Conflicts over the right to stability of metalworkers diseased from work in the Campinas region, São Paulo, Brazil

Abstract

The objective is to discuss conflicts in work and health-disease processes related to the job stability of metalworkers with work restrictions in the region of Campinas, São Paulo, Brazil. The methodology, characterized as knowledge’s shared construction, included interviews, document analysis and participant observation, between 2019-2022. The results point to companies’ actions to promote the mischaracterization of the link between work and illness, preventing the access to stability and dismiss sick workers. Workers experience this process painfully, but, with labor union support, they develop forms of resistance aiming at maintain stability and protecting health. The study contributes to health and social protection policies as it highlights the collective dimension of the health-disease’s determination through work, as well as the necessity to mobilize different institutions and agents in the production of knowledge and actions to social struggle for health.

Keywords
Workers’ health; Social protection in health; Labor unions; Working conditions

Resumo

O objetivo é discutir os conflitos nos processos de trabalho e saúde-doença relacionados à estabilidade no emprego dos metalúrgicos com restrições laborais na região de Campinas, São Paulo, Brasil. A metodologia, caracterizada como construção compartilhada de conhecimentos, incluiu a realização de entrevistas, análise documental e observação participante entre 2019 e 2022. Os resultados apontam as ações empresariais para promover a descaracterização do nexo entre trabalho-doença, impedir o acesso à estabilidade e demitir os operários adoecidos. Os trabalhadores vivem esse processo com penosidade, mas, com apoio sindical, desenvolvem formas de resistência visando manter a estabilidade e proteger a saúde. O estudo traz contribuições para as políticas de saúde e proteção social por destacar a dimensão coletiva da determinação da saúde-doença pelo trabalho, além da necessidade de mobilizar diferentes instituições e agentes na produção de conhecimentos e ações para a luta pela saúde.

Palavras-chave
Saúde do trabalhador; Proteção social em saúde; Sindicatos; Condições de trabalho

Resumen

El objetivo es discutir los conflictos en los procesos de trabajo y salud-enfermedad relacionados con la estabilidad de empleo de los metalúrgicos con restricciones laborales en la región de Campinas, São Paulo, Brasil. La metodología, caracterizada como construcción compartida de conocimientos, incluyó la realización de entrevistas, análisis documental y observación participante, entre 2019-2022. Los resultados señalan las acciones empresariales para promover la descaracterización del nexo trabajo-enfermedad, impedir el acceso a la estabilidad y despedir a los obreros enfermos. Los trabajadores viven ese proceso de forma penosa, pero, con el apoyo sindical, desarrollan formas de resistencia con el objetivo de mantener la estabilidad y proteger la salud. El estudio brinda contribuciones para las políticas de salud y protección social al destacar la dimensión colectiva de la determinación de la salud-enfermedad laboral, además de la necesidad de movilizar a diferentes instituciones y agentes en la producción de conocimiento y acciones para la lucha por la salud.

Palabras clave
Salud del trabajador; Protección social en salud; Sindicatos; Condiciones de trabajo

Introduction

Different demands in present production process—such as intensification and prolongation of working hours, management by stress, exposure to harmful elements, among others—are related to the emergence or worsening of physical and mental health problems¹-⁴. Such problems include, on the one hand, occupational accidents and diseases and, on the other, diseases common to the population but whose frequency, onset, and severity are modified by work, or whose etiological spectrum is broadened or complicated. Suffering, malaise, and diffuse symptoms also contribute to the relationship between work and health-disease¹.

Accidents and illnesses can lead to time off work for recovery, for varying periods, and can result in restrictions or disabilities⁵. The inability to work due to an accident or illness can be total or partial, temporary or permanent, and is an indicator of workers’ wearing down in the areas of health, labor, and social security.

During the 1980s, workers in the metallurgical industries of the Campinas region, São Paulo, achieved job stability until retirement in collective bargaining agreements for workers with permanent and partial reduction in work capacity, whose etiology is related to work, in contrast to social security legislation, which grants only 12 months of job stability. In order to return to work after a period of leave and professional rehabilitation, workers with work restrictions must be reintegrated into a job that is “compatible” with their condition.

