Graça Druck and Carles Muntaner offer two different approaches to discussing the impact of outsourcing or contracting out and precariousness (terceirização and precarização in Portuguese) on worker health and safety, a topic that has been under-researched in Brazil and maybe worldwide. Druck is a labor sociologist who has a long trajectory studying outsourcing, particularly in the petrochemical industry in Bahia. She provides an important contribution to the debate on the relationship between outsourcing and workplace mortality by describing the current status of outsourcing in Brazil, and the legal and political struggle around Bill 4,330.

Druck first situates the growth of outsourcing in Brazil as part of the flexible accumulation brought about by productive restructuring and neoliberal policies in the 1990s. She then summarizes the evidence available in the peer-reviewed and gray literature in Brazil to argue that the weight of evidence indicates that there is a strong relationship between outsourcing and precariousness, which combined produce job insecurity, intensification of work, increased exploitation and segmentation of the workforce into first and second class workers, unsafe and unhealthy working conditions, and weakening of trade unions and labor power, among other impacts. These impacts were empirically demonstrated in the petrochemical, electrical, and construction sectors in Brazil through data that compared outsourced and permanent workers, which showed higher mortality rates in the former. Yet, she did not list any longitudinal (or even cross-sectional) epidemiological study that controls for confounding variables and compared workplace morbidity and mortality in different workplaces or sectors of the economy. Maybe such studies are still lacking in Brazil.

Muntaner, a social epidemiologist with a long trajectory studying relationship between conditions of employment and health, briefly reviews current theoretical frameworks to study precarious employment at the global and national levels. He briefly outlines the changes in employment conditions since World War II that led to the growth of the social construct "precarious employment" in what he calls wealthy countries. The main issue his essay argues for is to link precarious employment with social class because these concepts are complementary theoretically and empirically. He rejects the notion of precarious employment as an attribute of the individual, a psychological rather than a sociological one, which makes the employment relationship invisible and may create an artificial group of vulnerable workers without properly considering the social relationships between sellers and buyers of labor.

It is very timely for Brazilian scholars, union leaders, and government officials to study the impacts of outsourcing in the health and safety of Brazilian workers and society, given the widespread diffusion of terceirização (an epidemic according to Druck) to all sectors of the economy in the last two decades. In addition, there is a need for worker health researchers in Brazil to unveil the dramatic changes in employment and working conditions brought about by neoliberalism in a middle-income dependent country. Comparing permanent with outsourced workers is not enough, because it may well be that outsourcing worsens conditions for all workers, not only those outsourced.

As an Associate Editor of the CSP for about two and a half years now, I've read plenty of occupational epidemiology articles that measure associations between proximal risk factors derived from poor working conditions, such as low task autonomy or control/high demand, or exposure to chemical, biological, or physical hazards, and socioeconomic position variables (e.g. income, education, or occupation). Some of the reasons for this dominant focus on proximal relationships may be a combination of methodological and/or ideological pragmatism, i.e., it is probably easier to study these associations in small studies with little human and financial support and/or the focus may derive from simplistic and acritical understanding of the exploitative social relations of production embedded in outsourcing and precariousness.

On the other hand, there is a dearth of multilevel studies in the Brazilian safety and health literature that connect the micro, meso, and macro levels of analysis or worker health in more complex models - as proposed by the Employment Conditions and Health Inequalities report produced by the World Health Organization Commission on Social Determinants of Health ¹1. Benach J, Muntaner C, Santana V, Chairs F. Employment conditions and health inequalities. Final report to the WHO Commission on Social Determinants of Health (CSDH) Employment Conditions Knowledge Network (EMCONET). Geneva: World Health Organization; 2007. - to account for the impact of what I'd call the "siamese twins" terceirização and precarização on worker's morbidity and mortality at the local, regional and national levels.

Alves ²2. Alves G. Trabalho e neodesenvolvimentismo: choque de capitalismo e nova degradação do trabalho no Brasil. Bauru: Canal 6; 2014 analyzes in-depth the recent expansion of both in the Brazilian neodevelopmentalist economic model and proposes interesting theoretical frameworks that address the social class issues raised in Muntaner's essay. For example, he hypothesizes that the just-in-time production method is closely linked to the just-in-time way of life characteristic of the last few decades; thus, the health impacts of the twin brothers may reach beyond the workplace and affect worker health on a 24-hour cycle. In a word, he suggests that just-in-time workers become just-in-time consumers and just-in-time citizens at home, since we all live now in a just-in-time society. As a result, precarious workers also live a precarious life outside the workplace, exposed to stressful work and home conditions that likely affect their physical and mental health. If his argument is correct - it sounds definitely plausible - we should expect an increase in a range of chronic diseases and fatalities, still to be empirically determined.

The type of research necessary to address these complex issues will definitely require the creation of an interdisciplinary and multicenter research program funded by multiple sources for several years. One may ask if there are reliable and valid data in Brazil to allow for such complex research. The availability of good national data sources such as the Pesquisa Nacional por Amostra de Domicílios (Brazilian National Household Survey), the Pesquisa Nacional de Saúde (Brazilian National Health Survey), the Cadastro Geral de Empregados e Desempregados (General Inventory of Employment and Unemployment - CAGED), the Anuário Estatístico de Acidentes de Trabalho (Annual Statistics of Workplace Accidents - AEAT), among others, implies that there is at least good potential for linkages between employment and health data at the national, and maybe, state and local levels.

Future research should also aim at unveiling the numerous pathways through which the macro political economy shape dynamic social relations of production that in turn lead to particular patterns of worker health and safety in different sectors of the Brazilian economy. This ambitious agenda should take advantage of a variety of quantitative and qualitative methods (i.e. numbers and words) that together would allow for a comprehensive description and explanation of the serious challenges faced by the whole Brazilian working class in the last few decades. I hope that the contributions of Druck and Muntaner will encourage many to take on this task!!

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