https://doi.org/10.1177/1403494821993707© Author(s) 2021Article reuse guidelines: sagepub.com/journals-permissionsDOI: 10.1177/1403494821993707journals.sagepub.com/home/sjpScandinavian Journal of Public Health, 1–5IntroductionGlobally, the construction sector employs an estimated 7% of the world’s paid workforce [1], andaccounts for about 13% of global gross domesticproduct (GDP) [2]. Excess mortality from suicideamong construction workers has been consistentlyobserved in countries such as the United Kingdom[3], the USA [4], Denmark … Continue reading “global gross domestic product | My Assignment Tutor”
https://doi.org/10.1177/1403494821993707© Author(s) 2021Article reuse guidelines: sagepub.com/journals-permissionsDOI: 10.1177/1403494821993707journals.sagepub.com/home/sjpScandinavian Journal of Public Health, 1–5IntroductionGlobally, the construction sector employs an estimated 7% of the world’s paid workforce [1], andaccounts for about 13% of global gross domesticproduct (GDP) [2]. Excess mortality from suicideamong construction workers has been consistentlyobserved in countries such as the United Kingdom[3], the USA [4], Denmark [5], Italy [6], Australia[7] and Canada [8]. In England for example, the riskof suicide among low-skilled male constructionworkers is over three times higher than the malenational average [9]. Here we argue that a uniquecombination of factors may place construction workers at heightened risk of suicide during and after theCOVID-19 pandemic.Compositional drivers of suicide in theconstruction workforceThere are some well documented compositional factors that are theorised to contribute to the elevatedsuicide rates among construction workers in manyindustrialised countries. Gender is one of these: construction workers are predominantly men, and men’sgreater risk of suicide relative to women is well documented [10]. Globally, the male-to-female suiciderate ratio is about 1.9; however, in high-incomecountries, the age-standardised suicide rate for menis more than 3 times higher than that of women [10].Men are also less likely than women to seek helpwhen distressed [11]. In addition, the constructionworkforce is commonly younger than the generalCOVID-19 and suicide risk in the construction sector: preparing for aperfect stormTAnIA L. KInG1 & AnTHOny D. LAMOnTAGnE1,21Centre for Health Equity, University of Melbourne, Melbourne, Australia, and 2Institute for Health Transformation andSchool of Health and Social Development, Deakin University, Burwood, AustraliaAbstractAims: Worldwide, construction industries are considered to be key economic pillars of the societies they serve, andconstruction workers constitute a sizeable proportion of the global paid workforce. In many parts of the world, constructionworkers are at elevated risk of suicide. Here, we examine the extent to which construction workers may be differentiallyexposed to the economic effects of COVID-19. Methods: A narrative review and synthesis of the literature was conducted.Results:The economic and labour market shock resulting from the COVID-19 pandemic has led to a convergence of factorsthat may significantly exacerbate suicide risk among construction workers, particularly among those with lower skills.Conclusions: With important insights from previous financial crises, it is vital that governments, industry andworkplaces act rapidly to mitigate suicide risk among vulnerable groups such as construction workers. Mentalhealthcare investment is needed, and must be complemented by prevention and control in the workplace andin the general community. Anticipating, preparing and acting to ameliorate this risk, particularly among lowskilled construction workers, will save many livelihoods, as well as lives.Keywords: Occupational health, suicide, mental health, workplace, COVID-19Correspondence: Tania L. King, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207Bouverie Street, Melbourne, VIC 3010, Australia. E-mail: tking@unimelb.edu.auDate received 6 October 2020; reviewed 20 December 2020; accepted 13 January 2021993707 SJP0010.1177/1403494821993707King and LaMontagneCOVID-19 and suicide risk in the construction sectorarticle-commentary2021COMMentAry2 King and LaMontagneworking population, and suicide rates are typicallyhigher in younger men relative to older groups [12].Furthermore, low socioeconomic position is also arisk factor for suicide, particularly among young men[13]. While these compositional characteristics of theconstruction workforce are likely to contribute to theelevated suicide rates among construction workers, itis recognised that other factors play an importantrole, and increasing attention is being paid to workplace characteristics of the construction sector(referred to below as contextual drivers).Contextual drivers of suicide in theconstruction workforceInformal and undeclared work arrangements are common within the global construction workforce, whichmeans there are significant gaps in social security protections for workers [14]. Construction jobs are ofteninsecure, with a high prevalence of temporary andcasual arrangements, and there is high mobility withinthe workforce [14, 15]. Construction workers alsohave limited job control, as well as regular periods ofunemployment or underemployment [16]. There is alarge body of work demonstrating that many of thesecharacteristics including job stressor exposures [17,18], underemployment [19] and loss of employment(unemployment) [20] are