key: cord-0835227-cla1r5uo
authors: Agudelo-Suárez, Andrés A.; Vargas-Valencia, Mary Yanet; Vahos-Arias, Jonny; Ariza-Sosa, Gladys; Rojas-Gutiérrez, Wilder J.; Ronda-Pérez, Elena
title: Precarious employment and health: A qualitative study in Venezuelan immigrant population in Colombia
date: 2020-11-30
journal: J Migr Health
DOI: 10.1016/j.jmh.2020.100009
sha: 05aef2100a7be73e7c51bfa082225b58dba67f84
doc_id: 835227
cord_uid: cla1r5uo

BACKGROUND: Employment and working conditions are considered as an element that impacts on health inequalities, especially among vulnerable groups such as the immigrant population. This study aims to describe the characteristics of precarious employment in the Venezuelan immigrant population in Medellín (Colombia) according to its theoretical model and its relationship with the perception of their physical, mental, and psychosocial health. METHODS: A qualitative study was conducted with a focused ethnography perspective. 31 people with Venezuelan origin and work experience were interviewed in the city of Medellin and its metropolitan area and 12 key informants from different formal and informal social organizations that work with the immigrant population. A narrative content analysis was carried manually and by using the Atlas.Ti 8.0 software. The principles of analytical induction were applied to carry out a thematic analysis of the main categories defined in the precarious employment framework. RESULTS: The following characteristics of precarious employment were found: instability in employment conditions, work in the informal or submerged economy, limited empowerment, absence of social benefits, high vulnerability, low income, and a limited capacity for exercising labor rights. This situation affects mental health conditions, access to health services, and the presence of risks due to the work they perform. CONCLUSIONS: The Venezuelan working population in Medellín is found in a precarious employment situation. Inclusive social strategies and policies that take into account the reality of this population are required.

In recent decades, there have been important social and population shifts due to the movement of people between countries ( Segal, 2019 ) . Some countries, traditionally senders of migrants, are becoming receivers of people of productive age. Over the last few years in Latin America, Chile, for example, has received working immigrants mainly from Haiti, Colombia, Peru, Bolivia, and Argentina ( Cano and Soffia, 2009 ). The Venezuelan population is currently facing upheavals in its political and social order that have caused a massive exodus ( Crasto and Álvarez, 2017 ) . Colombia faces a change in its population structure due to the arrival of families and individuals who find opportunities for wellbeing in the country in contrast with their native country ( Fernández-Nino and Bojorquez-Chapela, 2018 ) . Even though there are variations in statistics available, over one and a half million enterprises that are not formally registered with national government authorities. By contrast, informal employment is an employment-based concept defined in terms of the employment relationship and protections associated with the worker's job ( Bonnet et al., 2019 ) .

With regard to employment conditions, an analysis of transformations in the job market is mandatory, as it has caused greater flexibility of hiring conditions and fewer employment benefits. This translates into greater precariousness ( Tompa et al., 2007 ) , which can be extreme in vulnerable groups -immigrant populations, women, and those with irregular migratory status ( Porthe et al., , 2010 -and in specific activities and sectors of the economy. Precarious employment emerges as a social determinant with impact on health inequalities ( Benach et al., 2014 ) as it has effects on physical, mental, and psychosocial health ( Quinlan, 2013 ; Vives et al., 2013 ) .

Precarious employment as a concept has its roots in numerous sociological texts, even if with different shades in its definition Kreshpaj et al., 2020 ) . However, Marcelo Amable developed research on the Spanish salaried population that resulted in a complex model for studying job precariousness ( Amable et al., 2001 ; Amable, 2006 ) . The model analyzes the following characteristics: job instability, empowerment, vulnerability, wage level, social benefits, and capacity to exercise workers' rights, and was applied to the immigrant working population in Spain ( Porthe et al., , 2010 .

Accordingly, this study aims to describe the characteristics of job precariousness in the Venezuelan immigrant population in Medellin (Colombia) using the theoretical model defined above and previously defined, and its relation to perceptions of physical, mental, and psychosocial health.

This study was granted approval by the Committee of Bioethics of Research at the School of Dentistry at the Universidad de Antioquia (affiliation of the head researcher) under Act 3 of 2018. All interviewees gave their informed consent to participate in the research and for their interviews to be recorded. This is considered no-risk research, as it does not intervene in the social or health situation of the participants. The writing took into consideration the standards for qualitative reports ( O'Brien et al., 2014 ) .

