Tops, frocks, bananas, and coffee—these are likely to be your top answers when asked to think of “fair trade.”

Historically, the fashion industry and agriculture sector have claimed the top spots for industries most likely to violate workers’ rights.

But is it time we applied the same scrutiny to the healthcare industry and promoted the same kind of awareness of consumer behaviour and demand witnessed in other sectors?

Wide scale abuses have been reported in the manufacture of several commodities used routinely in the NHS, from surgical instruments to disposable medical gloves, throwing into the foreground the moral and ethical responsibilities of this sector.

A new report “In good hands—tackling labour rights concerns in the manufacture of medical gloves” shows how this multi-billion pound industry has been built on exploitative labour practices of many of its workers within the supply chain by unaccountable manufacturers.

With a focus on two major international glove brands and abuses found within their factories, the report shows how, through its purchasing practices, the NHS and the medical community have an opportunity to influence this global market as a force for positive change.

With growing emphasis on infection control, and strict practices in hospitals worldwide, the need for disposable medical gloves is growing. The industry has a market value of more than $5bn (USD), but most of the production of medical gloves is outsourced to factories in Malaysia and Thailand, and a handful of other Asian countries.

While the healthcare industry plays a critical part in building the economy in many of these countries, labour laws remain weak and government enforcement even weaker. Global demand and competition turn human labour into a commodity and labour standards become secondary to price.

Through evidence from industry watchers, the report exposes endemic and serious labour rights abuses of workers in factories in Thailand, Malaysia, and Sri Lanka. Violations such as forced overtime without pay, lack of rest breaks with excessive production quotas, anti-union activities, and exposure to hazardous products are widely reported.

The workforce in these production sites is heavily reliant on migrant workers from less affluent neighbouring countries, which brings with it specific challenges. Extortionate recruitment fees, confiscation of identification documents such as passports, restricting the workers’ freedom of movement—all binding them to the employer even more and further contributing to their vulnerability. Dirty and dangerous working conditions, including significant exposure to chemical by-products, excessive noise, repetitive motion and frequent lifting without adequate personal protection equipment is common in factories in Malaysia and Thailand.

This type of spotlight on industry practices has prompted several companies to increase efforts to become good corporate citizens. Human rights challenges within this sector should be of foremost concern for consumers, companies, and governments. The voice of healthcare professionals can be very powerful in integrating consideration of labour standards into purchasing decisions in the NHS.

More direct pressures, including the introduction of the UK Modern Slavery Act 2015, will drive more transparency within supply chains. It requires companies doing business in the UK (approximately 17 000) to publish a board approved public annual slavery and human trafficking statement.

Further pressure and accountability is added by the UN Guiding Principles on Business and Human Rights. Businesses have a responsibility to minimise human rights violations in their supply chains, irrespective of whether the business contributed directly to the violation, and a duty to adequately address any abuses that do occur.

The regulatory environment is closing in and shaping the market, bringing with it the opportunity to embed a zero tolerance principle towards labour rights abuses.

There is a huge opportunity and responsibility for the NHS to leverage its significant purchasing power to foster improvements in the working conditions for workers globally, promote decent work for all, and eradicate modern slavery from within its supply chains.

Read the new report at www.bma.org.uk/ingoodhands.

Arthy Santhakumar is a senior policy adviser in the international and immigration division of the BMA. Her focus is global health and international development, and she leads on the BMA’s Medical Fair and Ethical Trade campaign. She is the co-author of the report “In Good Hands—tackling labour rights concerns in the manufacture of medical gloves.”

Competing interests: Nothing further declared.