Occupational epidemiology and work related inequalities in health: a gender perspective for two complementary approaches to work and health research

Abstract

Objectives: To provide a framework for epidemiological research on work and health that combines classic occupational epidemiology and the consideration of work in a structural perspective focused on gender inequalities in health. Methods: Gaps and limitations in classic occupational epidemiology, when considered from a gender perspective, are described. Limitations in research on work related gender inequalities in health are identified. Finally, some recommendations for future research are proposed. Results: Classic occupational epidemiology has paid less attention to women's problems than men's. Research into work related gender inequalities in health has rarely considered either social class or the impact of family demands on men's health. In addition, it has rarely taken into account the potential interactions between gender, social class, employment status and family roles and the differences in social determinants of health according to the health indicator analysed. Conclusions: Occupational epidemiology should consider the role of sex and gender in examining exposures and associated health problems. Variables should be used that capture the specific work environments and health conditions of both sexes. The analysis of work and health from a gender perspective should take into account the complex interactions between gender, family roles, employment status and social class. G ender division that is present in all societies means that men and women are assigned different duties and responsibilities as well as different entitlements. Although the precise definition of this division varies between societies, there is a high degree of consistency in the sexual division of work with those who are defined as female having, primarily, responsibility for household and domestic labour and males having a primary role in paid work.1 This sexual division of labour permeates all levels and spheres of society, even epidemiological research.In the field of work and health research, early work tended to draw upon male only samples but by the end of 1980s the situation reversed and many studies focused on women only samples and work related differences in health among women. There was little truly comparative research. Nowadays, the dramatic changes in gender related patterns of employment make necessary a gender comparative approach that also includes men in the analysis. This gender approach means to take into account the sexual division of labour, as well as the potential different meanings of any particular role for men and women in different social contexts. This framework should recognise that the social relations of gender operate in complex ways. Thus, similar circumstances may affect both men and women similarly. Equally, similar social circumstances may produce different effects upon the health of men and womenfor example, because of the interaction of other factors or the different meanings of these circumstances depending on sex. It is also important to build an explicit consideration of differences within m...

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Sickness Absence and Precarious Employment: A Comparative Cross-National Study of Denmark, Finland, Sweden, and Norway

“…29,30 Possible explanations are that where part-time employment results from limited employment choices, particularly for women, it increases the risk of negative health impacts, as previously shown, 40 or that taking up part-time work is an attempt by women, more than men, to resolve their work-family imbalances. 41 Regarding company sector, our finding that women working in “private service” (Denmark, and Norway), and “other sectors” (Denmark only) were less likely to report absence than workers in “public service,” was in line with previous studies, 42 showing higher sickness absence risks among public sector employees compared to private sector employees. The degree of employment protection for public sector employees largely exceeding that in the private sector, especially employees in the municipal sector, 42 may explain these differences.…”

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Sickness Absence and Precarious Employment: A Comparative Cross-National Study of Denmark, Finland, Sweden, and Norway

“…29,30 Possible explanations are that where part-time employment results from limited employment choices, particularly for women, it increases the risk of negative health impacts, as previously shown, 40 or that taking up part-time work is an attempt by women, more than men, to resolve their work-family imbalances. 41 Regarding company sector, our finding that women working in “private service” (Denmark, and Norway), and “other sectors” (Denmark only) were less likely to report absence than workers in “public service,” was in line with previous studies, 42 showing higher sickness absence risks among public sector employees compared to private sector employees. The degree of employment protection for public sector employees largely exceeding that in the private sector, especially employees in the municipal sector, 42 may explain these differences.…”

Association between passive jobs and low levels of leisure-time physical activity: the Whitehall II cohort study

“…However, our findings, which appear to be applicable only to men, were based on a large well-characterised occupational cohort with repeated measurements of psychosocial work environment (ie, passive jobs) during a 5-year follow-up that allowed us to study previously ignored examination of the cumulative effect of passive work on LTPA. The lack of association between passive jobs and LTPA for women is consistent with research into work-related gender inequalities in health showing that working conditions seemed to affect men somewhat more negatively, while the impact of family demands on health is greater in women 22. The choice of the LTPA measure, which is not considered work-related (whether paid work or unpaid domestic chores) physical activity neither a measure of total physical activity, may have contributed to the lack of association observed since LTPA measures may categorise women as inactive when they might actually be quite active.…”

Compensation benefits in a population-based cohort of men and women on long-term disability after musculoskeletal injuries: costs, course, predictors

“…It emphasises the need to better understand the population on very long-term disability. It also reinforces the relevance of studying work disability and its risk factors from a gender perspective50 and corroborates the call from other researchers to use stratification strategies to do so 12 25…”

Sickness Absence and Precarious Employment: A Comparative Cross-National Study of Denmark, Finland, Sweden, and Norway

“…29,30 Possible explanations are that where part-time employment results from limited employment choices, particularly for women, it increases the risk of negative health impacts, as previously shown, 40 or that taking up part-time work is an attempt by women, more than men, to resolve their work-family imbalances. 41 Regarding company sector, our finding that women working in “private service” (Denmark, and Norway), and “other sectors” (Denmark only) were less likely to report absence than workers in “public service,” was in line with previous studies, 42 showing higher sickness absence risks among public sector employees compared to private sector employees. The degree of employment protection for public sector employees largely exceeding that in the private sector, especially employees in the municipal sector, 42 may explain these differences.…”

Association between passive jobs and low levels of leisure-time physical activity: the Whitehall II cohort study

“…However, our findings, which appear to be applicable only to men, were based on a large well-characterised occupational cohort with repeated measurements of psychosocial work environment (ie, passive jobs) during a 5-year follow-up that allowed us to study previously ignored examination of the cumulative effect of passive work on LTPA. The lack of association between passive jobs and LTPA for women is consistent with research into work-related gender inequalities in health showing that working conditions seemed to affect men somewhat more negatively, while the impact of family demands on health is greater in women 22. The choice of the LTPA measure, which is not considered work-related (whether paid work or unpaid domestic chores) physical activity neither a measure of total physical activity, may have contributed to the lack of association observed since LTPA measures may categorise women as inactive when they might actually be quite active.…”

Compensation benefits in a population-based cohort of men and women on long-term disability after musculoskeletal injuries: costs, course, predictors

“…It emphasises the need to better understand the population on very long-term disability. It also reinforces the relevance of studying work disability and its risk factors from a gender perspective50 and corroborates the call from other researchers to use stratification strategies to do so 12 25…”