This paper is part of an ongoing project: "A qualitative approach for studying the employment, working and health conditions of the Venezuelan immigrant population in Medellín (Colombia)". A qualitative, interpretative, and emergent study was conducted. The researchers opted for a focused ethnography approach, described as an ethnography of small groups and targeted to a specific topic ( Morse 2003 ) . In this case, we present a thematic analysis according to the theoretical model of job precariousness and its adaptations for other studies in the immigrant population ( Amable et al., 2001 ; Amable, 2006 ; Porthe et al., 2009 Porthe et al., , 2010 . Table 1 presents the main categories and concept definitions.

-Key informants in organizations: 12 participants were identified who are members of 11 public, private, and community organizations (formal and informal) that promote better conditions for the Venezuelan immigrant population ( Table 2 ). In the case of one organization (National Labor School), an interview with two participants was possible. The principal researcher (AAAS) contacted these organizations through web pages, Facebook, and other social networks, and by referrals.

-Venezuelan population: 31 participants over age 18, born in Venezuela and with minimal work experience in Colombia, residing in Medellin and the metropolitan area, and without restrictions in their migratory status were interviewed for the study. For the selection of participants, theoretical and/or intentional sampling strategies were used; some were recruited through the collaboration of key actors in organizations and others by snowball sampling through referral ( Vázquez et al., 2011 ) . The final number of participants was determined by saturation, that is, upon verifying that no new data for the objectives of the study were emerging. This process was verified by all members of the research team ( Saunders et al., 2018 ) . The sociodemographic characteristics of the Venezuelan population interviewed are summarized in Table 3 .

Fieldwork took place between March and June 2018. Semistructured interviews of 30-70 min were conducted. A guide of topics was considered and questions were adapted from previous studies ( Agudelo -Suarez et al., 2009 a) and in accordance with the type of participant (organizational key informant or Venezuelan immigrant). The questions enquired about topics related to the characteristics of the migratory process and work history (Venezuelan and Colombian), current work and employment conditions, relationships with colleagues and superiors, perceptions of physical, mental, and psychosocial conditions, occupational hazards, access to health services, and expectations and plans for the future. Interviews were carried out by three members of the research team (AAAS, YV, and WR). Fieldwork was complemented with basic sociodemographic data in the case of the Venezuelan participants in the study ( Table 3 ) .

The interviews were audiotaped in MP3 format and transcribed initially in Spanish by a transcriber hired by the research group. Later, a specialized translator in academic editing carried out the translation of the interviews from Spanish to English, ensuring that the meaning was preserved. The final transcription was reviewed by the researchers to guarantee data quality.

All members of the research team took part in the initial review of the interviews, and data were segmented manually, identifying fragments and meanings to make a narrative analysis of the content ( Vázquez et al., 2011 ) . Supported by Atlas.Ti 8.1, a set of codes and categories was developed. This process was led by the main researcher and reviewed by the rest of the research team. The process of analytic induction allowed verification of the previous hypothesis against data from the interviews and the determination of negative and extreme cases, starting from a proposed theme analysis ( Amable et al., 2001 ; Amable, 2006 ; Porthe et al., 2009 Porthe et al., , 2010 . Finally, triangulation was used as a strategy to ensure consistency and quality of data (process led by the main researcher and supported by the rest of members of the research team). Extracts of the discourses are presented in the text labeled according to data source (Int: interviewee, number, and sex; KI: key informant, number, and sex).

Findings are presented in accordance with the categories designated in the employment precariousness model and the perceptions of the participants. Additionally, they reflect the perception of the state of health and its relationship with work precariousness.

According to the migratory process, the insertion of the Venezuelan immigrant population in the city is characterized by segmentation in Table 1 Dimensions of precarious employment for interviews' analyses.

Job instability It is characterized by the presence of temporary or short-term contracts. The literature also comments about the term "job insecurity " and is defined as the discrepancy between the level of security that a person experiences and the level that they would rather have, and refers to the degree of uncertainty about their employment conditions. Empowerment

It is referred to the institutional relations, of legal protection of the salary relation, that contemplate the union presence and the individual or collective level of negotiation on the working conditions. Vulnerability

It refers to the set of social power relations, explicit or implicit, in the workplace. Vulnerability is related to low levels of empowerment, except that, rather than manifesting themselves in normative terms, they appear in social relations in the workplace.

