the imprints of each

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institution’s mandate– ILO stands for social justice and human and labour rights, WHO for the right to health, and WB for reducing poverty and promoting development through financial

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assistance. The study included interviews and a CDA, and was approved by the University of Toronto’s Health Sciences Research Ethics Board on October 7th, 2011. The CDA was exempt

Selection of Texts

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from ethics review because it relied exclusively on publicly available texts.

Ten publicly accessible texts ranging in purpose, length and format and produced between 1999

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and 2012 were selected (Appendix 1). This period corresponds to the implementation of the Agenda and events such as the arrival of a new leader at the ILO in 1999, the 2008-2009

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financial crisis, and 2012 release of the WB Jobs Report. Seven of ten texts were produced by the ILO, WHO or WB, two by the ILO and either the WHO or WB, and one by the ILO for G20 leaders.

The Agenda (one of 10 texts) provided the starting point. Texts central to decent work, jointly produced by at least two institutions, and that provided context on each institution’s mandate 9

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were included. For ILO texts, the text had to be central to the Agenda and/or focus on social protection (i.e. policies that guarantee income security and access to essential social services, especially vulnerable groups) because of its relevance to health and health equity, and potential

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contrast to other conceptualizations (i.e. economic). The text had to describe events relevant to the context in which the ILO operates, and have a relationship to WHO or WB texts. For WHO

the ILO decent work definition using these criteria.

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and WB texts, we assessed the extent to which these texts reinforce, contradict or are silent on

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• Text represents inter-textual chains by outlining commitments between the ILO and either institution to cooperate on the Agenda; and,

• Text is expected to provide a contrasting perspective to the Agenda.

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While constitutional documents provided insights on institutional mandates, they were excluded from in-depth analysis because our study did not primarily focus on the history of these

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institutions.

Data Analysis

Our analytic approach to CDA was in line with ones used by others who have examined the reproduction of power asymmetries between institutions in texts and social practices that enable some discourses to be advanced over others (Fairclough 2001e; Teghtsoonian, 2009b). Texts were analyzed from 2012 to 2013. We determined the frequency of use for DW, Agenda, and job(s). While a count illustrates frequency and temporal changes in a term’s use, it is not a 10

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substitute for how a term is used. In keeping with Fairclough’s (1993b) approach to CDA, which draws upon Foucault’s conception of power, we conducted an in-depth reading, involving analysis at different levels of specificity ranging from single words to phrases to entire texts. The

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lead author analyzed the texts to explore: implicit and explicit claims about DW, including

instances of health equity and economic justifications; and, use of positioning statements and rhetorical devices (e.g. metaphors), which encouraged adoption of a DW approach or not, or how

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a text reinforces the interests of powerful forces. The use of linguistic techniques such as a

declarative tone and transitivity (e.g. who is doing what to whom?) were assessed (Fairclough,

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1993c; Atkinson & Coffey, 2004). Instances of intertexuality (i.e. borrowing words from another text) were examined to determine how texts reflect each other to contribute similar and competing notions of DW. Consistent with the study questions and input from co-authors, the first author developed and refined a coding scheme according to the discursive elements that

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emerged from an iterative application of the analytic framework and concepts (e.g. health equity). The first author undertook coding using ATLAS.ti 6.2 qualitative data management

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Findings

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software using the above analytic approach.

We first describe the uses of DW, DWA and job terms. We then explore emerging themes from our CDA and their relationship to study questions. Themes include: challenges and realities of promoting “one” agenda; complex intersection between decent work, health and health equity concepts; emphasis on economic and pro-market interests versus social dimensions of work; and, relative emphasis on individual versus collective responsibility for decent work.

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The presence of decent work, DW Agenda and job terms

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Appendix 2 outlines how frequently DW, DWA and job terms are used in policy texts. Variability in document length (range: 2 to 422 pages) should be noted when reviewing the frequency of each term’s use, and so caution should be exercised when comparing these

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numbers. Even taking document length into account, the use of DW decreased over time (from 1999 to 2012), and in several instances, references to DW and the Agenda are noticeably absent.

