Whether setting up a base, or forming new relationships with overseas partners, western companies are falling over themselves to establish a presence in the booming economies of India and China. Along with this trend is the need for employers to appreciate the potential occupational health difficulties inherent in these markets. In addition to unfamiliar diseases, businesses must contend with a system of health provision that is different to anything they have dealt with at home.
For example, although the health and safety regulatory regime in India and China is not as prescriptive as that in the UK, rapid economic growth has led to a highly competitive and volatile employment market, in which corporations go to great lengths to retain the best individuals, particularly where there has been an investment in training. Consequently, occupational health and wellness programmes have emerged as a powerful retention tool over the past five years and are heavily used for the national workforce.
The picture is different among expatriate workers and business travellers, who tend to under-use the health resources available to them in their country of assignment. Such individuals will often wait until they are in a major city or until they are home again before they address any physical health issues. This clearly isn’t in the interests of the employer or employee.
Lack of in-house resources
In terms of how OH and wellness services are delivered, most companies in China and India – even very large ones – lack in-house resources, again because of the historically light regulatory regime. At best, you may find a safety department or a nurse, but even these services will be centralised, with little provision for smaller, regional operations. Therefore, the majority of such programmes are delivered by private-sector firms specialising in OH.
It is against this backdrop that many a western company sending personnel to China or India must make their plans. Too often, pre-deployment health checks are purely medical and give little consideration to issues such as the remoteness of the destination or availability of medical infrastructure.
Such a medical check-up will identify the risk associated with a diabetic traveller, for example, or an employee who has suffered a pulmonary embolism, but it is unlikely to then ask how far such individuals will have to travel for a blood test, or regular anti-coagulant medication.
OH is not intended to reject people from work, so ensuring continuity between planning at home and execution abroad is vital. What adjustments are required for an individual with specific medical needs to work safely overseas? More importantly, what resources are available for that illness and can we identify in advance which experts will take care of this individual?
The most effective approach is to organise pre-deployment checks and briefings through a provider that is active in the destination country. So, rather than relying solely on local GPs for any subsequent medical requirements, pre-travel planning becomes part of a package that includes outsourced care on the ground.
Selecting the right outsourced partner is important, but it is not hard to get a feel for whether they genuinely have a grasp of the destination market. Sensible questions to ask might include who their existing clients are in the region, which hospitals and clinics they use, and whether they are subcontracting, or adding real value.
A good partner should be able to identify which tests and checks will be relevant and necessary for a particular job or sector. Unlike the UK, where a validated questionnaire is often sufficient to identify an individual’s health risks, many Chinese employers may insist on a full physical check-up.
The second vital element of pre-deployment planning is to brief employees properly on the environment they will be entering. The specific challenges individuals will face depend on a number of factors, including the nature of the work and whether they will be in an urban or rural area.
Even in a seemingly familiar corporate setting, the health challenges can be surprising and potentially serious. Take, for example, the expat worker whose driver contracts pulmonary tuberculosis. This infectious disease will be of great concern not only to the driver and his passenger, but also to his family, and will require a fast and knowledgeable response from the company’s healthcare provider.
Hepatitis B also continues to be a live issue in India and China, where it is endemic. Other serious illnesses, all but eradicated in the West, include typhoid, cholera and some tropical diseases. It is essential that travellers are made properly aware of these unfamiliar diseases and are educated on how to protect themselves through good hygiene and avoiding suspect food.
While this may seem obvious, some of the most important tips – such as avoiding raw vegetables – appear positively counter-intuitive to Westerners.
Pollution, over time, can also have an impact on the health of expats. In India, the main challenge is dust, while travellers to China must contend with more chemical pollution. This can be a problem where a worker or family member has allergies, asthma or another respiratory problem that may be aggravated by poor air quality. Travellers must be equipped with a preventative strategy for treatment, as well as a relationship with the provider in the country, which can provide on-going follow-up care.
But, in addition to these physical conditions, the single greatest health issue facing expats working in India or China is likely to be stress and associated mental health problems. For example, it is not exceptional for expats to work 16 hours a day, consuming little but soft drinks and hamburgers. They find themselves in a buzzing high-pressure market, geared for 24-hour living, where they can go to a bar or a restaurant in Bangalore or Shanghai at 3am.
More rural areas present different, but equally pressing, challenges. Living and working in an area where you are not fluent in the language or customs – and have little contact with anyone who understands your own – can be intense.
Pre-deployment advice must anticipate this kind of behaviour and flag up the warning signs before they inevitably lead to depression and burnout.
The changing demographic of expat workers has also had an impact. Previously falling largely into the 60-plus age bracket, today’s expat workers in China and India are frequently younger, wealthy and sexually active. Their families may either have decided to stay at home, or return home after a trial period. The potential for relationship stress is clear, and break-ups are common.
This area is rarely touched in pre-deployment counselling, despite being one of the most obvious concerns for anyone considering prolonged separation from families and loved ones.
Conducting OH or workplace assessments is now expected of good employers in India and China. Greater awareness of workplace health is also being driven by a flurry of related legislation. In China, one good example is a new law preventing employers discriminating against workers with hepatitis B, who are frequently excluded from the workplace, despite posing no threat to colleagues.
This trend is making it much easier for foreign businesses to come in and work with local partners, who are now much more sensitive to the value of maintaining the health and safety of their workforce. Assuming both countries are able to maintain their significant economic growth, the use of wellness and OH programmes will also continue to increase.
In terms of keeping ahead of the rapid pace of new legislation, it is worth working with an organisation with local expertise. This is particularly the case in China where, unlike in India, English translations of new laws only arrive long after they have come into effect.
While the situation is fast improving for companies looking to secure the health and wellbeing of their expat workers in India and China, these markets still have some serious challenges to work through.
Training of specialist OH professionals has inevitably failed to keep pace with rapid economic growth and the extra demand it has created among financial services companies, for example. In India, the production of ‘factory doctors’, who take only a short course, will not meet constantly rising business expectations, while many senior posts must be filled by expensive expat healthcare professionals.
Private-sector providers of OH services are seeking to fill the gap by training their own doctors, but the goal of relying on nationally sourced professionals is a medium to long-term project.
Living and working in a foreign country – particularly where the culture can be so different – is one of the most fulfilling and horizon-expanding experiences a person can have. But it can also be a mental and physical challenge for the unprepared, and employers have a duty to ensure expat workers are properly briefed and supported at every step. In the case of India and China, this means understanding both the employee and their destination, as well as ensuring continuity between planning, briefing, and the situation on the ground.
Dr Olivier Lo is medical director, group corporate care services and Asia Pacific region, International SOS.