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Key Labor Market Indicators Analysis With Household Survey Data 1St Edition Ina Pietschmann Online Ebook Texxtbook Full Chapter PDF
Key Labor Market Indicators Analysis With Household Survey Data 1St Edition Ina Pietschmann Online Ebook Texxtbook Full Chapter PDF
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Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Copyright © 2016. World Bank Publications. All rights reserved.
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Key Labor Market
Indicators
Copyright © 2016. World Bank Publications. All rights reserved.
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
OTHER TITLES IN THE ADePT SERIES
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
STREAMLINED ANALYSIS WITH ADePT SOFTWARE
Ina Pietschmann
Steven Kapsos
Evangelia Bourmpoula
Zurab Sajaia
Michael Lokshin
Copyright © 2016. World Bank Publications. All rights reserved.
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
© 2016 International Labour Organization
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Attribution—Please cite the work as follows: Pietschmann, Ina, Steven Kapsos, Evangelia Bourmpoula, Zurab Sajaia, and
Michael Lokshin. 2016. Key Labor Market Indicators: Analysis with Household Survey Data. Streamlined Analysis with ADePT
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ISBN (paper): 978-1-4648-0784-8
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DOI: 10.1596/978-1-4648-0784-8
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Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Contents
Acknowledgments................................................................................... xiii
Abbreviations ............................................................................................ xv
Chapter 1
Introduction ................................................................................................ 1
Plan of the Book..................................................................................................1
What Is the Purpose of Labor Market Analysis and a
Labor Market Information System? ..................................................................2
How Does the ADePT-LMI Module Contribute to LMIA Systems? ................6
Notes....................................................................................................................6
Reference .............................................................................................................7
Copyright © 2016. World Bank Publications. All rights reserved.
Chapter 2
Concepts and Definitions .......................................................................... 9
Introduction ........................................................................................................9
Underlying Concepts of the ADePT-LMI Module ..........................................10
Labor Force Framework .....................................................................................11
Individual Variable Concepts ...........................................................................27
Notes..................................................................................................................28
References..........................................................................................................29
Further Reading .................................................................................................31
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Contents
Chapter 3
Analyzing Labor Statistics with the ADePT-LMI Module ..................... 33
Introduction ......................................................................................................33
Output Information Tables ...............................................................................34
Data Output Tables ...........................................................................................37
Final Remarks ..................................................................................................115
Notes................................................................................................................116
References........................................................................................................118
Further Reading ...............................................................................................120
Chapter 4
Software User Guide.............................................................................. 123
Introduction ....................................................................................................123
Using the ADePT-LMI Module for Labor Market Information and
Analysis .........................................................................................................123
Understanding the Data..................................................................................124
Create Input File .............................................................................................126
Load Input File into ADePT........................................................................... 154
Assign the Variables from the Input File to the Relevant Fields ...................156
Choose Tables and Specify Table Option .......................................................158
Generate Tables ...............................................................................................161
Save Projects ...................................................................................................161
Notes................................................................................................................162
References........................................................................................................163
Further Reading ...............................................................................................164
Chapter 5
Getting Started with ADePT.................................................................. 165
Copyright © 2016. World Bank Publications. All rights reserved.
Introduction ....................................................................................................165
Installing ADePT ............................................................................................166
Launching ADePT ..........................................................................................166
Overview of the Analysis Procedure............................................................... 168
Specify Datasets ...............................................................................................169
Map Variables ..................................................................................................171
Select Tables and Graphs ................................................................................173
Generate the Report .......................................................................................175
Examine the Output........................................................................................176
Working with Variables...................................................................................177
vi
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Contents
Boxes
Figures
vii
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Contents
Screenshots
viii
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Contents
ix
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Contents
3.59: Table 44: Working Poor and Share of Working Poor in Total
Employment by Sex and Region, Mongolia, 2008 ..............................105
3.60: Table 45: Working Poor and Share of Working Poor
in Total Employment by Status in Employment and Sex,
Mongolia, 2008 .....................................................................................106
3.61: Table 46: Working Poor and Share of Working Poor in Total
Employment by Sector and Sex, Mongolia, 2002 ...............................107
3.62: Table 47: Working Poor and Share of Working Poor in Total
Employment by Education Completed and Sex, Mongolia, 2008 ......108
3.63: Table 48: Working Poor by Hours of Work per Week and by Sex,
Mongolia, 2008 .....................................................................................109
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Contents
Tables
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xi
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Copyright © 2016. World Bank Publications. All rights reserved.