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Given its centrality to the institution’s policy activities, ILO texts refer liberally and explicitly to DW and the Agenda. Most ILO texts feature declarative statements that position DW and the Agenda as fundamental to labour and employment policy development, encouraging its full integration in policy processes.

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“Nonetheless, employment and labour ministries need to enhance their capacity to engage with finance, trade and other ministries at the stage of policy development to ensure that the goal of decent work is “built in” as opposed to “tacked on” to key government policies.” (Promoting Policy Coherence for DW and Full, Productive Employment; ILO with OECD; 2011, p. 6)

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In texts produced with WHO or the WB or independently by each of these institutions, DW or

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the Agenda are mentioned less frequently (Appendix 2), and explicit mention of the more allencompassing DW concept is eclipsed in favour of other broader discourses about work. Implicit mentions of DW are present in joint ILO/WHO documents, and include the need to protect workers’ health and rights, but not decent work. Instead, DW is reframed in health and health equity terms through references to policies that promote rights and social protection schemes and link explicitly the protection of the health and rights of workers to accessing quality health services. This reframing is evident in the following:

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“Countries must protect the health and rights of their health workers by optimizing their working conditions. By protecting health workers, countries would ensure that those providing health services are themselves healthy. This will in turn facilitate people’s rights of access to quality health services.” (WHO/ILO/UNAIDS Policy Guidelines, 2010, p. 1)

Decent work is also implicit in texts on the Better Work Partnership (International Finance Cooperation (IFC), the private financing arm of WB Groups) and the ILO to improve

compliance with labour standards and competitiveness in global supply chains. There are cursory

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references to social protection and fundamental rights for groups who need protection – both are

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linked to ILO’s DW concept.

“Some of the key indicators include [a measure of] weak compliance with labour standards; industries that employ a larger number of workers, especially women and/or other disadvantaged groups” (ILO/IFC Better Work Initiative, 2009).

In other texts, the DW concept is absent. Instead, the term “job” is more frequently employed

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with periodic qualifiers such as good or better, in two of three WHO/ILO documents. Qualifying terms such as ‘good’ or ‘better’ imply some features of the ILO DW definition. According to the WB, “jobs are labor activities that generate income, monetary or in-kind without violating

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fundamental rights and principles at work…. jobs can take the form of wage employment, self-

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employment, and farming. They can be formal or informal.” (WB, 2012a:329) In contrast, ‘work’ is more all-encompassing and includes social, physical and mental activities that are performed to accomplish something (Oxford Dictionary, 2013).

In summary, the implicit and explicit presence, and absence of the DW concept in texts analyzed provide some indication of frequency and preference of use in terms by different institutions;

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however, it does not elucidate how concepts are positioned. To deepen understanding of which discourses were being reinforced, we examined the Agenda’s influence on other work agendas

The challenges and realities of promoting “one” Agenda

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(see Appendix 3).

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The Agenda is explicitly mentioned in most texts co-developed with the ILO. This is expected because the Agenda functions as a frame for the ILO’s policy priorities. However, temporal

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context matters. Ten years after the Agenda’s creation, the ILO responded to the 2008-09 economic crisis with its Global Jobs Pact (2009). The ILO employs the term jobs (also part of the Agenda) and not decent work as a positioning statement directed at global actors. That said, an analysis of the Pact reveals that it draws upon the Agenda by making explicit references to the

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fundamental principles and rights at work, social protection, gender equality and social dialogue. The G8 endorsement of the Pact represents a form of third party validation to invoke legitimacy and authority for this approach and we would add framing as a ‘jobs’ pact.

