Bonnie Rogers, DrPH, COHN-S, LNCC, FAAN Professor & Director North Carolina Occupational Safety and...

Bonnie Rogers, DrPH, COHN-S, LNCC

, FAANProfessor & Director

North Carolina Occupational Safety and Health Education and Research Center

University of North Carolina School of Public Health

Chapel Hill, North Carolina, USA

Women and Work: Hazards, Protection, and Health Promotion

Women and Work: Hazards, Protection, and Health Promotion

Women make up about 42% of the global paid workforce

Contributions to health and economic development are often undervalued or not included

Work-related hazards persist for both paid or unpaid work

Women and Work:Hazards, Protection, and Health Promotion


Increasing burden of women and unpaid health work:

Aging population

Increasing incidence of disease requiring long-term care

Increasing reliance of health sector on ambulatory and out-patient services



Canada & USA research survey (1997): 70-80% of care for the elderly is provided by family

Canada: 80% of paid and unpaid caregivers are women; 75% between the ages of 50 and 65

USA: 55-70% of primary caregivers are women; average woman will spend 18 years taking care of a parent



Positive aspects of women’s employment: Socialization Increased self-esteem Skill development

World Health Organization (WHO): Many jobs in low income countries or poor,

less-educated women expose women to harmful working environments

These women shoulder extremely heavy workloads at home and work



Harmful working environments

Pesticide exposures result in: Poisoning Cancer Skin diseases Abortions Premature deaths Malformed babies



Harmful working environmentsReproductive problems - (miscarriages,

low birth weights, and malformations) result from exposure to:

Solvents Pesticides Organic pollutants Heavy workload Postural factors Shift work



Harmful working environmentsChemical exposures affects breast milk

Contaminate breast milk, leading to breastfeeding problems, reducing vital milk supply for infants in poor populations

Interfere with fertility-suppressing effects of breastfeeding, increasing chance of early conception



Harmful working environments In developing countries, such as Latin America

and Asia, women work in office and factory jobs Low status of work causes stress Lack of social services makes life taxing



Harmful working environments Sexual harassment is common and may result

in guilt, shame, anxiety, depression, and other health consequences

Survey of nurses in Turkey: 75% experienced sexual harassment in the hospital

44% by male physicians 34% by patients 14% by relatives of patients




Health care workers are exposed to: Infection Needlestick injuries Violence Musculoskeletal injuries Burnout




Women in developed countries are exposed to physical tasks, such as:

Highly repetitive movements Awkward postures Biological agents




Psychological risk factors Psychological harassment Sexual harassment Monotonous work

Discrimination from low status

Less control over work environment, which is associated with cardiovascular, mental, and musculoskeletal ill health



Women in paid employment Work more hours on household tasks than men

Child care Elder care Subsistence activities Housework

Generally have simultaneous family and household obligations

Comprise the largest group in office, sales, and health care



Workplace Hazards Biological

Chemical

Enviromechanical

Physical

Psychosocial

Reproductive



Biological Hazards

Infected patients of healthcare workers - 35 million or 12% of the

workforce are health workers

Bloodborne pathogens contamination - from blood and body fluids

and tissues

Biological agents in lab workers - 80% are women



Biological Hazards

Hepatitis B, C, and HIV infections - from 2 million needlestick injuries/year

Hepatitis C and HIV - 2 of 20 most serious bloodborne pathogens

Hepatitis B- most common bloodborne infection- only one of three serious viruses

for which immunization exists



Biological Hazards transmitted from patient to healthcare workers by direct contact, aerosol, and needlestick

Staphylococcal Streptococcal Syphilis Tuberculosis Herpes simplex Varicella Rubella Cytomegalovirus



Biological Hazards of M. Tuberculosis (TB) transmitted in health care facilities probably result from: Unrecognized or delayed diagnosis of

pulmonary or laryngeal TB

Delayed recognition of drug resistance

Delayed initiation of effective therapy

Inadequate ventilation of TB isolation rooms

Lapses in TB isolation practices

Lack of adequate respiratory protection



Chemical Hazards

More than 1 million paid household workers employed as

Housekeepers Cleaners Janitors

Exposed to variety of chemicals, such as Solvents Ammonia Pesticides



Chemical Hazards

Employed in manufacturing and office environments exposed to:

Organic solvents - used to degrease machinery can cause

Skin rashes Headaches Dizziness Bone marrow depression



Chemical Hazards 70,000 commercially-sold chemicals

Anesthetic gases Antineoplastic agents Solvents Sterilants Germicides Hydrocarbons

Many can lead to organ system problems Reproductive Gastrointestinal Endocrine Immune



Chemical Hazards

Disinfectants 2% alkaline glutaraldehyde

Disinfects instruments Chemical injuries or irritation Allergic contact dermatitis Rhinitis Asthma

Soaps and detergents for handwashing Skin irritation Damage to the barrier/integrity of the skin



