Since the beginning of human history, there has been a disease from which humans have constantly suffered. It is ‘musculoskeletal disorders’. As moving the body is essential for living, people has been suffered from various disorders appearing in the muscles, bones, ligaments, and nervous tissues that make up the human body.

 

Now, when you look up ‘musculoskeletal disorders’ on the internet, you will find so many contents listed on the full page. ‘Musculoskeletal disorders’ have become one of the common diseases in Korea where anyone can easily find major diseases, symptoms, general characteristics, treatment, and specialized hospitals.

 

In the background of these well-known musculoskeletal disorders, there was a historical struggle of workers erupted through IMF economic crisis. However, it is not well-known that ‘musculoskeletal disorders’ are still the ‘most common work-related disorders’ that make workers sick and it is needed to decrease labor intensity to prevent the disorders. Also, it is hard to find that regular risk assessment for musculoskeletal disorders is being properly performed every three years.

 

We can say that “work-related musculoskeletal disorders” is the background of our institute’s founding, Korean Institute of Labor Safety and Health (KILSH). Various individuals and groups established the KILSH together, raising this problem in the field and organizing musculoskeletal disorders as a worker’s occupational disease. Work-related musculoskeletal disorders have been the most mentioned occupational diseases in the <Workplace>, which welcomes the 200th issue.

 

How did musculoskeletal disorders become work-related disorders?

“At the beginning of 2002, there were workers whose back, shoulders, arms and legs hurt in Geoje Okpo. Not long after, about 30% of the workers among the workers who were found to have musculoskeletal disorders claimed compensation for occupational disease collectively under pressure and conciliation from the company, and all of them were compensated as work-related disorders. The company said that the workers were exaggerating their symptoms which were not severe, and they claimed the compensation with the power of the labor union because they did not want to work. They also said that it was a temporary phenomenon which is about to pass such as organic solvents or manganese poisoning. However, their predictions were wrong. 11 workers from Halla Climate Control and 32 from Casco went into a collective claim in July 2002, and 27 from Daewoo Commercial Vehicles in November 2002. This year, 33 from Samho Heavy Industries, 21 from Doowon Precision Industries, and 10 from Daehan Yiyeon began the collective claim strike for work-related musculoskeletal disorders. Now, there is an explosive strike of collective claims and fight to stop strengthening labor intensity at workplace in various regions, transcending industries ranging from Pulmuone, urban railways, railroads, Hyundai Motors, and Ssangyong Motors.”

 

As you can see from above article from <Workplace> written at the time when we were preparing the institute’s founding, ‘musculoskeletal disorders’ appeared in the world as a work-related disorder resulted from a series of strikes for collective claims by metalworkers in 2003, led by Daewoo Shipbuilding workers in 2002. Of course, there was an example of work-related musculoskeletal disorders of the Korean Telecom operators and Hyundai Precision Workers even before that. The strikes for collective claims of metalworkers which culminated in 2003, however, had a completely different characteristic. It was not found or identified by experts in a specific occupational group. It was based on organizing of workers in the field. They shouted, “My back hurts, my shoulder hurts, You, employer take the responsibility”, “Worker is not an iron man. Prepare measure to prevent musculoskeletal disorders!”, “Are you sick? Let’s treat it! Is it hard? Let’s take a break!”, They demanded that this is an occupational disease, and it needs to be resolved, presenting their broken and damaged body as an “evidence”. Thus, musculoskeletal disorders emerged as a major social problem.

 

Workers watched their co-workers being pushed out of the factory where massive layoffs were rampant in the 1997-1998 economic crisis and neoliberal restructuring. Workers watched the jobs of former co-workers being filled with precarious workers such as subcontractors and non-regular workers. Workers endured from reinforced labor intensity for survival by being assigned the extra share of someone who left. They named the musculoskeletal disorder which was unfamiliar at the time as ‘bone disease’. Furthermore, the movement was organized in the way of the strikes for collective claims, asserting “stopping the strengthening of labor intensity” as a fundamental measure.

 

These strikes for collective claims in the metal manufacturing industry became an opportunity to inform organized workers that musculoskeletal disorders are occupational diseases and can be treated through occupational diseases compensation, and these disorders are due to collective factors such as strengthened labor intensity. Workers realized it is not true that ‘it is natural to get sick when you work’ and ‘it is natural to get sick when you get older’. Furthermore, not only individual factors such as age, height, weight, and hobbies, or handling of heavy objects, awkward work posture, vibration, etc. but also collective factors, the conditions of the labor process (labor intensity, working conditions, working hours, job stress, etc.) were found to be the most important underlying feature.