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G8 leaders declared that the Jobs Pact is “relevant to respond to the crisis at worldwide level and advance the social dimension of globalization”, and that advanced, emerging and developing countries as well as international organizations should work together to ensure employment-oriented growth and promote social cohesion …” (2009 Summit, Global Jobs Pact, p. vi)

An explicit focus on jobs appears in texts for state leaders: “Our ultimate objective is to provide more and better jobs for our citizens to promote social inclusion in all countries and to foster development and poverty reduction.” (Cannes Action Plan for Growth and Jobs; G20, 2009)

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The Bank’s Jobs Report (2012b) uses a similar tactic. It establishes early on that many ‘job agendas’ exist: “If language shapes thinking, there are times when the ways in which people refer to jobs seem to be at odds. Gaps probably arise from the different characteristics of jobs

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being emphasized in different societies.”(Ibid, cover page), and state that “jobs agendas are

diverse but connected” (WB, 2012c:17). The description of the Agenda extends beyond jobs as earnings to include a discussion of the value of jobs to individuals and society. It acknowledges

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how the Agenda has gained political buy-in. Since 1999, “many governments have used it to articulate their policy agendas on jobs” (WB, 2012d:158). The Bank does not claim to advance

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one agenda nor does it explicitly endorse the ILO Agenda. It remains silent on the possibility of a common universal agenda, yet makes the connection between diverse agendas said to be warranted in different countries. We interpret this as the Bank subtly exerting its power through the competing knowledge it advances and normalizing certain beliefs about job creation and

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effective labour policy. While the discourse of more and better jobs reflects a response to the crisis, this narrower framing results in some dimensions of decent work (e.g. social protection) being taken up by some institutions and not others. Our findings also point to partial adoption of

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the Agenda by the WHO, less so by the Bank. This partial adoption begs the question about the

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presence of health and health equity claims about decent work in these texts.

The intersection between decent work, health and health equity Health and health equity principles were more explicitly present in ILO, WHO or ILO/WHO texts. Uses of health and/or health equity as justifications for DW were expressed through the language of guaranteeing workers’ rights, which is explicit in the Agenda. Without stating DW,

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these excerpts speak to some Agenda directions, including social protection (e.g. preventing occupational health hazards) and social dialogue (“workers, employers, their representatives

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should participate...”).

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All workers should be able to enjoy the highest attainable standard of physical and mental healthii and favourable working conditions. The workplace should not be detrimental to health and well-being. Primary prevention of occupational health hazards should be given priority. …. Activities related to workers’ health should be planned… with a view to reducing inequalities in workers’ health …. Workers and employers and their representatives should also participate in such activities. (Workers’ Health: Global Plan of Action; WHO, 2007a, p. 5)

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The WHO’s imperative to put workers’ health on the agenda of workplaces and global leaders, is not incompatible with decent work. When WHO adopts economic rationales to demonstrate the value of investing in workers’ health, the impact of these interventions may, however, be inadvertently interpreted exclusively in economic terms. Quoting the 60th World Health

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Assembly, WHO positions: “health as a prerequisite for productivity and economic development” (Ibid, 2007b, p. 3); “workers [as representing] half the world’s population, [as] major contributors to economic and social development” (Ibid, p. 5); and, calls for attention to

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“high-risk sectors of economic activity” (Ibid, p. 6). These strategic appeals to economic interests signal the influence of broader economic discourses, and represent instances of how

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health can be reframed in economic terms. “Measures need to be taken to minimize the gaps between different groups of workers in terms of levels of risk and health status. Particular attention should be paid to high-risk sectors of economic activity, and to the underserved and vulnerable working populations, such as younger and older workers, persons with disabilities and migrant workers, taking account of gender aspects.” (Ibid; WHO, 2007c, p.6)

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While the factors that affect fair access to jobs are acknowledged, some texts are more silent on structural root causes of social and material deprivation from unfair work. The emphasis is rather

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on what factors affect an individual’s opportunity to access a fair job.

