1. 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 and Work: Hazards, Protection, and Health Promotion

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

45.  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 - 3 rd leading cause of occupational death  Homicide - 2 nd leading cause of occupational fatality for women Women and Work: Hazards, Protection, and Health Promotion Women and Work: Hazards, Protection, and Health Promotion

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

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

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

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

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

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

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

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

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

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

56. “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 Women and Work: Hazards, Protection, and Health Promotion

57. “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 Women and Work: Hazards, Protection, and Health Promotion

58. “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 Women and Work: Hazards, Protection, and Health Promotion

59. “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 Women and Work: Hazards, Protection, and Health Promotion

60. “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 Women and Work: Hazards, Protection, and Health Promotion

61. “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 Women and Work: Hazards, Protection, and Health Promotion

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

63. Merci beaucoup ! Dr. Bonnie Rogers rogersb@email.unc.edu Women and Work: Hazards, Protection, and Health Promotion Women and Work: Hazards, Protection, and Health Promotion