strong predictors of poormental health as well as suicidal thoughts, behavioursand mortality. Construction workplaces are also highlymasculine environments in which dominant masculine norms prevail [21]; many masculine norms areknown risk factors for suicidal behaviours [22]. Thenet effect of these factors is a psychosocial and normative environment that appears to exacerbate suiciderisk among construction workers in some countriesand contexts.economic crises and suicide: whyCOVID-19 may represent the (im)perfect storm of risk factors forconstruction workersThe constellation of differential exposures and differential vulnerabilities characteristic of the construction sector represents a recognised high-risk publichealth situation in many countries preceding theCOVID-19 pandemic. The economic and labourmarket shock resulting from the COVID-19 pandemic has the potential to exacerbate suicide riskprofoundly in this substantial proportion of the working population. We focus here on suicide because ofits severity as an outcome, acknowledging that thereare also various other impacts of economic shocks onphysical and mental health. We also acknowledge thatthere is likely to be substantial global variation, withconstruction sectors in some countries more affectedthan others.Forecasts emerging from the World Bank suggestthat the COVID-19-induced global recession will bethe most severe since the Second World War, and willprecipitate economic declines in per capita outputs inthe largest share of economies since 1870 [23].Globally, the economic contraction associated withCOVID-19 is already leading to substantial job lossesacross many sectors. In September of 2020, theInternational Labour Organization estimated thatwork-hour losses recorded in the second quarter of2020 (compared to the final quarter of 2019) were17.3%, equivalent to 495 million full time jobs, a pattern that appeared to be sustained over the third quarter, with projections that fourth quarter statistics willbe more dire than previously predicted [24]. The summative picture emerging from these statistics is of ableak economic forecast that is unlikely to ease quickly.The association between recession or economic contraction and suicide is well recognised [25]. The globalfinancial crisis (GFC) of 2007–2009 was associatedwith an excess in suicides across the world [25–27]. Astudy of global public data from 63 countries foundthat the relative risk of suicide related to unemploymentattributable to the GFC was 20–30% [26]. Similar estimates were reported elsewhere such as in Australia,with an estimated 19–22% increase in the suicide rateamong the unemployed in association with a rise fromapproximately 4% to 6% unemployment [27], and a7% increase in suicide among employed men [27].Alarmingly, the course of COVID-19 and its economic,social and health consequences are as yet indeterminateand it is likely that the mental health costs of COVID-19 will not be fully realised and reckoned for manyyears. Recognising the different vulnerabilities of different groups within society is essential to informing coordinated and proactive intervention efforts.Construction worker vulnerability to unemployment and financial hardship due to the COVID-19-induced economic contraction highlights their currentprecariousness. This, combined with vulnerabilitiesunique to the industry and its workforce composition,represents an unfortunate confluence of factors thatplaces them at particularly heightened risk of suicideduring and after the COVID-19 pandemic.Preparing for, and responding to, thispotential crisisConsiderable insights have been gleaned from extensive studies of economic shocks and their associatedimpacts on public health, and should inform responses.In high-income countries, many people who die byCOVID-19 and suicide risk in the construction sector 3suicide are experiencing mood disorders or substanceuse problems at the time of death [28]. Investment inmental health services is therefore crucial. Mental healthservices commonly fail to engage men – both in terms ofinitiating contact, and in retaining engagement whencontact is made – and it is therefore vital that investmentis made in mental healthcare approaches that are tailored to men’s needs in general, but particularly to bluecollar men’s needs in the construction and relatedsectors. The growing availability of online or telehealthservices may offer an opportunity to engage in ways thatminimise stigma and other barriers.Mental healthcare-directed interventions must alsobe complemented by prevention and control in theworkplace and in the general community. Industrybased suicide prevention programmes can play a critical role. Some are consistent with best practice suicideprevention and Mrazek and Haggerty’s spectrum ofinterventions for reducing the risk of mental disorders[29]. MATES in Construction in Australia, for example, has been shown to have social validity among construction workers [30], effectiveness in shifting beliefsaround suicide [31], and effectiveness in improvingsuicide prevention literacy, intentions to offer help toworkmates and intentions to seek help for themselves[32]. Employers, in addition to being key partners inindustry-based programmes, are obliged to ensurepsychologically as well as physically safe working conditions in most industrialised democracies. Manyemployers and unions also provide support servicesfor workers in distress – such as employee assistanceprogrammes (EAPs). For precariously employed construction workers, union membership can offer accessto EAPs, redundancy funds and other services. Allconstruction sector stakeholders have important contributions to make in mitigating the economic impactsof the pandemic; the scaling up of existing programmeswould be most expeditious. Finally, governments at alllevels have critical roles to play through unemployment and retraining programmes, and stimulation ofthe economy through investment and/or incentivisingsustainable jobs and sustainable businesses [33].Other government efforts – such as measures tostrengthen housing stability – will complement labourmarket strategies.Inequities within construction workersand the need for an intersectional eyeIt is also important that approaches attend to intersectionality and seek to understand the ways that theexperiences of construction workers may vary by different identities and axes of disadvantage. Fundamentalto this is the need to recognise that some groups are atgreater risk of suicide than others. We know that lowerskilled construction workers such as labourers are atgreatest risk of suicide, and that during the GFC, suicide rates among this group increased to a greaterextent than for higher skilled workers in the sector[34]. This may be explained by the fact that as unskilledworkers, they are exposed to poorer working conditions and lower pay, and they are typically youngerthan other workers [34]. Unskilled workers are alsoknown to be more vulnerable to job loss, and are moresocially disadvantaged. In effect then, they will be atparticularly heightened risk as a result of COVID-19because they have limited social resources to bufferthe effects of exposure to poor working conditions,unemployment, or both. Further to this, worldwide,the construction industry relies heavily on migrantlabour [35]. Migrant construction workers are oftenemployed informally, heightening their vulnerabilityto unsafe, unfair and sometimes illegal work arrangements and practices [35]. In many countries, migrantworkers also experience significant levels of discrimination and stigmatisation, intensifying their experiences of marginalisation [36]. Migrant workers aremore likely than other workers to lose their jobs during times of economic contraction, and limited accessto social protection (many are excluded from healthand income security measures) threatens the healthand wellbeing of many of these migrant workers andtheir families [36]. Access to social protection andassistance may be further obstructed by experiences ofdiscrimination and stigmatisation.The convergence of these differential vulnerabilitiesand exposures within construction workers are ofmajor public health significance, particularly becausethey align with fundamental inequities within societythat place more socially disadvantaged groups atgreater risk of suicide as well as poorer health outcomes more generally [37]. Ensuring all workers haveaccess to social protection such as sickness benefits,income support during periods of unemployment andaffordable healthcare is vital, and has been identifiedas fundamental to fighting COVID-19 according tointernational labour standards [38]. This also alignswith broader calls for mental health strategies to beless focussed on treatment interventions, and morefocussed on the social determinants of health [39] –approaches that are relevant and applicable across sectors, and will also set the foundations for a moreequitable world beyond COVID-19.ConclusionWorldwide, construction industries are considered tobe key economic pillars of the societies they operatein, and construction workers constitute a sizeableproportion of the paid workforce. There are many4 King and LaMontagnedifferent needs and imperatives that governmentsaround the world are grappling with as they rapidlytry to respond to the challenges that the COVID-19pandemic has presented. Rightly, the initial focus hasbeen on addressing the most pressing and salienthealth effects of COVID-19 infection and transmission. But the public health risks clearly extend beyondthat of the immediate effects of the virus, and theeconomic impacts of COVID-19 represent a particular risk to construction workers around the world.Anticipating and preparing to mitigate this risk, particularly among low skilled construction workers, willsave many livelihoods, as well as lives.AcknowledgementsThe author(s) dedicate this article to the memory oftheir treasured colleague, Allison Milner. Her work– represented extensively in the evidence documented here – laid much of the foundation for thearguments presented and continues to influence andinspire.Declaration of conflicting interestsThe author(s) declared no potential conflicts ofinterest with respect to the research, authorship, and/or publication of this article.FundingThe author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was supported by an(Australian) national Health and Medical ResearchCouncil (nHMRC) partnership project Grant(APP1134499) and a nHMRC ‘Million Minds’ Grant(APP1199972). TK is supported by an AustralianResearch Council Discovery Early Career ResearcherAward (DE200100607).OrCID iDTania L. King https://orcid.org/0000-0002-1201-2485references[1] Martin P. The recession and migration: alternative scenarios.Working paper no. 13. International Migration Institute,University of Oxford: 2009.[2] Schilling DR. 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