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Acknowledgments
This book, and the ADePT software module that accompanies the book, is
the result of collaboration between the International Labour Organization
(ILO) and the World Bank. The authors are grateful to Rosina Gammarano,
Francisco Guerreiro, Richard Horne, Phu Huynh, Kee Beom Kim, Devora
Levakova, Akiko Minowa, Yves Perardel, Marie-Claire Sodergren, Theo
Sparreboom, and Christian Viegelahn for key inputs and assistance through-
out the process of developing the software module and producing the
manuscript.
The authors thank Lynne Butler, Antonio Junior Indart, Owais Parray,
and Roberto Pes for organizing a training session on the ADePT ILO Labor
Market Indicators Module in Dili, Timor-Leste, and Makiko Matsumoto
Copyright © 2016. World Bank Publications. All rights reserved.
xiii
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Copyright © 2016. World Bank Publications. All rights reserved.
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Abbreviations
xv
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Abbreviations
xvi
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Chapter 1
Introduction
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Key Labor Market Indicators: Analysis with Household Survey Data
Labor market
Labor
Statistics information
statistics
and analysis
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Chapter 1: Introduction
the balance of labor demand and supply, the current labor market situation
(stock), and developments (trends) over time. An LMIA system also identi-
fies priority issues and target groups in the labor market to evaluate and help
formulate appropriate policies.
There are various sources of labor statistics: (a) censuses and surveys of
households (“persons”), such as population censuses, labor force surveys
(LFSs), and household income and expenditure surveys (HIESs); (b) surveys
of establishments (“companies”), such as establishment surveys, employ-
ment and earnings surveys, and occupational employment and vacancy
surveys; and (c) administrative data (“records”), such as educational
enrollment data, migration records, and employment services records. As
table 1.1 shows in detail, each source of information has strengths and
limitations. Taking these into consideration, a fully developed LMIA sys-
tem incorporates information from a variety of sources. For example, from
an establishment survey one can easily surmise where the vacancies in the
labor market are (which sectors, which occupations, etc.). But only from
a household survey can one identify which subcategory of the population
might be interested and has the right skills to fill those vacancies.
Information
sources Strengths Limitations
Household – Comprehensive coverage of – Sampling prevents reliable estimates
surveys population for small groups
– Detailed questioning permits precise – Lower quality of data on sensitive,
measurement of statistical concepts income-, and employer-related topics
for short reference periods – Cannot provide estimates of
Copyright © 2016. World Bank Publications. All rights reserved.
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Key Labor Market Indicators: Analysis with Household Survey Data
The strengths and limitations of the various statistical sources imply that
there is no single data source that can meet all needs in an LMIA system.
Therefore, it is crucial to use all available information sources and to under-
stand the strengths and limitations of different types of surveys and other
data sources.
LMIA systems have three main functions (figure 1.2):
Function 2 Function 3
Function 1
Monitoring and reporting on Information exchange and
Labor market analysis
policies coordination
Component 1 Component 3
Component 2
Collection and Institutional
Analytical
compilation of data arrangements and
capacity and tools
and information networks
Copyright © 2016. World Bank Publications. All rights reserved.
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Chapter 1: Introduction
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Key Labor Market Indicators: Analysis with Household Survey Data
Notes
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Chapter 1: Introduction
Reference
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Copyright © 2016. World Bank Publications. All rights reserved.
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Chapter 2
Introduction
Labor market information (LMI) produced with the ADePT ILO Labor
Market Indicators Module measures characteristics of the population and
labor force; the quantity, structure, and quality of employment; the extent
of labor underutilization; and the extent of poverty among workers, among
others.
