Improving Capacity to Monitor Workers' Rights & Health

Recognizing that 1) working conditions, income, and employment all directly impact health and well-being, 2) preventable occupational health disparities exist in San Francisco, and 3) SFDPH’s Environmental Health Section holds a unique role in ensuring healthy living and working conditions, SFDPH staff have begun to explore how the Section can support monitoring of the work environment and support compliance and enforcement of labor and occupational health and safety laws.

Enforcement of workplace laws helps create safer, healthier workers and work environments. Currently, various federal, state, and local agencies, such as the U.S. Department of Labor, the California Department of Industrial Relations, and the San Francisco Office of Labor Standards Enforcement, are responsible for enforcement of occupational health and safety laws and labor laws (such as minimum wage, paid sick days, workers compensation, etc).

Given existing political, resource and capacity constraints, many enforcement agencies are complaint-driven, meaning they respond to worker complaints of labor and safety violations, but there is no systematic visiting of all workplaces to ensure universal compliance with federal, state, or local legal requirements. For example, at current staffing levels, it would take the state occupational safety and health agency 139 years to inspect each of the 1.2 million California workplaces one time. (AFL-CIO, 2007)

Recognizing the existing constraints faced by enforcement agencies and building on lessons learned from UNIDOS and the Chinatown Restaurant Worker CBPR Study, SFDPH is currently exploring if and how the Environmental Health Section can complement the work of existing regulatory agencies responsible for occupational health and safety and labor law enforcement. Below are descriptions of SFDPH’s recent and current pilot projects to explore how the agency can support better monitoring and enforcement of workers’ rights and healthy work environments.

SFDPH Current and Recent Pilot Projects

Requiring proof of workers’ compensation insurance coverage to receive health permits

All employers in California, except for the State, are required to provide workers’ compensation coverage for their employees through the purchase of workers’ compensation insurance or by being certified by the State as permissibly self-insured. However, some employers unintentionally or intentionally do not comply with the law. For example, one study found that 15% of new employers and 9% of all employers were illegally uninsured for workers compensation. (CHSWC, 2007) To support implementation of the existing law that promotes workers’ recovery from work-related injuries and illnesses, SFDPH EHS began requesting proof of workers compensation coverage for all new health permit requests and renewals for food establishments. The list of all businesses that receive licenses and permits is available through SFDPH EHS.

How This Impacts Health: Requiring proof of coverage will increase the likelihood that if a worker is injured on the job, he or she will be able to access workers compensation during recovery or rehabilitation. Without workers’ compensation, workers may experience increased financial hardship (possibly leading to evictions, moving to substandard housing, not being able to pay for food or medical care, etc) and increased pressure to return to work before completely recovering from work. These increased pressures may result in decreased access to health-promoting resources (like primary care, healthy foods, stable housing, social support, etc) and increased risk of stress, depression, re-injury or non-complete recovery, hypertension, and cardiovascular disease.

Potential suspension or revocation of health permits for restaurants that have failed to pay minimum wage

San Francisco has a local minimum wage ordinance that requires employers to pay a minimum wage that is higher than the state and federal levels. When compliance with the ordinance is not forthcoming, the San Francisco Office of Labor Standard and Enforcement (SFOLSE) may request other city agencies to revoke or suspend any registration certificates, permits, or licenses held or requested by the employer until the violation has been remediated. SFOLSE and SFDPH EHS have been collaborating on several pilot cases involving restaurant owners. SFDPH EHS is able to suspend or revoke a restaurant’s health permit based upon the provisions in the California Health and Safety Code requiring all food facilities to operate in accordance with all applicable local, state, and federal laws and regulations.

How This Impacts Health: Research has shown that income is one of the strongest and most consistent predictors of health and disease. Even in the most affluent countries, people who are less well off have substantially shorter life expectancies and more illnesses than the rich. In the United States the poorest communities can expect to live at least 6.5 years shorter than rich men and women. The diminished health status is understandable when income is tied to meeting one’s basic needs. Homelessness, hunger, malnutrition, and difficulty in accessing health care and paying medical bills all affect health. The health of employees who do not receive minimum wage may be further affected because employers who violate wage laws are less likely to offer health insurance, paid sick days, and injury prevention training.

Observing and reporting lack of compliance with labor law posting requirements

Between March and April 2009, three Environmental Health Inspectors participated in a pilot program to observe and report lack of compliance with labor law posting requirements. Specifically, as part of their routine restaurant inspections, the inspectors noted whether the following six posters were posted in a conspicuous location in the restaurants:

  • Notice to Employee of Injuries Caused by Work (right to Workers Compensation)
  • Safety and Health Protection on the Job
  • Access to Medical and Exposure Records
  • San Francisco Paid Sick Leave
  • San Francisco Minimum Wage
  • No Smoking

Of the 198 restaurants observed, over 70% did not have the six posters required to be posted. These results were similar to the findings of the Chinatown Restaurant Survey Findings. All restaurants that were observed without proper signage were sent a letter notifying them of their lack of posting and were reported to the appropriate enforcement agency. Following completion of this pilot, SFDPH is exploring various aspects of the feasibility of monitoring labor law postings.

How This Impacts Health: In San Francisco, almost all workers are entitled to minimum wage, breaks and meal times, overtime pay, paid sick days, access to health care benefits, workers’ compensation, and other rights guaranteed under existing labor and occupational safety and health codes. Each of these rights supports workers’ health in direct and indirect ways. At the same time, labor law requirements such as paid sick days and access to health care benefits help protect public safety by ensuring sick workers are able to take time off from work and seek care needed. A number of workplace laws require public posting of the laws to ensure that workers’ know that they are entitled to these rights.

Supporting educational outreach to workers and employers

SFDPH Environmental Health is a partner with the Labor Occupational Health Program of the University of California in a grant, funded by the National Institute of Occupational Health, to explore and develop an intervention in which food service inspectors provide occupational safety information and resources to restaurant owners and managers during their inspections. With guidance from food inspectors, restaurant owners and managers, and Environmental Health Directors, the project team will identify potential “sentinel” hazardous conditions in restaurants which would serve as a trigger for the provision of educational materials.

How This Impacts Health: The California Division of Occupational Safety and Health (Cal/OSHA) recognizes that there are multiple tools for decreasing worker injuries, illnesses and fatalities including enforcement, incentives promoting voluntary compliance, employer/employee education and training to identify and abate worksite hazards (Cal/OSHA User’s Guide, 2005). Since health inspectors visit restaurants several times a year, they have more opportunities to assist restaurant owners with the identification of health and safety hazards and to provide tools to reduce them.

Understanding the Spectrum of Enforcement Activities and Potential Roles for SFDPH

In summer 2009, SFDPH developed the Health Agency Enforcement Roles fact sheet to clarify the spectrum of enforcement activities that occur at the local, state and federal levels and what roles and responsibilities the authorized enforcement agency and/or health department may play to promote compliance with existing workplace laws. This broad overview includes a range of activities, but is not an exhaustive list.


For more information about any of these pilot projects, please contact: This email address is being protected from spambots. You need JavaScript enabled to view it. , (415)252-3957.