Content uploaded by Luz Claudio
Author content
All content in this area was uploaded by Luz Claudio
Content may be subject to copyright.
This article describes the current situation of occupa-
tional health (OH) in Mexico, including socioeco-
nomic context, legislation, health system, and educa-
tive and investigative resources, as well as the practice
of OH. Workplace accidents per 100 workers
decreased from 7.23 to 2.3 workers in 20 years; deaths
decreased from 1.68 to 0.9 per 10,000 workers, while
the occupational disease rate increased from 0.6 to 1
per 10,000 workers. This can be interpreted as an
improvement in preventive measures as well as prob-
lems of recognition and registry. In Mexico OH faces
challenges that range from needs for professional
training and performance to needs for development
of legal measures, coordination, information, and
research. Key words: occupational health; occupational
medicine; social security; Mexico.
INT J OCCUP ENVIRON HEALTH 2006;12:346–354
O
ccupational Health (OH) in Mexico has
expanded significantly since the creation of
the Institute of Social Security in that country.
During this time and notwithstanding the fact that it
has seen important advances, OH has not met the
health needs of the Mexican worker population and
continues to be limited with regard to the impact of
providing health services. We describe OH in Mexico
in its general context, the main statistics available,
needs for education and training, and the current prac-
tice of OH.
CHARACTERISTICS OF THE POPULATION
Mexico has a population of approximately 100 million
inhabitants, of whom 46% are males and 54% females.
In one decade (1990–2000), the percentage of adults
and the elderly in Mexico increased 1.2%, with a life
expectancy of 75 years.
1
By the end of 2004, the worker
population by economic sector was distributed as fol-
lows: mining, agriculture, livestock, and related occu-
pations, 16.2%; transportation industry, 24.1%; service
industry, 59.3%. The economically active population
(EAP) represents 42% of the entire population, of
whom 35% are women. The proportions of the EAP
who do not have social security insurance are estimated
at 31% of women and 69% of men, who are underem-
ployed or who work in the informal economy. Unem-
ployment during 2004 was 3.74%,
2
which in general
terms could be considered low, but underemployment
is enormous (39% of the EAP). This favors informal
work settings and the migration of the work force
mainly to the United States, where workers of Mexican
origin included in the U.S. Census amounted to 10% of
the Mexican EAP in 1980, 13.5% in 1990, and 20% in
2000. Monies remitted by migrant workers to their fam-
ilies in Mexico increased from $3,673 million U.S.
(USD) in 1995 to $16,612 million USD in 2004, ren-
dering this one of the principal sources of foreign cur-
rency income in the country.
3
OCCUPATIONAL HEALTH LEGISLATION
AND AUTHORITIES
Although it has been more than ten years since the
signing of the North American Free Trade Agreement
(NAFTA), which establishes economic exchange
between Mexico, Canada, and the United States, the
agreement has yet to reach its full potential. The chal-
lenge continues to be one of integrating the economies
of the three countries, despite the inequalities of their
respective levels of income, wealth, and development,
and to protect the health of workers in the process.
Article 123 of the Political Constitution of the
United States of Mexico establishes worker and
employee rights and obligations and also separates
workers into two groups: Group A is composed of pri-
vate-sector workers, and Group B includes government
346
Occupational Health in Mexico
FRANCISCO RAÚL SÁNCHEZ-ROMÁN, MD, MSC,
CUAUHTÉMOC ARTURO JUÁREZ-PÉREZ, MD, MSC,
GUADALUPE AGUILAR MADRID, MD, MSC, LUIS HARO-GARCÍA, MD, MSC,
VÍCTOR HUGO BORJA-ABURTO, PHD, LUZ CLAUDIO, PHD
Received from the Unidad de Investigación en Salud en el Tra-
bajo (FRS-R, GAM, VHB-A) and the División de Discapacidad y Rein-
corporación Laboral Coordinación de Salud en el Trabajo (CAJ-P),
Instituto Mexicano del Seguro Social, Cuauhtémoc, Mexico; the
División de Estudios de Postgrado e Investigación, Facultad de Med-
icina, Salud en el Trabajo, Universidad Nacional Autónoma de
México (LHG-A); and the Department of community and Preventive
Medicine, Division of International Health, Mount Sinai School of
Medicine, New York, New York (LC). Supported by a Fogarty Inter-
national Center grant.
Address correspondence and reprint requests to: Francisco Raúl
Sánchez-Román, MD, Av. Cuauhtémoc #330, Edificio C, Coordi-
nación de Salud en el Trabajo, 1er piso, Centro Médico Nacional
Siglo XXI, Instituto Mexicano del Seguro Social, Col. Doctores,
Deleg. Cuauhtémoc, 06725 México, D.F., México; telephone: (+52)
(55) 5761-0725, 5530-8260; fax: (+52) (55) 5538-7739; e-mail:
<raul.sanchezr@imss.gob.mx>.
workers. The governing law for Group A is the Ley Fed-
eral del Trabajo (Nationa Labor Law, LFT); for Group B
the governing law is the Ley de los Trabajadores al Servi-
cio del Estado (State Workers Law, FSS). The LFT estab-
lishes the obligations of employers and workers with
respect to basic safety and hygiene conditions in the
workplace, and includes a list of 161 occupational dis-
eases, along with a guide for determination of func-
tional and anatomic losses, permanent disabilities asso-
ciated with injuries and occupational diseases.