This chapter provides an overview of core concepts and definitions
of the variables used as inputs into the module, and the indicators pro-
duced in output tables. A sound understanding of the underlying concepts
and standards is the precondition for correctly using ADePT to produce
information from household surveys, and for correctly interpreting the
ADePT tables.
All information in the following sections corresponds to international
Copyright © 2016. World Bank Publications. All rights reserved.
statistical standards. The labor statistics concepts were adopted during ses-
sions of the International Conference of Labour Statisticians (ICLS), which
is convened every five years by the Governing Body of the International
Labour Organization (ILO).
Over the years, the ILO has developed a number of analytical
and research instruments and tools that apply the adopted labor standards,
such as the ILO Key Indicators of the Labour Market (KILM; ILO 2013b),
the ILO Decent Work Indicators (ILO 2012), and the ILOSTAT database.1
This chapter draws heavily from these databases and related publications.
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Key Labor Market Indicators: Analysis with Household Survey Data
This section presents the standard definitions used for the key underly-
ing concepts of the ADePT-LMI module, as well as relevant explanations
related to these concepts. Some of the main underlying concepts of the
ADePT-LMI module refer to households, while others refer to individuals.
Both are included in this section.
In order to use and accurately interpret the tables obtained through the
ADePT-LMI module, it is important to understand the main underlying
concepts, beginning with a description of the household variable concepts.
Welfare Aggregate
als who are likely to benefit from or be adversely affected by different poli-
cies or programs, such as social protection schemes, taxes, or subsidies.
In the context of the ADePT-LMI module, welfare aggregates typically
refer to monthly household consumption per capita, measured in local cur-
rency units (Deaton and Zaidi 2002).
Poverty Line
The binary variable Poverty line displays the minimum level of consump-
tion or income deemed necessary to achieve an adequate standard of living
in a given country. National poverty lines are thresholds defined at the
10
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Chapter 2: Concepts and Definitions
The backbone of labor statistics and their analysis is the labor force frame-
work, which splits the population into categories that thereafter can be
examined in more detail.
Copyright © 2016. World Bank Publications. All rights reserved.
Working-Age Population
The population can be divided into populations below and above the work-
ing age. The minimum age limit for defining the working age varies among
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Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Key Labor Market Indicators: Analysis with Household Survey Data
Labor Force
The labor force comprises the employed and the unemployed, while
the remainder of the working-age population is outside the labor force
(figure 2.1).
Employment
According to the resolution adopted by the 19th ICLS (ILO 2013c), the
concept of work comprises any activity performed by persons of any sex and
Copyright © 2016. World Bank Publications. All rights reserved.
age to produce goods or to provide services for use by others or for own use.
This concept is aligned with the general production boundary as defined in
the System of National Accounts (SNA) 2008 (SNA 2008).2 Five mutually
exclusive forms of work are identified for separate measurement, as follows:
12
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Chapter 2: Concepts and Definitions
Population
Employed Unemployed
the following:
• Employed persons “at work,” that is, who worked in a job for at least
one hour during the reference period
• Employed persons “not at work” during the reference period
due to temporary absence from a job or to working time arrange-
ments (such as shift work, flextime, and compensatory leave for
overtime).
13
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Key Labor Market Indicators: Analysis with Household Survey Data
Unemployment
14
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Chapter 2: Concepts and Definitions
and (a) carried out activities to “seek employment,” although they were not
“currently available” but would become available within a short subsequent
period established in the light of national circumstances (i.e., unavailable
jobseekers); or (b) did not carry out activities to “seek employment” but
wanted employment and were “currently available” (i.e., available potential
jobseekers).
Among those who did not carry out activities to seek employment,
it may be useful to categorize “discouraged jobseekers,” comprising those
who did not seek employment for labor market reasons. These reasons may
include past failure to find a suitable job; lack of experience, qualifications,
or jobs matching the person’s skills; lack of jobs in the area; and considered
too young or too old by prospective employers.
Unemployment Concepts
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Duration of Unemployment
15
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Key Labor Market Indicators: Analysis with Household Survey Data
Employment Concepts
Status in Employment
16
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Chapter 2: Concepts and Definitions
• Employees are all those workers who hold “paid employment jobs,”
where the incumbents hold explicit (written or oral) or implicit
employment contracts that give them a basic remuneration that
is not directly dependent upon the revenue of the unit for which
they work.
