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Printed in Switzerland
Karen Messing, PhD
CINBIOSE, Université du Québec, Montréal, Canada
and
Piroska Östlin, PhD
Karolinska Institute, Stockholm, Sweden
World Health
Organization
Department of Gender, Department of Public Health
Women and Health (GWH) and Environment (PHE)
Family and Community Sustainable Development
Health (FCH) and Healthy Environments (SDE)
Table of Contents
Acknowledgments IV
Preface V
1. Introduction 1
2. The sexual division of labour: “women’s work”
and “men’s work” 2
The division of labour in unpaid work 5
Health and safety issues arising from the sexual
division of labour 6
Occupational health-related sex and gender differences 8
3. Health implications of sex and gender differences 11
Compensation for occupational health problems
in the industrialized world 14
Occupational health problems of women
in low-income countries 15
Specific problems for men 18
4. Relevant legislation and policy 20
Special treatment for women? 22
5. Gender bias in occupational health research 24
6. Recommendations 28
Research 28
Databases 28
Research topics 28
Research tools and methods 29
Occupational health policies and programmes 30
Changing the context 30
Changing international and national policies 31
Changing workplace practices 33
Occupational health and safety training and capacity
development 34
Occupational health service delivery 35
Legislation and ethical norms 35
Bibliography 36
A cknowledgments
Acknowledgments
T
his publication was produced for WHO by Dr Karen Messing
from CINBIOSE, Université du Québec à Montréal, Canada and
Dr Piroska östlin from the Karolinska Institute in Stockholm,
Sweden, with input from Dr Claudia García-Moreno, Department
of Gender, Women and Health (GWH) and Dr Gerry Eijkemans,
Occupational and Environmental Health Unit in the Department of
Public Health and Environment (PHE), WHO.
iv
Gender Equality, Work and Health: A Review of the Evidence
Preface
W
ork − formal and informal, paid and unpaid − plays
impacts on health.
Work affects women’s and men’s bodies and minds in many ways.
Workers can gain great satisfaction from their jobs, but they can also
illness. Working under pressure with little power to change the work
All over the world, women and men suffer discomfort, disease, injuries
and death from their work. In general, the problems associated with
men’s work are better known, since men do visibly heavy and dangerous
work such as mining, cutting trees, fishing and building. More recently,
preface
of the working environment on health, but this research has not yet
majority of the world’s women work, and the consequent harm to their
in both formal Health Programme (OEH) within the Department of Public Health and
and informal
Environment (PHE), a WHO Symposium, entitled “Gender and Work-
work
related Health Issues: Moving the Agenda Forward” at the Women, Work
and Health Conference, held June 2-5, 2002, in Stockholm, Sweden. The
issues related to industrial work, agricultural work and sex work and to
the symposium provided valuable input for this global overview paper.
some specific issues for women, including the types of jobs they do,
vi
Gender Equality, Work and Health: A Review of the Evidence
discussed.
of which entail great danger for their health. This review highlights the
vii
1. Introduction
W
orkers have always had to balance their need for income
against their desire for healthy working conditions. This
balancing act is becoming more difficult as the world moves
toward a single global marketplace with intense competition. Both
men and women need steady, well-paid employment to guarantee a
future for themselves and their children. At the same time, as Lagerlöf
points out (WHO, 2005), pressure to maximize profits has created a
marketplace where good jobs are hard to find and keep. Fewer and fewer
employers readily offer regular, permanent, well-paid employment. In
the industrialized countries, labour organizations are weakened by
pressures from global competition, while developing countries may
attract investment by weak protections for the workforce.
In this highly competitive labour market, both women and men may
find it impossible to ensure enough income to keep their families
alive and healthy in the long term while insisting that their health
be protected in the short term. This publication provides a global
overview of gender issues in research, policies and programmes on
work and health and highlights some specific issues for women. In
particular, it will examine some apparent incompatibilities between
women’s struggles for economic and social equality and their need to
protect their health.