However, the recognition of work-related illness and work restrictions, return to work, and job stability are marked by different understandings and conflicts between companies, unions, and the state. These conflicts have intensified since the economic crisis (2014-2016), followed by stagnation (2017-2019) and the Covid-19 pandemic (2020-2023), marked by high unemployment and changes in labor relations, the incorporation of so-called “Industry 4.0”⁴,⁶ and changes in labor and social security legislation, with implications for social protection and workers’ health⁷.

The aim of this article is to discuss conflicts in work and health-illness processes related to job stability among metalworkers with labor restrictions in the Campinas region. Addressing the conflicts surrounding this issue in the period 2014-2022 allowed to problematize the production process, the generation of wearing down, and its forms of expression in collective health and illness, considering the conditions set for the action of unions and public agents in social and health protection.

Methodology

The methodology is characterized as a field study inspired by participatory research and the shared construction of knowledge in health, in which we sought to enable the participation of workers⁸. The theoretical-conceptual framework of the study comprises the relationships between the production process and health-disease, within the scope of Collective Health/Workers’ Health⁹.

The main interlocutors of the research were workers, union members, and technicians from the Health Department of the Metalworkers’ Union of Campinas and Region (SMCR), who contributed to the planning of the research, the granting of interviews, and the indication of data sources, in addition to the validation of the final results.

The data collection process, between 2019 and 2022, included: a) conducting 19 open interviews, recorded on audio and later transcribed, with workers, members of the Internal Accident Prevention Committee (CIPA), union members, and technicians from the SMCR Health Department; b) document analysis based on SMCR reports, union press articles, collective bargaining agreements, and conventions; c) participant observation in collective activities promoted by the union.

The systematization, analysis, and interpretation of the data followed the theoretical framework of Workers’ Health, based on the wearing down-reproduction approach⁹. To reduce the asymmetries between scientific and practical knowledge in the shared construction, we sought to get closer to the workers’ representations and languages about work, health, and collective action. The interviews conducted in this study were considered as the workers’ own knowledge constructed in their relationship with the researchers⁸.

The empirical material was systematized based on three thematic categories that emerged during the analysis process and organized the presentation of the results, namely: (1) decharacterization of work-related illness and questioning of stability; (2) illness and expulsion of workers through the production process; and (3) work, illness, and stability: reflections for collective action in health.

This research complies with ethical legislation and was approved by the Research Ethics Committee, process no. 14834819.6.0000.5240, according to opinion no. 3.647.481 of 2019. In order to protect the anonymity of the interviewees, their real names have been concealed and replaced with pseudonyms.

Results and discussion

Decharacterization of work-related illness and questioning of job stability

Since the 1980s, metalworkers in Campinas, together with other metalworking groups in the state of São Paulo, have achieved job stability for workers who have fallen ill due to work (known as ‘clause 68’) through collective bargaining with employers’ unions and companies. The main element of the clause is the guarantee of employment for workers who are victims of work-related accidents or illnesses, with reduced work capacity, provided that: (a) they have become unable to perform the job they previously held; (b) they are able to perform a job compatible with their working capacity; (c) the causal link is recognized by public bodies such as the National Social Security Institute (INSS in the Portuguese acronym); and (d) they participate in the INSS vocational rehabilitation process.

The epidemiological profile of these workers mainly includes repetitive strain injuries (RSI) and injuries or sequelae from work accidents, similar to other locations such as the metalworkers in the industrial belt of São Paulo. A number of health conditions that are not recognized as work-related, such as cardiovascular and mental health problems, are excluded¹⁰.

Companies have questioned the job stability of metalworkers with work restrictions since it was first achieved by workers. However, this has intensified in the context of recent economic crises and changes in labor legislation in Brazil since 2014. We can summarize this as companies’ actions to undermine the process of recognizing work-related illness and expel sick workers from the production process. This represents an extremely painful process for workers, marked by conflicts in the work process.

In order to have access to the stability conferred by the clause, workers must obtain expert recognition of their incapacity to work, which is a criterion for removal from work and the granting of accident-related sickness benefits by Social Security¹¹. The Work Accident Report (CAT) is a fundamental instrument in the recognition by Social Security of the occurrence of a work-related accident or illness and, thus, provides access to social security rights. As stated by Ivone, a union member and factory worker in the electronics industry, the policy of metalworking companies in the Campinas region is not to open CATs: “To my knowledge, there is only one CAT that has been recognized by the company. And there is a lot of illness at work. (The others) are filed outside” (Ivone).