• Employers are those workers who, working on their own account
or with one or a few partners, hold “self-employment jobs” (i.e.,
jobs where the remuneration is directly dependent upon the profits
derived from the goods and services produced), and, in this capacity,
have engaged, on a continuous basis, one or more persons to work for
them as employee(s).
• Own-account workers are those workers who, working on their own
account or with one or more partners, hold “self-employment jobs”
and have not engaged on a continuous basis any employees.
• Members of producers’ cooperatives are workers who hold “self-
employment jobs” in a cooperative producing goods and services.
• Contributing family workers are those workers who hold “self-
employment jobs” as own-account workers in a market-oriented
establishment operated by a related person living in the same
household.
• Workers not classifiable by status include those for whom insufficient
relevant information is available or who cannot be included in any
of the preceding categories.
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Occupation
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Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Key Labor Market Indicators: Analysis with Household Survey Data
1. Managers
2. Professionals
3. Technicians and associate professionals
4. Clerical support workers
5. Service and sales workers
6. Skilled agricultural, forestry and fishery workers
7. Craft and related trades workers
8. Plant and machine operators and assemblers
9. Elementary occupations
10. Armed forces occupations
X. Not elsewhere classified.
of detail.
18
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Chapter 2: Concepts and Definitions
market segregated? Are men and women distributed equally across sectors,
or are they concentrated in certain sectors? How does segregation correlate
with other labor market outcomes?
Based on the most recent revision (Revision 4, 2008) of the International
Standard Industrial Classification of All Economic Activities (ISIC)8 there
are 21 major sectors (categories). These sectors are further disaggregated
into divisions, groups, and classes.
Sectors of ISIC Revision 4 are:
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Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Key Labor Market Indicators: Analysis with Household Survey Data
countries should fully reflect the structure of the national labor market and
information needs for nationally relevant purposes.
A Broad sector variable is also a categorical variable that derives from the
sector of economic activity variable. It aims to capture the more aggregate
categories of economic activity where employed people are found. The most
common broad sectoral categories are agriculture, industry, and services.
Information on employment by broad economic activity can be very useful for
comparisons across countries and for broad structural shifts in the economy.
The main activities under the agricultural sector are agriculture, hunt-
ing, forestry, and fishing (category A in ISIC 4), and the industry sector
comprises mining and quarrying, manufacturing, construction, and public
utilities (electricity, gas, steam, and air conditioning supply and water sup-
ply; sewerage, waste management, and remediation activities). Based on
ISIC 4, this means that industry includes categories B to F. Finally, the
services sector consists of wholesale and retail trade; restaurants and hotels;
transport, storage, and communications; finance, insurance, real estate and
business services; health and education; arts; and community, social, and
personal services. Based on ISIC 4, the broad sectoral category for services
includes categories G to U (KILM 4).
The variable Public sector employment captures the number and share of
people working in the public sector. The public sector refers to the general
government sector as defined in the SNA plus any resident, publicly owned
enterprises and companies operating at central, state (or regional), and
local levels of government.9 A person who is employed directly by those
Copyright © 2016. World Bank Publications. All rights reserved.
Type of Contract
The variable Type of contract captures the type of employment contract held
by workers, which is intended to provide insights into the legal relationship
20
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Chapter 2: Concepts and Definitions
Earnings
21
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Key Labor Market Indicators: Analysis with Household Survey Data
Hours of Work
A. Hours actually worked, the key concept of working time defined for
Copyright © 2016. World Bank Publications. All rights reserved.
22
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Chapter 2: Concepts and Definitions
The resolution also provides definitions for two concepts of working time
arrangements that describe the working time in a job, namely the organiza-
tion and scheduling of working time, regardless of type of job, and formalized
working time arrangements that comprise specific combinations of those
characteristics and that have legal recognition.