2. The sexual division
of labour:
“Women’s” work
and “men’s” work
D
uring the last few decades the proportion of economically
active women has increased dramatically in both developing
and developed countries. According to World Bank estimates,
from 1960 to 1997, women have increased their numbers in the global
labour force by 126% (World Bank, 2001). Today, women make up
about 42% of the estimated global working population, making them
indispensable as contributors to national and global economies (ILO,
Today, women
2000a; WHO, 1999).
make up
about 42% However, women have moved into specific niches in the labour force
of the estimated (Anker, 2001; Östlin, 2002a). An examination of data for 200 occupations
global working (1970 to 1990) shows that one third of all workers in Finland, Norway and
population, Sweden would have to change occupations to eliminate occupational
making them segregation by sex (Melkas and Anker, 2001), and a similar figure has
indispensable been found in the United States of America (USA) (Tomaskovic-Devey,
as contributors 1993). In paid work in the developing countries, women and men work
to national and at different tasks in agriculture (London et al., 2002; Kisting in WHO,
global economies 2005), mining, manufacturing and services (Acevedo, 2002; Parra
Garrido, 2002). Women are more likely to work in the informal economy
sector and they do specific types of informal work, such as domestic
work, street vending and sex work (Acevedo, 2002, p. 84; Bumiller, 1990:
Chapter 6; Shivdas in WHO, 2005). They may work from their homes, in
which case their work is invisible and may not be considered as work
even by the women themselves (Acevedo, 2002 :76-77).
Gender Equality, Work and Health: A Review of the Evidence
The sexual division of labour: “women’s” work and “men’s” work
Gender Equality, Work and Health: A Review of the Evidence
The sexual division of labour: “women’s” work and “men’s” work
However, women who play multiple roles in the family and the
workplace appear to acquire self-confidence and economic and social
independence that may outweigh the additional stress that comes
from their heavy responsibilities (Barnett and Marshall, 1992; Pugliesi,
1995; Romito, 1994). On the other hand, women’s changing roles have
also contributed to more role conflicts among certain groups of women
such as managers (Kolk et al., 1999; Lundberg, 2002). Measurements
of stress levels during and after work show that whereas men generally
unwind rapidly at the end of the working day, women’s stress levels
remain high after work, particularly if they have children living at home
(Frankenhaeuser et al., 1989; Lundberg and Frankenhaeuser, 1999).
Gender Equality, Work and Health: A Review of the Evidence
The sexual division of labour: “women’s” work and “men’s” work
this issue have felt that it would not be a good strategy to argue for
inclusion of work-related menstrual problems in the occupational
health and safety system, due to fears of a negative effect on
employment possibilities for women.
Gender Equality, Work and Health: A Review of the Evidence
long (Chamberland et al., 1998). The same physical load may exert
greater strain on the average woman than on the average man, since
women’s average lifting strength is only 50% of men’s (Vingård and
Kilbom, 2001), although the difference for pushing and pulling in
the horizontal plane is smaller (Snook and Ciriello, 1991). However,
differences within a sex are much greater than differences between
the average values for each sex; there is great overlap between women
and men for all important physical differences. When designing
tools, both the difference and the degree of overlap between women
and men are important, if one wishes to minimize repetitive strain
injuries attributable to hand-tool interactions (McDiarmid et al.,
2000; Messing, 2004).
Women’s and men’s reproductive systems differ greatly. Women In order to make
menstruate, become pregnant and nurse children, and these processes the workplace
may be affected by workplace exposures. Men produce sperm, and accessible to
this process is very sensitive to exposure to chemicals, vibration and women and
radiation. men with no
discrimination,
There may be sex differences in metabolism of toxins, but little employers must
knowledge on this is available (Setlow et al., 1998; Wizemann and take into account
Purdue, 2001). It has been hypothesized that the average woman is diversity among
at greater risk of harm from fat-soluble chemicals because of a higher employees related
proportion of fat tissue, thinner skin and slower metabolism (Meding, to both biological
1998). Women are said to have an average of 25% fat by body weight, sex and gender
compared to 15% for men (Parker, 2000). However, even if body fat differences
does prove to play a role, it is unwise to presume that an average sex
difference applies to all or even most individuals in a population,
(Messing, 2004). Exogenous hormones have different effects on
women and men (Nilsson, 2000). No studies have carefully dissected
out the relative contribution of differences in exposures, body size,
fat composition and hormones to metabolism of chemical toxins.