4
This law
is utilized as a general guide for cases of workers’ com-
pensation for national and state government workers as
well. The Reglamento Federal de Seguridad, Higiene, y
Medio Ambiente de Trabajo (National Safety, Hygiene,
and Occupational Environment Law) sets forth the
bases for OH services organization and protections for
child laborers and pregnant and breastfeeding women,
as well as surveillance, inspection, and administrative
sanctions.
5
As a member of the International Labor
Organization (ILO), Mexico has ratified most OH-asso-
ciated agreements and recommendations.
At present, the Secretaría del Trabajo y Previsión Social
(Mexican Work and Social Security Secretariat, STPS) is
the governmental agency in charge of establishing and
enforcing OH-related norms, as well as setting permissi-
ble limits for occupational exposures, and calling
together worker representatives, private businesses, insti-
tutions of higher education, and health personnel;
nonetheless, its surveillance capacity is limited. Addition-
ally, the Secretaría de Salud (Mexican Health Secretariat,
SSA) does not play a relevant role in OH-related regula-
tion and surveillance. This sets a wide gap between the
laws as they are laid out in the statutes and the actual
implementation and enforcement of these laws.
THE HEALTH SYSTEM
The health system in Mexico is composed of private
and public institutions with various levels of responsi-
bility for workers’ protections. The formal sector of the
population that includes workers in private businesses
and in the national and state governments possesses
social security institutions that guarantee care for life
contingencies such as diseases and occupational
injuries, general or common diseases, maternity, dis-
ability, old age, death, work cessation at an advanced
age, and retirement.
6
These institutions are financed by
worker, employer, and government contributions and
distinguish between the two types of workers.
The largest form of health insurance for workers is
dictated by the Ley del Seguro Social (Social Security Law,
LSS). Signed into law in 1943, it established the obliga-
tion of the private sector to provide social security for its
workers. The Instituto Mexicano del Seguro Social (Mexican
Institute of Social Security, IMSS) is the institution
charged with providing medical, economic, and social
services to private-sector workers (Group A Workers).
IMSS is the largest social security institution in Mexico
and at present provides services to more than 800,000
businesses and their more than 12 million workers (30%
of the EAP), as well as their beneficiaries; this represents
coverage of 40% of the entire population of the country.
The Federal Government provides services to its
workers through the Instituto de Seguridad y Servicios
Sociales para los Trabajadores del Estado (Institute of Secu-
rity and Social Services for State Workers, ISSSTE),
which provides care for 2.5 million workers, reaching
5.9% coverage of the total population of Mexico. Other
government-related institutions, such as Petróleos Mexi-
canos (Mexican Oil Company, PEMEX), the Armed
Forces, and the Navy, possess a distinct health system
that covers 1.1% of the population. Finally, Mexican
state governments also provide social security services
to their workers. Some states have their own institu-
tions, while others subcontract through another social
security institution. This type of state coverage involves
less than 1% of the population.
Half of the Mexican population has no access to med-
ical coverage. Medical care for the uninsured workers is
provided by health institutions subsidized by the govern-
ment at public state institutions, the IMSS, or by charita-
ble institutions. Recently, a popular insurance policy was
put into effect that offers low-cost limited coverage to
the low-income population who do not have medical
coverage from their employers, or those who work in the
informal economy where coverage is not available.
There is also a growing private care system in Mexico
that provides coverage for catastrophic and routine
medical expenses, payment-per-service, and prepaid or
co-paid medical care services. These types of coverage
have increased over the past several years due to the
growing tendency of the health sector to open up to
private investment. Most of these services are adminis-
tered by insurance companies and do not include OH
at present. It is estimated that this system provides cov-
erage to 1.1% of the population in Mexico.
OCCUPATIONAL MEDICINE TRAINING
AND RESEARCH RESOURCES
Education and training of human resources in occupa-
tional medicine (OM) and in safety and industrial
hygiene (SIH) have been scarce and do not meet the
needs of the country. At present, 50% of medical schools
in Mexico include some OH curriculum in their pro-
grams, usually one course of a few hours’ duration, and
few promote practical training in enterprises during the
last year of the education. At the postgraduate level,
there are two courses in OM in Mexico: one has been
sponsored by the IMSS since 1968 and the other by
PEMEX since 1995. At present, the IMSS is training 50
OM specialists per year at five sites, Mexico City, Jalisco,
Nuevo León, Guerrero, and Veracruz; PEMEX partici-
pates in the training of eight OM specialists at two cam-
VOL 12/NO 4, OCT/DEC 2006 • www.ijoeh.com Occupational Health in Mexico • 347
puses (Tamaulipas and Mexico City). The course of
study is two years in duration and the curriculum is
based on the disciplines of occupational pathology, toxi-
cology, epidemiology, safety and industrial hygiene, soci-
ology, and legislation.
7
Each campus receives accredita-
tion from the corresponding state university.
The total number of OM specialists who had com-
pleted residencies in the field as of February 2005 was
699. It is estimated that 610 of them continue to be
active in the field, 52% working at the IMSS and the
remainder at other social security institutions, private
businesses, or combinations of both. In addition, there
are two university-level OM specialty courses, from
which over 60 specialists were graduated. These courses,
promoted by public universities in Aguascalientes and
Chihuahua, provide an alternative option to residency
courses for physicians employed at private companies.
