Abstract

Organizations cannot function without healthy and safe employees, a

stark reality evidenced by the COVID-19 pandemic in 2019-20: when
lives are threatened, everything else becomes secondary. Few would
question that there is a critical need to build HR-relevant knowledge
of how to manage the health and safety of employees. Despite the duty
of care carried by organizations and the fact that those who work
across national borders are a particularly vulnerable group, there is
surprisingly little discussion about their health and safety. We
examined the literature relevant to the health and safety of
international employees across four research disciplines. Our review of
180 papers found a growing yet fragmented field offering important
insights with implications for HRM. Our paper is intended as both a
review and a call for future advancement. We bring together disparate
but related research streams in order to understand what is known
about occupational health and safety related to working across
national borders and to outline a roadmap for future research and
practice.

Introduction
As an increasing number of organizations participate in the global
marketplace, more and more employees engage in work across
national borders (henceforth, international work). Employees who
engage in international work face unique demands and pressures and
are exposed to risks that make them more vulnerable to hazards
compared to those who work in a single location, with potentially
harmful consequences for their health and safety. There are different
types of stressors associated with different types of international work
(e.g., expectations of constant, including off-hours, availability of
members of virtual global teams, Lirio, 2017; busy travel schedules
with little time for recovery among international business travellers,
Mäkelä & Kinnunen, 2018; working in challenging or even dangerous
conditions in areas devastated by natural disasters or wars in the case
of aid and development workers; Fee & McGrath-Champ, 2017).
Although the majority of those who engage in international work
(henceforth, international employees) are unlikely to face life-
threatening situations, awareness of health and safety issues and the
various risks involved in their work has been heightened by recent
rising socio-political tensions worldwide (Chen, 2017) and events such
as the COVID-19 pandemic that began in 2019-2020, a disaster with
far-reaching implications for individuals, employers, communities,
and the global economy (Caligiuri, De Cieri, Minbaeva, Verbeke, &
Zimmermann, 2020).
As these brief examples illustrate, the context of international work is
volatile, uncertain, complex, and ambiguous (Teece, Peteraf, & Leih,
2016) and is a source of continuous challenges for human resource
management (HRM), given that employers carry the responsibility of
duty of care for their employees’ occupational health and safety
1

(OHS), and this responsibility falls within the scope of the HR function
(Gannon & Paraskevas, 2019). Despite its importance, the health and
safety of international employees remains an under-explored topic
within HR research. This is surprising, given that scholars in other
disciplines, particularly health sciences, have provided plentiful
evidence that international employees face various risks (e.g., travel-
related stress, deteriorating cardiovascular health, affective disorders,
mental health challenges, increased alcohol consumption; Chan,
Leung, & Liu, 2016; Fliege et al., 2016). With few notable exceptions
(e.g., Anderzén & Arnetz, 1997), this important body of knowledge has
been largely disregarded by HR scholars.
This paper brings together disparate and multidisciplinary research to
review and understand what is known about OHS among international
employees. We begin by briefly identifying the group of employees
who are the main focus of our review and explaining the importance of
addressing OHS issues from an HR perspective. We then outline the
aims and scope of our paper, describe our method and analyses, and
present our results. We distil several important research findings and
provide ideas for future research.

Section snippets

International work and types of employees we include in

our review
The focus of this paper is on international employees, or those who
engage in international work. International work involves engaging
with various organizational stakeholders (such as clients, suppliers,
business partners, or colleagues) across national borders in order to
perform one’s job. Features of this work range from increased
communication with non-domestic stakeholders to expatriation
(temporary relocation) or transfer (permanent relocation) of
employees and, in some cases, their

Occupational health and safety

The World Health Organization (WHO) defines a healthy workplace
as: “one in which workers and managers collaborate to use a continual
improvement process to protect and promote the health, safety and
well-being of all workers and the sustainability of the workplace…”
(World Health Organization (WHO, 2010, p.90). This definition,
widely viewed as the basis for OHS, encompasses: safety in the
physical work environment (e.g., physical hazards); physiological
health (e.g., risk of disease); health

The importance of addressing the health and safety of

international employees
Although there are no data available for the prevalence and/or costs of
work-related injuries and illness specifically among international
employees, the issue is well-documented for the general population of
employees so it is reasonable to assume that it is also a concern that
applies to international employees. According to the International
Labour Organization, 2.3 million people around the world experience
work-related injury or illness every year, with over 6000 work-related
deaths every

Aim, scope, and contributions of the paper

Responding to calls to include OHS in HR research (Guest, 2017), and
specifically in the case of international work (Collings et al., 2007), in
this paper we conduct a broad systematic review and content analysis
of the literature on the OHS of international employees. We consider
investigations that have examined multiple OHS stakeholders and
phenomena, across various levels of analysis, including: the external
context for OHS (e.g., health risks in a hostile location); organizational
context

Method
We searched seven databases that span several disciplines for English-
language articles published between January 1980 and December
2019. We chose 1980 as the starting point as it aligns with the rise of
the MNC and the upturn in international work and global mobility
(Tichy, 1988). Table 1 and Fig. 1 show the details of our literature
search. We used a broad range of search keywords such as HRM,
multinational corporation (MNC), expatriates, health, international
business travel, safety, and

OHS topics associated with international work

We identified a wide range of OHS topics relevant to international
work across the four research disciplines. As shown in Table 2, some
variables have been studied primarily as antecedents to OHS
outcomes in international employees (e.g., pre-existing health
conditions); other variables have been studied primarily as outcomes
of international work (e.g., anxiety). A few variables, such as jetlag,
have been studied in some contexts as antecedents (e.g., jetlag as an
antecedent of increased

Theoretical perspectives
Recognizing that there is a norm in disciplines such as Health to not
be explicit about theories being applied, our fourth research question
focused on the theories used in the remaining disciplines. This is
supported by our findings: there is a clear difference between
disciplines in terms of the application of theory. Overall, 69 (38%) of
the papers included in the review were explicitly informed by theory.
Thirty-nine papers in Management (63% in that research discipline),
18 papers (72%) in

Key findings and conclusions for HRM

We present the conclusions from conceptual work and findings from
empirical research organized into several major themes that emerged
from the literature. We start by focusing on the findings and
conclusions relevant to the individual; then move to proximal factors
in international work, including social and family factors; and then to
the contextual influences in the organization and external
environment.

Discussion
Globalization influences organizations in complex ways and
international work is part of life for many people worldwide. We
suggest that volatile and uncertain global events such as
environmental disasters, epidemic crises, or conflicts causing social
displacement, increase the responsibility for HR scholars and
managers to be well-informed about the OHS issues that impact on
international employees.
Our goal with this paper is to draw attention to this topic and provide
a broad review of

Conclusion
There is great potential for future HR research to develop a much
stronger understanding of OHS issues for international employees.
With this review, we have identified several OHS issues in work that
crosses national borders, from research across four research
disciplines, each of which provides unique insight on our topic of
interest. We hope that our paper will encourage exploration at the
interface between OHS and international work in order to advance
knowledge and build healthy and safe