Also, the percent of fat varies among women and men according to
age, physical fitness and training (Clarkson and Going, 1996). When
The sexual division of labour: “women’s” work and “men’s” work
10
3. Health implications
of sex and gender
differences
S
tudies, mainly from high-income industrialized countries
show that women’s increased participation in paid
employment not only strengthens their social status and
their individual and family’s financial situations, but also is beneficial
to their mental and physical health (Waldron et al., 1998). The
same is true for men. Valkonen and Martikainen (1995) estimated
that in a Finnish male cohort aged 30 to 54, 80% of all deaths, and
5% of circulatory deaths, could be attributed to the experience of
unemployment. Among Russian men, life expectancy decreased by Employment
6.5 years between 1989 and 1994, possibly as a result of increased outside the home
unemployment leading to health-damaging behaviours, such as heavy is an important
alcohol consumption, smoking and violence (Shkolnikov et al., 2001). source of social
Employment outside the home is an important source of social support
support and
and self-esteem, and helps women to avoid social isolation in the home
self-esteem,
(Romito, 1994; Razavi, 2000). A study from the Philippines showed that
and helps women
women who engaged in paid work improved the quality of their diets
to avoid social
(Bisgrove and Popkin, 1996). Despite this general observation, many
isolation in the
jobs, especially those available to women in low-income countries
home
or to poor, less-educated women in high-income countries, expose
women to harmful working environments.
11
Health implications of sex and gender differences
that can impair health. These hazards are related to both physical
(such as heavy lifting and carrying, repetitive working movements,
sustained static postures, awkward postures, night work, long hours,
violence, noise, vibration, heat, cold, chemicals) and psychosocial
exposures (e.g. stress related to high mental demand, speed, lack
of control over the way work is done, lack of social support, lack of
respect, discrimination, psychological and sexual harassment). In
developed countries, women are exposed to some physical hazards
more often, such as highly repetitive movements, awkward postures,
biological agents in hospital environments, and to intense exposure to
the public in some jobs (Östlin 2002b; Messing, 2004).
1 A maquiladora (or maquila) is a factory that imports materials and equipment on a duty-free and tariff-free basis
for assembly or manufacturing and then re-exports the assembled product usually back to the originating country.
http://en.wikipedia.org/wiki/ accessed August 9, 2006.
12
Gender Equality, Work and Health: A Review of the Evidence
2 Adjusted for job title or ergonomic exposure, at minimum, and for age and other factors, where possible, by stratified or
multivariate analysis.
3 Odds ratio or prevalence ratio (and confidence interval or probability).
4 Only the p value and not the confidence interval was given in this study.
Source: Reprinted, with permission from Elsevier, from Work-related musculoskeletal disorders: Is there a gender differential, and if so, what
does it mean?, 474-92, 2000.
13
Health implications of sex and gender differences
14
Gender Equality, Work and Health: A Review of the Evidence
Another Swedish study revealed that women and men are often offered
different rehabilitation measures for similar work-related health
problems. Men, more often than women, receive education in their
rehabilitation programme, and women receive rehabilitation benefits
for a shorter period of time than men (Bäckström, 1997; Burell, 2002).
Again, a similar study in Quebec showed that educational opportunities
...women and
were more limited for injured women workers and compensation for
men are often
inability to assume usual household responsibilities was more readily
offered different
granted for household tasks usually done by men (Lippel and Demers,
rehabilitation
1996).
measures for
In addition, women’s work in many countries is still performed in the similar
domestic sphere and in the informal economy, and is thus invisible work-related
in the public, economic, and institutional sphere. As a result, many health problems
of women’s work-related accidents and diseases are not recorded as
occupational, not compensated by work insurance systems and not
included in thinking about occupational health.