8,9
In the areas of training in industrial safety, there are
two types of undergraduate programs, one specialty
program and eight master’s-degree programs, that are
sponsored by public and private universities, with more
than 1,000 professionals who have graduated in this
area. Training in industrial hygiene and occupational
toxicology is more limited because there are no specific
training courses.
10
There exist at present two special-
ization courses in occupational nursing and a specialty
in ergonomics, but there are no specific specialty
courses for related areas such as social work, and the
participation of psychologists is limited.
The certification process for professionals in OM is
relatively recent because there is a need to guarantee
the performance of these professionals, and there are
a limited number of senior OM professionals who can
oversee these certifications.
In the medical area, there is a National Registry
System that evaluates the practice of the profession,
including undergraduate degrees, specialties, and sub-
specialties, along with master’s and doctoral degrees.
The professional certificate (national license) for the
OM specialty is awarded by the Secretaría de Educación
Pública (Mexican Public Education Secretariat, SEP)
after completion of the specialty course. The Consejo
Mexicano de Medicina del Trabajo, A.C. (The Mexican
Board of Occupational Medicine, CMMT), created in
1985, is an independent, nongovernmental organiza-
tion that evaluates and certifies physicians in OM. Cur-
rently, graduates of formal specialization courses and
physicians with two years of practical experience in OM
and 500 hours of coursework related with the specialty
have the opportunity to obtain initial certification
awarded by the CMMT and subsequent recertification
every five years. During the period 1999–2001, over
1,600 physicians were certified and received a national
license in OM. These physicians included individuals
without formal training in OM, but who meet the
CMMT-established requirements.
11
It is estimated that
9,000–12,000 physicians work in private-sector enter-
prises and the majority have no training in OM, despite
the fact that there had been a 50% increase in the
number of OM-certified physicians in Mexico during
the 1998–2000 period.
12
In the field of SIH, the Consejo Mexicano de Profesion-
ales Certificados en Administración de Riesgos, A.C. (Mexi-
can Board of Certified Risk Administration Profession-
als) is the body that certifies professionals responsible
for workplace safety and hygiene and that requires ini-
tial examination and recertification every three years
for either of its two modalities. In coordination with
some of the universities in the country, the STPS offers
courses in health and occupational safety directed
toward personnel employed at technical- and profes-
sional-level companies.
13
There are 11 university-level,
multidisciplinary-focused master’s-degree programs in
OH that contribute to knowledge in the different areas
involved in worker health care. The majority of the 32
Mexican states have one or more societies or associa-
tions in the different OH fields, especially in OM, SIH,
and nursing, and there are over 20 professional associ-
ations throughout the country that promote academic
activities among their members.
The development of research programs in OH is
scarce. There exist few sources of financing for
research projects, and these are essentially limited to
funding awarded by the Consejo Nacional de Ciencia y
Tecnología (National Board of Science and Technology,
CONACYT), the IMSS, and the ISSSTE. OH profes-
sionals interested in the development of research proj-
ects often carry out their research with personal
resources. Although research publications in the field
have increased during the past decade, production
continues to be scarce and possesses limited method-
ologic rigor, with an average of four to five articles per
year, the majority of articles published by health insti-
tutions.
14,15
There is no national agenda concerning
research lines or areas in OH due to the lack of an inte-
gration of interests among training, health, and gov-
ernmental institutions.
THE PRACTICE OF OCCUPATIONAL HEALTH
Occupational health professionals and technicians are
employed at diverse sites such as private businesses,
social security institutions, governmental agencies, and
institutions of higher education, and as independent
consultants.
At private companies, the principal incentive for
establishing OH services is to decrease absenteeism
and reduce the cost of the work-risk insurance pre-
mium, which is based on severity-index and work-risk
frequencies.
16
The general perception is that OH pre-
ventive activities are obligatory measures on the part of
employers.
At the government social security institutions,
although preventive actions are contemplated, the main
348 • Sánchez-Román et al. www.ijoeh.com • INT J OCCUP ENVIRON HEALTH
activities are oriented toward medical care and workers’
compensation, and indemnization for injuries. The prin-
cipal function of the physician is to certify occupational
accidents and diseases and to evaluate the physical con-
ditions of workers to determine the awarding of pen-
sions or indemnity, and to review workers’ legal claims.
Professionals and technicians in the field of safety
and hygiene have the responsibility for implementing
preventive activities in high-risk enterprises. Safety and
hygiene technicians and professionals are entrusted
with performing preventive actions in companies with
high risks of disaster, which represent 1% of all IMSS-
affiliated companies. These professionals also conduct
support studies to confirm occupational exposures and
accident reconstructions in view of worker claims.
DATA ON OCCUPATIONAL HEALTH
The majority of social security institutions do not have
public information systems, or if they do, these are very
limited. The IMSS, which provides the broadest OH
services, has developed its own information system
whose data are used as national referents. Although the
IMSS database is the most comprehensive in Mexico, it
represents information about only 30% of the EAP.
In 2004, a total of 12,297,653 workers were registered
with IMSS by 804,389 enterprises.