Hours “usually worked” per week identifies the most common weekly work-
ing schedule of a person in employment over a selected period. The internation-
ally agreed statistical definition of usual hours of work refers to the hours worked
in any job during a typical short period such as one week. The definition is
applicable to all types of jobs, even those for which the worker does not possess
a working contract (e.g., in small-scale or family enterprises and self-employed
workers). Hours usually worked includes overtime that occurs systematically
every day or week and excludes time not worked on a usual basis. This measure
is not affected by unusual absence or by irregular or unusual overtime, whether
worked for premium pay, regular pay, or without compensation (ILO 2013b).
For some countries, data are available only according to hours actually
worked. This measure includes time spent at the workplace on productive
activities (“direct hours”) and on other activities that are part of the tasks
and duties of the job concerned (“related hours”). The latter can include, for
example, cleaning and preparing working tools and certain on-call duties.
The concept also includes time spent at the place of work when the person
is inactive for reasons linked to the production process or work organization
(“down time”), since during these periods paid workers, for example, still
remain at the disposal of their employer, while the self-employed may con-
tinue working on other tasks and duties. Hours actually worked also includes
“resting time,” or short rest periods spent at the place of work since they
are necessary for human beings and because they are difficult to distinguish
Copyright © 2016. World Bank Publications. All rights reserved.
separately (even if paid workers, for example, are not “at the disposal” of their
employer during those periods). Explicitly excluded are lunch breaks if no
work is performed, since they are normally sufficiently long to be easily dis-
tinguished from work periods. The international definition relates to all types
of workers, whether in salaried or self-employment, paid, or unpaid work, and
carried out in any location, including the street, field, or home (KILM 7).
The variable Willing to work more hours is important when combined with
the Hours of work variable because it can produce estimates of Time-related
23
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Key Labor Market Indicators: Analysis with Household Survey Data
Time-Related Underemployment
(or jobs), (b) available to work additional hours, and (c) worked less than a
threshold relating to working time.
Secondary Employment
24
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Chapter 2: Concepts and Definitions
ees, with principal activities including the negotiation of rates of pay and
conditions of employment for its members. Excluded from the definition are
nonoperating unions or branches, that is, those that have no members at the
time the data are being collected.
Trade union membership connects to one of the Decent Work Indicators
related to social dialogue, aims to reflect freedom of association, and is at the
core of the fundamental principles and rights at work.
Trade union concepts differ largely between countries and over time and
often refer to national legislation such as labor codes or trade union acts
used for union registration. These definitions might have changed over time
in line with new laws or regulations adopted in this field.
25
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Key Labor Market Indicators: Analysis with Household Survey Data
Working Poverty
number and proportion of the working poor. Countries use different meth-
ods. For example, surveys on household consumption expenditure or, in
some cases, household income can provide information on household con-
sumption expenditure. However, household consumption data are usually
preferred since they tend to be more reliable and give a better reflection of
the real current living standards of households. A level of household con-
sumption expenditure (or income) is then set, below which the person or
household is considered to be poor.
Since this indicator requires a cross-tabulation of employment and pov-
erty status on the basis of household survey data, both sets of information
26
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
Chapter 2: Concepts and Definitions
must be derived from the same source (typically household income and
expenditure surveys [HIESs] or living standards surveys [LSSs]). However,
as these surveys often do not have probing questions related to employment
as in a typical labor force survey (LFS), the employment data derived in
the cross-tabulation should be compared with other survey- or census-based
estimates of employment to identify potential biases in the estimates. If large
differences are observed, working poverty rates derived from an HIES can be
applied to employment estimates from an LFS to obtain an estimate of the
total number of working poor in a country.
Enrollment
Educational Attainment
27
Pietschmann, Ina, et al. Key Labor Market Indicators : Analysis with Household Survey Data, World Bank Publications, 2016. ProQuest Ebook Central,
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much how to cure cancer—so much can, and is being constantly
done by one method or another—but how to educate people so that
we can get hold of cancer early. The problem is one of diagnosis,
and is therefore to be solved by education and courage, not by
hesitation and fear.
No statement of the cancer problem would be complete without
some mention of two methods of treatment which have recently
come much to the fore: namely, the use of X-rays and of radium.
To give any really useful account of these is very difficult, as no
really satisfactory groups of cases have been published, and one
can only speak from one’s own experience and that of colleagues
who have been working with them.
