A/HRC/20/15 unacceptable. In these circumstances, the right to health requires that workers, at all times, retain the right to refuse dangerous or unsafe work without fear of losing their job. 44. The duty of States to minimize hazards in the workplace includes both physical and psychosocial hazards. There is a growing body of evidence linking psychosocial hazards, such as stress and work overload, with psychological disorders such as anxiety, depression and burnout,45 and physical conditions such as cardiovascular disease, musculoskeletal disorders, gastro-intestinal disorders and impaired immune competence.46 Ongoing reports linking high rates of attempted and completed suicide amongst workers in the technology industry with requirements to work extremely long hours are of particular concern. B. Services 45. The right to health further requires that occupational health services are available, accessible, acceptable and of good quality. These services must be tailored to the needs of workers. For example, services must be made available at easily accessible locations and during hours that accommodate workers schedules; they must include the rehabilitation of affected individuals back into the workplace; health workers must be aware of the specific health risks faced by workers, and they must be trained to detect, prevent and treat occupational diseases. The ILO Occupational Health Services Convention No. 161 also states that occupational health services are essential to maintaining a safe and healthy working environment in order to facilitate optimal physical and mental health, and to adapting work to the capabilities of workers in the light of their health. 46. The obligation to ensure access to occupational health services may be met through the direct provision of services by the State or through social health insurance that covers all workers against occupational diseases and injuries. In most cases, social health insurance must be provided by the employer. Where this not possible, States must provide direct coverage or subsidize the purchase of private insurance based upon the economic needs of each worker. In all cases, insurance benefits must include preventative, promotive and curative health services, and must be tailored to address the specific occupational health risks faced by workers in their respective work sectors. C. Gender 47. With respect to all of the above, it is critical that a gendered perspective be adopted in the formulation and implementation of occupational health laws and policies. A genderbased approach recognizes that biological and socio-cultural factors play a significant role in influencing the health of men and women. The disaggregation of health and socioeconomic data according to sex is essential in the monitoring and evaluation of all occupational health laws and policies. 48. In many respects, women are particularly vulnerable to negative health impacts resulting from conditions of work. The majority of women who work are employed in the informal sector, particularly in the lowest paid, lowest skilled jobs, where they are more 45 46 Tom Cox, Amanda Griffiths and Eusebio Rial-González, Research on work related stress, European Agency for Safety and Health at Work (Luxembourg, Office for Official Publications of the European Communities, 2000); S. Stansfeld and B. Candy, “Psychosocial work environment and mental health – a meta-analytic review,” Scandinavian Journal of Work and Environmental Health, vol. 32, No. 6 (December 2006), pp. 443-462. Tom Cox, Amanda Griffiths and Eusebio Rial-González, Research on work related stress. 15