A closer look at the health of platform workers

An army of workers around the world, some more visible than others, share a common model: they rely on apps that assign them tasks, algorithms that monitor their every move and clients who rate their performance. But why does this model jeopardise workers’ health and safety? And how can platform workers deal with it?

Hired with the impersonal click of a button, they are the final link in a business model that has managed to spread across and colonise nearly every sector – from transportation and food delivery to home cleaning, childcare, elderly care and a wide range of online work.

A legion of workers worldwide, some more visible than others, share the same model: they work for apps that assign them tasks, algorithms that monitor their every move and clients who rate their performance. Despite its promise of freedom and flexibility, this fragmented system has evolved into one that is competitive, over-monitored, precarious, and exhausting – and one which poses a serious threat to workers’ health.

“The impact on health is direct, especially for those whose income relies entirely on digital platforms,” says Nuria Matilla-Santander, an epidemiologist specialising in occupational health and part of the GIG-OSH project, which studies the health of platform workers across several European countries. Preliminary findings show that these workers experience higher rates of musculoskeletal pain, eye strain, headaches, and poorer mental health. The most common risks – whether they work on-site as drivers or delivery workers, or in front of a screen – are psychosocial: fatigue, stress, anxiety, and depression. These issues are primarily driven by the instability of their work and the low wages they receive.

“Wages are a major factor impacting their mental and physical health. Eight out of ten platform workers earn below the poverty line.”Nuria Matilla-Santander, an epidemiologist specialising in occupational health

This precariousness, within a highly competitive environment, forces workers to remain constantly connected to access more tasks, extend their working hours – which sometimes exceed 12 hours a day – and blur the boundaries between personal and professional life. “The digital precariat faces heightened risks when compared with the traditional precariat,” explains Henar Álvarez, professor of labour law at the University of León in Spain. “In addition to precariousness, there is added stress from having to be constantly available. All of this results in mental overload, self-imposed pressure, and conditions like technology anxiety and technology addiction.”

Neither flexibility nor freedom is straightforward in a system where workers are constantly under the control of an algorithm. If they reject a task, take longer than expected, or fail to meet the client’s expectations and receive a poor rating, the algorithm records it. Based on unclear criteria, it may penalise them by assigning worse shifts or fewer tasks. In some cases, it can even log them out, effectively expelling them from the app. This constant pressure leads to heightened stress, anxiety and fatigue.

“It’s a model based on constant coercion, confirms Nuria Soto of the Spanish collective Riders X Derechos. "You’re a number, not a person."

Between 1 and 3 per cent of the global workforce is currently exposed to these health risks, including an estimated 28 million people in Europe – a number expected to rise to 43 million in 2025 – even as it remains unclear who should protect them and how.

Protection for employees, but not the self-employed

Of the more than 500 digital labour platforms operating in Europe, 79 per cent do not employ contracted workers; instead, those at the end of the chain are classified as self-employed. Companies continue to justify this model by positioning themselves as mere intermediaries, though the judicial system has begun to challenge this. Courts have demonstrated in some cases that a true employment relationship exists – one in which workers are subject to control, organisation and pricing imposed by the platform.

The correct classification of workers as self-employed or employees is still being determined on a case-by-case basis in the courts. This has implications for workers’ health: platforms are only required to supervise safety, provide protective measures and offer training courses for their employees.

Freelancers, as Álvarez points out, have an “obligation and responsibility” to protect themselves.
In response, trade unions and collectives like Riders X Derechos are calling for the legal status of workers to be clarified as a first step toward ensuring their safety. “If you’re falsely classified as a self-employed worker, you face greater precariousness and increased health risks. The priority, therefore, is to determine the true nature of the employment relationship – not based on what the parties want, but on what the law dictates,” argues José Varela, head of digitalisation at UGT. “Health is directly tied to recognition of employment relationship,” adds Soto.

A new European Union Directive approved in 2024 takes a step forward in this regard. Following the example of Spain’s pioneering Riders’ Law, it establishes the presumption of employment in the platform economy. This means that workers will be considered employees by default, and it will be up to the companies to prove why they shouldn’t be. The Directive, welcomed by European trade unions, does leave the final decision to each individual state – each will set its own rules to determine whether or not the presumption applies, which could lead to uneven implementation.

However, even though many freelancers will be reclassified as employees and have their rights to a minimum wage, rest periods, health provisions and social protection recognised, the question remains: what will happen to those who are not? “The challenges associated with the self-employment status of platform workers will persist,” warns the European Agency for Safety and Health at Work. The Agency is particularly concerned about those working on-demand in sectors such as domestic work, caregiving and online tasks – especially those competing for simple microtasks, many related to artificial intelligence training. These workers, less visible than delivery drivers, are often more isolated, less organised, and face the same issues of exhaustion, stress, and job insecurity.

