A study on how to solve the problem of missing health check-ups for intermittent workers such as film staff(2022)

Seon-woong Lee, member of the Korean Institute of Labor Safety and Health, Specialist in Occupational Environmental Medicine

Korean Institute of Labor Safety and Health

1. Film staff’s continuous omission of health checkups and working conditions

According to the Korean Film Council, the staff involved in film production are employed for an average of 4.7 months per film on an intermittent basis. According to the 2019 safety and health survey of film staff, only 33% of film staff personnel underwent a health checkup at least once within the past two years due to this intermittent work pattern. In this situation, the Empathy Occupational and Environmental Medicine Center, together with the film industry labor union, tried to find the cause of the low health checkup rate of workers in the film industry and to find a solution to the problem. In addition, an attempt was made to use questionnaires to investigate their health status and provide more accurate information about the frequency of health check-ups.

The total number of film staff who participated in the survey was 204, and the average age was 33.7 years-old. The average number of working hours per day including overtime in the last 3 months of the survey subjects was 10.1 hours, and the average number of working hours per week including overtime in the last 3 months was 50.2 hours. In the past three months, 26.7% of people exceeded 52 hours per week for one week or less per month; 18.4% exceeded 52 hours per week for two to three weeks per month; and 11.3% of people exceeded 52 hours every week. More than half (56.5%) of the total number of people exceeded 52 hours per week per month. In addition, 83 people (44.9%) were subject to a special health checkup for night work under the Occupational Safety and Health Act.

Table 1. Number of
health checkups during film work

2. Health risk factors and health status of film staff

For male workers, job stress was higher than the reference value in the areas of “job demand,” “job instability”, and “physical environment.” In the case of female workers, the stress level was higher than the reference value in the areas of “job demand,” “job instability,” “relationship conflict,” and “physical environment.” As indicated by the long working hours, both men and women were in a situation with high “job demands.” In addition, significant “job instability” was observed due to intermittent contracts, and harmful work environments such as heat waves and cold exposure. These factors caused great stress due to the “physical environment.”

Among the film staff, 34 people (16.8%) were victims of workplace bullying using the Negative Behavior Experience Questionnaire (NAQ-R). This is on par with the nursing profession, where workplace bullying is generally regarded as a risk factor as revealed in Korean studies. In addition, there were 52 (27.8%) high-risk drinkers with an AUDIT-K score of 13 or higher, which was more than twice that of the general population overall. A high degree of nicotine dependence was found in 34.5% of men and 9.5% of women.

Anxiety symptoms with a GAD-7 score of 5 or higher were found in 86 patients (42.2%). As a result of a community psychological survey in 2014, this was almost 18% higher than the highest level in Ansan (23.9%), and clearly higher than anxiety symptoms in all regions. In addition, there were 38 patients (18.6%) with a CES-D score of 21 or higher. This is higher than the depression symptom rate (11.8%) in Ansan, which was the highest measured by reflecting the characteristics of the community immediately after the Sewol ferry disaster at the time of the 2014 community psychological survey.

There were 25 (15.1%) patients with insomnia with an ISI score of 15 or higher, which is higher than that of 6.9% to 11.8% in the study of the general population in the community especially considering the relatively young age group with an average age of 33.7 years-old. In addition, the overall insomnia symptom rate of 60% was higher than that of 11.4% of 1,534 workers of the parent company, who work in 4 groups and 3 shifts. 

According to the night work special health checkup questionnaire 28 people had indigestion representing 15% of the total survey subjects. Among them, 17 people had indigestion and were eligible for the special health exam due to night work. Eleven people had indigestion but were not eligible for the special health exam due to night work. This is a very high level of indigestion compared to 0.39%, which was the result of the same questionnaire for those who received special health checkups for night work in 2017. 

The number of patients with musculoskeletal symptoms requiring treatment in more than one part of the body (NIOSH standard 4) was 55, or 26.9%. This is higher than the parent auto parts maker (21.4%), the parent electronics assembly company (18.3%), and the parent shipbuilding company (15.4%), which are generally known as industries with a high risk of musculoskeletal disorders as outlined in the 2019 Metal Workers Union Gyeongnam region survey of musculoskeletal factors. 

3. Health check-up status of film staff and cause of omission

On average, the survey subjects performed health checkups once every 8.62 years, so the number of annual checkups was 0.12 per person, and when converted into a percentage checkup rate, it could be estimated that the health checkup rate was about 12% per year (Table 1). This is significantly lower than the national general health checkup rate of 76.9% in 2018.

When asked if they had ever received guidance or information from the manufacturer about the company’s workplace health checkup, 82% of the workers answered no. Almost all of the workers (95.4%) said that they had not received any information about the special health checkup. The most frequent reason for not performing a health checkup was that neither the national health checkup (workplace health checkup of the Corporation and the Ministry of Labor) nor the health checkup of the industrial complex were provided at work. 

The reason for the low health checkup rate of movie staff is that even though most of them are insured through the four major types of insurance, they have a short-term contract about twice a year, so the workplace has not conducted the workplace checkup itself. In addition, the situation in which people were not notified as subjects for workplace checkups also had a significant impact. 

