May Day: The hidden health crisis of Bangladesh's workers

Every year, as the first of May arrives with the red of workers' flags and the sound of marches, Bangladesh pauses to honour its labour force. It is through the hands of its workers that the country has stitched its place on the global economic map, emerging as one of the largest economies by nominal GDP and among the fastest-growing in the region.

According to the 2024 Labour Force Survey by the Bangladesh Bureau of Statistics (BBS), in Bangladesh our labour force is about 73.8 million, including 48.5 million men and 25.3 million women.  About 62 percent of the population of the country is engaged in labour.

Among them, 84 percent of workers generally work in the informal sector, who do not have official contracts, protection, and representation, and for women, this rises to 96.6 percent. Meanwhile, the National Child Labour Survey 2022 shows that nearly 1.78 million children are engaged in labour, which is against the law.

Yet beneath the rhetoric of solidarity and the promise of reform lies a quieter, more urgent story where the profound physical and mental toll that millions of workers bear in silence – largely unseen and underserved. This May Day, it is not enough to celebrate labour. We must speak plainly about what labour is costing our workers in body and in mind.

The physical toll of work

The work-related hazards remain one of the most persistent public health challenges worldwide. According to a new global report by the International Labour Organization (ILO), more than 840,000 people die each year from health conditions linked to psychosocial risks, such as long working hours, job insecurity, and workplace harassment. In another report, ILO points out that over 2.3 million people die every year due to occupational accidents. That is more than 6,000 deaths every day.

These are not just statistics. They represent construction workers exposed to unsafe conditions, factory workers breathing polluted air, and informal labourers without basic protections. In Bangladesh's garment sector, more than 500 major accidents have been recorded over the past decade. At the same time a report from The Daily Star depicts that, 68 percent of workers in the ready-made garment industry have not received any safety training.

In countries like Bangladesh, where a significant proportion of workers are in the informal sector, occupational safety often remains weakly enforced. The result is a cycle where economic vulnerability forces individuals into unsafe work, and unsafe work deepens vulnerability.

Dual burden of communicable and non-communicable diseases

Workers typically live in crowded and congested areas, with poor sanitation and hygiene. Communicable diseases such as tuberculosis, respiratory infections, dengue and other infectious diseases are prevalent in these areas. At the same time, the prevalence of non-communicable diseases is also increasing.

Research indicates that the proportion of deaths from non-communicable diseases in Bangladesh rose from 43 percent in 2000 to almost 70 percent in 2019. Low-income communities suffer from diseases such as hypertension, diabetes, heart disease and chronic respiratory disease because of their poor living environment and work-related stress.

Safeguarding women in workplace

In the garments sector, where a large portion of the workers are women remains deprived of their maternal health needs. Only 25 percent of women workers receive maternity leave, and many are forced to return to work before completing the standard eight-week postnatal recovery period. In some instances, they are even forced to take "voluntary" retirement. While some factories have childcare facilities, they are often unsatisfactory.

This lack of protection raises a critical issue, as the health of mothers affects the health of women as well as the health and productivity of the future workforce.

The unspoken vault

While physical risks are more visible, the mental health burden among workers remains unspoken but it is equally alarming.

In Bangladesh's ready made garment sector (RMG), where over four million workers, predominantly women, drive more than 80% of the country's export earnings, the burden of mental health remains largely overlooked. Evidence from a recent cross-sectional study conducted in Savar between 2023 and 2025 presents a concerning picture. It shows that 58.7% of garment workers reported symptoms of depression, while anxiety affected 73.6%, and 19.9% reported stress. The burden is not evenly distributed. Female workers had nearly three times higher odds of both depression and anxiety compared to male workers.

The study also shows that the older age and longer job tenure were also significantly associated with higher levels of psychological distress, indicating the cumulative impact of prolonged exposure to demanding work conditions. Higher monthly income was associated with increased odds of depression and anxiety, while stress was additionally linked to substance use.

These findings highlight how workplace pressures, alongside limited psychosocial support, are affecting worker well-being. Addressing this requires integrating workplace-based mental health screening, gender-sensitive interventions, stigma reduction, and accessible support services.

Implementation is everything

The 2025 amendment to the Bangladesh Labour Act expanded legal protections, introduced strict prohibitions against forced labour and sexual harassment, simplified union registration, and extended some coverage to previously excluded groups including domestic workers and seafarers. The RMG Sustainability Council has worked to establish safety committees in factories, and international pressure, especially from the European Union, has nudged regulatory enforcement in the right direction.

But there are still rooms to progress. The 2025 amendment appears designed primarily to demonstrate formal compliance with ratified ILO conventions rather than to address the lived realities workers face, such as, inadequate wages, rampant casualisation of permanent work, minimal accident compensation, and almost no social protection for the informal majority. Rights advocates claim that the laws protect workers on paper but inspectors, enforcement, and political will protect them in practice.

Health insurance for workers from every sector should be ensured. A study shows that 86.7 percent of workers in the informal sector, including rickshaw pullers, restaurant workers, and shopkeepers are willing to enroll in health insurance schemes if they are affordable. Nearly 70 percent of total healthcare expenditure is paid directly out-of-pocket by individuals. As a result, most of the large informal workforce remains completely outside any form of health insurance coverage.

Towards a healthier future of work

Labour Day should not only be a moment of recognition rather it should be a call to action. To ensure a healthy future, occupational safety must be strengthened particularly for informal workers. Both production and worker well-being are important in sustainable development. A distinct budget should be allocated for fire safety, maintenance, and safety equipment in factories. In labour-dense areas, effective primary healthcare centres need to be established. Industrial establishments should also collaborate with local government bodies to finance, set up, and operate these primary healthcare services.

Mental health must be integrated into workplace policies, this includes reasonable working hours, supportive supervision, and access to mental health services. Finally, workers' voices must be central. Policies designed without workers often fail to address real conditions on the ground.

As Bangladesh stands at a crossroads where we are graduating from least-developed-country status, the health of its workers is not a marginal issue. It is the very foundation of the country's future. A workforce that is chronically ill, psychologically exhausted, and economically precarious cannot build the prosperous Bangladesh that everyone claims to want.

-The writer is a Professor of Department of Economics at University of Dhaka and Executive Director of ARK Foundation