The COVID-19 pandemic has negatively impacted on the health and wellbeing of populations directly through infection, as well as through serious societal and economic consequences such as unemployment and underemployment. The consequences could be even more severe for those more vulnerable to the disease, such as the elderly and those with underlying health conditions. Indeed, there is evidence that such vulnerable populations are disproportionately affected in terms of both, their health and the socioeconomic impact. The aim of our study was to determine whether occupational health (OH) professionals thought that the COVID-19 pandemic might further disadvantage any particular group(s) of vulnerable workers globally, and if so, which group(s). A cross-sectional study was carried out with a sample of OH professionals by means of an online questionnaire which was shared via email within the ICOH (International Commission for Occupational Health) community. Data was collected over a period of two weeks in May 2020 and 165 responses from 52 countries were received. In this paper, the responses relating to questions about vulnerable workers are reported and discussed. Globally, our responders felt that those in less secure jobs (precarious employment (79%) and informal work (69%)), or unemployed (63%), were the most at risk of further disadvantage from this pandemic. The majority felt that their governments could act to mitigate these effects. There were suggestions of short-term alleviation such as financial and social support, as well as calls for fundamental reviews of the underlying inequalities that leave populations so vulnerable to a crisis such as COVID-19.

In the United Kingdom (UK), ethical guidance for doctors assumes a therapeutic setting and a normal doctor-patient relationship. However, doctors with dual obligations may not always operate on the basis of these assumptions in all aspects of their role. In this paper, the situation of UK occupational physicians is described, and a set of models to characterise their different practices is proposed. The interaction between doctor and worker in each of these models is compared with the normal doctor-patient relationship, focusing on the different levels of trust required, the possible power imbalance and the fiduciary obligations that apply. This approach highlights discrepancies between what the UK General Medical Council guidance requires and what is required of a doctor in certain roles or functions. It is suggested that using this modelling approach could also help in clarifying the sources of moral conflict for other doctors with "dual obligations" in their various roles.

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Introduction‘Job security increases health, wellbeing and job satisfaction. Higher rates of unemployment cause more illness and premature death’. Encouraging individuals to be at work can be beneficial, but it also raises questions such as: Do the socially disadvantaged have access to opportunities to improve their health? Do they have fair access to health-enhancing ‘good’ work? OH professionals can have an important influence in matters of health and work, both at ‘front line’ and policy levels. This paper identifies the ethical issues that arise in the wider social determinants of health (SDOH) discourse, from an OH perspective.MethodsAn applied ethics analytical approach was used to examine the relationship between OH and SDOH, especially in terms of worklessness arising from ill-health. The capability approach as a theory of justice was used. Specifically, a concept of health justice when one is unable to work through ill-health or disability was explored.ResultsAreas of ethical concern:The medicalisation of the ill–health assessment process, whereas societal factors are ignored.The extension of ‘responsibilisation’, i.e. making individuals responsible for their ability to work as well as for their health.Ethical tensions for OH practitioners when their relationship with the worker may not be the traditional ‘doctor–patient’ one.DiscussionUnemployment, job insecurity and sickness absence are serious problems, impacting on the health of individuals and society, and a financial burden to employers and the State. However, although it may be desirable for individuals to be in employment to improve their health, there is also a danger that those unable to work become stigmatised. So, ‘tackling’ these problems should be done in fair and ethical ways. A first step is identifying the ethical issues.