In 2007, a Filipina organization in Quebec (PINAY) sought the help of university researchers to document the workplace health and safety experiences of domestic workers. Together, they surveyed 150 domestic workers and produced a report that generated interest from community groups, policy-makers, and the media. In this article, we-the university researchers-offer a case study of community-university action research. We share the story of how one project contributed to academic knowledge of domestic workers' health and safety experiences and also to a related policy campaign. We describe how Quebec workers' compensation legislation excludes domestic workers, and we analyze the occupational health literature related to domestic work. Striking data related to workplace accidents and illnesses emerged from the survey, and interesting lessons were learned about how occupational health questions should be posed. We conclude with a description of the successful policy advocacy that was possible as an outcome of this project.
Few Canadian data sources allow the examination of disparities by ethnicity, language, or immigrant status in occupational exposures or health outcomes. However, it is possible to document the mechanisms that can create disparities, such as the over-representation of population groups in high-risk jobs. We evaluated, in the Montréal context, the relationship between the social composition of jobs and their associated risk level.
We used data from the 2001 Statistics Canada census and from Québec's workers' compensation board for 2000-2002 to characterize job categories defined as major industrial groups crossed with three professional categories (manual, mixed, non-manual). Immigrant, visible, and linguistic minority status variables were used to describe job composition. The frequency rate of compensated health problems and the average duration of compensation determined job risk level. The relationship between the social composition and risk level of jobs was evaluated with Kendall correlations.
The proportion of immigrants and minorities was positively and significantly linked to the risk level across job categories. Many relationships were significant for women only. In analyses done within manual jobs, relationships with the frequency rate reversed and were significant, except for the relationship with the proportion of individuals with knowledge of French only, which remained positive.
Immigrants, visible, and linguistic minorities in Montréal are more likely to work where there is an increased level of compensated risk. Reversed relationships within manual jobs may be explained by under-reporting and under-compensation in vulnerable populations compared to those with knowledge of the province's majority language.
Language barriers are often cited as a factor contributing to ethnic inequalities in occupational health; however, little information is available about the mechanisms at play. The authors describe the multiple ways in which language influences occupational health in a large garment factory employing many immigrants in Montreal. Between 2004 and 2006, individual, semi-structured interviews were conducted with 15 women and 10 men from 14 countries of birth. Interviews were conducted in French and English, Canada's official languages, as well as in non-official languages with the help of colleague-interpreters. Observation within the workplace was also carried out at various times during the project. The authors describe how proficiency in the official languages influences occupational health by affecting workers' ability to understand and communicate information, and supporting relationships that can affect work-related health. They also describe workers' strategies to address communication barriers and discuss the implications of these strategies from an occupational health standpoint. Along with the longer-term objectives of integrating immigrants into the linguistic majority and addressing structural conditions that can affect health, policies and practices need to be put in place to protect the health and well-being of those who face language barriers in the short term.
Standing at work has been associated with discomfort and cardiovascular symptoms. Because standing postures vary in duration, mobility, and constraint, we explored associations between specific postures and pain in the lower extremities.
We used multiple logistic regression to analyze associations between work factors and pain in the lower extremities during the previous 12 months that interfered with usual activities. We used data from among 7757 workers who were interviewed in the 1998 Quebec Health and Social Survey.
Among all respondents, 9.4% reported significant ankle or foot pain, and 6.4% had lower-leg or calf pain. Significantly more women than men had pain at both sites. Both leg or calf and ankle or foot pain were strongly associated with standing postures, whole-body vibration, psychological distress, female gender, and being aged 50 years or older. Constrained standing postures were associated with increased ankle or foot pain for both men and women and with leg or calf pain for women, compared with standing with freedom to sit at will.
Freedom to sit at work may prevent lower-extremity pain. The effects of specific sitting and standing postures on cartilage, muscle, and the cardiovascular system may help explain discomfort in the lower extremities.
Cites: Int Arch Occup Environ Health. 2003 Oct;76(8):584-9012898271
Work content is adversely affected by precarious employment conditions, with consequences for workers and clients/customers. Three examples are taken from professions involving long-term relations between workers and clients. Adult education teachers hired on short-term contracts to teach primarily immigrant populations prepare their courses under less favorable conditions than regular teachers and their employment context foments hostility among teachers. Special education technicians are hired on a seasonal basis which interferes with their ability to coordinate and plan their efforts in collaboration with teachers. Workers in shelters for women suffering conjugal violence who were hired on a casual or on-call basis were unable to follow up with women they helped during their shifts and more rarely engaged in one-on-one counseling. Precarious work contracts can affect mental health not only through employment insecurity but also through negative effects on the ability to do one's job and take pride in one's work, as well as weakening the interpersonal relationships on which successful, productive work depends.