Classifies workers according to the degree of economic dependency related to employment conditions and possible material deprivation.

Social protection mechanisms for the working population, which can contribute to mitigating their precarious employment situation. Capacity to exercise workers' rights Ability to exercise and negotiate rights related to employment conditions without harming the employment situation for workers.

Source: adaptation for research purposes of previous studies ( Amable et al., 2001 ; Amable, 2006 ; Porthe et al., 2009 ; Porthé et al., 2010 ) . Source: by the authors. Source: by the authors.

the job market. A considerable number of the interviewees mentioned they were placed in the service sector, many in the informal economy and some do not have a written contract. In some cases of informal and verbal agreements, employment conditions were discussed verbally with the employer, in terms of salary, working hours, and working days per week. This places them in a position of instability and fear of losing their jobs ( Table 4 : 1a, 1b). The following quote is an example of the many reports highlighting stressful situations as a result of the informal agreements:

"Well, here pressure is greater… As I tell you, no, here there is much pressure because there I am in my country, and here you feel more pressure, more, more… as I tell you, fear of losing the job, you know?

The situation is almost more stressing than in Venezuela " (Int-10, male)

Participants perceived that job instability and the fear of loss of employment force workers to accept substandard employment conditions, as compared to local hires, due to their current economic needs to support themselves and the fundamental need to be able to send money to their families ( Table 4 : 1c, 1d). They mentioned that administrative and legal requirements to work and remain in the country are determinants of instability in employment conditions. In some cases, it is more expensive to hire Venezuelans legally than Colombians in the same type of job. As an example, one interviewee expressed his concerns about the legal requirements to have work and residence permit in Colombia:

"Oh no " "I have to tell you there is a possibility that the special permit to remain but when I arrived it was very complicated, I even had 6 months to be here, then I was thinking about going to Ecuador, Peru or Chile using what I was earning here because the visa protocol is very hard, very hard for one to take risks. Even investors, Venezuelans who want to invest here to set an example to other Venezuelans, it is very hard. It is very complicated to become legal here " (Int-16, Male) 

"Which is the real problem: Venezuelans are irregular in the country, say 90%. This leads to work informality " (KI-10-11, females) "He has his papers because his family is Colombian so he has ID. All the same, I am not sure… I think they are exploitative slaver. I do not have anything else to say about those people ". (Int-9, female) "But we also have the case of a person who is working informally because he does not hold a permit or even if they had it we all know people here have been taking advantage of the situation of Venezuelans and are hiring and then not paying them. We have those cases where people are abusing ". male) Source: by the authors.

According to the participants' discourses, the capacity of the working Venezuelan population to negotiate employment conditions and the extent of social protection are low. Although some hold a special permit to remain (PEP, in Spanish) granted by the state, the relationship between employee and employer falls into the informal system. In many cases, salary and working conditions are unilaterally set by the employer ( Table 4 : 2a). In the case of workers in the informal economy, the capacity for empowerment is null. The following quote is an example of an informal coffee vendor on the streets, talking about her labor situation and inability to have better employment conditions: I sell tinto (refers to a kind of coffee). I have to work hard because I have not found a job and have to send money to Venezuela to my kids and family. Right now, I go out in the morning, from six to twelve, twelve thirty. After I go out in the afternoon, from three to six. Then, at night I go out again from seven to nine thirty or ten. I have to do it that way because I only have one bottle and want to get money to send so I can help where I am because they are supporting me. I had to move after living with my cousin, to live with another cousin with the hope to have some day a more stable job to help my family more. It is very hard " (Int-20, female)