A study based on the experience of professionals at the Workers’ Health Reference Center (CEREST)¹² found that CATs filed by companies, based on subjective criteria used by experts, have greater validity in Social Security medical examinations than those filed by unions or health services. The literature indicates that the work of Social Security experts is generally guided by accounting and administrative concerns, serving the economic interests of companies and the State. Experts tend to view workers as prone to malingering and potential fraudsters¹¹,¹³.

Companies also interfere in medical examinations and inspections in order to conceal workers’ health problems. Following a complaint by the SMCR in 2016, the Public Prosecutor’s Office and the Federal Police launched “Operation Hypocrites,” which investigated a fraud scheme carried out by private occupational physicians that benefited metalworking companies in Campinas and the surrounding region, denying the causal link between work and illness¹⁴.

In a Worker Health Surveillance (VISAT) action and labor inspection carried out at the end of 2018 at an electronics factory in Hortolândia, with the participation of the Public Ministry of Labor, CEREST, and SMCR, management delayed the entry of the team while modifying aspects of the work process, such as the pace of the production line. The main target of the inspection was the “servers” sector, which produces computer systems for accessing, processing, storing, and securing large volumes of data, whose main customers are other companies or public agencies, i.e., it was a central sector in the company’s production process due to the high value of its products. This location, where several health problems had occurred, was shut down:

They [managers] were making an announcement to the people out front “and” when we arrived at the server room, everything was stopped, nothing was working [...] there was no production, we couldn’t see[...] for example, a worker picking up a chassis weighing almost ten kilos.

(Elis, union member and electronics factory worker)

From the companies standpoint, the lower the rates of accidents or occupational diseases, the lower the amounts paid under the Occupational Environmental Risks (RAT) and Social Security Accident Factor (FAP) schemes, i.e., companies obtain economic advantages by concealing the occurrence of accidents and occupational diseases. The concealment of this information also masks the Technical Epidemiological Social Security Nexus (NTEP), reducing the epidemiological history of health and disease problems in the company and in the sector¹⁵.

In order to gain job stability upon returning to the factory after a period of leave, workers must undergo professional rehabilitation provided by Social Security. The purpose of rehabilitation is to restore workers’ physical, psychological, and social abilities, as well as to reduce the time and costs of granting benefits, with the aim of quickly reestablishing their status as taxpayers. However, the Social Security vocational rehabilitation program has been dismantled since the 1990s, with the scrapping of services, lack of investment, and a small number of workers, resulting in insufficient practices to promote a safe and healthy return to work¹¹,¹⁶,¹⁷. The actions of medical examiners and the dismantling of the rehabilitation program make it difficult for workers to achieve stability: “to have real stability, you have to meet the requirements of the collective agreement, and not everyone does” (Agenor, worker and safety representative at an automotive assembly plant).

Another situation imposed by companies is ‘compatible work’ without leave from work. In practice, this means that sick workers remain in the factory because they have been denied their right to leave. According to Beth, a union member and auto parts worker: “there are people with their arms in casts who stay in the factory, all so they don’t have to go to the INSS.”

In this sense, companies tend to push sick workers to remain at work, without formal registration or leave to recover their health, using ‘compatible service’ to obscure the link between illness and work. This practice refers to the notion of ‘compatible work without leave’ that entered the professional rehabilitation circuit in Brazil in the 1990s under the influence of the International Labor Organization¹⁸, being absorbed by companies and disseminated in the workplace. In the perception of the workers themselves, this practice contributes to the worsening of the disease.

Illness and expulsion of workers through the production process

Actions to decharacterize work-related illness and circumvent the stability of sick workers should not be taken out of context from the production process itself in factories.

Workers classify the factory management method as “fear management”, which includes pressure to produce, the imposition of work intensification, the creation of a competitive environment, and the exclusion of sick workers. The term “fear management” can be understood as a worker expression that alludes to what, in academia, has been called "management by stress", characterized by maintaining constant pressure on workers to make problems and bottlenecks quickly visible to management in order to reduce costs and intensify work¹⁰.