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“Fairness in access to jobs can actually be measured rigorously, building on the emerging literature on inequality of opportunity. This literature explores to what degree factors beyond talent and effort matter in accessing jobs. These factors include the circumstances in which a person is born: location, family background, gender, ethnicity, and language (WDR on Jobs, WB, 2012, p. 172).”

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While the Bank acknowledges health determinants (e.g. gender, ethnicity), their focus is on inequality of opportunity in accessing a job. Failure to attain health equity also entails an infringement on fairness and human rights. Based on these findings, we contend that contemporary pro-market approaches pose fundamental challenges to advancing the Agenda,

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which by definition, encompasses a range of social interventions. This led us to interrogate the relative presence of pro-market and economic claims.

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The emphasis on economic and pro-market interests versus the social dimensions of work

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The language of economics and market-based solutions permeates several policy texts analyzed. However, texts differ in their treatment and positioning of these concepts. As early as 1919, the ILO Constitution stated:

“All national and international policies and measures in particular those of an economic and financial character, should be judged [through a worker’s rights lens] and accepted only in so far as they may be held to promote and not to hinder the achievement of this fundamental objective [e.g. all human beings, irrespective of race, creed or sex, have the right to pursue both

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their material well-being and their spiritual development in conditions of freedom and dignity, of economic security and equal opportunity]” (ILO Constitution, 1919)

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In more recent ILO texts, the language used is not as authoritative. Economic growth is said to be essential but not sufficient to ensure equity, social progress and the eradication of poverty. Similar claims by the Bank caution forcefully against extending social protection, a core pillar of

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the Agenda.

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“Formalizing countries need to design their social protection systems in ways that extend their coverage without penalizing employment [emphasis added].” (2013 World Development Report on Jobs; WB, 2012e)

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“In formalizing economies, there is an effort to support social cohesion by extending the coverage of social protection to as many workers as possible. Broad coverage regardless of the type of job is often seen as part of a social contract. But extending coverage without distorting incentives to work is difficult and may have adverse impacts on productivity and long-term growth.” (Ibid, WB, 2012f)

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“Labor policies and institutions can improve labor market information, manage risk, and provide voice. But these advantages can come at the expense of labor market dynamism, reduced incentives for job creation and job search, and a gap in benefits between the covered and uncovered. The challenge is to set labor policies on a plateau—a range where regulations and institutions can at least partially address labor market imperfections without reducing efficiency.” (Ibid, WB, 2012g)

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Protecting the vulnerable through social protection schemes is acknowledged. Yet there is a strong drift towards privileging economic measures to foster job creation particularly in WB texts (e.g. exclusive use of jobs; social protection schemes to extend their coverage without penalizing employment). We also observed a shift in language by the ILO following the 2008-09 crisis from one focused exclusively on decent work to a focus on jobs:

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“…[actions] promoting core labour standards and other international standards that support the economic and jobs recovery and reduce gender inequality….. ;ensuring that short-term actions are coherent with economic, social and environmental sustainability (ILO Global Jobs Pact, 2009, page 3)”

Economic and pro-market interests are often juxtaposed with social ones, reflecting a recurring tension across several texts. Not surprisingly, several texts call for balanced and realistic policy

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measures to the financial crisis. Balance is often described in relation to social progress and economic development. The ILO argues that any response must reflect the Agenda and focus on

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protecting vulnerable workers and workers’ rights.

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“A renewed effort to ratify and improve application of the Conventions concerning fundamental principles and rights at work would send a clear signal of the relevance of these instruments to shaping a fair globalization as well as addressing the rebalancing of national and global economies.” (Promoting Policy Coherence for DW and Full, Productive Employment; ILO with OECD; 2011, p. 6)

While the WB Jobs Report mentions social protection schemes, it consistently states that these cannot compromise labour market dynamism. Through the use of a powerful “cliff” metaphor,

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this excerpt illustrates the polarized viewpoints that continually plague global labour policy.