The action of both these methods of treatment is in essence the
same. It has been found that X-rays and radium have the power of
destroying living tissue when such is exposed to their action for
varying lengths of time. Fortunately, cancerous tissue is destroyed
before normal healthy tissue, and it is the aim of the treatment to
expose the growth to that dosage of rays which will kill the malignant
tissue but just fall short of doing harm to the normal tissue.
Sometimes this is more easily done with X-rays and sometimes with
radium; it all depends on the position of the growth. This all sounds
very attractive, and one would think that, on the surface of things,
with such a weapon at our disposal, every case could easily be
efficiently dealt with. But, like many other superficially attractive
things, it is found on further examination to have its drawbacks.
Although a proper dose of X-rays will kill cancer tissue, a smaller
dose will stimulate it to further action. Further, these rays have,
comparatively speaking, a very low penetrating power. They are
absorbed and rendered inactive by thin layers of metal, of skin or of
other tissue.
Now, as has already been explained, a malignant growth, as well
as extending superficially, tends to spread very deeply and also to
involve neighbouring structures, and when X-rays or radium are
applied to it, we find that in some cases it will deal with the more
superficial parts of the growth but leave the deeper parts untouched,
or even more active than before. All kinds of methods have been
tried to get over this, such as burying radium in the substance of the
growth, and using very big doses, applied to various aspects of the
growth, but, so far, although there have been some very encouraging
results, the problem has not been solved.
As has been said, it is extremely difficult to estimate the exact
value of this treatment, as no figures are of any value till seven years
at least have elapsed after treatment, and no such figures have been
published. There can be no doubt, however, that an occasional case
has been cured, but it is the experience of all that the results of
radium treatment do not approximate in any way to the percentage
of cures obtained by surgery, even in those types of cancer which
react best to X-rays or radium.
Dr Knox, of the Cancer Hospital, London, who has had much
experience of high tension X-rays, says that the treatment of
malignant disease by X-rays has not yet reached that stage where it
ought to be given to any operable case instead of an operation. I
think this opinion may be regarded as an authoritative statement of
the situation as it is at present.
This is not all, however; X-rays and radium have a very important
place in the treatment of cancer, and as far as we can see at
present, the future hope lies in a judicious combination of one or the
other of these with surgery, for early operable cases, and their
prolonged and intensive use in those advanced cases which cannot
be removed by other means. A few advanced cases have even been
rendered operable by this means.
In combination with surgery this method has its very greatest use
in the prevention of superficial recurrences. In every operation, in
spite of the greatest care, it is impossible to avoid the setting free
into the tissues of a few cancer cells which may grow later into a
recurrence. Post-operative radiation bids fair to abolish this type of
recurrence, which formerly accounted for a good percentage of all
recurrences.
From time to time many methods have been brought forward
which have for a little while promised well, but so far none of them
has produced results in any way comparable with those obtained by
complete removal of the growth by surgical means.
I have not dealt with these in any detail here because, whether
ultimately we use drugs, surgery, violet leaves or any of the recently
popularised methods of “taking thought” to cure the disease, the
main point of my thesis will still hold good, and that is, that by far the
most important factor in the cure of the disease is that of early
diagnosis. This lies in the hands of the public far more than in those
of the medical profession. If the public want early diagnosis they will
get it, when they insist on it, just as they get anything else they insist
on, from self-government to prohibition, no matter how good or bad it
may be for them.
Briefly stated, most cases of early cancer are curable, and the
diagnosis of early cancer is only to be made by looking instead of
waiting. On these facts, certain constructive proposals can be based.
They are so simple that they are not likely to be heeded for some
time to come, for the public has always preferred Abana and
Pharpar, rivers of Damascus, to washing in Jordan, and I suppose
always will do, till we reach a more enlightened age.
Nevertheless I believe it is true, and without exaggeration, to say
that about ninety per cent. of all cases could be cured or prevented if
the following statements were accepted.
If all persons over forty years of age were routinely examined once
every six months to see that they had not cancer, or a precancerous
condition, and if these when found were promptly dealt with, then
cancers of the rectum, tongue, lip, breast, skin and uterus would
cease to be the plagues they are at present.