Management by stress affects all workers, but is imposed particularly violently on those who are ill. At an automotive assembly plant in Indaiatuba, sick workers are prevented from occupying compatible positions and are isolated in a glass-walled room pejoratively called the “oasis” or “coffee area”. They are given derogatory nicknames by managers such as “living dead,” “broken leg,” and “short arm” (Geraldo, worker and union member at an automobile assembly plant). Such despotic practices aim to segregate and isolate workers who openly confront the misrepresentation of illness at work by seeking internal and external means of defending their health⁵.

The pressure exerted by management through stress on all workers also constrains and, ultimately, prevents sick workers from remaining in work groups. Gilberto, a union member and worker in an auto parts factory, observes about compatible work:

It’s less aggressive than normal work, but it’s not compatible. [...] you have to keep up with the pace. And when you can’t keep up and you stand still, sitting [...] you hear people saying, ‘look, the guy has stopped, now I have to leave here to do his work. [...] And this brings up a huge conflict.

(Gilberto)

Gilberto’s reflection allows us to consider the limits of compatible jobs in the face of the reality of intensified work (“keeping up with the pace”) in the production process. The organization of production and work in factories, geared toward the intensification of work, constitutes an obstacle to the existence of jobs that effectively respect workers’ limitations and enable their return and permanence in the company¹⁰. The exclusion of workers with disabilities is related to the dynamics of production, which imposes productivity and work intensification¹⁹. This is even more so in the current scenario of productive transformations (Industry 4.0), with the reinforcement of intensification and job elimination. For example, at an automotive assembly plant in Sumaré, robots were incorporated into the stamping, bodywork, painting, and machining departments, increasing the pace of work and replacing manual processes such as trunk welding, parts transport, and suspension assembly. At an electronics factory in Hortolândia, the Internet of Things was implemented in production quality control, replacing a process previously carried out by workers.

In this context, management by stress encourages workers to internalize management ideology, including the segregation of sick workers. According to Ney, a union member and worker at an auto parts factory, “the company has a policy of segregating these workers,” aiming to “create a hostile environment for sick workers.”

In addition to the intentional actions of management, Gilberto identifies the exploitation of labor itself as the source of exclusion and isolation of compatible workers, which is partially internalized by the workers:

The extent of the exploitation that the company imposes on them [those who are not sick] and the fact that they cannot stop and see us standing still, they treat us [those who are sick] like bums. And [the company] takes those of us who have health problems and puts us in a situation where we often have to work at the same pace as those who are not sick.

(Gilberto)

The intense pace of work is related to the Profit-Sharing Program (PLR) agreed between companies and unions, which links workers’ pay to production targets, that is, “behind [the PLR] is the intensification of work” (Victor, union member and auto assembly worker).

The inclusion of sick workers in the work group is not accompanied by an adjustment of targets and work pace. Consequently, in addition to the sick worker being classified as ‘low performance’, the work group is penalized because the other workers must ensure that the targets are met, which leads to a collective perception that the inclusion of workers with disabilities increases the workload for the group¹⁰.

Faced with the constraints experienced in the production process, many workers develop ways of hiding symptoms and illnesses. One such way is self-medication, especially with painkillers and anti-inflammatory drugs, according to Beth: “Workers don’t even go to the infirmary. They self-medicate inside the factory”.

The abuse of painkillers in the workplace is associated with the physical and psychological demands of the production process, as well as the lack of access to sick leave²⁰. Self-medication by workers to control pain, without the necessary removal from the conditions that caused the symptoms, has “a perverse palliative effect” that leads “to the worsening of clinical conditions due to continued exposure to causal factors”¹³ (p. 188). Self-medication is related to the development of chemical dependence, a decrease in long-term effectiveness, and worsening symptoms, increasing dependence on disability benefits, the risk of exclusion from the labor market, and premature death²¹.

The concealment of illness can reach extreme cases, such as that of a worker who put his arm in a cast on Friday “to immobilize it and see if the pain would go away,” but “on Sunday [...] he took off the cast and went to work on Monday” (Beth). However, this individual management of pain, suffering, or illness, in addition to promoting the worsening of the problem, chronicity, or the overlap of other conditions, is not viable over time: “if I am sick and I keep quiet, I don’t expose myself and the company doesn’t know that I am sick. Now, there are many who hide it... They hide it until they can’t take it anymore” (Ivone). In other words, the intensification of work limits the possibilities of individual management to hide symptoms and, sooner or later, leads to the exposure of illness to management.