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“Labor policy should avoid two cliffs: the distortionary interventions [e.g. that clog the creation of jobs in cities and in global value chains, and the lack of mechanisms for voice and protection for the most vulnerable workers, regardless of whether they are wage earners. The first cliff undermines the development payoffs from agglomeration and global integration; the second leads to low living standards and a social cohesion deficit….. Policies should remove the market imperfections and institutional failures that prevent the private sector from creating more good jobs for development (WBR on Job Development, pgs. 22-23) Interventions such as active labour policies are characterized as distortionary because they provide work disincentives, in contrast to others aimed at protecting workers against market

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fluctuations and the power of employers. This text singles out the most vulnerable workers rather than stating that all workers have the right to voice and protection (a central tenet of DW). In context, the Bank’s president stated in his address to the ILO: “While some have suggested

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that the Bank should only focus on the poorest, I think that would fail to provide our service as a true multilateral institution” (WB President Address to ILO, 2008). While health equity is

implicit, which sub-groups to target is a topic of debate depending on which actor is influencing

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the policy agenda and their interest in profit making (Ottersen et al. 2014c). This contested issue

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led us to explore who is in ‘charge’ including the role of individual responsibility for DW.

Relative emphasis on individual versus collective responsibility for decent work All texts call for increased collaboration between institutions, governments, workers and

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employers to promote workers’ well-being. The divergence stems from what is emphasized and who is responsible. Some texts are more silent on the structural root causes of social and material deprivation resulting from unfair work. Instead, factors affecting an individual’s opportunity to

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access a decent job are advanced. A closer reading also revealed evidence of the discourse of individual responsibility for DW. This framing is rooted in a discourse of labour as commodity

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skewed in favour of letting markets decide without protective and enforceable policy measures. While the ILO states in its 1919 constitution that “labour is not a commodity”, this language was not present in any texts analyzed. The discourse of individual responsibility functions by making claims about “personal development” and “people’s aspirations”, which we argue extends to making individuals responsible for accessing DW. As the next quote illustrates, the underlying

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logic about individual responsibility reflects a perspective in which rational, independent and entrepreneurial citizens are responsible for taking care of themselves (Moore, 2008b:1161).

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“Combining the objectives of preventing poverty and protecting against social risks, thus empowering individuals to seize opportunities for decent employment and entrepreneurship” (ILO/ WHO Social Protection Floor: for a Fair and Inclusive Globalization (2009), p. xxix).

The discourse of individual responsibility is more implicit in other texts. The ILO/ WHO Social

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Protection Floor makes several references to human empowerment (including gender

dimensions), and empowering excluded groups. “[The social protection floor] aims to protect

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those who are unable to earn a decent income through employment and to empower workers to seize economic opportunities and work their way out of poverty.” (ILO/ WHO 2009, p. 10) Taken in isolation, the language refers to “empowering workers” to take individual responsibility without explicitly acknowledging the socio-cultural and economic circumstances that

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disadvantage workers from doing so in the first place. In summary, our findings point to the implicit and explicit presence and juxtaposition of health, economic, and health equity framings

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Discussion

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of DW, which are enabled or silenced by broader discourses.

Studies on work and health have largely focused on understanding associations and causal connections between biological pathways and socio-environmental working conditions that produce ill health (Benach et al. 2007c). However, research has not sufficiently examined how issues such as DW are conceptualized nor has it adequately considered the relationship of these different conceptualizations to health and health equity. Language and definitions do matter what is taken up or not in policy texts can influence how DW comes to be understood and acted 21

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upon by global institutions. This also matters for health - daily living and working conditions do improve people’s chances to achieve their full health potential (WHO, 2007). As our findings suggest, a decision to use one term (jobs) over another (decent work) reinforces broader

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discourses regarding who is ‘in charge’ of the work agenda (i.e. markets, individual workers). Drawing on Foucault, other scholars have shown how this re-conceptualization of the social in economic terms enables markets to turn individuals into “enterprising selves”, and takes the onus

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off governments and even markets for protecting individual health (Rose, 1999).