 

In addition, the labor union has accumulated valuable experience in “organizing workers” and “improving the workplace” through this fight. At the time, the goal of collective claims was not simply an approval for compensation, so not only the patients but also the entire union members could become the subject of the fight to improve their own working conditions and alleviate labor intensity. Along with this, the strikes of workers led to the result of “introduction of the risk assessment for musculoskeletal disorders”. The risk assessment led by the government for the prevention of musculoskeletal disorders was unprecedented in the world. The legal basis for the assessment was newly established in Article 24 of the Occupational Safety and Health Act in 2003.

 

Rapid response from employers,

Workers’ musculoskeletal disorders trapped in the system

As stated earlier, the legalization of the “Risk assessment for musculoskeletal disorders” in 2003 was the result of the struggle for collective claims developed by workers in the metal manufacturing industry. At the same time, however, it was the product of a compromise formed within the limits of no further progression of the fight. The employers and the government needed institutional means to effectively stop the musculoskeletal strikes that were on the verge of proliferation, and the labor groups faced the limit of not being able to expand the fight beyond the struggle for compensation of work-related disorder, to decrease work intensity and restore power over the workplace. At the time, business community feared that the musculoskeletal strike would go beyond the “treatment of sick workers” to the actual fight for “stop restructuring, stop the strengthening of labor intensity,” and was making every effort stop the fight. It was because the musculoskeletal strikes to make workplace not suffering from a ‘bone disease’ was inclined to advance into a movement that demanded workers’ control over appropriate manpower and production in the workplace. The employers quickly recognized that this fight was about to seriously damage profits and violate their own domain, management rights. On the other hand, it is true that the labor union fell a step behind to advance the musculoskeletal strikes to a struggle to stop intensification of workload. In fact, the issue of “labor intensity” was put forward in the campaign, though there was also a reality where perceptions of “It is good enough to get compensated and treat musculoskeletal disorders” are everywhere.

 

“In most workplaces, it is not easy to even engage in collective claims strike. Above all, the seeable and un-seeable repression of the employers, monitoring of health checkups, obstruction of the investigators’ entry into the workplace including criminal prosecution for trespass, the pressure to withdraw compensation claims, disadvantage on overtime work, termination of the contract, violent events, total rejection of labor negotiations, etc. make workers feel so painful that they are not even worth as mechanical parts. But if you look at what you need to do next after you fight for collective claims, you realize that this was rather an easy part.”

 

Great determination was required to organize this fight, as the August 2003 issue (volume 1) <Workplace> conveys the atmosphere at the time. Therefore, it was true that workers had a realistic view in some workplaces that minimizing conflict with employers was advantageous for workers in receiving treatment. As a result, a ‘compromised’ statement was drawn in the provisions of the legislation and the Ministry of Labor’s definition of 11 musculoskeletal burdened work, although there was some confrontation on this provision. ‘Risk assessment for musculoskeletal disorders’ was a legal system that could not be found in the world. It was an institutional product which reflected the power relationship between employers and workers at the time, and it was quickly enacted. Compared with other existing systems in Occupational Safety and Health Act, the risk assessment (including investigation on demand by the occurrence of disease or introduction of a new process in addition to regular investigations) significantly allowed participation and intervention of labor union. Therefore, it can be said that risk assessment was accepted as a somewhat “tense compromise” in that it could be a powerful tool for workers to improve the workplace.

 

 

Figure 1. Compensated work-related disorders and work-related musculoskeletal disorders (1996-2009)

 

Meanwhile, the demand for compensation of musculoskeletal disorders, which was raised in the form of collective claims, can also be confirmed through the change in approval rate. After the strikes, the approval rate for musculoskeletal disorders showed a much different pattern from before reflecting vigorous struggle. In 1998, during the IMF economic crisis and neoliberal restructuring period, only 124 (7%) had musculoskeletal disorders among work-related disorders. In 2003, when the collective claim struggle reached its peak, the number of work-related disorders reached 4,532 (49.6%), and the approval rate reached 93.7%. Since then, musculoskeletal disorders have fallen to 2,901 (38.7%) in 2005 as the government and employers control it actively, but then gradually recovered, reaching around 70% from 2008 to the present. This statistic shows that there are so many workers suffering from musculoskeletal disorders and that the number of workers’ compensation applications is increasing. At the same time, however, we can see that there is still a barrier to the approval of compensation for musculoskeletal disorders.

