Valutazione del rischio, sorveglianza sanitaria, monitoraggio biologico e promozione della salute sul luogo di lavoro: focus sulla relazione tra migranti, lavoro e salute

Over the last 50 years, the migratory phenomenon has progressively grown, reaching 281 million of international migrants in 2020. In the same year, 8.6 million third-country nationals were employed in the European labor market (4.6% of the total population in working age) and, in particular, migrants represented about 12% of workers. Italy hosts an estimated resident migrant population of about 5 million, which is the 8.5% of total residents. This population is recognized as one of the most vulnerable in society and frequently performs the so-called 3D jobs - dangerous, dirty, demanding / degrading. The Italian Insurer Institute (INAIL) described 564049 accident reports and 1221 fatal outcomes reports in 2021, charged by foreign workers in 18% and 15.2% of cases, respectively; considering occupational diseases, 55288 were reported in the same year, almost 8% of which charged by foreign workers. According to the National Institute of Statistics, in 2016 the incidence rate ratio of occupational accidents was higher in foreign population compared to Italians (3.3% vs 2.8%) and in 2020 it was higher in the construction sector (3.3% vs 1.9%) and in healthcare (4.5% vs 2.9%). The scientific literature reports a greater risk of injury and a significant prevalence of occupational accidents and diseases in migrant workers compared to native. Some studies, for example, reported a higher incidence rate ratio (1.57, 95% CI 1.50-1.65) and a relative risk of fatal injury of 4.4 in migrant workers compared to native workers. In the agricultural sector, especially, where the phenomenon of labor exploitation, illegal hiring and occupational damage is particularly spread, focusing the attention on finding and reporting and preventing this condition is therefore essential. Migrant workers are also particularly exposed to the risk of infection and worse clinical outcomes from Sars-Cov-2, due to different factors, such as inadequate standards of their social conditions, fewer opportunities in access the health system and the employment mainly in essential works. Some Authors report higher ORs in Blacks, Native Americans and Hispanic individuals (respectively 2.47, 5.82, 3.11) compared to the White race considering hospitalization and death and a mortality ratio of 1.42 versus 1.28 in male foreigners versus natives. Nonetheless, subjects belonging to minor ethnic groups appear to be under-represented in vaccination studies. Furthermore, a suboptimal vaccination coverage compared to the host country general population was highlighted (70.9% in White race versus 36.8% in Black race) and a high hesitation rate towards the vaccine against COVID-19 in ethnical minorities. Moreover, it is strong the need to fill the gaps in risk assessment, health surveillance data, information and training, and to improve the access to health services and plan preventive interventions. Our study is part of the European project "FARm", developed in the responsible agriculture supply chain and the Asylum, Migration and Integration Fund, aimed at the finding and reporting of conditions of vulnerability, exploitation and irregularities for the population at risk. It is carried out by the development of an original experimental approach, made up of shared outreach activities, through trained operators and mobile units, allowing to intercept the addressees inside and outside the workplace, to early identify distress markers and spread health promotion interventions. The sequence of project activities started with a context analysis using various sources of interception to access the "cases", whose data were acquired through an “ad hoc” questionnaire (97 items), which allowed the analysis of sanitary and non-sanitary indicators. Information material was produced and spread and periodic reports, dissemination initiatives and final reports were carried out. The population examined was mainly composed of males (96%), especially coming from Asia (51%); in most cases (66%) the migration was motivated by the search for a job. Any educational qualification was achieved in 13.21% of subjects, while 9% earned a University Degree or Diploma; approximately 89% is familiar with Italian language. A residence permit was held in 77% of cases. The general health was good for over 80% of the participants, while 17% of them reported a condition of more or less serious sufferings. 51% of the respondents reported to be affected by at least one pathology, with a higher prevalence of osteo-muscular diseases concerning spine and upper limbs (32 and 17%, respectively). 81.13% of interviewees said they were satisfied with the work performed. Periodic health surveillance was adopted in 75% of cases and 9 out of 10 workers received training about the use of PPE. It is a matter of concern that only 5.66% of the workers are aware of the term "caporalato", while 25% said they had been a victim of exploitation with consequences on mental and physical health. This project is a first step which provided a new useful method in order to acquiring more reliable data, identifying criticalities in prevention systems, characterizing intervention priorities, monitoring the risk of accidents, developing good practices, improving risk perception, identifying new tools for managing related problems, implementing scientific knowledge.