This is the context in which the companies’ medical and outpatient services operate. For Ivone, the medical clinic “maps the problems and difficulties you have and takes them to the company.” These services are used by management to monitor the health of workers, with a view to identifying symptoms early and decharacterizing the relationship between illness and work. In practice, they participate in management by stress, which for workers creates a feeling of being continuously monitored: “it’s constant surveillance. That’s what workers experience today inside a factory” (Gilberto).

The aim of decharacterizing the relationship between illness and work is to prevent workers from gaining stability and to expel them from their jobs. In the case of workers who do not obtain recognition of the link between illness and work, dismissal can be carried out with the payment of compensation by the company, corresponding to the period of stability granted by law:

The company prefers to pay [...] and dismiss. They pay the [...] months of stability and send them away.

(Beth)

In some places, dismissal is immediate:

They arrive at the infirmary with the INSS return and are dismissed right there. They don’t even return to the factory.

(Beth)

For Ney, in recent years, in the context of productive transformations and a reduction in the number of workers, management “is really trying to clean up the factory” and, to this end, even proposes agreements “to end the process and eliminate [those who are sick] from within.” A similar situation was found in a study conducted in the São Paulo Metropolitan Region: the pressure and demands placed on sick workers by management were intensified to the point of making “continuing in their jobs unbearable”²² (p. 98), leading them to request termination or accept agreements.

According to Table 1, the number of employees in the automotive industry in Brazil decreased by 27,000 in the last ten years (2014-2023), representing about 1/5 (21.5%) of the workforce employed in the sector at the beginning of the historical series (2014). The mass expulsion of workers from the sector occurred simultaneously with companies’ adherence to economic policies such as the Employment Insurance Program (Law 13,189/2015), between 2015 and 2017, and the Emergency Program for the Maintenance of Employment and Income (Law 14,020/2020), which is in effect during the Covid-19 pandemic. During this period, despite fluctuations, production remained above 2 million units per year, while the production/employment ratio varied between 19.96 and 27.66 units produced on average per worker per year, with the lowest levels occurring during the years of economic crisis (2015, 2016, and 2020).

Table 1
Production and employment in the Brazilian automotive industry, national data, 2014-2023.

Year	Units Produced	Number of Employees	Production/employment ratio
2014	3.177.859	125.977	25,23
2015	2.452.290	117.660	20,84
2016	2.195.712	109.530	20,05
2017	2.754.142	109.910	25,06
2018	2.894.904	111.043	26,07
2019	2.951.446	106.705	27,66
2020	2.020.229	101.223	19,96
2021	2.256.324	101.050	22,33
2022	2.380.161	101.889	23,36
2023	2.339.354	98.933	23,65

There is evidence that layoffs have effects not only on those who are laid off, but on the workforce as a whole²⁴-²⁶. Physical and mental health problems and workplace accidents are related to the lack of job stability²⁴, as well as being grounds for dismissal, especially in times of crisis²²,²⁴,²⁷. Workers who remain employed during mass layoffs experience a deterioration in their working conditions and health²⁵, with an increase in medication use and hospital admissions²⁶. Studies of metalworkers show that in times of crisis, sick employees are excluded, while periods of economic expansion, marked by intensified work, select these workers for continued employment or dismissal¹,¹⁰,²⁸.

Workers with reduced work capacity have higher rates of long-term unemployment and difficulties in returning to formal employment²⁹, a situation that tends to worsen their health condition²²,²⁷. Ultimately, the dismissal of sick workers probably means condemnation to open unemployment or underemployment. Therefore, stability constitutes a barrier to the summary exclusion of sick workers from the labor market¹⁹, especially due to the rapid consumption of the workforce, in which the worker’s “useful life” is reduced: “today, if you have four or five years with a company, you rarely get a job at another company because your history is already a history of illness” (Geraldo).

The Labor Reform, implemented in 2017, encouraged companies to question the job stability of workers with work restrictions. With the end of ultra-activity—which established the validity of clauses even after the end of the agreement, until a new regulatory instrument was established⁷—companies have refused to renew job stability. This occurred mainly in auto parts, which accounts for most of the metalworkers in Campinas. Thus, as of 2017, part of the category became unprotected from job stability.

