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The climate crisis and loss of biodiversity, two closely related threats to human and planetary health, meet the criteria for the World Health Organization (WHO) to declare an international public health emergency, as occurred with COVID-19 (1), and urged by numerous scientific journals (2).
Attaining decent work, understood as "opportunities for women and men to work in conditions of freedom, equity, security and human dignity" (3), in the context of the climate emergency, creates a paradox for worker health. Outdoor workers (notably those in agriculture and construction), many of them informal workers, are among the populations most vulnerable to climate-related hazards. Simultaneously, they are inevitably at risk of exposure due to their role in maintaining the economy and functioning of society. A similar situation happened during the pandemic with essential workers (4). The WHO declaration of a public health emergency helped manage that global crisis.
A consequence of the industrial revolution The current climate crisis is a direct consequence of the Industrial Revolution where key processes emerged to explain the current situation: the appearance of wage labor and the working class, with consumerism as a basic economic driver, and the exploitation of natural resources – especially fossil fuels – in their own territories and in the colonies.
The extension of this capitalist model of society to virtually the entire planet is a reality. Now, we see how this economic system has brought both great harm and significant benefits.
Since its beginning, capitalism has wrought great suffering for people, masterfully described, among others, by Fredrich Engels in the Manchester of 1845 (5) or the London of 1838 in Charles Dickens` Oliver Twist (6). Although working conditions have since improved in many countries, there are still unbearable examples worldwide of worker exploitation and suffering. Among them, child labor, where 70% are working in agriculture (7) or some underregulated platform work (8), in a context of ever-increasing social inequalities (9).
On the other hand, due to improved working and life conditions, there has also been an extraordinary increase in the world population, from one billion at the beginning of the 19th century to approximately eight billion today, leading to a linear increase in life expectancy at birth, which doubled globally between the beginning of the 20th century and the present. In 2015, the Lancet Commission on Planetary Health (10) pointed out that never before has humanity faced such an unintended paradox. While human well-being has been improving, the planet has been degrading. A contradiction that can no longer be sustained.
We have lived as if our planet`s resources are unlimited. Based on comparisons to average temperature readings of the planet between 1850 and 1900, the United Nations International Panel on Climate Change estimated in its latest report that temperatures increased by 1.1° C between 2011 and 2020. This increase is very close to the 1.5° C established by the 2015 Paris Agreement as the limit beyond which climate impacts may become irreversible. Beyond any reasonable doubt, this is mostly attributable to the greenhouse effect produced by CO2 emissions, a consequence mainly of human activity and our way of living initiated by the Industrial Revolution.
This global increase in temperature, with heat waves, floods and other extreme temperature events as its most obvious manifestations, is already having effects on worker health (12, 13). Climate change is also having effects on the economy and the labor market, both in the primary (agriculture and fishing) and services (tourism) sectors, with reductions in productivity and employment. Estimates from the European Commission reveal an average loss of 3% of GDP among EU countries between 1980 and 2020 (14). Simultaneously, we should not forget that the capitalist society that emerged from the Industrial Revolution is based, among other pillars, on full or near full employment. As such, wages represent the main economic resource for the majority of people, in addition to being the primary source of wealth generation for society, on whose income and taxes the welfare state was built. Of course, employment means much more than wage earning, as it plays a fundamental role in the social processes that sustain human dignity and social cohesion (15). However, only approximately 50% of the employed population, mainly in high-income countries, enjoy decent employment with a living wage and social rights (16).
The resulting Gordian knot before us is enormous, with humanity facing the climate emergency and trying to move from fossil fuels to renewable energy sources, while simultaneously seeking to maintain and increase decent employment for all Earth`s inhabitants, boosting the welfare states at the same time (17).
Controlling climate-related hazards and just green transition The alternatives proposed to escape this crossroads vary between those that propose a new paradigm, which radically changes the current economic model, betting on measures that break drastically from the capitalist economy (18), versus a gradual process, supported by mitigation, adaptation, and compensation policies (19).
Favoring this second alternative, but without ruling out the need to profoundly change human consumption patterns with important repercussions on the productive system (energy, transportation, food, etc.), gradualist policies will also directly or indirectly impact employment and working conditions during the transition from carbon emission energy to green energy.
To cope with this urgent situation, specific control measures have been proposed over the last few decades. Schulte and colleagues have systematically reviewed the literature (20, 21, 22), identifying new and exacerbated old climate-related hazards such as extreme temperatures, air pollution, ultraviolet radiation, natural disasters, biological hazards, indoor air quality, etc., and they also assessed the impact of employment transition and economic burden on occupational health equity and mental health. On this basis, the US National Institute for Occupational Safety and Health has elaborated recommendations to mitigate and control the impact of several climate-related hazards on worker health and well-being (23). Similarly, the EU Agency for Safety and Health at Work has published guidelines for heat at work (24). Going further, some governments, such as Spain, have begun regulating and enforcing specific measures (25).
Implementation of these workplace preventive measures to mitigate the impact of climate change is the responsibility of employers, with full participation of workers. Devoting resources to hazard recognition; performing risk assessments to identify which workers are most vulnerable to climate change-related hazards; and implementing a control strategy with policies, procedures, equipment, and work organization changes aiming to eliminate or minimize the impact of these hazards can improve employer preparedness (26).
Adaptation policies to reduce emissions of CO2 and other gases that are driving the greenhouse effect, still with limited results, could mean a loss of six million jobs worldwide, according to estimates of the International Labor Organization (ILO) (27). This same estimation predicts a promising creation of 24 million jobs, mainly in economies emphasizing recycling and reutilization of manufactured products (the so-called "circular economy"), infrastructure construction, development of renewables and energy efficiency. Also, during this transition, new forms of work will emerge (e.g., human-robot interfaces and artificial intelligence), and with them the need to train workers, both new and existing, to adapt to those new forms of work.
While waiting for positive results from mitigation and adaptation policies, a just transition to a green economy must simultaneously incorporate compensation policies. To achieve this, it is essential to strengthen social protection systems, a cornerstone of decent employment. For example, there were measures adopted during the pandemic, such as temporary employment regulation for employees or benefits covering the cessation of activity of the self-employed. Similar compensation measures may help workers affected by mitigation and adaptation policies during a transition phase, possibly to a lesser degree than in the pandemic, but lasting longer.
In summary, as was the case in the most recent public health emergency, the COVID-19 pandemic, declaring the climate emergency as an international public health emergency by the WHO could play a critical role in managing this new global health crisis. Research programs, supported by global occupational health surveillance systems, to monitor the effectiveness of mitigation, adaptation and compensation measures are urgent.
Conflict of interest statement The authors report no conflicts of interest.
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Background: The welfare state has a long history of uncertain future. Nonetheless, health indicators of people living in countries with a more universal and generous welfare state remain better than those living under less generous and more individualist welfare regimes. In this essay, we reflect on how occupational health, as part of public health, can contribute to the sustainability of the welfare state. Methods: Over the course of the political and social transformations of the State, from single guarantor of security to assuming civil and social rights, the practice of public health has added, to its original objectives related to the control of epidemics of contagious diseases, the promotion of health and the reduction of inequalities in health. In the context of the 2030 Agenda of Sustainable Development Goals, there is a great opportunity to expand the welfare state through public health policies. Results: On the other hand, the welfare state is only possible when persons are employed in the formal sector. Through their taxes, workers and employers support the welfare state. Occupational health, by preventing injury and illness, and promoting the health of working people, can contribute significantly to the existence of decent work and a quality labour market. Conclusion: The mission of occupational health is to help people enjoy a healthy and prolonged working life, as a critical component of human well-being.