In addition, the hundreds of thousands of informal workers who aren’t even registered as self-employed remain unprotected. These workers are particularly prevalent in online jobs, the care sector and delivery – an activity that has become a gateway to the labour market for many undocumented migrants, who often rent out other riders’ accounts, remaining completely invisible.

Safety for everyone

To reduce the health gap between platform workers, some argue for extending protection to all of them, regardless of their contractual status. “No one opposes proper classification – this is the starting point. Everyone should be classified according to their status, whether they are a dependent worker or self-employed. But why is the health of the dependent worker considered more valuable than that of the self-employed? Shouldn’t fundamental rights, such as health, be universal?” asks María Luz Rodríguez, professor of labour law at the University of Castilla La Mancha in Spain and a consultant in platform economics.

When asked who should be responsible for providing these new protections, Rodríguez points unequivocally to the platforms: “They are the ones employing people and they are the ones who should ensure their health,” she explains. “The European Union may not have the authority, but individual countries do. This can be addressed through legislation.”

Rodríguez points to legislation that has made progress in this regard, including the 2016 El Khomri law in France, which, based on the concept of ‘social responsibility,’ requires platforms to provide accident insurance and recognise the right to training for their entire workforce.

Another option for improving working conditions and health, as she points out, is through collective bargaining – a tool that has, until now, been denied to the self-employed due to competition laws, a barrier that the new Directive also aims to address. There are already some examples, such as the agreement signed in Denmark between the translation service platform Voocali and the HK Privat union, which has established, among other things, a minimum wage for self-employed workers.

“Before, the unions weren’t even mentioned; now the Directive recognises us as essential social actors” José Varela, head of digitalisation at UGT

Beyond the European Union, on a global scale, trade unions are currently working towards a binding international standard (specifically, a Convention and Recommendation under the framework of the International Labour Organisation [ILO]) to clarify the relationship between platforms and the workers who create value for them. The right to associate and engage in collective bargaining, as well as, very importantly, the protection – for all platform workers – derived from the ILO’s conventions on occupational health and safety, are two of the priorities that the trade union movement wants to see included in this international instrument.

Is a healthier model possible?

There are currently no accident statistics for the platform sector – nor is there precise data on how many people work in it. However, according to the most recent annual report by Fairwork on the state of the global platform economy, this model “is still far from meeting the basic standards of decent work”.

The competition, pressure and race against the clock, in addition to psychosocial risks, can lead to carelessness, injuries or accidents, which, in the case of drivers or delivery workers, can be fatal. Similarly, the tyranny of the algorithm and the significant influence of customer ratings not only increase stress but also leave workers vulnerable to abuse, harassment and discrimination.

“There is an imbalance of power between clients and workers,” says Olivia Blanchard, a researcher on platform-based home care. “There have been reports of workers being assigned more tasks than agreed upon and clients who threaten to leave negative reviews.”

“Ratings are often biased,” adds Álvarez. “They are not neutral. For example, drivers may receive lower ratings simply because they are immigrants, or female delivery workers may be rated more harshly due to sexism. The algorithm only serves to amplify these biases.”

The management of algorithms is another key issue addressed by the European Directive, which will require platforms to be more transparent about how they operate and the criteria they use to rate workers. This is also one of the key demands from trade unions worldwide, to be included in the binding international standard set to be finalised in 2026.

“We need to understand the model behind the tool, because right now, that model prioritises efficiency above all else – cutting costs and getting things done as quickly as possible. However, the same technologies could be used to benefit the worker.” Olivia Blanchard, researcher on platform-based home care

Could other, ‘more human’ algorithms be designed – or negotiated with unions and workers – to establish rules of the game that are less damaging to workers’ health? The answer is yes. In fact, several cooperatives set up by former platform workers around the world are already putting this into practice.

“We have everything in place to comply with labour rights regulations, including risk prevention training and an app with an open-source algorithm. There is no scoring system that impacts the amount of work assigned, nor any system designed to foster competition. Our models prioritise cooperation,” says Soto, a member of the courier cooperative Mensakas.

Another key aspect of this ‘more human’ model is reduced automation. “There is always someone workers can reach out to,” Soto explains, a lesson that conventional platforms could learn from.

“We shouldn’t adopt a Manichean view either, one that assumes that everything the development of platforms brings is harmful,” says Rodríguez, in one of her articles. She acknowledges that this model has also provided “access to employment for groups that face greater difficulties”. The real challenge, she suggests, may lie in ensuring that these workers don’t end up sick.