Chapter 10: Gender, work and health: a step forward in women’s occupational health
Working life, in all its forms and domains, is probably one of the most important arenas for action if the objective is to improve the health status of populations in general and to reduce gender inequalities in health. However, the relationship between work and health goes beyond its consideration from a traditional occupational health perspective that only addresses exposure to job hazards, primarily from traditional male jobs, and when addressing specific job hazards for women is often limited to reproductive health. Work, both employment and unpaid domestic and family work, is a social determinant of health that to a great extent shapes the identities and opportunities of people. Moreover, the gender division of work determines work-related gender inequalities in health. Two parallel approaches have dominated the research on work and health. On the one hand, classical occupational health has focused on job safety and hygiene hazards prioritizing the study of male worker populations where their prevalence is typically higher. On the other hand, social epidemiology has considered work as a social determinant of health or as a proxy of socio-economic status. Traditional occupational health has focused on job hazards typical of male occupations and the interest in women’s occupational health has often been limited to reproductive hazards. On the other hand, the examination of work as a determinant of health has used different conceptual frameworks depending on gender. Moreover, it has emphasized sex differences, a biological construct; rather than gender differences, a social, cultural and personal construct, based on the categories of male and female. Three types of problems in the way occupational health research has dealt with sex and gender are: (1) hazards in women’s work have been underestimated; (2) although male workers have been relatively well studied, their experience has not often been examined in relation to their gender; and (3) gender has not always been treated appropriately in studies of mixed populations. In order to examine work as a social determinant of health, we propose a framework of analysis that: (1) starts with the interaction between paid work and the domestic sphere; (2) takes into account the intersection with other axes of inequality, primarily social class, through a unified model that brings gender and socio-economic inequality together in a common framework; (3) separates the carer and the breadwinner roles in the private sphere; and (4) includes a comparative approach between different welfare state regimes.
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