This category refers to the degree of defenselessness of the Venezuelan working population in confronting situations of abuse, arbitrariness, and unfair treatment in the host country (Colombia). A sizable number of the participants perceive that not having a work permit or a job contract places them in a situation of insecurity in the working scenario, in terms of the exercise of workers' rights, such as inclusion in the country's General System of Social Security ( Table 4: 3a) . As an example, one participant expressed his feelings of vulnerability and defenselessness in his current job: "(…) I already, I sincerely was tired. I was very tired. The schedule was very hard and I truly couldn't make it and went and spoke with him. I said I honestly did not put up with the pace that I wanted to look for something else. He just got upset and wanted me to work that day because he did not have anyone else. I said yes, ok, no problem, I would work for another week while he found someone else. I would work for another week. In fact, payments were to be moved forward and everything was cool. A week passed and he did not find another person and when I asked for my money, he kicked me out at gun point and never paid me ". (Int-1, male)

This category encompasses various aspects. First, within the formal economy, it examines whether the salary is perceived as fair considering the agreed working conditions and commensurate with time invested and risk exposure, safety, and the like. Second, it considers whether earnings are adequate to cover basic needs and unforeseen expenses.

In the first case, interviewees perceived that incomes were lower than the legal minimum salary in Colombia (around 252 dollars monthly). Others reported their perception of receiving lower salaries when compared with the local working class. Some said that have income related to tips, and others receive additional income from work at a different job -especially on weekends ( Table 4 : 4a, 4b). In the second case, in regards to their salary covering basic needs, the interviewees consider that one of the fundamental reasons to keep their employment (formal or informal) is the ability to send money to their families. Economic factors to be considered include the devaluation of the bolivar, which makes the cost of living in Colombia higher than in the neighboring country. However, the purchasing power of the Colombian currency is higher for their families in Venezuela, as expressed by one participant:

Approximately how much money do you send home?

The least I send is 20 thousand pesos. They are almost 2 million bolivares Source: the authors.

What can you buy with the 2 million bolivares?

It is not much but at least there is a comparison. Two million is about twicet the minimum wage in Venezuela (Int-18, male)

Social benefits depend on hiring agreements with employees. In the case of verbal contracts, the study participants reported receiving only their salary without social security or other benefits. Those who have fulfilled the administrative requirements to remain legally in the country have a legal contract with social security benefits and additional benefits ( Table 4 : 5a). As an example, a key informant mentioned, the most vulnerable, in terms of social benefits and working conditions, are those in the informal economy:

"Most of work is always informal. As I have said, here, for example, you walk all the tramway from Buenos Aires Station to San Jose and all the donuts, hotdogs, all things are tended by a Venezuelan and all, mostly, I mean from 100% of Venezuelans in Medellin, at least 80% are without any type of contract, they work per labor and don't have social security. I am talking of about 80% who work without a stable contract and work on the informal sector, many selling candy for example ". (KI-8, male)

The capacity to exercise workers' rights is limited due to several factors. Foremost, it is related to high vulnerability and low perceived empowerment. Second, irregularity -not possessing a permit to remain and work -prevents this population from accessing a contract with full benefits ( Table 4 : 6a, 6b). According to the participants, the practices of employers who hire Venezuelans need to be monitored, including the investigation of work exploitation ( Table 4 : 6c). Participants emphasized that there are structural factors relating to administrative paperwork from both the Colombian and the Venezuelan governments with regard to legalizing document. The following quote is the opinion of one participant about how these structural factors limit the ability to exercise the labor rights of Venezuelans:

"I have felt here that benefits are not so good. I am not sure if it is because I am Venezuelan and do not have power to demand my rights and say: look, I am earning very little and you are not paying commission for my sales. Look, I feel you are not paying me the increase because it is being discounted for other concepts " (Int-11, male)

Venezuelan participants have not reported a physical illness that prevented them from working. Some mentioned having suffered respiratory diseases such as flu; however, they did not seek medical care but only self-treated with rest and home remedies ( Table 5 : 1a, 1b). Study participants expressed the existence of factors related to access to health services that intervene in not seeking health services: costs, not having social security coverage, time constraints, and work pressure ( Table 5: 1c). Some reported having concerns about occupational hazards, as they are performing jobs for which they have no experience ( Table 5: 2a, 2b) . With regard to mental health, interviewees affirmed having symptoms of depression, anxiety, and stress due to the migratory process and doing work for which they are unprepared. Many participants complained about the fact that they are trained professionals now working in lowqualification jobs in Colombia ( Table 5: 3a) . As an example, one participant expressed his day-to-day feelings in the host country:

"Emotionally, what can I say, it is hard, it is hard. I am not going to say no. That you don't get depressed is a lie. Sometimes there are mornings when you get up and you don't want to get out of bed and do not want to see anyone's face because you miss them. You feel like what would I be doing if I were there and things were not what they are or maybe… You remember what you were back then at home. You live in a constant flashback and that is not worth anything here " (Int-23, male)

The findings of this study provide knowledge of employment precariousness among the Venezuelan immigrant population according to the characteristics delineated in the model that was adapted and applied. This population is characterized by accessing lower-skill jobs, being less stable in terms of contracts, social benefits, and enrolment in the security system, and often working in the informal economy. These conditions place this group in a situation of relative social vulnerability, which can have effects on health mainly due to increased stress, anxiety, and depression and greater vulnerability to occupational hazards derived from their lack of experience.

Migratory status constitutes a determinant of social inequalities, as immigrants take the most precarious jobs Benach et al., 2010 ) . The population interviewed, as in previous studies ( Porthe et al., , 2010 , exhibits several extreme or negative cases when compared with the theoretical construct ( Amable, 2006 ) . This situation is may be explained by the fact that the theoretical model was originally developed for salaried workers, and there are many nuances in the working immigrant population related to working contracts in the strict sense; many of them work in the informal economy ( Bartley and Ferrie, 2001 ) .

One of the characteristics of the migratory process, similar to findings in other studies ( Porthé et al., 2007 ; Agudelo-Suarez et al., 2009b ) , is the difficulty of access to the job market, which has been segmented into limited job openings, even for those having the qualifications to access higher-skill jobs. High demand, the competition with the locals, the administrative and legal requirements for the accreditation of foreign credentials and degrees, and regularization of residency and work permits are obstacles that must be overcome. Analyses must take into account in the demand and supply of jobs in the city of Medellin as compared to other cities in Colombia.

Overall, the interviewed population did not report major physical health problems. This has been described in the literature as the "healthy immigrant effect , " similar to the "healthy worker effect " ( Chowdhury et al., 2017 ) , and is due to selective immigration of people with stronger physical and mental states and better aptitudes to face the migratory process. However, the literature warns about the temporality of this effect, as the health of these people can be affected by different social conditions encountered ( Gotsens et al., 2015 ) . The interviewed population in this study was young and had mostly been in the city a short time. However, in analyzing their replies about mental health, investigators must consider the "immigrant syndrome "-called the Ulysses syndrome in some literature -defined as being associated with chronic stress. This condition is typical in those facing the challenges that arise from being in a different culture which, coupled with work dissatisfaction, work temporality, and high rotation of job positions, create feelings of marginality and exclusion ( Achotegui, 2004 ; Gálvez Herrer, Gutiérrez García et al. 2011 ) .

Regarding the perception of occupational hazards, most studies concur that immigrant populations tend to be at greater risk of various hazards at work, mainly associated with lower-skill qualifications for which they are unprepared . Many of them do not receive the requisite training for the work they perform, which can have an impact on their health situation in the short-and mid-terms (Agudelo Agudelo- Suarez et al., 2011 ) .

As a strength of this study, the benefits of qualitative research must be acknowledged that allowed us to approach the interpretation of the participants' individual perceptions and experiences as those directly involved and affected by the topic of study. To the best of our knowledge, this is the first study of this type in Colombia to explore beyond the study group and examine different perspectives by including key informants from formal and informal organizations in addition to the working immigrants. As a limitation, it is important to consider that these results are limited to the city of Medellin and that to capture the broader reality, it should be complemented with studies in other cities and their experiences in terms of health and work.

Interviews took place during a period characterized by greater affluence of the immigrant population with higher skills; migratory processes have changed since then. At present, we face a difficult period due to the COVID-19 pandemic caused by the SARS-CoV-2 virus. This pandemic has had a profound impact on social and labor inequalities, especially in vulnerable groups such as immigrants ( Hu, 2020 ; Koh, 2020 ) . This may have led to higher unemployment rates, more precarious employment conditions, and greater exposure to occupational risks that exacerbate the physical and mental situations of immigrants like these participants ( Alahmad et al., 2020 ) .

This study suggests the creation of specific research lines for this social phenomenon, as the issues of immigration, work, and health are changing in Colombia. This research will be complemented with epidemiological approximations that allow understanding some fundamental aspects of employment and work conditions and their relation to physical, mental, and psychosocial indicators.