There are repeated insurance changes that are not included in the Health Insurance Corporation’s time standard for registration of local or workplace checkup subjects in the current year, and these are institutionally in the blind spot of checkup subject registration. For this reason, although 45% of the subjects fall under the special health checkup for night work under the Occupational Safety and Health Act, they are omitted from the special checkup target set by the workplace and related ministries. It is judged that such a low health checkup rate of film staff will have a long-term adverse effect on the various health risk situations in this study as well as the issue of equity in the right to health as health insurance subscribers. Therefore, normalizing the health checkup, which is a basic right as a health insurance subscriber, is a basic prerequisite for proper health management of film staff.

4. Recommendations for normalization of health checkups for intermittent workers such as film staff

Currently, labor inspectors generally check whether workplaces are providing guidance to employees subject to a checkup in order to determine whether workplace health checkups have been implemented. However, for industries with repeated short-term contracts, there is no need for the manufacturer to notify, as the inspection target set by the corporation and the current worker do not match, and the obligation to notify is meaningless.

(1) In order to resolve these institutional loopholes, the health management system for intermittent work industries should be reorganized. It is the duty of business operators to apply for additional examinations as those subject to the current health examination rules. The system should be reorganized so that intermittent workers can be registered and added as workers at an actual workplace. 

If the production company changes to new contractors and makes additional applications for examinations at the time production starts and announces it, the employer’s duty for basic workplace health checkup has been fulfilled. After that, it is necessary to induce the checkup to be carried out individually or in units of business sites. Currently, there is no legal action against non-application for change of screening subject in the Health Checkup Operational Regulations. Therefore, the judgment of non-execution of health checkup for intermittent workers and violation of employer’s obligations for non-notification is a blind spot in the application of the law. For this reason, in the case of film staff, it is common that night work is repeated as shown in the survey results, but they do not receive health protection under the Occupational Safety and Health Act.

Therefore, it is necessary to normalize special health checkups for film staff’ doing night work and provide institutional support. According to Article 158 of the Occupational Safety and Health Act, the government can provide cost support for work environment measurement and worker health checkup, and the target for health checkup support is also specified in the notice of the Ministry of Employment and Labor. The special health checkup support is to support workers in small businesses with fewer than 20 employees, and workers who find it difficult to undergo screening due to intermittent contracts as daily workers, but who are highly exposed to harmful factors. Film industry workers are also representative of intermittent contract workers. They have a very low health checkup rate and are subject to various health risks as seen in this study. In addition, nearly half of the workforce is subject to a special health checkup for night work under the Occupational Safety and Health Act. Therefore, they are suitable for the special health checkup support conditions for vulnerable groups, so it is appropriate to select them as targets for additional support for the ‘Health Stepping Stone Project’ of the Occupational Safety and Health Agency.

(2) It is also necessary to supplement the Act on the Promotion of Movies and Video Products. ‘Protection from safety accidents’ is stipulated in Article 3-6 of the Act, and the Film Promotion Committee is carrying out the ‘Movie Site Emergency Medical Support Project’, which provides ambulances and rescue personnel to film shooting sites based on this Act. However, the law does not adequately grant the responsibility of film producers or the state support for basic activities for preventing occupational diseases or promoting health, such as medical checkups, which is the subject of this study. Therefore, it is necessary to revise the relevant article to give film producers the duty to prevent not only safety accidents but also a wide range of occupational accidents and diseases, and furthermore, to give producers the responsibility for health promotion activities.

(3) In addition, the film industry labor standard contract should be revised. The film industry labor standard contract is a standard labor contract that has been widely used in the film industry since 2010. An obligation to Article 12 of the contract should be added that requires employers to provide movie production workers the health exam based on National health insurance Act and should inform them of this right. Then filmmakers can recognize their obligations and workers can prevent their rights from being violated.

(4) In addition, the film Promotion Committee should carry out support activities related to health checkups. It is necessary to explain and promote the health checkup system itself and its significance. In the early stage, until the health checkup system is established, it is possible to guide and support the application for change of checkup subjects. In addition, methods such as subsidizing the cost of the secondary checkup and providing preferential treatment for movie companies with a high rate of health checkups can be considered.

(5) Lastly, not only film workers, but also a significant number of workers with short-term, project-based employment contracts are omitted from health checkups and follow-up care. As the global economy is reorganized, service sector jobs are expanding mainly to low-skilled and non-regular workers, employment and work types that are completely different from traditional industrial societies are emerging. In the film industry, the reality is that five years after signing up for workers’ health insurance, one out of five workers has not received a proper medical checkup. This situation illustrates the problem. Discussions about the transition of the social insurance system, such as the national employment insurance system, have been on the rise since the corona virus pandemic, but fundamental issues are not actively raised regarding health insurance, which has the highest enrollment rate and the largest scale. Improving the coverage rate, which is mainly being discussed, is also an important task. However, it is necessary to face the reality that the number of people who are omitted from the national health checkup is increasing due to the ambiguous employment relationship. It is necessary to start a discussion that goes beyond the workplace-based registration system.