Women Work and Health: Have we made progress?

1. Women Work and Health: Have we made progress? Dame Carol Black Expert Adviser on Health and Work Department of Health, England Consultant Adviser on Health Department of Work and Pensions, UK

2. Social Determinants of Health • The social gradient • Stress • Early life • Social exclusion • Work/Unemployment • Social support • Addiction • Food • Transport • Education

3. Work: its value • Work is a social determinant of health • Work is generally good for health – the two are inextricably linked • Enabling people to be in productive work is a health issue • Work provides income: material well-being and participation in today’s society • Work meets important psychosocial needs in societies where employment is the norm • Employment and socio-economic status are the main drivers of social gradients in health • Work needs to be ‘good work’ Galen (129-200) “Employment is nature’s physician and is essential to human happiness.”

4. A more feminised workforceUK Workforce participation rates 1971 to 2008 Is this work ‘good work?’ From R.Donkin, The Future of Work, 2010

5. A more feminised workforceUSA Workforce participation rates 1948 to 2005

6. Theneedsofaworker,maleorfemale • To be healthy enough to work • Safe healthy workplaces - physically safe- emotionally healthy • good work: • job security • work varied and interesting • workers have some autonomy, control and task discretion • fair rewards (not just financial) for effort • supportive social relationships • worker engagement. The various countries of the world are at different stages in providing the above. The nature of work is changing in many countries.

7. Women and work in the European Union Women: • More likely than men to be unemployed or in low-paid jobs • Still dominate employment in sectors such as health care and social services, education, public administration and retailing • Severely under-represented in economic decision-making : • Only 11% of board members in Europe’s biggest listed companies are female • Only 3% of such companies have a woman in charge (Norway is the exception – the result of a quota by law) Men: • Work as technicians, engineers, finance professionals and managers • Remain about twice as likely as women to be managers, and three times as likely to be senior managers

8. Dehumanisation of work Anna Sam: ‘The Tribulations of a Check-out Girl’ Sam often heard mothers admonish their children as they approached her till: “If you don’t work hard at school you will end up like that lady at the counter.” You do not often see men working on supermarket checkouts except for students in part-time jobs. Work can make you sick. It took a book for businesses to wake up and realise that here was not a human machine but a living, breathing and thinking human being. Example taken from R.Donkin, The Future of Work, 2010

9. Dehumanisation of work Polly Toynbee: ‘Hard Work’ In the book she explored the disadvantages for those in low-paid work by undertaking, aged 55 at the time, a series of poorly-paid, poorly-regarded jobs. Often she worked as a casual agency employee at or near the minimum wage. Not only was her experience an indictment of policies that have broadened the gap between rich and poor in the UK... ...it also highlighted the working realities for thousands of women. Some 80% of the ten lowest-paid occupations are undertaken by women.

10. Low-income US women and employment Findings from a US study of employment experiences and opportunities of low-income women in racially-segregated communities: • 52% are currently working in low-wage service-sector jobs, and prefer jobs in healthcare and childcare • Women typically have held several jobs for relatively short periods, with work histories punctuated by periods of non-work and welfare receipt • They often stop working because of layoffs, childcare and transportation problems, pregnancy, illness or disability • Most are single mothers, and they evaluate the costs and benefits of working in terms of their overall family responsibilities. From Scottish Government and Health Action Partnership International, 2012

11. Long-term unemployment Can lead to: • Poorer physical health • Poorer mental health • Greater usage of medical services • Poorer social integration • Loss of worth and self-confidence • Less monetary resources • Trans-generational effects Re-employment can reverse these changes

12. What prevents us from working The two most common reasons given are: • Common mental health problems • Musculo-skeletal problems • High prevalence across population • Little or no objective disease or impairment • Most episodes settle rapidly, though symptoms often persist or recur • Essentially whole people, with what should be manageable health conditions • Psychosocial factors important – especially in chronic disability. Plus other factors: • Chronic diseases – mental and physical • Obesity-related diseases • Domestic violence, addiction • Lack of education and/or skills • Deprivation, poverty, lack of jobs. Relative importance of these factors will vary with gender, type of work, and country.

13. Women: poverty, mental ill-health and work in the EU • Women form the majority of the EU’s economically inactive, more likely than men to be poor. Some 35% of single parents, mainly women, live in poverty. • Adults in the poorest fifth of the income distribution are more at risk of developing a mental illness than those on average income – and they are less likely to be employed. • Therefore, poorer women have worse levels of mental health and coping capacity to deal with life circumstances. • One in six adults in the UK suffer from a common mental health disorder such as depression, anxiety, phobias and panic attacks. • About 12.8 million working days (40% of total in UK) are lost due to stress, anxiety and depression each year. From Scottish Government and Health Action Partnership International, 2012

14. Domestic Violence Globally, at least one in three women is beaten, coerced into sex or otherwise abused by an intimate partner, in the course of her lifetime. Some of the reasons DV still persists: • Women’s economic dependence on men • Expectations of roles within relationships • Limited access to employment in formal and informal sectors • Limited access to education and training for women • Lesser legal status of women in some countries by written law and/or practice (though with some ongoing improvement). • Domestic violence has damaging consequences to health and to the economy. • In India, each incident of domestic violence translates on average into women losing seven working days [United Nations report]. • This is a difficult topic for employers, but there are some exemplary companies

