Protocol | Workplace

She got hurt working for Amazon. Here's why she doesn't want to quit.

Despite her chronic back pain, fulfillment center worker Allegra Brown wants to change Amazon, not leave.

An Amazon warehouse worker
Amazon warehouse injury rates are substantially higher than those of other employers in the industry.
Photo: Amazon

Allegra Brown, a picker at an Amazon fulfillment center, said the back pain that's kept her in bed during her days off this week doesn't make her want to quit. It makes her want to push for change.

Brown's injuries are not even among the more than 24,000 serious injuries recorded in U.S. Amazon facilities in 2020 — a rate about 50% higher than the national average — and yet she and many other more seriously injured workers have chosen to remain with the company.

"Honestly, if you think about it, I could leave this job, the problems are still going to be there. It's a good job," she said. "It's just the stuff that happens. If they fix the problems like that, if we weren't so overworked like that, it pays decent money. It's not bad."

After all, good jobs are hard to find. "I could go to another job, yeah. Or I could stay here, fight it out. And at some point I do plan on leaving," she said. "I could fight it out and help make change for future employees, so they have a better work experience."

Brown is one of the Amazon fulfillment workers who works with United for Respect as a member leader, a nonprofit group advocating for dignity in the workplace of large corporations. She has worked at her facility for nearly four years despite persistent back pain.

As a picker, Brown spends most of her time fulfilling orders, and so she can't sit during her shift. Amazon provides two short breaks and a 30-minute lunch break, but to take a break, one must meet the TOT rule. The company requires that for breaks, each person's last "scan" of an item needs to occur the minute the break begins, and each person's first scan on the return back from break has to happen the minute the break ends. Because the break room is quite a long walk from Brown's work area, she actually loses most of her time rushing from and to the break room for the 20-minute breaks.

"It's a big walk. You have to factor in all this other stuff; you're not really getting a break," she explained. One of the easiest changes Amazon could make to allow people a better rest (which could in turn help with injury prevention for problems like Brown's back pain) would be to remove the TOT rule, she explained. "There are better ways you can track people than using the time off-task," she said.

Most of the people Brown works with experience similar physical pain, she said. Because of the time pressure and quotas for all of their jobs, the lack of a real break can compound to cause serious injuries.

Amazon's high injury rates were reported last week in a study by the Strategic Organizing Center, a labor advocacy group that used data from the Occupational Safety and Health Administration to analyze the rates of serious injury in fulfillment and delivery roles. The SOC is using the data to push for changes to Amazon's notoriously long hours, strict and limited break schedules, and repetitive-motion work that can cause chronic pain. The group found that Amazon's serious injury rate was more than double Walmart (its closest competitor) last year, and that Amazon employees take an average of one to two weeks longer to recover from these injuries than the average injured warehouse employee.

"While any incident is one too many, we are continuously learning and seeing improvements through ergonomics programs, guided exercises at employees' workstations, mechanical assistance equipment, workstation setup and design, and forklift telematics and guardrails—to name a few," an Amazon spokesperson told Protocol in an email.

Amazon also announced a research partnership with the National Safety Council on Thursday to explore how to reduce musculoskeletal disorders (the most common kind of injury). The company and its research partners will spend the next five years trying to create a "prevention program" that involves "educating employees and employers about injury prevention," according to their statement.

Amazon did temporarily remove the TOT policy as part of its coronavirus protection measures in early 2020 — and the change caused a corresponding drop in injury rate. SOC's analysis of the data showed that the various pandemic-related changes to workplace productivity expectations — mainly the end of the TOT rule — caused injury rates in Amazon centers to decrease 28% in 2020 as compared to 2019.

But now that Amazon has reinstated most of its pre-pandemic productivity quotas, the safer workplace appears to have been a temporary victory for workers like Brown.

"At times like this, you'd think they would be more lenient, they would take it easy on us. I get it, we're essential employees," Brown said. "Still, you're overworking your employees, you're not giving us any time to recuperate, overworking us. That's one of the main reasons why I got involved" with United For Respect, she explained. With enough pressure, Brown and her fellow workers believe Amazon can be forced to make its working environment safer.

Image: Yuanxin

Yuanxin Technology doesn't hide its ambition. In the first line of its prospectus, the company says its mission is to be the "first choice for patients' healthcare and medication needs in China." But the road to winning the crowded China health tech race is a long one for this Tencent- and Sequoia-backed startup, even with a recent valuation of $4 billion, according to Chinese publication Lieyunwang. Here's everything you need to know about Yuanxin Technology's forthcoming IPO on the Hong Kong Stock Exchange.

What does Yuanxin do?