 

The reality of institutionalized risk assessment for musculoskeletal disorders

Since the ‘Risk assessment for musculoskeletal disorders’ was legislated, a total of 6 periodic investigations (every three years since the first one in 2004) were performed. However, the initial purpose was lost, and the investigations were implemented superficially because the risk assessment was carried out as a duty of the employer. The musculoskeletal strikes that erupted from the streets based on organizing workers were trapped inside the walls of individual workplaces. The field investigation which had been conducted by workers with the initiative came to give the initiative to the hands of the employers and their contracted specialized agencies.  The problems of improving workplace and labor intensity were narrowed down to a preventive program and treatment of patients. In short, it can be said that as the movement was incorporated within the framework of the legal system, the meaning of the political struggle was deconstructed which demanded relief of labor intensity including reduction of working hours and restoring power of workers over the workplace.

 

Then, what is the current situation of risk assessment for musculoskeletal disorders? This can be seen in part from the results of a survey conducted by the Korea Occupational Safety and Health Agency (KOSHA) in 2019. This survey investigates every single workplace in 9 industries with a high risk of occupational accidents among manufacturing industries and a sample of workplaces among 13 manufacturing and non-manufacturing industries which has occupational hazards but not applicable to previous 9 industries. As a result, it was found that 27,221 (25.3%) of the 107,665 workplaces in 9 industries conducting the risk assessment. Among them, only 16.3% of the workplaces were conducted regularly every three years. In the sample revies, only 7.6% of the workplaces conducted the risk assessment among the 13 industries. Of course, it is impossible to grasp a more detailed situation with this data, and we can tell only whether the risk assessment has been conducted. However, it can be confirmed that there are many workplaces that do not their duty, even though the risk assessment for musculoskeletal disorders has been institutionalized as a duty of employers which is supposed to be conducted every three years. These results aroused concern that the risk assessment was not properly conducted apart from the criticism that the initial purpose had faded. Accordingly, the government is currently seeking a plan to increase the implementation of the risk assessment. We must look back on whether the workers’ power has been lost to implement risk assessment based on the field as it narrows down to legal obligations.

 

Furthermore, even if it is compelled to conduct a risk assessment for musculoskeletal disorders, questions arise about the effectiveness of the investigation itself. In 2019, 67.2% of compensated workers for work-related disorders had musculoskeletal disorders, which cost a lot. The risk assessment can help to reveal the situation of work-related musculoskeletal disorders and to increase the approval rate for compensation. However, the ultimate goal of the risk assessment is to prevent musculoskeletal disorders by improving the working environment. However, not only that very few workplaces do the risk assessment, but also the risk assessments are being conducted superficially. For this reason, it has not led to discussions on improving the working environment and labor intensity through reduction of working hours and reformation of the shift system other than an intervention with ergonomic factors.

 

Despite of this situation, there are some exemplary cases in the metal manufacturing industry improving the workplace through a field investigation conducted with the initiative of workers using the risk assessment for musculoskeletal disorders. Rather than being left to the hands of experts, they are constantly seeking a method of the investigation conducted by workers themselves such as designing field survey sheets for workers. Beyond the research method focused on ergonomic evaluation under the guise of objective and scientific investigation, workers actively introduced subjective evaluation of labor intensity that reflects their experiences, which was developed in several previous risk assessments. In addition, by investigating workers’ experiences of treatment and care, they intend to improve measures for the patients. The working environment is effectively improved by listing the recommendations from the investigations and checking how the recommendations are being implemented. In the metal manufacturing industry, it can be said that after going through “phase 1” widely publicizing the musculoskeletal problem, they are now in “phase 2” trying to improve the working environment and labor intensity.

 

In addition, just as workers suffering from musculoskeletal disorders who made this problem become a social issue along with the increase in the unionization rate, mainly by the metal workers in the early 2000s, workers in various sectors such as school cafeteria, mart, cleaning, construction are demanding countermeasures through applicating compensation and revealing their musculoskeletal disorders. Now, it can be said that ‘phase 1’ is in full swing at other sites than the manufacturing industry.

 

Tasks for achieving effectiveness of risk assessment for musculoskeletal disorders

There are quite a few points that need to be emphasized in order to bring back the original purpose that the risk assessment for musculoskeletal disorders was introduced for prevention. Workers need to fight for these policy changes. 