Work contributes to health and health inequity in complex ways. The traditional exposure-disease framework used in occupational health research is not equipped to address societal contexts in which work is embedded. The political economy approach to public health directly examines macro-level societal contexts, but the attention to work in this literature is mostly on unemployment. As a result, we have limited understanding of work as a social determinant of health and health inequity. To fill this gap, we propose a conceptual framework that facilitates research on work, health, and health equity in institutional contexts. As an illustration of different social institutions creating different work-related health, we present characteristics of work and health in the United States and the European Union using the 2015 Working Conditions Surveys data. The results also highlight limitations of the traditional exposure-disease approach used in occupational health research. Applying the proposed framework, we discuss how work and health could be investigated from a broader perspective that involves multiple social institutions and the sociopolitical values that underpin them. Such investigations would inform policy interventions that are congruent with existing social institutions and thus have the potential for being adopted and effective. Further, we clarify the role of research in generating knowledge that would contribute to institutional change in support of population health and health equity.

Work contributes to health and health inequity in complex ways. The traditional exposure-disease framework used in occupational health research is not equipped to address societal contexts in which work is embedded. The political economy approach to public health directly examines macro-level societal contexts, but the attention to work in this literature is mostly on unemployment. As a result, we have limited understanding of work as a social determinant of health and health inequity. To fill this gap, we propose a conceptual framework that facilitates research on work, health, and health equity in institutional contexts. As an illustration of different social institutions creating different work-related health, we present characteristics of work and health in the United States and the European Union using the 2015 Working Conditions Surveys data. The results also highlight limitations of the traditional exposure-disease approach used in occupational health research. Applying the proposed framework, we discuss how work and health could be investigated from a broader perspective that involves multiple social institutions and the sociopolitical values that underpin them. Such investigations would inform policy interventions that are congruent with existing social institutions and thus have the potential for being adopted and effective. Further, we clarify the role of research in generating knowledge that would contribute to institutional change in support of population health and health equity.