15
Health implications of sex and gender differences
16
Gender Equality, Work and Health: A Review of the Evidence
17
Health implications of sex and gender differences
18
Gender Equality, Work and Health: A Review of the Evidence
19
4. Relevant legislation
and policy
T
he key areas in occupational health policy and legislation
which are explicitly related to gender refer to two broad
categories: the treatment of sex differences, and the methods
for handling discrimination, including sexual harassment. Legislation
Legislation and and policy involving sex differences includes protection of pregnant
policy involving and nursing workers exposed to hazardous working conditions (Heide,
sex differences 2001; Lippel, 1998) as well as provisions concerning access to certain
includes protection types of work that are seen to be more dangerous to women, such
of pregnant and as night work. An ILO convention, adopted in 1948, prohibited night
nursing workers work for women, and certain national legislation incorporated these
exposed to hazardous provisions, which are now incompatible with European equality law
working conditions (Heide, 2001). While the European legal provisions governing night
work will probably disappear with time, other countries, not bound
by European law, may still prevent women from performing night
work and other types of work perceived as inappropriate for women.
Legislation governing discrimination in the workplace is prescribed
both on a national and an international basis (Loutfi, 2001), and in many
countries, aims to prevent both sexual harassment and discrimination,
including discriminatory hiring practices that may rely on pre-
employment tests of physical capacity, and limits on lifting weights
(Messing et al., 2000; Demers and Messing, 2001). Jurisdictions vary in
the degree to which they provide for sex-specific working conditions
and programmes. The treatment of discrimination is also variable.
20
Gender Equality, Work and Health: A Review of the Evidence
5 Precarious employment is defined by Quinlan and others as jobs that do not correspond to the norm of fulltime,
relatively secure employment performed at the employer’s place of business during a specified time, usually during
the day.
21
Relevant legislation and policy
in the labour mar- While women’s claims for industrial disease are sometimes greeted
ket usually results with scepticism (Reid et al., 1991, Lippel, 2003), it has been shown that
in increased risk to women workers with claims for musculoskeletal injuries profit greatly
the health of both from organized support groups (Bueckert, 1999).
women and men
22
Gender Equality, Work and Health: A Review of the Evidence
23
5. Gender bias
in occupational
health research
I
nvestigating the complex ways in which biological, social and
environmental factors interact to impact the health of women and
men should be a basic element of all health research, including
research on work and health.
24
Gender Equality, Work and Health: A Review of the Evidence
25
Gender bias in occupational health research
26
Gender Equality, Work and Health: A Review of the Evidence
27
6. Recommendations6
T
he following recommendations concerning research
and policy elaborate, from a gender perspective, on the
recommendations presented in the WHO global strategy of
occupational health. Moreover, the authors suggest the adoption of
new approaches in order to strengthen gender considerations in both
research and policy.
Research
Databases
1 Sex-disaggregated data on both occupational exposures and
occupational diseases and injuries need to be collected
systematically at international, regional, company and union
levels. Information should also be gathered on exposures and
diseases related to unpaid work and on attempts at reconciling
the demands of paid and unpaid work.
Research topics
2 Increased research on women’s health at work is necessary,
particularly in developing countries.
6 These recommendations are a synthesis of the recommendations made by Elizabeth Lagerloff, Sophia Kisting
and Meena Shivdas in each of their review papers included in the bibliography, and those resulting from this global
overview by Karen Messing and Piroska östlin.
28
Gender Equality, Work and Health: A Review of the Evidence
29
Recommendations
7 See also WHO Global Strategy on Occupational Health for All, 1995.
30
Gender Equality, Work and Health: A Review of the Evidence
31
Recommendations
32
Gender Equality, Work and Health: A Review of the Evidence
33
Recommendations
34
Gender Equality, Work and Health: A Review of the Evidence
35
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