17
Of the total IMSS-
affiliated companies, 0.9% were large companies that
employed the highest percentage of workers (41.6%),
followed by small enterprises that represented 10.6% of
all IMSS-affiliated companies and employed 24.3% of
workers. The medium-sized companies comprised 1.5%
of the total and employed 14.1% of workers, and the
micro enterprises, which constituted 87% of all IMSS-
affiliated companies and employ 20% of IMSS-regis-
tered workers.
18
These data are in contrast to the 2002
Escuesta Nacional de Microempresas (National Micro-enter-
prise Survey) conducted by the Instituto Nacional de
Estadística, Geografía e Informática (National Institute of
Statistics, Geography, and Informatics, INEGI) and the
STPS, which reported data on more than 4 million busi-
nesses, of which 99% corresponded to the micro-, small,
and medium-sized enterprises that generate 76% of
jobs.
19
This indicates that a large number of workers in
micro, small, and medium-sized companies are not reg-
istered and do not receive social security services.
IMSS-affiliated workers come from the following
economic activities: manufacturing industry (31.5%);
personal and home services (22.4%); commerce
(20.7%); construction industry (8.8%); social and com-
munity services (6.8%); transport and communication
(5.6%); agriculture, cattle management, forestry, hunt-
ing, and fishing (2.3%); electrical industry and potable
water distribution (1.3%); and extraction industries
(0.6%). The ratio of men to women with work-risk
insurance coverage is 2:1.
20
The LFT and the LSS establish that occupational
risks (OR) are accidents and diseases to which workers
are exposed during the performance of or directly due
to their jobs. Occupational accidents (OAs) include
accidents that occur during the time the worker is in
transit from his or her home to the workplace and from
VOL 12/NO 4, OCT/DEC 2006 • www.ijoeh.com Occupational Health in Mexico • 349
TABLE 1 Rates of Occupational Risk, Permanent Disabilities, Death, and Disease Registered at the IMSS, 1985–2004
Workers with
Occupational Risks/ Permanent Disabilities/ Deaths/
Disability
Occupational
100 Workers 1,000 Workers 10,000 Workers
Pensions/
Risk ______________________ ______________________ ______________________ 1,000 Insured
Year Insurance OA IA OD OA IA OD OA IA OD Workers†
1985 6,516,928 7.23 1.07 0.06 1.63 0.14 0.59 1.68 0.44 0.015 4.2
1986 6,680,200 7.73 1.27 0.07 1.98 0.19 0.64 1.81 0.56 0.020 4.7
1987 7,098,896 7.28 1.24 0.07 1.75 0.19 0.65 1.61 0.55 0.015 4.7
1988 7,486,947 6.63 1.13 0.05 1.66 0.17 0.43 1.64 0.53 0.010 5.2
1989 8,023,144 6.28 1.11 0.04 1.59 0.16 0.42 1.26 0.37 0.013 4.7
1990 8,703,149 5.75 1.04 0.04 1.43 0.12 0.38 1.18 0.34 0.007 3.5
1991 9,142,688 5.52 1.00 0.07 1.52 0.12 0.63 1.38 0.41 0.018 3.4
1992 9,995,621 5.38 0.97 0.08 1.52 0.13 0.74 1.36 0.41 0.014 3.5
1993 9,783,854 5.03 0.95 0.07 1.54 0.14 0.71 1.34 0.42 0.008 3.4
1994 9,027,717 4.78 0.91 0.07 1.42 0.12 0.72 1.35 0.36 0.003 2.4
1995 9,335,187 4.09 0.86 0.04 1.43 0.13 0.43 1.28 0.32 0.008 2.1
1996 10,134,368 3.48 0.77 0.02 1.12 0.09 0.26 1.04 0.28 0.004 1.8
1997 10,933,550 3.18 0.74 0.02 1.03 0.08 0.23 0.95 0.33 0.002 1.5
1998 11,608,140 2.87 0.67 0.02 0.91 0.07 0.19 1.00 0.27 0.008 1.3
1999 12,476,677 2.75 0.66 0.03 0.91 0.07 0.38 0.92 0.25 0.007 1.1
2000 12,698,939 2.87 0.74 0.04 1.14 0.09 0.54 1.05 0.35 0.008 1.2
2001 12,599,681 2.70 0.70 0.045 1.00 0.10 0.50 0.90 0.30 0 1.2
2002 12,245,209 2.50 0.70 0.037 1.10 0.10 0.50 0.90 0.30 0.003 1.3
2003 12,169,503 2.30 0.60 0.10 1.00 0.10 0.80 0.90 0.30 0.003 1.2
2004 12,297,653 2.30 0.60 0.10 1.00 0.10 0.70 0.90 0.20 0.001 1.2
*OA = work accidents, IA = in-transit accidents, OD = occupational diseases.
†Non-professional diseases.
the workplace to home and are known as in transit acci-
dents (IAs).
4,21
The difference between OAs and IAs is
that the latter are not included in the OR insurance-
premium determination. In these cases the IMSS
absorbs the total expenses generated by the event.