Prior to the approval of Law 13.429/2017, which expands outsourcing, metalworking factories in the Campinas region had already adopted it in parts of the production process. At an automotive assembly plant located in Indaiatuba, for example, the logistics sector, responsible for receiving parts, inventory, and pre-assembly, is outsourced. A similar situation occurs at an electronics factory in Hortolândia, where the separation of inputs for the assembly of notebooks and computers is carried out by outsourced workers in a warehouse attached to the main plant. Outsourcing creates divisions among workers and allows companies to circumvent labor stability laws, as outsourced workers are classified in a different professional category and represented by other unions with collective bargaining agreements that are generally inferior to those of metalworkers, and do not enjoy job stability.

During the Covid-19 pandemic, there were layoffs and reductions in working hours and wages based on Provisional Measure (MP) 936/2020, converted into Law 14.020/2020. Factories adopted different production arrangements based on the MP, using only one of the provisions or both simultaneously, for the entire factory or for specific groups of workers. In this way, the legislation provided ample freedom for companies in its adoption.

At the Indaiatuba automotive assembly plant, production was concentrated in one shift, with temporary layoffs for half of the workers (about 900) between July and September 2020. Outsourced logistics accompanied the automaker in reorganizing shifts and reduced workers’ hours and wages by 50%. According to Chico, a worker and safety representative at the assembly plant, “there was already a trend toward layoffs [...] and Covid made it worse”. Between the end of 2020 and the beginning of 2021, even with the job stability stipulated by the MP, the assembly plant laid off 500 workers in successive Voluntary Layoff Plans (PDV). Among them, 50 sick workers (with job stability under the agreement) were laid off in PDVs for this target audience.

The production rearrangements and layoffs during the pandemic took place in the context of the installation of a new global production platform for the automaker, with an increase in automation and robotization. In this sense, “the pandemic serves as a laboratory for many things” (Jorge, outsourced worker at the automaker), that is, government programs allowed companies to carry out the necessary restructuring to face the economic crisis, learning how to produce more with fewer workers and lower wages.

In summary, the analysis points to the erosion of the right to job stability for workers with labor restrictions under the collective agreement for metalworkers, with limits on its application related to productive restructuring and the decline of the union movement at the national level.

The erosion of job stability includes some elements already discussed in the previous thematic category, such as denial by medical experts and the dismantling of the INSS professional rehabilitation program. Two other elements can be added to these: (1) the end of ultra-activity by the 2017 Labor Reform, which pressures unions to sign agreements without job stability; (2) production reorganizations, with: ‘multiskilling’ which stipulates job or sector rotation and raises questions about the effective change of function required by the agreement; the outsourcing of parts of the production process, which excludes contingents of workers in the metalworking category; and the intensification of work through robotization/automation, profit sharing, and management by stress, which force sick workers out of their jobs.

Work, illness, and stability: reflections for collective action in health

Although management by stress acts to establish a competitive environment in factories and intensify work, exclusion, dismissal, and aggravation are not the only possible paths for workers: they develop individual and collective actions to protect their health.

Initially, it should be noted that much of the workers’ defense and resistance to protect their health does not constitute clear or well-defined forms, remaining diffuse and restricted to the individual sphere. In other words, they do not acquire open expression and are difficult to capture by researchers, professionals, or union members.

Some forms of individual defense are referred to in the literature as “mediations of suffering”³⁰ (p. 9), including attempts to deny or conceal wearing down, and control pain. The concealment of symptoms and self-medication are part of this form of defense, with the potential to produce harmful effects.

Another form is “self-isolation,” in which workers avoid returning to the workplace. According to Luiz, a union member and worker at an automotive assembly plant, “there are some colleagues who can’t go to the factory”; the night before the day when workers “try to go to the factory, is one of the worst nights [...] they start to feel sick.” Self-isolation can emerge as a defensive attitude of sick workers in the face of exclusion in the workplace¹³, constituting a resource adopted for the management of psychological crisis situations³¹. However, it is a manifestation of suffering related to the occurrence of mental and cardiovascular health problems, as well as an increased risk of mortality³².