Foucault suggests that discourses and social practices are varied, and there are only relative accepted truths operating within a system of cultural norms and no overarching totality (Foucault 1980d; Rabinow, 1985). Some discourses are enabled by making resources for constructing what

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is meant by a concept more available while making others less available (Miller & Fox, 2004). Findings point to the language of economics as a disciplinary and regulatory power and its role as a normalizing discourse maintained by privileged groups (Foucault, 1980c). This discourse is

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influenced by neoliberal economic globalization, which has been demonstrated to permeate the thinking of the WB and UN agencies such as the WHO (Navarro, 2007b). Rushton and Williams

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(2012a) argue that the dominance of the neoliberal discourse “colonizes” global health efforts. Neoliberalism in global health governance has deep roots spanning “at least three decades during which health and other areas of social policy have been subjected to… the privileging of marketbased responses, commodification and individualization of responsibility for health” (Ibid, 2012b:163). Our findings support these authors’ assertion. This neoliberal discourse also creates the conditions for deregulating labour and financial markets (Navarro, 2007c). The World Bank as a global financial institution and as a global norm-setter is impacted by neoliberal policies, 22

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with profound implications for ensuring equitable and healthy working conditions. The Bank’s use of poverty reduction strategies has been called a form of regulatory power to govern others at a distance, which echoes our findings about encouraging individual responsibility for DW

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(Joseph, 2010).

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A shift in ILO framing to a more World Bank framing of DW especially following the 20082009 crisis elevates the relative position of economic solutions for improving working

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conditions. The changing framing has policy implications. Scholars have asserted the current system of global governance does not adequately protect the public’s health, especially those most vulnerable (Ottersen, 2014d). Policies to protect workers’ health, while important, can offer limited solutions for action on DW. Competing belief systems influence what gets taken up

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especially when there is no consensus on how best to achieve a balance between social and economic measures in promoting decent work policy. Although an analysis of 190 country labour policies concluded that a global floor for DW can be realized without detrimentally

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affecting the global competitiveness of countries, conflicting claims persist (Heymann & Earle

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2009c). Our CDA findings contribute evidence on how such claims permeate several texts.

Returning to the notion that global institutions securitize work through policy to maintain social order, our analysis shows that this is indeed the case for DW. While the Agenda attempts to normalize what constitutes DW, dominant discourses, each with their own logics and claims, compete or silence other discourses. As our findings suggest, the need to put health on the agenda of workplaces can crowd out other relevant agendas (e.g. DW Agenda). Policy 23

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instruments operate as rhetorical and normative modes of discourse to convince others to take action (Fischer, 2002). While the Agenda has been adopted by bodies such as the UN Economic and Social Council (2006) as a policy instrument for achieving full and productive employment

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and decent work for all, we conclude that DW remains a contested notion and more than one ‘agenda’ is operating. In an era of globalization when “contested institutional and actor

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experimentation is more likely” (Murray, 2010), this is not surprising.

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While the ILO has been characterized as an “institutional device to reduce the commodity character of labour relationships”, it too has been criticized for adopting a more narrow definition of work that equates the achievement of full employment with being employed in a job (Standing, 2002; 2008: 358). Given the ILO’s tri-partite structure, views of what DW means by

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its governance structure are likely conflicted (Vosko, 2002). Other scholars recommend an expansion of DW that extends beyond work as an economic occupation and set of social relations. They argue for a more nuanced analysis of the activity of work based upon the

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subjective investment that people make in their work to determine whether the work experience is a decent one or not (Deranty & MacMillan, 2012). These calls for an expanded

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conceptualization of DW could help redress the imbalance between economic and social framings of work to ensure that health and health equity remain at the forefront.

