Abstract
BackgroundPrecarization of labor conditions has been expanding over the last three decades as a consequence of global economic transformations. The health workforce labor market is exposed to these transformations as well. In Mexico, analyses of the nursing labor market have documented high levels of unemployment and underemployment; however, precarization has been not considered as a relevant indicator in these analyses. In this study, precarization is analyzed using a quantitative approach to show its prevalence and geographic distribution between 2005 and 2018.MethodsA repeated cross-sectional study was carried out with data from the population-based National Occupation and Employment Survey (ENOE in Spanish) which is administered quarterly to people 15 years or older in over 120 000 households. All individuals who reported having nursing training (technical or university level) were selected for this study. Our main variable was labor precariousness, which included three dimensions: (i) economic, (ii) regulatory, and (iii) occupational safety. We show the evolution of the relative weight of nursing activity between the years 2005 and 2018, the main socio-demographic characteristics of nurses as well as their main labor conditions, and the geographic distribution of precariousness for the 32 federal states in México.ResultsFour of the five indicators of labor precariousness increased among the group of nurses analyzed: (a) the percentage of people with no written contract, (b) the percentage of people with incomes lower than two times the minimum wage, (c) the percentage of nurses without social security, and (d) the percentage of nurses without social benefits. The percentage of nurses that work under some condition of work precariousness increased from 46% in 2005–2006 to 54% in 2018. Finally, the number of states with high precariousness level increased from seven in 2005–2006 to 17 in 2018.ConclusionsThroughout Mexico, nursing precariousness has expanded reaching 53% by 2018. The advancement of precarization of nursing jobs implies a reduction in the capacity of the Mexican health system to reach its coverage and care goals as nurses represent 52% of all available workers that provide direct services to the population.
Highlights
Precarization of labor conditions has been expanding over the last three decades as a consequence of global economic transformations
Regarding the socio-demographic profile of subjects with nursing training, four results stood out: (i) the percentage of men went from 6% between 2005 and 2016 to 15% in between 2016 and 2018 (P < 0.001); (ii) the percentage of people 24 years or less grew almost 32% (P < 0.001), while the group of 25- to 44-year-olds decreased by 21% (P < 0.001); (iii) university-trained nurses increased by 43% in 14 years, going from 40.1% in 2005– 2008 to 57.4% in 2016–2018 (P < 0.001); and (iv) seven out of every ten nursing personnel are concentrated in metropolitan areas, the percentage of nurses in rural areas increased by 75% (Table 1)
The general labor profile of the nurses studied was constant throughout the 14 years analyzed, except the percentage that reported being economically active, the percentage of nurses working in the health sector, and the percentage of nurses working in a public institution
Summary
Precarization of labor conditions has been expanding over the last three decades as a consequence of global economic transformations. In Mexico, analyses of the nursing labor market have documented high levels of unemployment and underemployment; precarization has been not considered as a relevant indicator in these analyses. In 2012 in Mexico, it was stated that the country had achieved Universal Health Coverage through a strategy that focused financial, material, and human resources on populations that had historically lacked insurance and the declaration of universal coverage by itself does not guarantee that the services provided by the institutions will have positive effects on health since this requires the provision of a further set of resources, human resources, distributed equitably and according to population needs, in health centers and hospitals within the system. Availability was still far from the human resources of other countries with similar incomes, and Mexico had serious geographical distribution problems as well
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