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					          Women and Work:
Hazards, Protection, and Health Promotion

   Bonnie Rogers, DrPH, COHN-S, LNCC
                    , FAAN
            Professor & 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 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
            Women and Work:
Hazards, Protection, and Health Promotion

   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
             Women and Work:
Hazards, Protection, and Health Promotion

   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
             Women and Work:
 Hazards, Protection, and Health Promotion

 Harmful   working environments

   Pesticide   exposures result in:
        Poisoning
        Cancer
        Skin diseases
        Abortions
        Premature deaths
        Malformed babies
            Women and Work:
 Hazards, Protection, and Health Promotion

 Harmful working environments
   Reproductive problems - (miscarriages,
    low birth weights, and malformations)
    result from exposure to:
        Solvents
        Pesticides
        Organic pollutants
        Heavy workload
        Postural factors
        Shift work
                Women and Work:
Hazards, Protection, and Health Promotion

   Harmful working environments
     Chemical 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
             Women and Work:
 Hazards, Protection, and Health Promotion

 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
              Women and Work:
 Hazards, Protection, and Health Promotion

 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
                Women and Work:
Hazards, Protection, and Health Promotion

   Harmful working environments
       Health care workers are exposed to:
             Infection
             Needlestick injuries
             Violence
             Musculoskeletal injuries
             Burnout
                Women and Work:
Hazards, Protection, and Health Promotion

   Harmful working environments
       Women in developed countries are
        exposed to physical tasks, such as:
             Highly repetitive movements
             Awkward postures
             Biological agents
                Women and Work:
Hazards, Protection, and Health Promotion

   Harmful working environments

       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 and Work:
Hazards, Protection, and Health Promotion

 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
           Women and Work:
Hazards, Protection, and Health Promotion

   Workplace Hazards
       Biological
       Chemical
       Enviromechanical
       Physical
       Psychosocial
       Reproductive
            Women and Work:
 Hazards, Protection, and Health Promotion

 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
             Women and Work:
 Hazards, Protection, and Health Promotion

 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
           Women and Work:
 Hazards, Protection, and Health Promotion

 BiologicalHazards transmitted from patient
 to healthcare workers by direct contact,
 aerosol, and needlestick
      Staphylococcal
      Streptococcal
      Syphilis
      Tuberculosis
      Herpes simplex
      Varicella
      Rubella
      Cytomegalovirus
              Women and Work:
 Hazards, Protection, and Health Promotion

 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
              Women and Work:
Hazards, Protection, and Health Promotion

   Chemical Hazards
       More than 1 million paid household
        workers employed as
           Housekeepers
           Cleaners
           Janitors


       Exposed to variety of chemicals, such as
           Solvents
           Ammonia
           Pesticides
            Women and Work:
Hazards, Protection, and Health Promotion

Chemical Hazards

  Employedin manufacturing and office
  environments exposed to:
       Organic solvents - used to degrease
        machinery can cause
            Skin rashes
            Headaches
            Dizziness
            Bone marrow depression
              Women and Work:
Hazards, Protection, and Health Promotion

   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
           Women and Work:
 Hazards, Protection, and Health Promotion

 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
            Women and Work:
Hazards, Protection, and Health Promotion

 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
           Women and Work:
Hazards, Protection, and Health Promotion

 Chemical Hazards

   Antineoplastic   agents
     Carcinogens, Mutagens, Teratogens
     Significant health hazard to nurses and
      pharmacists
     Detectable levels in pharmacy air and patient
      rooms
     Nurses report:
         Lightheadedness      Hair loss
         Nasal sores          Facial flushing
         Nausea               Depressed leukocytes
             Women and Work:
Hazards, Protection, and Health Promotion

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
               Women and Work:
Hazards, Protection, and Health Promotion
   Enviromechanical Hazards

     Jobsheld mostly by women with
      musculoskeletal disorders
           Assembly line workers
           Cashiers
           Food checkers
           Typewriter keyboard operators
               Women and Work:
Hazards, Protection, and Health Promotion
   Enviromechanical Hazards

     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
                Women and Work:
 Hazards, Protection, and Health Promotion
Enviromechanical Hazards
  Improved 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                             Heavy or multiple lifts
                                           Posture and physical
          Gender
                                          activity
          Length of employment
                                           Previous back injury
            Women and Work:
 Hazards, Protection, and Health Promotion
Enviromechanical Hazards
  More  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 and Work:
 Hazards, Protection, and Health Promotion

Enviromechanical Hazards

  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
                Women and Work:
 Hazards, Protection, and Health Promotion

 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
               Women and Work:
Hazards, Protection, and Health Promotion
   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
              Women and Work:
Hazards, Protection, and Health Promotion
   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
               Women and Work:
Hazards, Protection, and Health Promotion

   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
              Women and Work:
Hazards, Protection, and Health Promotion

   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
                Women and Work:
    Hazards, Protection, and Health Promotion

   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
               Women and Work:
Hazards, Protection, and Health Promotion

   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
               Women and Work:
Hazards, Protection, and Health Promotion

   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.
                Women and Work:
Hazards, Protection, and Health Promotion

   Psychosocial Hazards
       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.
                Women and Work:
Hazards, Protection, and Health Promotion

   Psychosocial Hazards
       Situational
            Factors related to conditions of the job such
             as workload, conflicts with managers and
             co-workers, job satisfaction, unreasonable
             expectations, and tight schedules.
               Women and Work:
Hazards, Protection, and Health Promotion

   Psychosocial Hazards
       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.
                Women and Work:
Hazards, Protection, and Health Promotion

   Psychosocial Hazards
       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.
               Women and Work:
Hazards, Protection, and Health Promotion

   Psychosocial Hazards
       Professional
            Factors concerned with knowledge and
             skills acquisition, role preparation, the
             practice area, and professionalism.
                  Women and Work:
    Hazards, Protection, and Health Promotion
   Psychosocial Hazards
       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
               Women and Work:
    Hazards, Protection, and Health Promotion
   Psychosocial Hazards
       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
                Women and Work:
Hazards, Protection, and Health Promotion

   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
                Women and Work:
 Hazards, Protection, and Health Promotion
 Reproductive        Hazards
   Manywomen 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
               Women and Work:
Hazards, Protection, and Health Promotion

   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
                 Women and Work:
Hazards, Protection, and Health Promotion
   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
                Women and Work:
Hazards, Protection, and Health Promotion

   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)
                Women and Work:
Hazards, Protection, and Health Promotion

   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.
                 Women and Work:
Hazards, Protection, and Health Promotion

   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
              Women and Work:
Hazards, Protection, and Health Promotion

   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
              Women and Work:
Hazards, Protection, and Health Promotion

   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
              Women and Work:
Hazards, Protection, and Health Promotion
“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 and Work:
Hazards, Protection, and Health Promotion
“Improving the Health of Women in the Workforce”

     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.
           Women and Work:
Hazards, Protection, and Health Promotion
“Improving the Health of Women in the Workforce”

   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 and Work:
Hazards, Protection, and Health Promotion
“Improving the Health of Women in the Workforce”
 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.
            Women and Work:
Hazards, Protection, and Health Promotion
“Improving the Health of Women in the Workforce”
     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.
               Women and Work:
 Hazards, Protection, and Health Promotion
“Improving the Health of Women in the Workforce”
     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.
               Women and Work:
 Hazards, Protection, and Health Promotion
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
         Women and Work:
Hazards, Protection, and Health Promotion


            Merci beaucoup !


            Dr. Bonnie Rogers
         rogersb@email.unc.edu

				
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