There are many ways startups can crack open the health care market in China, and Yuanxin has focused on one: prescription drugs. According to its prospectus, sales of prescription drugs outside hospitals account for only 23% of the total healthcare market in China, whereas that number is 70.2% in the United States.

Yuanxin started with physical stores. Since 2015, it has opened 217 pharmacies immediately outside Chinese hospitals. "A pharmacy has to be on the main road where a patient exits the hospital. It needs to be highly accessible," Yuanxin founder He Tao told Chinese media in August. Then, patients are encouraged to refill their prescriptions on Yuanxin's online platforms and to follow up with telehealth services instead of returning to a hospital.

From there, Yuanxin has built a large product portfolio that offers online doctor visits, pharmacies and private insurance plans. It also works with enterprise clients, designing office automation and prescription management systems for hospitals and selling digital ads for big pharma.

Yuanxin's Financials

Yuanxin's annual revenues have been steadily growing from $127 million in 2018 to $365 million in 2019 and $561 million in 2020. In each of those three years, over 97% of revenue came from "out-of-hospital comprehensive patient services," which include the company's physical pharmacies and telehealth services. More specifically, approximately 83% of its retail sales derived from prescription drugs.

But the company hasn't made a profit. Yuanxin's annual losses grew from $17 million in 2018 to $26 million in 2019 and $48 million in 2020. The losses are moderate considering the ever-growing revenues, but cast doubt on whether the company can become profitable any time soon. Apart from the cost of drug supplies, the biggest spend is marketing and sales.

What's next for Yuanxin

There are still abundant opportunities in the prescription drug market. In 2020, China's National Medical Products Administration started to explore lifting the ban on selling prescription drugs online. Although it's unclear when the change will take place, it looks like more purely-online platforms will be able to write prescriptions in the future. With its established market presence, Yuanxin is likely one of the players that can benefit greatly from such a policy change.

The enterprise and health insurance businesses of Yuanxin are still fairly small (accounting for less than 3% of annual revenue), but this is where the company sees an opportunity for future growth. Yuanxin is particularly hoping to power its growth with data and artificial intelligence. It boasts a database of 14 million prescriptions accumulated over years, and the company says the data can be used in many ways: designing private insurance plans, training doctors and offering chronic disease management services. The company says it currently employs 509 people on its R&D team, including 437 software engineers and 22 data engineers and scientists.

What Could Go Wrong?

The COVID-19 pandemic has helped sell the story of digital health care, but Yuanxin isn't the only company benefiting from this opportunity. 2020 has seen a slew of Chinese health tech companies rise. They either completed their IPO process before Yuanxin (like JD, Alibaba and Ping An's healthcare subsidiaries) or are close to it (WeDoctor and DXY). In this crowded sector, Yuanxin faces competition from both companies with Big Tech parent companies behind them and startups that have their own specialized advantages.

Like each of its competitors, Yuanxin needs to be careful with how it processes patient data — some of the most sensitive personal data online. Recent Chinese legislation around personal data has made it clear that it will be increasingly difficult to monetize user data. In the prospectus, Yuanxin elaborately explained how it anonymizes data and prevents data from being leaked or hacked, but it also admitted that it cannot foresee what future policies will be introduced.

Who Gets Rich

  • Yuanxin's founder and CEO He Tao and SVP He Weizhuang own 29.82% of the company's shares through a jointly controlled company. (It's unclear whether He Tao and He Weizhuang are related.)
  • Tencent owns 19.55% of the shares.
  • Sequoia owns 16.21% of the shares.
  • Other major investors include Qiming, Starquest Capital and Kunling, which respectively own 7.12%, 6.51% and 5.32% of the shares.

What People Are Saying

  • "The demands of patients, hospitals, insurance companies, pharmacies and pharmaceutical companies are all different. How to meet each individual demand and find a core profit model is the key to Yuanxin Technology's future growth." — Xu Yuchen, insurance industry analyst and member of China Association of Actuaries, in Chinese publication Lanjinger.
  • "The window of opportunity caused by the pandemic, as well as the high valuations of those companies that have gone public, brings hope to other medical services companies…[But] the window of opportunity is closing and the potential of Internet healthcare is yet to be explored with new ideas. Therefore, traditional, asset-heavy healthcare companies need to take this opportunity and go public as soon as possible." —Wang Hang, founder and CEO of online healthcare platform Haodf, in state media China.com.

Zeyi Yang
Zeyi Yang is a reporter with Protocol | China. Previously, he worked as a reporting fellow for the digital magazine Rest of World, covering the intersection of technology and culture in China and neighboring countries. He has also contributed to the South China Morning Post, Nikkei Asia, Columbia Journalism Review, among other publications. In his spare time, Zeyi co-founded a Mandarin podcast that tells LGBTQ stories in China. He has been playing Pokemon for 14 years and has a weird favorite pick.

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