Chemical Hazards

Latex Increased exposure with use for universal

precautions

Atopic persons have increased risk

Estimate prevalence from 2.9% in general hospital workers to 17% in selected groups



Chemical Hazards

Antineoplastic agents Carcinogens, Mutagens, Teratogens Significant health hazard to nurses and

pharmacists Detectable levels in pharmacy air and patient

rooms Nurses report:



Hair loss Facial flushing Depressed leukocytes

Lightheadedness Nasal sores Nausea

Enviromechanical Hazards

Create unsafe or inadequate working conditions for employees which may result in injuries and illnesses

Most common and current problems women are faced with include musculoskeletal disorders, particularly low back problems, and carpel tunnel syndrome

Poor or unfitting tools to do the task Lifting tasks Bend and flex in sharply angular positions




Jobs held mostly by women with musculoskeletal disorders

Assembly line workers Cashiers Food checkers Typewriter keyboard operators




Jobs require long standing, poor sitting posture, and sometimes awkward positions

Create a postural load - results in back pain, muscle stress, and general body fatigue

Sitting at a desk for long periods Blood pooling and edema in the lower

extremities



Enviromechanical HazardsImproved work conditions improve work situation

Properly designed chairs and work stations Frequent or regular breaks

Back injuries: 3rd most commonly reported injury Most lost work days Most prevalent type of injury in nursing

Several contributory factors include: Age Gender Length of employment



Heavy or multiple lifts Posture and physical activity Previous back injury

Enviromechanical HazardsMore women in construction over past two

decades in U.S. Women in construction face 5 safety and

health issues: Reproductive hazards Ergonomic concerns Lack of adequate sanitary facilities Poor-fitting personal protective equipment &

clothing Lack of proper health, safety, and skills

training




Women recommend:

Tools, materials, and equipment should be available in sizes and designs for women

As back injuries are a major concern for women, safe lifting techniques should be encouraged for those with less upper-body strength than average male construction workers



Physical Hazards

Primarily in jobs that are radiation-related Ionizing radiation

Kills the cell directly (causes burns, hair loss)

Alters the genetic material of the cell (causes cancer or reproductive damage)

Associated with diagnostic processes X-ray Fluoroscopy Angiography Therapeutic nuclear medicine interventions,

such as radioisotope implants



Physical Hazards

Ionizing radiation Dose of radiation depends on time, distance,

& shielding Greatest dangers to exposed workers from:

Scatter - small amount deflected or reflected from beam

Unexpected exposure - in undefined “radiation area” or because the equipment is not well maintained



Physical Hazards

Ionizing radiation Radiation workers at risk need careful

monitoring Diagnostic radiology (x-ray, fluoroscopy, and

angiography for diagnostic purposes, dental radiography, and computerized axial tomography (CAT) scanners)

Therapeutic radiology in nuclear medicine for diagnostic and therapeutic procedures

Radio-pharmaceutical laboratories are potentially at risk



Psychosocial Hazards Common in the work environment NIOSH: Job stress - harmful physical and

emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker



Psychosocial Hazards Occupational stress may be a particular

problem for women More employed women than men reported high

levels of stress and stress-related illnesses

60% of women surveyed - job stress was their# 1 problem



Psychosocial Hazards Stress – manifests both physiological and

psychological symptoms Persistent unrelieved stress –

Reduces productivity Increases accidents Absenteeism Leads to maladaptive behaviors, such as

substance abuse Nearly everyone agrees that job stress

results from the interaction of the worker and the conditions of work



Psychosocial Hazards Stressors can lead to injuries, health status

effects, reduced worker productivity, and can ultimately affect quality of care:

Organizational Environmental Situational Personal Technological Professional



Psychosocial Hazards

Organizational Factors related to policy and operational

controls such as lack of shared decision-making, role ambiguity, ineffective organizational leadership, inadequate resources, lack of opportunity for challenge or growth, job safety, and poor economic and professional incentives.




Environmental Factors concerned with the quality of the

work such as the design of the work station, ventilation, smoking/passive smoking, noise, lighting, hygiene, clutter, and shiftwork.




Situational Factors related to conditions of the job such

as workload, conflicts with managers and co-workers, job satisfaction, unreasonable expectations, and tight schedules.




Personal Factors such as demographics, (e.g., age,

gender) motivation, health status, personality, (e.g., passive, aggressive) coping and communication skills, and multiple role performance.




Technological Factors related to advances in technology

which result in rapid changes in work processes or equipment without adequate training, interacting with computers and work depersonalization, and lack of knowledge to handle sophisticated technology.




Professional Factors concerned with knowledge and

skills acquisition, role preparation, the practice area, and professionalism.




