The labour force provides especially fertile ground for exploring gender and sex differences related to health, says Dr. Peter Smith. For one thing, the 11 most gender-segregated occupations in Canada—from construction trades to child-care and administrative support—are the same today as they were 25 years ago. This is despite the fact that the Canadian labour market added over 2.7 million women and 1.7 million men over this time period.
Smith, a scientist at the Institute for Work & Health (IWH), shared this fact with the some 100 people who attended the launch in mid-October of his five-year research chair in gender, work and health. His chair, one of nine recently awarded by the Institute of Gender and Health at the Canadian Institutes of Health Research (CIHR), is exploring how women and men differ with respect to risk of work injury, returning to work after an injury, and the relationship between job stress and chronic disease.
Although previous research has recommended guidelines on how to include gender and sex in work and health research, occupational health and safety (OHS) studies “have a history of exclusion,” Smith says.
He points to a study of OHS journal articles that found 30 per cent studied men only, seven per cent studied women only, and 11 per cent did not mention gender or sex at all when describing those studied. Among the remaining 50 per cent that studied both, 42 per cent did not examine the link between sex or gender and outcomes.
What’s more, the terms “gender” and “sex” are often used inconsistently. Smith cites another review of articles in gender and health journals that found only five per cent defined either “sex” or “gender,” and 38 per cent used the terms interchangeably.
It’s very important that we define these terms because they describe two very different mechanisms that might produce differences in our OHS findings and, in turn, our policy and intervention responses, says Smith. “Sex” refers to biological attributes including physical features, genes, hormones and anatomy. “Gender” refers to the socially constructed roles, relationships and behaviours of men, women and gender-diverse people that influence how people perceive themselves and others.
Exploring three OHS areas
During the five-year program, Smith is looking at gender and sex with respect to three OHS issues in particular.
(1) Risk of work injury. To take just one of many examples, Statistics Canada surveys show that men have about twice the rate of self-reported work injury as women, but when it comes to repetitive strain injuries (RSIs) only, women have a slightly elevated risk compared to men.
(2) Recovery and return to work. Women generally take longer to return to work. One review of prolonged disability among women with musculoskeletal disorders pointed to their more complex work situations, more complex injuries that are harder to describe to health-care professionals, and differing family and social roles.
Other research shows women and men are treated differently by health-care providers, potentially affecting recovery. For example, in a study of patients with knee arthritis (not necessarily work-related), doctors were 2.5 times more likely to recommend surgery for men than women. The study suggests this could be due to differences in how they describe their symptoms (with women using a more narrative style and men a more direct style) or to stereotypes about how men and women deal with pain or the amount of support they have at home post-surgery.
(3) Psychosocial work environment and chronic disease. This research stream builds on Smith’s previous findings showing an association between low job control and an elevated risk of hypertension among men but not women, and an association between low job control and an elevated risk of diabetes among women, but not men.
This is interesting, because we think of the factors causally related to hypertension and diabetes as being similar among men and women but, in this case, it doesn’t look like they are, says Smith.
Smith is going to dig deeper into all three issues.
There is much to untangle in the link between sex/gender and vulnerability to workplace injuries, return-to-work outcomes and the effect of psychosocial factors on chronic conditions, he says.
To get involved in this research program—as an OHS workplace or policy stakeholder (e.g. research advisor, study participant), research trainee, student or fellow researcher—please contact Smith at firstname.lastname@example.org. To listen to his full presentation on his research program.