Domestic workers from the Philippines in China: An opportunity for health promotion within the Belt and Road initiative

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The Chinese government recently announced it will allow local residents to employ foreign domestic workers (DW) in Mainland China, after a trial period in some cities [1]. This will expand existing legal labor migration to China, currently concentrated in the Special Administrative Regions (in Macao and Hong Kong). This presents a unique opportunity for China to assume regional leadership in developing strategies to protect and promote transnational migrant worker health.

Limited research was undertaken to document the health conditions of migrant Filipino DW in China [2]. Studies emerging from the Macao Special Administrative Region (SAR)—a key “platform” along the ancient maritime silk road, linking China to South East Asia, and the modern Lusophone speaking World—demonstrated a high burden of non-communicable diseases, including common mental disorders [3, 4], behavioral addictions [5] diabetes, obesity, and other cardiometabolic risks to health [6], poor HIV and STI testing [7] and evidence of a high burden of sexual and reproductive health challenges [8]. Poor social integration, discrimination, and barriers to health care access are known to be key social determinants of migrant mental health [9,10,11]. Poor quality social networks and discrimination [12] was associated with increased burden of common mental disorders among Filipino DW in Macao, and limited mental health treatments are currently available [13, 14]. A recent UN report suggested that improvements are needed to safeguard transnational migrants from discrimination in China [15]. This is especially relevant in the context of Mainland China, where most Filipina domestic workers are working illegally due to labor policy restrictions currently in place. Leadership from Beijing may translate to improvements in the health of transnational migrant workers across China.

The following are several key policies, that if enacted by the Chinese Central Government, could promote the health and welfare of these transnational workers in China [15]. First, China could consider gradually lifting restrictions on employment of foreign DW while concomitantly establishing legal procedures to protect existing undocumented workers. Second, China can ratify the International Labor Organization (ILO) Domestic Workers Convention, which aims to set guidelines for the protection and welfare of DWs. These guidelines could uphold standards for decent work across China, including within the Special Administrative Regions. Third, laws and regulations regarding non-discrimination, and standard labor contracts, wages, and working hours should be enacted. Fourth, policies can ensure access to adequate living and working conditions, insurance coverage for healthcare, and salaries to foster remittances and savings. Fifth, establish equitable procedures to handle complaints against employers. Finally, regulation of labor brokering agencies can be enforced to prevent usury and debt bondage. At present these policies do not exist in Macao.

China’s Belt and Road Initiative (BRI) promises to increase global connectivity and provide opportunities for economic development to participating countries. Domestic worker protection strengthens the “people-to-people bond,” which is one of the five priorities of the BRI. Protecting the health status of migrant workers from regional Asian BRI partners should be a priority. Filipinos employed as DW can fill a critical gap in the workforce available for family care for the large and rapidly aging population in China. By 2030, it is estimated that 10 million caregivers will be needed. They can also provide English language instruction for the children in their care. Providing the Philippines with this pathway for economic opportunity is useful and mutually beneficial, but failing to safeguard the health and wellbeing of this migrant population may undermine the full potential of the BRI, and exacerbate vulnerability and poor population health.