OBJECTIVE: To identify and select common diseases of possible occupational origin, managed through the Spanish National Health System. DESIGN: Cross-sectional study. SETTING: Catalonia (Spain). PARTICIPANTS: Data were collected on people over 15 years of age who were seen for the first time in a primary care clinic or were admitted to a hospital or had an episode of non-occupational sickness absence in catalonia in 2008 or died in this region in 2007. MAIN MEASUREMENTS: A total of 407 diagnostic codes for possible occupationally-related diseases were selected from a modified version of the european union ICD-10 list of diagnostic codes, from which 34 were selected and assessed by an expert panel. RESULTS: The initial 34 diagnoses represented 6.7% of all new outpatient visits, 13.8% of the sickness absence episodes, 13.6% of acute admissions and 15.8% of all annual deaths. Asthma appeared prominently in all four databases. The list was pared down to a final list of 26 four-digit icd-10 codes, that accounted for 3.3% of the first visits, 8.9% of lost work time episodes and 2.7% of acute admissions. CONCLUSIONS: The implementation of a "red flag" into the electronic medical record each time one of these 26 diagnostic codes is entered, could help to improve the reporting of occupational diseases.

OBJECTIVE: To identify and select common diseases of possible occupational origin, managed through the Spanish National Health System. DESIGN: Cross-sectional study. SETTING: Catalonia (Spain). PARTICIPANTS: Data were collected on people over 15 years of age who were seen for the first time in a primary care clinic or were admitted to a hospital or had an episode of non-occupational sickness absence in catalonia in 2008 or died in this region in 2007. MAIN MEASUREMENTS: A total of 407 diagnostic codes for possible occupationally-related diseases were selected from a modified version of the european union ICD-10 list of diagnostic codes, from which 34 were selected and assessed by an expert panel. RESULTS: The initial 34 diagnoses represented 6.7% of all new outpatient visits, 13.8% of the sickness absence episodes, 13.6% of acute admissions and 15.8% of all annual deaths. Asthma appeared prominently in all four databases. The list was pared down to a final list of 26 four-digit icd-10 codes, that accounted for 3.3% of the first visits, 8.9% of lost work time episodes and 2.7% of acute admissions. CONCLUSIONS: The implementation of a "red flag" into the electronic medical record each time one of these 26 diagnostic codes is entered, could help to improve the reporting of occupational diseases.

Background: Despite the fact that labour market flexibility has resulted in an expansion of precarious employment in industrialized countries, to date there is limited empirical evidence about its health consequences. The Employment Precariousness Scale (EPRES) is a newly developed, theory-based, multidimensional questionnaire specifically devised for epidemiological studies among waged and salaried workers. Objective: To assess acceptability, reliability and construct validity of EPRES in a sample of waged and salaried workers in Spain. Methods: Cross-sectional study, using a sub-sample of 6.968 temporary and permanent workers from a population-based survey carried out in 2004-2005. The survey questionnaire was interviewer administered and included the six EPRES subscales, measures of the psychosocial work environment (COPSOQ ISTAS21), and perceived general and mental health (SF-36). Results: A high response rate to all EPRES items indicated good acceptability; Cronbach's alpha coefficients, over 0.70 for all subscales and the global score, demonstrated good internal consistency reliability; exploratory factor analysis using principal axis analysis and varimax rotation confirmed the six-subscale structure and the theoretical allocation of all items. Patterns across known groups and correlation coefficients with psychosocial work environment measures and perceived health demonstrated the expected relations, providing evidence of construct validity. Conclusions: Our results provide evidence in support of the psychometric properties of EPRES, which appears to be a promising tool for the measurement of employment precariousness in public health research. ; Alejandra Vives is supported by Programme Alβan, the European Union Programme of High Level Scholarships for Latin America, scolarship nºE06D103150CL. This study was partially funded by the Fondo de Investigación Sanitaria (Health Research Fund) of the Instituto de Salud Carlos III (Spanish Health Ministry, PI031499).

Backgroud: Household service work has been largely absent from occupational health studies. We examine the occupational hazards and health effects identified by immigrant women household service workers. Methods: Exploratory, descriptive study of 46 documented and undocumented immigrant women in household services in Spain, using a phenomenological approach. Data were collected between September 2006 and May 2007 through focus groups and semi-structured individual interviews. Data were separated for analysis by documentation status and sorted using a mixed-generation process. In a second phase of analysis, data on psychosocial hazards were organized using the Copenhagen Psychosocial Questionnaire as a guide. Results: Informants reported a number of environmental, ergonomic and psychosocial hazards and corresponding health effects. Psychosocial hazards were especially strongly present in data. Data on reported hazards were similar by documentation status and varied by several emerging categories: whether participants were primarily cleaners or carers and whether they lived in or outside of the homes of their employers. Documentation status was relevant in terms of empowerment and bargaining, but did not appear to influence work tasks or exposure to hazards directly. Conclusions:/nFemale immigrant household service workers are exposed to a variety of health hazards that could be acted upon by improved legislation, enforcement, and preventive workplace measures, which are discussed.