The study has several limitations. Due to resource constraints, the analysis focused on 10 texts. The greater number of ILO texts compared to the WHO and WB, and small number of texts limit our ability to draw more conclusive statements about differences between texts. Therefore, this 24

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analysis only reveals some possible conceptualizations of DW. The range in document lengths can limit the extent of comparability between texts; however, the strength of CDA is not to account for the frequency but to deepen understanding of how these concepts are reinforced

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through claims within texts (Atkinson and Coffey 2004). We acknowledge like Fairclough

(2009) that there are many ways to analyze discourses and therefore related findings can be subject to multiple interpretations. Through its application, CDA challenges the status quo and

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what might otherwise be taken for granted about concepts such as DW and political agendas such as the DW Agenda. While our findings may have limited generalizability to other contexts,

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they provide a sense of how DW is taken up or not within policy texts. We call for further research that extends our understanding of how a complex phenomenon like work is discursively

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shaped through power relations between global institutions.

Post-2008-2009 economic crisis, considerable uncertainty faces global institutions, which must compete for reduced resources and demonstrate added value and impact. These conditions create

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a climate of self-interest, although greater cooperation and altruism are needed more than ever to raise the global floor for all workers. By issuing the “social protection floor for a fair and

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inclusive globalization” in 2009, the ILO re-purposed the Agenda as a solution to the recent crisis. The Bank’s Report on Jobs accounts for the health and social considerations of work, but does so without fully adopting the tenets of the DW Agenda. In its response to this Report, the ILO concluded that it “… paves the way for the Bank to align itself with the endorsement of the ILO Agenda by the UN and other international organizations and thus promote enhanced policy coherence.” (ILO, 2012:4). While opportunism and good will are necessary, it remains to be seen whether political action to improve working conditions can be sustained or whether it will 25

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further exacerbate health inequities. For example, there appears to be a further rapprochement between economic growth and DW, as suggested in the draft post-2015 sustainable development goal #8: “to promote sustained, inclusive and sustainable economic growth, full and productive

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employment and decent work for all” (ILO, 2014). According to the former ILO President, Juan Somavia, “normative action is an indispensable tool to make decent work a reality." (ILO, 2001) As this CDA has revealed, competition between health equity, health and economic claims

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underpinning global agendas and vested institutional interests about how to best achieve decent

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work for all may actually continue to undermine efforts to do so.

i

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References

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Keynes, a very influential economist advanced the potential for interventionist government policy by employing fiscal measures to manage economic ups and downs. ii This right to health language stems from article 12.1 in the International Covenant on Economic, Social and Cultural Rights: http://www.ohchr.org/EN/ProfessionalInterest/Pages/CESCR.aspx)

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World Health Organization, International Labour Organization, & Joint United Nations Programme on HIV/AIDS. (2010). The joint WHO-ILO-UNAIDS policy guidelines on health workers access to HIV and tuberculosis (TB) prevention, treatment, care and support services. Geneva: International Labour Organization. Retrieved from http://www.ilo.org/sector/Resources/codes-of-practice-andguidelines/WCMS_160898/lang--en/index.htm (accessed 11.08.14).

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Highlights

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The language of economics and market-based solutions permeates several texts Health equity principles about work are more present in ILO and WHO texts Use of jobs over decent work reinforces discourses about who dominates work agendas Decent work is conveyed in health and equity policy on rights and social protection We noted shifts in ILO decent work frame to a World Bank frame post-economic crisis

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• • • • •

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Appendix 1: Policy Texts analyzed by selection criteria The following policy texts were produced between 1999 and 2012 in Switzerland, France and US.