15. Co-ordinated community response in the UK • Government, law enforcement, courts, the voluntary sector and private sector have all worked together in partnership. Legislative framework and National Delivery Plans helped to set out the aims. • Some of the outcomes include: • 64% fall in the number of domestic violence incidents between 1995 and 2007/8. • Successful prosecution rate increased from 47% to 64% in 2007/08, and then 72.5% in 2009, and in some areas up to 90%. • Significant decrease in fatalities reported by the Metropolitan Police, from 49 deaths a year in 2003 related to domestic violence to 5 in 2010. • Greater coordination of services has meant better value for money, and more effective response.

16. EDV Global Foundation - Catalyst for change The Eliminate Domestic Violence global foundation is a non-profit organisation with the aim to eliminate domestic violence on a global scale. • Working in partnership with countries, international and national agencies, and based on credible international standards, the Global Foundation sets out to provide the expertise needed to achieve this. • The EDV Foundation can help by: • Identifying if there is baseline data available initially. • Providing suggested data sets. • Providing training and advice. • Providing on-going support. Founder: Baroness Scotland QC www.gfedv.org

17. International obesity statistics In an increasingly competitive global economy, only the healthiest businesses will prosper.Companies that invest to support employees’ health will be fitter to survive.

18. Obesity and consequent disease in the UK It is likely that by 2025 40% of adults will be obese, and the number of people living and working with chronic conditions will rise steadily, affecting morale, competitiveness, and profitability.

19. Rheumatoid Arthritis and work • RA is more common in women • Half UK adults with RA are of working age • 75% are diagnosed when of working age • One in three people with RA will have stopped working within 2 years. • Earlier diagnosis and appropriate treatment mean better retention in work. • Increasing from 10% to 20% the number of people treated within 3 months of symptoms would increase NHS costs in England by £11 million over 5 years • BUTcould result in £31 million gain for the economy due to reduced sick leave and work-related disability. National Audit Office Report 2009 Public Accounts Select Committee 2010

20. Rheumatoid Arthritis and work • Report identified lack of coherence in links between the National Health Service and organisations commissioned by the Department of Work and Pensions to get people back into work. • Only 56% of hospitals were aware of DWP schemes, and 33% of these did not give RA patients appropriate information. • Only 12% of family doctors gave information about continuing in employment to those newly diagnosed with RA. • Only 20% of patients with RA considered that they received sufficient information about employment issues. National Audit Office Report 2009

21. Cancer and workCancer is becoming a long term condition • 109,000 working-age people are diagnosed with cancer in the UK each year • 775,000 people of working age in the UK have had a cancer diagnosis • Long term cancer survivors are 1.4 times more likely to be unemployed yet… • … research shows that cancer patients want to work • One in four long term cancer survivors say their cancer is preventing them working in their preferred occupation • The average fall in household income for a family of working age with cancer is 50%... • ... and 17% lose their home MacMillan Cancer Support

22. National Cancer Survivorship InitiativeEmerging findings – September 2010 • Joint project: Macmillan Cancer Support, Department of Health and NHSI testing ways of providing Vocational Rehabilitation for people with cancer. • Seven pilot sites across England to test a model of VR which includes providing information, face to face support, and access to learning programmes and a case manager. Emerging themes: • Patients want attention to work issues early, and revisits during treatment and follow-up • Health professionals inadvertently give mixed messages about work • Line managers are key but may not have the knowledge and skill to manage a patient’s return to work • Patients need more information about rights and responsibilities with regard to employment • Specialist vocational rehabilitation services can proactively anticipate patient problems

23. Cancer and shift work • Extensive animal evidence suggests that disruption of circadian rhythms can increase the risk of cancer, by a variety of mechanisms. • Epidemiological studies provide supporting, but not conclusive, evidence of increased risk of breast cancer in shift workers • HSE has commissioned the Cancer Epidemiology Unit in Oxford University to investigate, using two large cohort studies (The Million Women Study and EPIUC-Oxford), focussing on shift-working in relation to cancer and other chronic conditions • Cross-sectional studies show that shift-working women are in general less affluent, with different reproductive histories and increased prevalence of obesity and smoking – thus probably with increased risk of cancer etc. • Analysis of these complex risk factors, once sufficient data are collected, will help this investigation of the relationship between night work and chronic disease

24. Changes and their consequences • The contraceptive revolution that from around 1965 gave women reliable independent control of their fertility • The changing nature of work, e.g. expansion of white-collar jobs, home working, job sharing • Expansion of work for secondary earners who may want to retain other interests beyond paid work • Equal opportunities and sex discrimination legislation • Increase in significance of attitudes, values, personal preferences in modern liberal societies • The new negatives: lifestyle, obesity, alcohol, lack of physical exercise, chronic disease

25. Church House Conference Centre London