The country needs to implement social policies for this population. Even though the immigration phenomenon is recent, current policies are restrictive and controlling. However, some important steps have been taken with the characterization of this population in Colombia and the creation of some social policies to guarantee access to health, social, and educational services for children and pregnant women, and to offer processes for regularization of the residence and work situation in the country through special residence permits (PEP, acronym in Spanish for Permiso Especial de Permanencia) ( Colombia. Consejo Nacional de Política Económica y Social. Departamento Nacional de Planeación, 2018 ). It is essential to continue developing inclusive strategies that allow for job creation and that respond to the needs of this working population. A fundamental aspect is to guarantee effective access to social and health services to prevent greater job precariousness.

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Emigrar en situación extrema: el Síndrome del inmigrante con estrés crónico y múltiple (síndrome de ulises). [Emigrating in an extreme situation: the immigrant syndrome with chronic and multiple stress

Migration and Health in the European Union

The migratory process, working conditions and health in immigrant workers in Spain (the ITSAL project)

Discrimination, work and health in immigrant populations in Spain

Invisible work, unseen hazards: the health of women immigrant household service workers in Spain

A qualitative study about immigrant workers' perceptions of their working conditions in Spain

COVID-19 stressors on migrant workers in Kuwait: cumulative risk considerations

Un Estudio de Trabajadores Asalariados en España. [Precarious Employment and its Impact on Health. A Study of Salaried Workers in Spain

La precariedad laboral y su repercusión sobre la salud: conceptos y resultados preliminares de un estudio multimétodos. Precarious employment and its health-related impact: concepts and preliminary results of a multi-methods study

Glossary: unemployment, job insecurity, and health

Precarious employment: understanding an emerging social determinant of health

Immigration, employment relations, and health: developing a research agenda

Women and Men in the Informal Economy: A Statistical Brief. Women in Informal Employment: Globalizing and Organizing (WIEGO) and International Labour Office (ILO)

Los estudios sobre migración internacional en Chile: apuntes y comentarios para una agenda de investigación actualizada

Healthy worker effect phenomenon: revisited with emphasis on statistical methods -a review

Documento CONPES 3950. Estrategia Para La Atención De La Migración Desde Venezuela

Percepciones sobre la migración venezolana: causas, España como destino, expectativas de retorno

Migration of Venezuelans to Colombia

Salud laboral y salud mental en población trabajadora inmigrante

Health inequality between immigrants and natives in Spain: the loss of the healthy immigrant effect in times of economic crisis

Intersecting ethnic and native-migrant inequalities in the economic impact of the COVID-19 pandemic in the UK

Movilidad e inserción de inmigrantes senegaleses recientes en la ciudad autónoma de Buenos Aires

Migrant workers and COVID-19

What is precarious employment? A systematic review of definitions and operationalizations from quantitative and qualitative studies

Asuntos Críticos en Los Métodos De Investigación Cualitativa

Standards for reporting qualitative research: a synthesis of recommendations

Extending a model of precarious employment: a qualitative study of immigrant workers in Spain

La precariedad laboral y la salud de los inmigrantes en España: ¿qué sabemos y qué deberíamos saber? [Precarious employment and immigrant health in Spain: what do we know and what should we know?

Precarious employment, ill health, and lessons from history: the case of casual (temporary) dockworkers 1880-1945

Saturation in qualitative research: exploring its conceptualization and operationalization

Globalization, migration, and ethnicity

Precarious employment experiences and their health consequences: towards a theoretical framework

Introducción a Las Técnicas Cualitativas de Investigación Aplicadas a La Salud

Employment precariousness and poor mental health: evidence from Spain on a new social determinant of health

The research groups thanks the Venezuelan population and the key informants which participated in the study whose answers allowed for the approach to the reality of hundreds of Venezuelans who fight on a daily basis for a better future in the middle of adversity in this migratory process in Colombia.

None.

All authors participated in the conception, design of the work, analysis, interpretation of data, critical review and approval of the final version. AAAS, MYV, WJRG carried out the fieldwork. AAAS coordinated the design of the study and drafted the manuscript. All authors are responsible and guarantors of all the aspects related to the content of this manuscript.