Aches, pains, and no health insurance for aging gig workers

When Mirza Khurram Shahzad, 58, lost his job as an air conditioning engineer in Islamabad five years ago, he sat at home for five months, sending out his resume in the hope of finding a new job. When he heard nothing back, he turned to ride hailing. “I realized that driving is also a skill, and I needed money, so I became a Careem driver,” he told Rest of World.

Since becoming a driver in 2019, Shahzad has settled into a routine. He starts work at 8 a.m., dropping off a doctor who lives in his neighborhood to the hospital where she works. Then he switches on the two ride-hailing apps on his phone — Careem and inDrive — and looks for passengers until 3 p.m. He then goes home. Working longer hours takes a toll on his body. “I don’t want to overexert,” he said. “I’ve developed hemorrhoids because of sitting for long periods of time; sometimes I have gas trouble and stomach aches.”

The nature of gig work — particularly driving, which involves sitting still for hours at a time — puts workers at risk of health conditions including back pain, joint pain, and hemorrhoids. It can also exacerbate existing health conditions and injuries. Older gig workers, who also have to contend with age-related health issues, are particularly impacted.

Escalating inflation, rising poverty levels, and widespread unemployment in Pakistan have prompted the country’s older population — including retirees and people made redundant by other industries — to enter the gig workforce. The Centre for Labour Research, an organization based in Rawalpindi, conducts research and annual surveys on platform work, in conjunction with research partner Fairwork. In its 2022 and 2023 surveys, at least 25% of the gig workers interviewed were above the age of 40 years. Researchers with the organization told Rest of World this number has likely increased since then. “In the last year, inflation has crossed 50%, compelling many to find work wherever it is easier,” said Iftikhar Ahmad, the Centre’s founder. “And we all know that access to gig work is relatively easier.”

According to Jennifer Cole, a biological anthropologist at Royal Holloway, University of London, the mid-fifties is when non-communicable diseases, such as cancer, heart disease, and hypertension, begin to surface. “It’s an age where, particularly if you haven’t got good health insurance, your requirement for health care starts to increase quite dramatically,” she told Rest of World. “The poorer you’ve been, the worse your health is going to be. And that would include people who’ve been doing manual jobs, construction and agricultural workers, taxi drivers … Their bodies are literally starting to get worn out.”

Pakistan does not have universal health coverage. According to the World Health Organization, only 10% of the country’s population is eligible for various government and state-sponsored health-care and social security programs. As a result, older gig workers slip through the cracks, ineligible for government health benefits that only apply to full-time employees.

“The problem stems from the fact that gig workers aren’t recognized as employees; they’re independent contractors, and so they’re not eligible for state-mandated health care benefits, such as minimum wage protection, pension, social security, and accidental coverage,” Lahore-based labor and law expert Hiba Akbar told Rest of World. “Legally speaking, it’s a smokescreen — (their) employers don’t have to deal with legal obligations.”

Older gig workers in Pakistan who spoke with Rest of World reported a range of health-related issues — several of which, they said, were a consequence of their work. Basharat Buraak, 56, has been a Careem driver since 2017. He spends nearly 10 hours a day on the road, and is diabetic. “My symptoms have certainly been exacerbated by the nature of my work,” he said. “My feet feel numb, I’m exhausted by the time I get home. I don’t drink enough water because I can’t keep stopping to go to the toilet.”

Given their precarious employment, older drivers struggle to get the health care they need. Kamran Sabir, 67, became a Careem driver about three years ago after retiring from his job as an accountant — his pension wasn’t enough to sustain him. After hours of driving every day, he told Rest of Worldhis joints ache, and he massages them with mustard oil. “Sometimes I wake up in the middle of the night and my hands feel numb,” he said.

“I’m exhausted by the time I get home; I don’t drink enough water because I can’t keep stopping to go to the toilet.”

