Domestic work is an old occupation with ancient Mesopotamian (present day Iraq, parts of present-day Iran, Syria, Turkey and Kuwait) sources referring to it. Historically, domestic workers were employed by those who could afford a helping hand to do their daily chores.

Domestic work was and is a highly feminized unorganized sector with minimal to nil government regulations in most countries. They are informal workers who are not taken seriously – both by their employers and by themselves as a house is not even seen as a place of work. As a result, workplace hazards at homes get ignored and illnesses due to this occupation goes unanswered thereby adding to the global disease burden.

Like any other workplace, working in a home is not a safe place – it has to be made as safe as possible.

The incomes of a domestic worker are low compared to the intensity of their workload; women being paid lesser than men. This in turn means poor nutrition, limited access to healthcare in case of any illness/discomfort due to work.

Domestic work was and is a highly feminized unorganized sector with minimal to nil government regulations in most countries.

What ails domestic workers globally despite the fact that they are so essential to a family; yet they are least respected, least paid, least rested (weekly offs and holidays), least supported in case of a health issue and most abused. They have no pension benefits, at least in developing countries. I think it is lack of awareness in people those who employ the domestic help.

In modern times, when both spouses are working, taking care of a domestic help should be a priority; sadly, it isn’t. This is because when both spouses go to work, it is the domestic help who takes care of the children and elderly at home. However, it is an observation that they are replaced if they ask for a raise or some benefits.

People often wonder what health issues can a domestic workers get due to working in homes. The people who employ them think home is the safest place to work, but alas, no, it is not.

Like any other workplace, working in a home is not a safe place – it has to be made as safe as possible. And we are not talking here about the dangerous carbon monoxide emissions that can be found in homes, but simpler hazards on which action can be taken by the home owner themselves.

Example: Fumes due to cooking in the kitchen not able to find a way out from the window can cause breathing difficulty. All it needs is an exhaust fan to reduce the fumes. This will benefit both the domestic help as well as the home owner in case the necessity arises to work in the kitchen.

Anyone who does any work in a home, be it the owner or a domestic help is exposed to hazards. For example, a broom to clean the floor creates dust cloud that can cause allergic rhinitis; a cleaning soap can cause allergic skin rash or eczema; lifting heavy weights can cause musculoskeletal issues, working without breaks can cause fatigue, lack of proper nutrition can cause fainting attacks etc.

Giving proper implements and materials is also important to prevent work-related health issues in a domestic help.

The house owner may not be able to systematically list all the hazards and take actions proactively but being aware and listening to feedback of domestic help and taking action can go a long way in preventing illness due to work as well as fostering a healthy working relationship. This is akin to what Ratan Tata did in the Indica car factory in the 1990s.

Ratan Tata had noticed the operators fix the rear strut of the car manually and would have to bend down 600 times to complete this operation on 300 cars each day. He had called his managers and asked, ‘how can we expect our men to do this throughout their lives? Surely it will damage their health. We must provide an automation solution on priority.’ The engineering department rose to the occasion and quickly developed a fixture to semi-automate the operation.

Ratan Tata became aware of the problem of the workers in the Indica car factory; he demonstrated compassion by seeing the suffering of the workers and its effect on their health and took action by asking the engineers to provide automation on priority.

Taking care of basic requirements of a domestic help and ensuring his or her health is preserved should be a priority, as it is useful to the house owner. An annual health check for the domestic help is useful. A sick domestic help can spread diseases, including tuberculosis.

Domestic workers usually work alone; there is no support of co-workers or any protection from the law – all these makes them vulnerable to a lot of occupational illnesses that go unreported and wrongly treated. The treatment should have been to identify what is causing the illness and mitigating those causative factors, most of it could be done by the domestic worker and the employer. What happens on the contrary is the complaints are being treated without mitigating the cause, in turn, sometimes creating another illness. That is why it is important to always consider ‘is my sickness because of the work I do.’

Bigger offices or factories employ a bigger number of workers who work similar to domestic help but with more clearly defined roles, weekly offs, salaries, medical checks, bonus etc. For example, there is food handler, cleaning staff, janitor etc. in large offices or factories. Proper training, equipment, materials are provided. The Admin or HR usually works closely with them and like any other employee, work-related health issues in them are proactively managed by the OH physician as also any new health issue.

Example: In one corporate office where I worked (which had just started), I noticed the housekeeping staff finding it difficult to shift large containers that would come periodically to the office. Immediately a trolley was ordered for them and ‘lifting technique’ was taught to them. Actions like these prevent any future musculoskeletal issues in them. All hazards in the office were identified and mitigated. 

In homes, on the other hand, one domestic help usually does almost everything, one after the other – there is no rest period, no meals, no weekly offs, erratic salaries etc. That is why domestic workers are prone to more work-related illnesses and an early morbidity making them jobless much earlier. 

When the home owner or the business owner speaks kindly to them, it makes a lot of difference to the morale of such workers. I recollect how even aircraft fueling attendants in the airstrips of oilfields of Oman would even walk up to the MD or the Dy. MD of the company (Petroleum Development Oman) as they alighted from the small aircrafts and shook hands and exchanged compliments with them. It makes world a wonderful place and workplace harmonious as opposed to ‘toxic’ if mutual respect is missing.

On the other hand I have heard from domestic helps how home owners treat them – they provide low quality cleaning agents that cause skin rashes, ask them to use underclothes as mops to clean the floor, do not provide them meals or even water, pay them lower than market rates, do not give them weekly offs, restricted long holidays, cut salary in case of sickness absence, sack them before it is Diwali (a major festival in India) so that they don’t have to pay the bonus.

Do you think the above conditions are good for any worker? How can a worker be happy? Never create a situation where a worker can retaliate. Be polite, treat them nice and see the returns.

I know people who have one domestic help working with them for 35 years and the other for 21 years. They do their medical checks, once in two years. The domestic help have the house keys, and have even helped raise their kids. In return they have educated the children of their domestic help. They have plans to give a small pension for life. And most importantly, they respect them. Do what you can – if not monetary help, the least one can do is to treat them as another human being. It is good for their mental health too.

Make the work of domestic helps working for your home or office or a large organization safe, respectful, relaxed, and interesting to win their loyalty to get optimal results.  

The ILO (International Labor Organization) has a Decent Work Agenda that encompasses most of the things discussed above. 

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Dr Ajay Sati is an Occupational Health physician who prefers to describe himself as an Occupationist, to denote, ‘an expert in diseases and other concerns of occupations.’ Dr Sati has managed health and wellness programs in industries he worked, like the atomic energy, and energy (oil & gas) in India and overseas. An experienced virtual consultation expert he was involved in many greenfield and brownfield projects providing inputs from health point of view.