16
Table 1 shows occupational permanent disabilities
(PDs), and deaths due to occupational risks, as well as the
disability rates for non-occupational diseases (IRs) during
the past 20 years. The annual incidence rate of on-the-job
accidents per 100 workers fell from 7.23 to 2.3 and the
death rate fell from 1.68 to 0.9 per 10,000 workers, while
the rate of occupational diseases for every 1,000 workers
increased from 0.6 to 1. This could be interpreted on the
one hand as improvement of accident-prevention condi-
tions and on the other as the result of work-risk recogni-
tion and registry. Figure 1 shows the anatomic areas
affected by occupational accidents, and Figure 2 demon-
strates the permanent disability (PDs) corresponding to
the affected regions, with accidents and sequelae in
hands reported as most prominent.
The main causes of death due to OAs are cranio-
cephalic trauma and thoracic and abdominal contu-
sions, the majority from automobile accidents. It is
important to point out that while the general death
rate related to occupational accidents has decreased
(Table 1), the fatality rate has increased; in 1997, 29.9
workers died per 10,000 occupational accidents, a
number that increased to 37.8 in 2004.
22
Figure 3 demonstrates the trends in occupational dis-
eases (ODs) registered most frequently with the IMSS.
Hearing loss, chemical bronchitis, and pneumoconiosis,
which have increased over the past several years, were
found to be the most common. The diverse types of der-
matitis, in addition to musculoskeletal injuries due to
cumulative trauma, occupy lower frequencies. We esti-
mate that the underreporting of ODs is significantly
higher in Mexico than in more developed countries.
23
Occupational accidents, disabilities and deaths are
shown by economic group for the year 2004 in Table 2.
Although there has been a decrease in the rates over
time, the economic activity groups with the most events
continue to be the same as those of ten years ago. The
highest rates of occupational accidents are found in the
food and beverage preparation and services industries.
350 • Sánchez-Román et al. www.ijoeh.com • INT J OCCUP ENVIRON HEALTH
Figure 1—Work accidents by affected
anatomic region. Source: IMSS Coor-
dinación de Salud en el Trabajo.
Memorias estadisticas 2004.
Figure 2—Permanent disabil-
ity by affected anatomic
region. Source: IMSS Coordi-
nación de Salud en el Tra-
bajo. Memorias estadisticas
2004.
26.9
10.2
10.6
8.0
8.1
7.2
2.7
2.2
18.1
12.6
9.8
7.5
6.6
6.1
6.2
4.4
3.7
The manufacture of metallic products had the highest
rate of permanent disabilities, and ground transporta-
tion industries had the highest accidental death rate.
The construction industry remains among the highest
in all three types of events.
Occupational diseases, disabilities and deaths by eco-
nomic activity sector are shown in Table 3. These data
have not changed much over the past decade. The
highest rates per event are found in the mining indus-
tries, including mining of metallic minerals, mineral
VOL 12/NO 4, OCT/DEC 2006 • www.ijoeh.com Occupational Health in Mexico • 351
Figure 3—Main occupa-
tional diseases, 1997–2004.
Source: IMSS Coordi-
nación de Salud en el Tra-
bajo. Memorias estadisti-
cas 1997–2004.
TABLE 2 Economic Activities with the Highest Rates of Occupational Accidents, Permanent Disabilities,
and Deaths, 2004
Occupational Permanent Deaths by
Accidents Disabilities Work Accidents
__________________ _________________ _________________
Rate/ Rate/ Rate/
No. of 100 1,000 10,000
Workers Cases Workers Cases Workers Cases Workers
1. Building construction and civil
engineering work 753,479 27,489 3.6 1,392 1.8 192 2.5
2. Professional and technical services 1,217,452 18,891 1.6 538 0.4 75 0.6
3. Buying and selling at self-service
stores and specialized department
stores, by merchandise line 408,963 18,888 3.9 271 0.7 8 0.2
4. Buying and selling of foods,
beverages, and tobacco products 520,731 15,145 2.9 377 0.7 63 1.2
5. Food manufacture 494,062 14,770 3.0 797 1.6 45 0.9
6. Public administration and social
security services 857,597 13,800 1.6 254 0.3 44 0.5
7. Food and beverage preparation
and service 141,313 13,369 9.5 225 1.6 21 1.5
8. Manufacture of metallic products
except for machinery and equipment 300,872 12,340 4.1 918 3.1 24 0.8
9. Overland transport 372,142 10,360 2.8 678 1.8 147 4.0
10. Buying and selling of prime matter,
materials, and auxiliary 334,918 10,032 3.0 412 1.2 38 1.1
11. Personal services for the home and
diverse 394,665 9,160 2.3 278 0.7 20 0.5
12. Manufacture of rubber and plastic
products 214,276 6,902 3.2 467 2.2 6 0.3
13. Manufacture and/or assembly of
machinery, equipment, apparatuses,
and electrical articles, electronic
articles, and their parts 391,232 6,565 1.7 338 0.9 3 0.1
14. Buying and selling of clothing articles
and other personal use articles 428,787 5,667 1.3 147 0.3 12 0.3
15. Temporary boarding articles 242,894 5,616 2.3 80 0.3 9 0.4
16. Other 5,274,876 96,475 1.8 4,744 0.9 362 0.7
National total 12,348,259 282,469 2.3 11,916 1.0 1,069 0.9
Source: IMSS Coordinación de Salud en el Trabajo. Memoria estadística 2004.
carbon, graphite, and non-metallic minerals. Only
eight deaths were registered as a consequence of occu-
pational diseases, the majority under the category of
mineral-extraction activities.