Similarly, if every patient who had taken more than a pound of
bismuth to relieve gastric pain were routinely explored to see that
cancer or gastric ulcer did not exist, the large majority of growths in
this region would be either prevented or cured. Similar rules can
easily be devised to deal with cancers arising in other parts. What is
wanted is a change of attitude on the part of everyone concerned.
After all, a fortnight in bed, with forty-eight hours of discomfort, is not
too great a price to pay for freedom from this disease, and, with
proper examination, even this would be unnecessary in most cases.
Every intelligent person is aware that, in order to ensure freedom
from dental disease, it is necessary to have his teeth examined
every six months, and to have small lesions dealt with in their very
early stages. All have come to this conclusion because they know
that neglected dental disease means pain; and they now look to see
that their teeth are normal, instead of waiting for a toothache to
come. It is true that there are still some of our weaker brethren who
still wait till they get toothache before they visit the dentist; and for
them there is nothing to be done. In the same way, if we wait for the
advanced signs of cancer to develop, the position with regard to its
cure will remain approximately what it is to-day.
The education of the public up to this pitch is by no means an
impracticable proposal. The position with regard to appendicitis is
very much the same as that of cancer. What has been done in the
case of appendicitis? The mortality is in proportion to the number of
hours during which the disease has existed. Twenty years ago
appendicitis was responsible for a large number of deaths. During
1919 and 1920 there was, in a large London General Hospital, only
one death from appendicitis, and yet there were at least 5 cases
dealt with every week. This improvement is entirely the result of
education of the public and their doctors. They know that to be cured
operation must be early, and so we no longer wait to see whether the
patient is going to die; if we suspect it, we look and see whether it is
present or not. True, we remove unnecessarily a fair number of
appendixes but, by so doing, we purchase, for a much larger number
of people, immunity from death by this disease. When exactly the
same principle is applied to cancer we shall be in a position to be a
great deal more satisfied than we are at present.
One of the most successful ways of treating a patient with fixed
ideas is by the use of explanation combined with strong counter-
suggestion. This is the method of psycho-analysis and hypnotism.
No patient is more susceptible to this kind of treatment than that
capricious lady, Public Opinion. If we want to realise the ideals put
forward in the early part of this essay, we must mobilise all our
resources: the Press; the Platform; the Consulting Room: for a
prolonged and intensive campaign against this black spot on our
civilization.
TO-DAY AND TO-MORROW
DAEDALUS: or Science and the Future
By J. B. S. Haldane. 5th imp.
ICARUS: or The Future of Science
By Hon. Bertrand Russell, F.R.S. 3rd imp.
THE MONGOL IN OUR MIDST
By F. G. Crookshank, M.D.
WIRELESS POSSIBILITIES
By Prof. A. M. Low
NARCISSUS: or The Anatomy of Clothes
By Gerald Heard
TANTALUS: or The Future of Man
By Dr F. C. S. Schiller
THE PASSING OF THE PHANTOMS
By Prof. C. J. Patten
PERSEUS: of Dragons
By H. F. Scott Stokes
LYSISTRATA: Woman’s Future and Future Woman
By A. M. Ludovici
CALLINICUS: a Defence of Chemical Warfare
By J. B. S. Haldane
QUO VADIMUS?: Glimpses of the Future
By E. E. Fournier d’Albe
THE CONQUEST OF CANCER
By H. W. S. Wright, M.S., F.R.C.S.
WHAT I BELIEVE
By Hon. Bertrand Russell, F.R.S.
THE FUTURE OF SEX
By Rebecca West
THE EVOCATION OF GENIUS
By Alan Porter
HYPATIA; or Woman and Knowledge
By Dora Russell (Hon. Mrs Bertrand Russell)
ÆSCULAPIUS: or Disease and The Man
By F. G. Crookshank, M.D.
Transcriber’s Notes:
Punctuation and spelling inaccuracies were silently
corrected.
Archaic and variable spelling has been preserved.
Variations in hyphenation and compound words have been
preserved.
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