Exposing a health problem in order to obtain recognition and access the protection afforded by job stability is a difficult decision, often taken only at the moment of dismissal. According to Ivone, this is a moment of “rebellion”: “people hide the fact that they are undergoing treatment and, when they are dismissed, they come to us [the union] [...] to talk about what was happening.” Studies show that the decision to disclose illness or disability is permeated by expectations of negative consequences, such as discrimination at work and the threat of job loss³³,³⁴.

Exposing the problem and seeking recognition of illness at work is a moment of rapprochement between workers and the union. Luiz’s account expresses a mobilization that can be oriented toward collective action in defense of health: “I was already angry about these pains and thought: you know what? I think I’m going to try to do something to help the people here at the factory”. Several workers who obtained recognition of the link between their illness and their work with the support of the union developed a trajectory of mobilization that included participation in factory groups, Internal Accident Prevention Committees (CIPA), and union leadership.

The SMCR prioritizes the fight to preserve job stability for sick workers and ensure that it is enforced. To this end, it seeks to mobilize the category during wage campaigns, refusing to sign collective agreements that do not include job stability and supporting workers both in confronting working conditions that are harmful to their health and in the fight for recognition of the relationship between illness and work. When dismissals occur, the SMCR acts to reinstate sick workers, however, “rare are the cases that have been reinstated by the courts” (Geraldo). In addition, the union seeks to reach out to outsourced workers, as in the case of the Indaiatuba assembly plant, where joint mobilizations were developed with logistics workers in the pre-pandemic period.

The SMCR Health Department and union factory directors participate in the process of returning sick workers to work, which includes determining a compatible position. The main item evaluated is whether or not there are targets in the workplace: “What are we trying to do? Put him [the worker] in jobs where there are no targets”, because “if there are targets, the person will continue producing and their problem, their illness, will get worse” (Ivone).

Although targets are evaluated when defining a compatible job, the evaluation remains limited and sporadic, failing to advance to a broader questioning of the production process in the company as a whole. The union’s agreement on profit sharing, for example, places limits on collective action in defense of health. During profit sharing negotiations, the focus is on increasing the value of the bonus, and the main argument is to increase the targets achieved. In other words, there is no questioning of the targets that intensify work and create a competitive environment, elements that are at the root of health problems and work restrictions.

Final considerations

The conflicts surrounding the stability of workers with disabilities in the Campinas region express the union’s opposition to companies’ actions to decharacterize the work-illness relationship and dismiss sick workers, as well as the mobilization to maintain stability in the collective agreement, ensure its application, and defend workers’ health.

The actions of the metalworkers in Campinas are in line with the experiences of workers’ groups in other parts of the country. Attempts to “clean up factories” by dismissing large numbers of workers, including sick workers, also occurred in the metalworking sector in the ABC region of São Paulo and in Curitiba, in the context of productive transformations and labor legislation, which workers confronted with strikes and mobilizations.

Such conflicts, problematized from the experience of the metalworkers in Campinas, have implications for health and social protection policies. For example, they point to the importance of the social determination of the production process on the health and illness of workers for health professionals and services that make up the Care Networks, which cannot be reduced to the specific and individualized risks of jobs and workplaces, thus emphasizing the collective dimension of the health-illness process.

In this sense, it is essential to develop research initiatives that value the knowledge shared between universities, worker groups, health services, and public agencies, and that are aimed at transforming working conditions and protecting workers’ health.

• Funding
  This article is the result of research funded by a doctoral scholarship granted by the National Council for Scientific and Technological Development (CNPq). The publication and translation of the article were supported by the Vice-Directorate for Research and Innovation (VDPI) of ENSP/Fiocruz.
• Eberhardt LD, Pina JA, Stotz EM, Bravo ES, Esteves TV, Takahashi MABC. Conflicts over the right to stability of metalworkers diseased from work in the Campinas region, São Paulo, Brazil. Interface (Botucatu). 2025; 29: e250352 https://doi.org/10.1590/interface.250352

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Edited by

• Editor
  Antonio Pithon Cyrino

• Associated editor
  Carlos Eduardo Carrusca Vieira

Publication Dates

• Publication in this collection
  11 Aug 2025
• Date of issue
  2025

History

• Received
  22 Oct 2024
• Accepted
  30 Mar 2025