 

First, it is needed to get rid of the limited definition of ‘musculoskeletal risk jobs’ of the Ministry of Employment and Labor, which are restricted to only 11 jobs. The ‘risk assessment for musculoskeletal disorders’ is stipulated to be performed for these 11 jobs. However, it has been criticized considerably since its introduction. This was because the provision was made only based on manufacturing jobs such as assembly line or shipbuilding process. Atypical work in various industries and jobs is not reflected and there is no consideration of gender and age differences although women or elderly workers may be more vulnerable. The provisions set the one-size-fits-all standard for the ‘risk job’ according to exposure time and lifting weight such as 2 hours per day or 5 kg and it sounds like they are saying that work-related musculoskeletal disorders cannot occur in the working environment below this standard. However, these provision remains unchanged despite the criticism. Many workplaces have been excluded from the risk assessment for not meeting the criteria for the risk jobs. Even if they are included in the risk assessment, their jobs may be evaluated as no-risk based on the exposure time and weight presented in the provision. Therefore, it is necessary to abolish the standards for the risk job.

 

Second, we need to change the situation that the risk assessment for musculoskeletal disorders is mainly limited to the evaluation of ergonomic factors. It’s hard to find the workplace where the risk assessment covers comprehensive investigations on the workplace including working conditions. This leads to failure of proper reflection of the fundamental cause of musculoskeletal disorders. In addition, the ergonomic evaluation-oriented investigation of the risk assessment makes workers depend on external experts, which makes it difficult for the workers to participate in the assessment. As a result, workers may remain only as of the subject of the investigation, not the actor of the investigation.

 

Third, it is necessary to improve the risk assessment for musculoskeletal disorders to play a practical role in the prevention of musculoskeletal diseases. This is to revive the original purpose of the investigation. For example, as risk assessments are limited to specific evaluations and only formally carried out, recommendations are narrowing down to a personal level, not demanding improvement of the workplace to employers. In addition, even improvement of the workplace has been focused on ergonomic improvement such as “installing ergonomically designed machine”. Furthermore, as a ‘program for prevention of musculoskeletal disorders’ is only mandatory to the workplace which has more than a certain number of compensated work-related disorders patients, it is difficult to have effectiveness in protection and prevention.

 

What to focus on in the future

Musculoskeletal disorder is not a disease which occur only in specific jobs and special occupations. Anyone who works can be exposed to it, and anyone can suffer from it. There were workers who revealed the painful reality to the world through labor unions’ organized movements and made an issue about work-related musculoskeletal disorders demanding countermeasures. There are also workers who later realize this as a ‘work-related disorders’ and begin to think about the improvement in the workplace. However, most of the workers are still thinking that it is natural to be sick when working, and employers are constantly struggling with workers to accumulate profits. Therefore, work-related musculoskeletal disorders are likely to continue to emerge as a social issue in the future, and an active response from society is required.

 

Especially, it is needed need to actively establish countermeasures against musculoskeletal disorder considering changes in the labor market and employment type beyond the traditional manufacturing industry. The government cannot respond well to changes in the labor market and employment patterns with the narrow view which is still confined to male workers in the manufacturing industry. The labor market has been changed already from the traditional manufacturing industry to the emergence of various service occupations. Precarious work such as intermittent, atypical, and unstable work emerged as the dominant work types since a lot of women or elderly workers have entered the employment market. Measures for “treatment and rehabilitation” for musculoskeletal disorders reflecting this emerging workforce are urgently needed as well as “protection and prevention” measures.

 

On the other hand, this status raises the need for change in the metal manufacturing industry either, which has been conducting risk assessment already. The aging of workers has become an urgent problem in the manufacturing industry where new hiring is not actually happened. The development of a new standard for the risk assessment suitable for elderly workers should not be postponed any longer.

 

Conclusion

Musculoskeletal disorders, which can be exposed and suffered by any working person, have emerged as an “occupational disease” in Korean society through the historic struggle of metalworkers. Since then, the fights surrounding them have decreased in intensity, but are being repeated and varied in various forms. Musculoskeletal disorders raise the question of ‘How decent work are you doing?’ to every single person at work. At the same time, our society is constantly being questioned. How can we have a “workplace that does not make workers sick” and a “workplace where we work as human”, and how should the standards be set? I want to say that the standard should be a worker’s body and life other than anything else.