20 Can productivity in SMEs be increased by investing in workers’ health?
5. Impacts of social protection and working
conditions in SMEs
5.1. Gaps in social protection: Impacts on workers and their families
The existence of benefits and structures to improve working conditions may be mandated by law, leaving the employer little choice but to offer them. However, it is
possible for the employer to create a working environment that punishes the acceptance of such measures, for example by delaying promotions, mobbing or other forms of
discrimination. In such a work environment, workers may be unwilling to accept their statutory benefits for fear of impairing their career.
It has been shown Allen, 2001 that the workers’ perception e.g. of a family- supportive organization is more important than the actual benefits offered: a perceived
low support has been shown to cause workfamily conflicts, a decrease in employment satisfaction and less commitment to the enterprise on the part of the workers Allen, 2001.
Working conditions also include access to social protection benefits such as health services. Such benefits are likely to significantly influence the health status of workers.
Access gaps might have an impact on income for whole families given the multitude of costs, from loss of income during illness to high expenditures for treatment and drugs.
These costs may amount to what is often referred to as catastrophic health expenditure, which may alone be a cause of poverty. Continuously high levels of out-of-pocket OOP
payments will also contribute to poverty, as they are likely to erode an individual’s savings over time. Further, the absence of social protection coverage in health acts as a key
determinant of quality of life, given the link to disability.
Other branches of social security are aimed at different aspects of an individual’s welfare. They include security in old age. Old-age pensions are aimed at providing income
beyond the working age. A lack of income support might have significant impacts on families, for example on the education of children or − in worst cases − child labour if they
are required to generate the family income. No comparative analysis has been found on the related impacts on former SME employees with and without pensions.
A lack of paid sick leave can motivate SME employees to continue working despite being ill. As this may reduce their ability to recover, their health status will be more
severely impacted for a longer period of time. Also, if they have to continue working while sick they are more likely to transmit communicable diseases to co-workers. However,
examples of special impacts of a lack of paid sick leave for SME employees could not be found in the literature.
Labour regulations might also impact on the health status of young children and their mothers. A recent review Heymann et al., 2013 evaluated the impact of four policies:
parental leave, breastfeeding provisions, child care and early education, as well as leave to take care of the child’s health needs. Among the main findings were that breastfeeding will
be more common if related provisions exist in the workplace or if mothers are entitled to paid maternity leave.
Child health outcomes are also improved when it is possible for parents to take child health-related leave. It was found that, internationally, fathers are less likely than mothers
to have the right to paid parental leave. Early childhood care and education, besides positively influencing the child’s development, provides care and supervision for young
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