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Joint WHO/ILO UNAIDS policy guidelines for improving health workers' access to HIV and TB prevention, treatment, care and support services (guidance note) (2010) World Bank Group President, Robert B. Zoellick at the International Labour Organization (March 17th, 2008 Address)

2013 World Development Report on Jobs (World Bank, released in October 2012) WHO Workers’ health: Global Plan of Action (2007) Cannes Summit Communiqué & Cannes Action Plan for Growth and Jobs (2011)






















Is expected to represent a deviant manifestation of the Decent Work Agenda

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Represents intertextual chains




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Recovering from the crisis: A Global Jobs Pact (ILO, 2009) Promoting policy coherence for decent work and full, productive employment (prepared in collaboration with OECD for G20 Meeting of Labour and Employment Ministers) (ILO, 2011) Better Work Initiative website (IFC (part of World Bank Group)/ILO) (2009) ILO/ WHO Social Protection Floor: for a fair and inclusive globalization (2009)




Describes critical events/ activities relevant to understanding the context in which the ILO and its Decent Work Agenda operate

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ILO Decent Work Agenda (1999)

Central to advancement of the Decent Work Agenda and/or has a particular focus on social protection

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Text (alphabetical by institutional author and chronological by year)


























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Appendix 2: Frequency of use of decent work, Decent Work Agenda and Job terms

Decent work

3

15

4

15

0 (better work is used instead) 5

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Cannes Summit Communiqué (2011) & Cannes Action Plan for Growth and Jobs (2011) (7 pages)

4

Job/Jobs

3

40

22 (only 3 are qualified as needing to be quality or good jobs)

0

0

8

22 (4 are qualified with term decent)

0

0

1

0

1

12

9

3

1310

0 (43 references to workers’ health) 0

0

0

0

7

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ILO/ WHO Social Protection Floor: for a fair and inclusive globalization (2009) (150 pages) Joint WHO/ILO UNAIDS policy guidelines for improving health workers’ access to HIV and TB prevention, treatment, care and support services (guidance note) (2010) (34 pages) World Bank Group President, Robert B. Zoellick at the ILO (March 17th, 2008 Address) (2 pages) 2013 World Development Report on Jobs (World Bank, released in October 2012) (422 pages) WHO Workers’ health: Global Plan of Action (2007) (12 pages)

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International Labour Organization (ILO) Decent Work Agenda (1999) (2 pages) Recovering from the crisis: A Global Jobs Pact (ILO, 2009) (22 pages) Promoting policy coherence for decent work and full, productive employment (prepared in collaboration with OECD for G20 Meeting of Labour and Employment Ministers) (ILO, 2011) (11 pages) Better Work Initiative website (IFC/ILO) (2009) (4 pages)

Decent Work Agenda

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The table summarizes the frequency of use of decent work, Decent Work Agenda and job terms in all ten documents included in the analysis. ILO documents are listed first followed by documents produced by the ILO with other organizations or with explicit references to the ILO, followed by the remaining documents by the WHO and World Bank. The count excludes table of contents, headers, footnotes/endnotes and references. If the term was included in the title of the document, it was only counted once.

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Appendix 3 Frames Health equity Right to health

Examples from Texts Guaranteeing workers’ rights explicitly mentioned in DW Agenda (ILO, 1999)

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Key Finding Health equity principles related to work are more explicitly present in ILO and WHO policy texts. Decent work is expressed in health and health equity terms through national policies that promote rights and social protection schemes.

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Activities related to workers’ health should be planned… with a view to reducing inequalities in workers’ health within and between countries (WHO, 2007)

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The language of economics and marketbased solutions permeates several policy texts analyzed.

Countries must protect the health and rights of their health workers (WHO/ILO/UNAIDs, 2010) Health as a prerequisite for productivity and economic development (WHO, 2007)

Economic

Avoid distortionary interventions that clog the creation of jobs (WB, 2010)

Economic, Market-based

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A shift in the ILO framing to a more World Bank framing of decent work following the 2008-09 economic crisis reinforces the relative position of economic solutions for improving working conditions. Use of ‘jobs’ over ‘decent work’ reinforces broader discourses regarding who is ‘in charge’ of the work agenda (i.e. markets, individual workers).

Economic, market-based Personal responsibility for work

Promote core labour standards that support the economic and jobs recovery (ILO, 2009)

“Empower workers to seize economic opportunities and work their way out of poverty.” (WHO/ILO, 2009) WB establishes early on that many job agendas exist (2010)

3