The disability-pensions rate for non-occupational
diseases has diminished from 4.2 to 1.2 per 1,000
insured workers (Table 1) due to legislative changes
that restrict access to this line of compensations rather
than to improvement in workers’ health conditions.
Figure 4 shows the main disabling disorders (non-
occupational diseases), whose trends have not shown
great variation over the past decade. The most frequent
are: degenerative articular diseases, complications
from diabetes, diverse types of cancer; cerebrovascular
disease sequelae, renal insufficiency, cardiopathies,
ophthalmopathies, mental diseases, and acquired
immunodeficiency syndrome. The progressive
increases of cases of cancer and chronic renal insuffi-
ciency, for which possible occupational causes have not
been discarded, are noteworthy. This type of chronic or
progressive disease under-reporting is due primarily to
lack of knowledge of primary care physicians concern-
ing the probable relationships of these diseases to occu-
pational exposures.
DISCUSSION AND CONCLUSION
In Mexico, workers’ health should be a high-priority
issue for governmental agendas, in that the social cost
of deterioration in the quality of life of the workers and
their families is an obstacle to sustainable development
of the country. In the face of limited employment
opportunities—in part caused by the negative effects of
the global economy—the Mexican work force is
pushed to emigrate to the informal sectors in Mexican
cities and to the United States. Such Mexican workers
are relatively uneducated, and lack knowledge of occu-
pational risks and means of protection for health.
24
Since the 1970s, hazardous industries from devel-
oped countries have been concentrated in Mexico.
352 • Sánchez-Román et al. www.ijoeh.com • INT J OCCUP ENVIRON HEALTH
TABLE 3 Economic Activities with the Highest Rates of Occupational Diseases, Permanent Disabilities,
and Deaths Due to Occupational Diseases during 2004
Permanent
Disabilities Due Deaths Due
Occupational to Occupational to Occupational
Diseases Diseases Diseases
__________________ _________________ _________________
Rate/ Rate/ Rate/
No. of 10,000 1,000 10,000
Workers Cases Workers Cases Workers Cases Workers
1. Overland transport 372,142 932 25.0 1,197 3.2 0 0
2. Construction, reconstruction, and
assembly of transport equipment
and its parts 391,232 766 19.6 824 2.1 0 0
3. Textile industry 129,925 531 40.9 605 4.7 0 0
4. Manufacture of rubber and plastic
products 214,276 508 23.7 539 2.5 0 0
5. Extraction and benefit of metallic
minerals 24,095 483 200.5 544 22.6 0 0.42
6. Basic metallic industries 67,441 462 68.5 658 9.8 0 0
7. Manufacture of metallic products,
except for machinery and equipment 376,905 339 11.3 468 1.6 0 0
8. Extraction and benefit of mineral
carbon, graphite, and non-metallic
minerals, except for salt 34,271 311 90.7 378 11.0 3 0.88
9. Professional and technical services 1,217,452 283 2.3 343 0.3 0 0
10. Constructions and buildings of civil
engineering works 753,479 229 3.0 302 0.4 0 0
11. Chemical industry 202,864 227 11.2 259 1.3 0 0
12. Generation, transmission, and
distribution of electrical energy 109,485 216 19.7 311 2.8 0 0
13. Manufacture of non-metallic mineral
products 129,844 212 16.3 248 1.9 2 0.15
14. Manufacture and/or assembly of
machinery, equipment, apparatuses,
accessories, electronics and
electrical articles and their parts 506,960 173 3.4 166 0.3 0 0
15. Paper industry 81,503 168 20.6 199 2.4 0 0
16.Others 7,812,418 1,578 2.0 1,796 0.2 2 0.002
National total 12,348,259 7,418 6.0 8,837 0.7 8 0.01
Source: IMSS Coordinación de Salud en el Trabajo, Memorias Estadísticas 2004.
These industries often use products that are prohib-
ited in the companies’ countries of origin, such as
asbestos, arsenic, anilines, butadiene, PVC, benzene,
and other agents cataloged as toxic or carcinogenic.
25
In addition to the influx of hazardous industries, we
observe the import and export of occupational dis-
eases derived from the exchange of the work force
between countries that results from economic global-
ization. Control and surveillance of such transfers
require decisive governmental cooperation to benefit
workers who are exposed to hazardous environments
and who return in subclinical or manifest-disease
stages to their places of origin.
26
Mexican workers confront new risks, such as psy-
chosocial pressures, intense work burdens, fatigue, and
physical wear and tear, in addition to the employment
of persons of advanced age and with disabilities, as well
as an increase of women in the workplace. All of these
issues are only marginally studied in Mexico. In addi-
tion, many Mexican workers have low quality-of-life
levels that add to the previously mentioned risks, such
as the lack of information about prevention. Damage
to health resulting from industrialization and risk trans-
ference, and the importation of occupational diseases
could become greater than corresponding conditions
seen in developed countries in previous decades.
The impact of globalization of national economies,
the NAFTA framework, and other commercial agree-
ments will continue to challenge occupational health
in Mexico. One main challenge comes from integrat-
ing the economies of the countries involved, despite
their inequality. Protection mechanisms for work,
human, economic, social, cultural, and environmental
rights should be ensured in such a way that commercial
agreements do not debilitate the legal framework or
the sovereignty of the states.