Saeedullah Khan, 62, is a taxi-driver turned gig worker in Karachi who works for ride-hailing platforms Careem and inDrive. He has been trying to save money to get a knee replacement surgery, which he says he needs because of the number of hours he has spent driving on Karachi’s chaotic streets. In addition to aching joints, Khan said he routinely suffers from headaches and rarely gets more than seven hours of sleep at night. Still, he said he will continue to work: “I don’t really have a choice, I have to support my family of six.”

Older gig workers are increasingly finding themselves plagued by health concerns, from lower back and elbow pain to work stress and reduced cognitive function, Asadullah Memon, general secretary of the Pakistan Workers’ Federation, told Rest of World.

One studypublished in 2022, found that out of 268 ride hailing drivers between the ages of 20 to 55 interviewed in Lahore, 38.4% reported pain in their inner elbow, a condition commonly associated with driving for long hours. Muhammad Azam, a UAE-based physiotherapist and the primary author of the study, told Rest of World that the older workers interviewed were “more prone” to elbow and joint pain, as well as numbness.

While ride-hailing platforms Careem and inDrive provide in-ride accidental insurance, these programs do not extend to medical coverage for drivers when they are not on the clock. Careem and inDrive did not respond to a request for comment.

A number of social security programs exist in Pakistan that could help older workers, but ride-hailing drivers are excluded from them because they are informal workers, according to Akbar, the labor academic. These programs range from social security provisions to the Workers Welfare Fund, which gives access to a range of funds and grants.

According to the International Labour OrganizationPakistan’s informal economy accounts for 71.7% of employment in jobs outside agriculture, including transport, construction, and manufacturing.

12.5 million The number of people in Pakistan over the age of 60.

Pakistan is among the world’s youngest countries, with two-thirds of its population of 220 million under 30 years. But there is also a growing number of people aged over 60 — nearly 12.5 million, according to a 2019 report published by the British Council and HelpAge International. The report estimates that there will be more than 40 million older people in the country by 2050, representing 16% of the total population.

“There are no (government) institutions protecting (aging) ride-hailing drivers. A limited company employee would get access to these privileges,” Khuwaja Umar, a former gig driver-turned-labor organizer from Karachi, told Rest of World. “People usually enter this field because of desperation, not out of choice.”

There have been some attempts at legislation to bring gig workers into the fold of state social security nets. The Pakistan Peoples Party (PPP) claimed it would introduce legislation for the social protection of digital platform workers in its 2024 election manifesto, stating that it would extend social security coverage under the Workers Welfare Fund and Employees’ Old-Age Benefit Institution to gig workers. The party won a majority in Pakistan’s Sindh province, and is currently part of Pakistan’s coalition government.  The PPP did not respond to a request for comment.

“People usually enter this field because of desperation, not out of choice.”

Amjad Ali Khan, 53, began driving for ride hailing platform inDrive about a year ago, when his job in real estate didn’t allow him to make ends meet. “(Construction materials) became really expensive and the demand for housing went down, so now I drive for ride hailing platforms to earn a living,” he told Rest of Worldon the phone from Islamabad.

Khan said he has only been able to earn 4,000 Pakistani rupees ($14) in March, hovering just above the national poverty line of 3,030 rupees ($11) per month. But he is not eligible for financial assistance through the federally operated Benazir Income Support Programme, meant for “formally employed” workers earning below 35,000 ($126). Last month, the program doled out relief packages containing rice, flour, and grain to workers nationwide — Khan said that he went to the local distribution point, but was sent back home empty-handed. “They told me my name wasn’t on their list because I am an informal worker,” he said. Now, he is debating trading in his car for a cheaper model to help with finances.

Being on the roads for 10 hours a day, nearly every day, has taken a toll on Khan’s health. He is often exhausted. “I find myself wobbling on my feet when I get out of my car after a day’s shift,” he said. “This kind of work requires that you look at your phone constantly, but also pay attention to passengers making bids. My eyes hurt and I get frequent headaches. My neck also hurts.”


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