Violence in the workplace Adds to both physical & psychological stress Major public health problem In USA:

2 million workplace assaults occur annually Homicide - 3rd leading cause of occupational death Homicide - 2nd leading cause of occupational fatality

for women




Violence in the workplace Convenience store clerks & taxicab drivers

are at greatest risk of homicide Health care & social service workers (mostly

women) have highest incidence of injuries from workplace assaults



Reproductive Hazards Major concern to many working women Disrupt the menstrual cycle and affect the

course of pregnancy or development of embryo/fetus.

Many chemicals including Pharmaceuticals Anesthetic gases Heavy metals Pesticides Organic solvents



Reproductive Hazards Many women may not know when they first

become pregnant and thereby remain at risk to potential exposure.

The adverse reproductive effects of some chemicals have been known for centuries

Lead was recognized as a hazard in ancient Rome Over 100 years ago, lead-exposed women in pottery

industry in Europe were at increased risk of sterility, miscarriage, stillbirth, and infant death in the neonatal period.

Studies of lead exposure at the turn of the century prompted several European governments to prohibit women from working with lead



Reproductive Hazards

An increasing number of pregnant women work

About 75% of all women who work are in childbearing years placing them at risk for reproductive toxicity

Biological, chemical, and physical agents in the work environment represent clear hazards to reproductive health



Reproductive Hazards Workplace substances that affect female

workers and their pregnancies can also harm their families

Without knowing it, workers bring home harmful substances that can affect the health of other family members – both adults and children

Lead brought home from the workplace on skin, hair, clothes, shoes, tool box, or car can cause lead poisoning in family members, especially young children

Most knowledge about reproductive toxins comes from animal lab studies



Health Promotion Health promotion & health protection strategies

can be implemented to: help educate women about potential risk on the job implement methods to alleviate or minimize risks

Preplacement & periodic examinations can be offered to:

obtain baseline health status data make appropriate recommendations for job

assignments provide monitoring and surveillance for women

who may be at greater risk (e.g., pregnant)



Health Promotion

Education - extremely important in worker health and safety program

The more an employee knows about specific workplace hazards the more effective they can be with helping to minimize workplace health risks.



Health Promotion

All employees should know: the general hazards of the workplace, the specific hazards related to their

particular job exposure to toxic substances implications for reproductive health measures for protective work practices

Preconception and prenatal education and counseling should be offered



Health Promotion

Recognizing many jobs are stressful, employee assistance and counseling programs should be provided for workers at risk

Programs should specify: Signs and symptoms of stress Stress management techniques Crisis intervention Referral services for long term counseling



Health Promotion

Any health programs offered should be designed to meet the needs of the target work group while at the same time containing costs for both the employee and employer



“Improving the Health of Women in the Workforce”

At a 1998 conference in Canada, “Improving the Health of Women in the Workforce,” the following recommendations were made which cut across boundaries in women’s health in the workplace:

Risks in women’s traditional jobs should be identified and prevention programs should be established for such hazards as repetitive movements, prolonged standing and for conditions that may potentiate exposures such as level of job control, supervisor support, flexibility in working scheduling, etc.




Women are often exposed to threats of physical violence and workplaces do not always deal with them adequately. Workplace stress may arise from a combination of small factors that add up to an unbearable burden, with high costs for health care and income replacement. Personnel cuts may make women who are confronted by needs of clients, patients, and students feel obliged to work ever harder to fill the gaps, but with fewer results.




Research and prevention strategies should be developed to document and counter the effects of sexual and psychological harassment, demanding (rigid, unpredictable) work schedules, workplace aggression, and violence.




Women are exposed to chemicals in many situations: In agriculture and manufacturing as well as in service

professions such as hairdressing, cleaning, laboratory work and health care, to name just a few.

Exposures can be multiple and complex, and can effect mental and physical health.

All chemical substances and mixtures should be considered as hazardous until proven otherwise.

Exposure to chemical substances should be reduced at the source through workplace design and engineering.

Controls and protective clothing should be also be provided.




There is a growing trend toward non-standard hours, shiftwork, mandatory overtime, and contract work. These conditions pose difficulties for women workers, particularly those with family responsibilities.




Occupational health prevention programs should address risks to male and female reproduction, including male and female fertility.

Programs should be developed to protect the health of pregnant women exposed to working conditions and the health of the fetuses, as well as to protect nursing women and their babies.

Working conditions in women’s jobs that pose a risk for them, their fetuses, or nursing infants in general (and in varying degrees) pose a risk for all workers.

Prevention programs should address these risks.



In Summary:Occupational health hazards to women are

ubiquitous and can cause serious problems for the worker and the family

Strategies to aid in the health promotion and protection of all workers must be of paramount importance in the eyes of legislators, policy makers, program planners, health care providers, and the workers themselves if we are to improve the health of women workers

It is vital that all aspects of women’s health be considered when engaging in health promotion and protection. Collaborative efforts to achieve this goal are a necessity



Merci beaucoup !

Dr. Bonnie [email protected]



Bonnie Rogers, DrPH, COHN-S, LNCC, FAAN Professor & Director North Carolina Occupational Safety and...

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