Social security institutions in Mexico confront prob-
lems derived from the demographic, epidemiologic,
and economic transitions that affect the institutions’
financial viability. With this situation in mind, propos-
als that do not contemplate OH services have been set
forth for health care reforms.
27
Recently, a public insur-
ance policy has been established with the objective of
offering low-cost medical care to the uninsured popu-
lation, and to reach national coverage in 2010. How-
ever, this policy does not contemplate OH services for
this population, who could be exposed to hazardous
working conditions within the informal economy.
The limited number of specialists trained to care for
OH needs, lack of updating of undergraduate and post-
graduate academic programs, and poor training meth-
ods add to the growing need for professional harmo-
nization at the global level, and render it necessary to
carry out actions to strengthen OH in Mexico. Also nec-
essary will be the participation and commitment of the
different institutions involved in academic and research
development in OH, to define research agendas accord-
ing to the prioritary health and quality-of-life problems
faced by Mexican workers.
28
To promote norms or reg-
ulations that permit the participation of workers and of
personnel trained in the diverse areas of OH would
result in greater risk control in companies and institu-
tions and an increase in the number of courses and spe-
cialized professionals.
29
The lack of information gener-
ated by institutions and companies renders national
worker-population health registries incomplete,
because they take into account only OH reports emitted
by the IMSS, principally in urban and industrial areas,
in addition to which such information is not integrated
into decision making for public health and policy.
30
IMSS has identified underreporting of 26% of work-
related accidents at the national level, probably due to
VOL 12/NO 4, OCT/DEC 2006 • www.ijoeh.com Occupational Health in Mexico • 353
Figure 4—Main non-occu-
pational diseases causing
disabilities. Source: IMSS
Coordinación de Salud
en el Trabajo. Memorias
estadisticas 2004.
administrative procedures, lack of worker affiliation on
the part of the enterprises, lack of knowledge on the
part of the workers, and care for non-severe accidents by
assistant medical services contracted by companies.
31
On the other hand, chronic work-related morbidity can
be diluted by expulsion of a sick worker before the end
of his or her productive life
32
and by underreporting
cases of illness due to cancer, cardiovascular, osteomus-
cular, neurologic, and psychiatric diseases in workers
who continue to appear in the social security system, a
situation corroborated in a study of the principal causes
of mortality in IMSS-insured workers.
33
This study iden-
tified cancer as the main cause, with a rate of
33.9/100,000 workers, followed by diabetes mellitus and
hypertensive disease complications with rates of 25.2
and 24.9, respectively. Among identified cancer types
that are noteworthy due to their possible occupational
relationship we find bronchial and lung cancers,
leukemias, liver, and encephalus.
International measures need to be established to
ensure minimum worker health protection as well as
compensation systems. The politics of health and the
practice of OH professions in Mexico should be
brought up to a standard level of excellence, without
losing sight of the international environment. These
professionals are capable of confronting the economic,
social, and technological transformation associated with
development, and the collaboration that would prepare
Mexico to confront the challenges of the future with
improved quality and professional competitiveness.
References
1. Instituto Nacional de Estadística, Geografía e Informática. XII
Censo General de Población y Vivienda 2000, México. [In
Spanish]
2. Instituto Nacional de Estadística, Geografía e Informática, Insti-
tuto Mexicano del Seguro Social. Encuesta Nacional de Empleo
y Seguridad Social 2004, México. [In Spanish]
3. Banco de México, Balanza de Pagos. México, mayo 2005. [In
Spanish]
4. Breña GF. Titulo IX Riesgos de Trabajo. En: Ley Federal del Tra-
bajo comentada y concordada. 2ª ed. México: Editorial Harla,
1988: 424-77. [In Spanish]
5. Reglamento Federal de Seguridad Higiene y Medioambiente de
Trabajo. 7ª ed. México: Ediciones Luciana, 2003. [In Spanish]