A number of researchers have pointed out that less is known about occupational determinants of health in women than in men. The authors examine inventories of ongoing Canadian research and of recent scientific publications in order to identify trends in the approaches used to study women's occupational health (WOH). We also consider conceptual issues in the treatment of the sex and gender of subjects. We observe that women have been the subject of relatively few investigations of occupational health in the natural or biomedical sciences and that studies of WOH have concentrated on the health care professions and on psychosocial stressors, with a deficit in toxicological and physiological studies. We use recent studies of mercury exposure in chloralkali process plants and of musculoskeletal disorders among office workers to provide specific examples of problems in conceptualizing WOH. We propose that WOH be studied more often, especially by researchers in the natural and biomedical sciences, and that such studies include both women and men, where possible, and consider the complex relationships of gender and sex to the pathways involved. More interdisciplinary research would facilitate this process, since social researchers have tended to focus more on gender/sex issues. Our findings demonstrate that it is necessary to explore the implications of using sex routinely as an explanatory variable in occupational health research and to increase emphasis on the mechanisms involved in any sex or gender differences sought or found. From an equity perspective, it is also important to situate biological sex differences so as to prevent them from being used erroneously to justify job segregation or inequitable health promotion measures.
Several studies have reported male-female differences in the prevalence of symptoms of work-related musculoskeletal disorders (MSD), some arising from workplace exposure differences. The objective of this paper was to compare two strategies analyzing a single dataset for the relationships between risk factors and MSD in a population-based sample with a wide range of exposures.
The 1998 Québec Health and Social Survey surveyed 11 735 respondents in paid work and reported "significant" musculoskeletal pain in 11 body regions during the previous 12 months and a range of personal, physical, and psychosocial risk factors. Five studies concerning risk factors for four musculoskeletal outcomes were carried out on these data. Each included analyses with multiple logistic regression (MLR) performed separately for women, men, and the total study population. The results from these gender-stratified and unstratified analyses were compared.
In the unstratified MLR models, gender was significantly associated with musculoskeletal pain in the neck and lower extremities, but not with low-back pain. The gender-stratified MLR models identified significant associations between each specific musculoskeletal outcome and a variety of personal characteristics and physical and psychosocial workplace exposures for each gender. Most of the associations, if present for one gender, were also found in the total population. But several risk factors present for only one gender could be detected only in a stratified analysis, whereas the unstratified analysis added little information.
Stratifying analyses by gender is necessary if a full range of associations between exposures and MSD is to be detected and understood.
Erratum In: Scand J Work Environ Health. 2009 Sep; 35(5):400
Prolonged standing is associated with health problems. Despite regulations providing for access to seats, most Québec (Canada) workers usually stand. Only one in six can sit at will. Standing service workers such as cashiers and sales personnel are often confined to a small area where sitting is theoretically feasible. In many other countries, such workers have access to seats. This study asks why North American workers do not press for seats. In a qualitative, exploratory approach, 30 young workers who usually work standing were interviewed about their perceptions and experiences of prolonged standing at work. All but one experienced discomfort associated with this posture, and two-thirds reported that they had changed their lifestyle in some way as a result of their symptoms. However, their accounts of relationships with employers, health care personnel, and the health and safety system suggest that many environmental factors as well as attitudes toward work, employers, health, and the body contribute to maintaining the status quo. Workers describe problems with the image of a seated worker and thought that asking for a seat would threaten their relationship with the employer. Personal comfort was considered an insufficient reason to challenge worksite design, attitudes, and organization.
We examined underestimation of nontraumatic work-related musculoskeletal disorders (WMSDs) stemming from underreporting to workers' compensation (WC).
In data from the 2007 to 2008 Québec Survey on Working and Employment Conditions and Occupational Health and Safety we estimated, among nonmanagement salaried employees (NMSEs) (1) the prevalence of WMSDs and resulting work absence, (2) the proportion with WMSD-associated work absence who filed a WC claim, and (3) among those who did not file a claim, the proportion who received no replacement income. We modeled factors associated with not filing with multivariate logistic regression.
Eighteen percent of NMSEs reported a WMSD, among whom 22.3% were absent from work. More than 80% of those absent did not file a WC claim, and 31.4% had no replacement income. Factors associated with not filing were higher personal income, higher seniority, shorter work absence, and not being unionized.
The high level of WMSD underreporting highlights the limits of WC data for surveillance and prevention. Without WC benefits, injured workers may have reduced job protection and access to rehabilitation.