6. Boletín de Información Estadística: “recursos y servicios.”
México, 1999. No. 19. Vol. 1. SSA; 1999. [In Spanish]
7. Facultad de Medicina UNAM. Plan único de especializaciones
médicas en medicina del trabajo, México 2003. México: Univer-
sidad Nacional Autónoma de México. [In Spanish]
8. Pallares AR. Especialidad de medicina ocupacional. Universidad
Autónoma de Chihuahua. Trabajo presentado en la XV Jornadas
Nacionales y 3er Simposium Internacional de Medicina del Tra-
bajo; 2000 ago 1-3; Ciudad de México, México. [In Spanish]
9. Universidad Autónoma de Aguascalientes. Departamento de
salud pública. Especialidad en Salud en el Trabajo. <http:// pos-
grado.uaa.mx/centros/biomedico/bio_espe.htm>. [In Spanish]
10. Ramos JM, Arias DR, Arias RL, Nava HR. Situación actual de la
salud en el trabajo en México. Revista Latinoamericana de
Salud en el Trabajo. 2000;1:28-30. [In Spanish]
11. Consejo Mexicano de Medicina del Trabajo, A.C. Reglamento
para la evaluación curricular de los candidatos a sustentar
examen para la certificación de competencias en medicina del
trabajo y para obtener la recertificación. Revista Latinoameri-
cana de Salud en el Trabajo. 2001;1:18-20. [In Spanish]
12. Aguilar SA, Ramos JM. Notas históricas sobre el consejo mexi-
cano de medicina del trabajo. Revista Latinoamericana de Salud
en el Trabajo. 2001;1:6-7. [In Spanish]
13. Tornero AF. Promoción educativa en salud en el trabajo por la
Secretaría del Trabajo y Previsión Social. Trabajo presentado en
la 1ª. Jornada Delegacional de Educación y Competencias Pro-
fesionales en el Salud en el Trabajo. IMSS Delegación Estado de
México Oriente 2000 feb 18; Tlalnepantla, Estado de México,
México. [In Spanish]
14. López RP. Tendencias y retos de la investigación en salud en el
trabajo. Trabajo presentado en la VI Reunión Nacional de
Investigación en Salud en el Trabajo 2002 ene 17-18. Ciudad de
México, México. [In Spanish]
15. Valdez ME, Garduño EJ, Gómez DA, Amato MJ, Morales ML,
Blanco FF, Muñoz HO. Análisis bibliométrico de las publica-
ciones realizadas por el personal de IMSS. Gac Med Mex.
2000;136:319-28. [In Spanish]
16. Reglamento de la Ley del Seguro Social en Materia de Afil-
iación, Clasificación de Empresas, Recaudación y Fiscalización.
En: Agenda de Seguridad Social, Reglamentos e Instructivos.
México: Ediciones Fiscales ISEF; 2003: 1-135. [In Spanish]
17. Instituto Mexicano del Seguro Social. Memoria Estadística de
Salud en el Trabajo 2004. Coordinación de Salud en el Trabajo.
México; 2005. [In Spanish]
18. Instituto Mexicano del Seguro Social. Memoria Institucional
2004. México, 2005. [In Spanish]
19. Instituto Nacional de Estadística, Geografía e Informática.
México. Encuesta Nacional de Micro negocios 2002.
<www.inegi.gob.mx/est/contenidos/espanol/sistemas/enamin
/enamin_2002/enamin.htm>. [In Spanish]
20. Instituto Mexicano del Seguro Social. XXIII Informe Mensual
de Patrones y Cotizantes del IMSS. México, 2004. [In Spanish]
21. Capítulo III del Seguro de Riesgos de Trabajo. Ley del Seguro
Social. En Agenda de Seguridad Social. México: Ediciones Fis-
cales ISEF, 2003: 22-38. [In Spanish]
22. Cálculo sobre la base de accidentes y defunciones por acci-
dentes de trabajo tomado de la Memoria Estadística de Salud en
el Trabajo 1997-2004. Instituto Mexicano del Seguro Social.
México. [In Spanish]
23. Organización Internacional del Trabajo. Estadística sobre tasa
de daños ocupacionales por actividad económica 1995–2004.
<http://laborsta.ilo.org/>. [In Spanish]
24. The Center to Protect Workers’ Rights. The Construction Chart
Book. The U.S. Construction Industry and Its Workers. Silver
Spring, MD. The Center to Protect Workers’ Rights, 2002.
25. Aguilar MG, Juárez PC, Markowitz S, Hernández PM, Sánchez
RF, Vázquez GJ. Globalization and the transfer of hazardous
industry: asbestos in Mexico. Int J Occup Environ Health.
2003;9:272-9.
26. Markowitz S. Exporting occupational diseases. Praventivmed.
2003;48:1-2.
27. Gómez DO. Reformas de la atención a la salud en México.
Informando y Reformando. 1999;1:6-7. [In Spanish]
28. De la Hoz RE, Parker JE. Occupational and environmental med-
icine in the United States. Int Arch Occup Environ Health.
1998;71:155-61.
29. Bedrikow B, Algranti E, Penteado BJ, Monrrone LC. Occupa-
tional health in Brazil. Int Arch Occup Environ Health.
1997;70:215-21.
30. Murphy PL, Sorok GS, Courtney TK, Webster BS, Leamon TB.
Injury and illness in the American workplace: a comparison of
data sources. Am J Ind Med. 1996;30:130-41.
31. Salinas TJ, López RP, Soto NM, Caudillo AD, Sánchez RF, Borja
AV. El subregistro potencial de los riesgos de trabajo en el Insti-
tuto Mexicano del Seguro Social. Salud Pública Méx.
2004;46:204-9. [In Spanish]
32. Franco EJ, Cuellar RR, Noriega EM, Villegas RJ. Los trabajadores
textiles de Naucalpan, Estado de México, y sus condiciones de
salud en 1989. Salud Problema. 1994;24:33-43. [In Spanish]
33. Borja AV, Aguilar MG, Carlos F, Guzmán JC, Juárez PC, Sánchez
RF. Años de vida saludable perdidos para las principales causas
de mortalidad en trabajadores asegurados al Instituto Mexicano
del Seguro Social. En: Martínez SH, Villasis KM, Torres LJ,
Gómez DA (eds). Las múltiples facetas de la Investigación en
Salud 4. México, D.F: IMSS, 2005:115-27. [In Spanish]
354 • Sánchez-Román et al. www.ijoeh.com • INT J OCCUP ENVIRON HEALTH
