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Gender equality and health experiences: workplace patterns in Northern Sweden
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Jämställdhet och hälsoupplevelser : arbetsplatsmönster i norra Sverige (Swedish)
Abstract [en]

Gendered practices of working life create gender inequalities through horizontal and vertical gender segregation in work, which may lead to gender inequalities in health experiences. The workplace is an important part of the social circumstances under which health opportunities and constraints are shaped. The workplace has also been identified as an important arena for gender constructions. Still, there is a lack of research about the relations between workplace gender equality and health experiences. The aim of this thesis was to explore gender equality and health experiences in a workplace setting.

Qualitative and quantitative methods were used. In the qualitative studies all caregiving staff at two establishments providing care for elderly was invited to participate in focus groups (Papers I & II). A moderator led 14 focusgroup discussions. Qualitative content analysis was used to analyse the transcribed discussions. For the quantitative studies questionnaire data from the Northern Swedish Cohort (n=836) were analysed and supplemented with register data about the participants’ workplaces. The register data were used to stratify the workplaces according to gender composition (paper IV) and to create gender equality indicators of the number of women and men at the workplace, education, salary and parental leave (Paper III). Cluster analysis was used to identify patterns of gender equality at the workplaces. Logistic regression analysis, adjusting for individual socio-demographics and previous psychological distress, were used to analyse psychological distress in relation to both clusters and gender compositions.

This thesis identifies various workplace patterns of gender equality and how they are related to health experiences. The results from the focus group study showed that workplace stressors had a structural character, often originating from societal processes outside the own organization, whereas health resources had a relational character and were constructed within the organization (paper I). Gender equality was seen as a structural issue not connected to the individual health experiences and gender inequalities were justified through focusing on personalities and interests in work division (paper II). The cluster analysis resulted in six distinctive clusters with different workplace patterns of gender equality (paper III). The most gender-equal cluster was characterized by gender equality in salary and parental leave and was associated with the lowest prevalence of psychological distress, with no significant differences between women and men. The clusters were associated with psychological distress among women only. The highest odds for psychological distress among women were found in a traditional unequal cluster. Analyses of the gender composition at the workplace showed that the highest prevalence of psychological distress was found at workplaces with a mixed gender composition (paper IV). The psychosocial work environment was rather similar independent of the workplace gender composition.The factors most strongly associated with psychological distress were high demands and low control at workplaces with more men, being looked down upon at workplaces with a mixed gender composition, and social support at workplaces with more women.

Gender perspectives highlight the importance of gender relations in research on work-related health. Gender inequalities at workplaces can be part of the explanation to women’s worse self-rated health. A multidimensional view of gender equality is necessary to understand health consequences of specific workplace situations. Workplaces are important arenas for health promotion activities and gender equality aspects needs to be taken into account to reach both women and men. Adequate health promotion needs to shift focus from individual health strategies to structural solutions that can challenge the root of the problem.

Abstract [sv]

Ojämställdhet i arbetslivet kan innebära olika hälsokonsekvenser för kvinnor och män. Arbetsplatsen är en viktig del av de sociala omständigheter under vilka hälsomöjligheter och -begränsningar skapas. Arbetsplatsen har också identifierats som en viktig arena för genuskonstruktioner. Trots detta saknas forskning om relationerna mellan jämställdhet på arbetsplatser och hälsoupplevelser. Den här avhandlingen syftar till att studera sambanden mellan jämställdhet på arbetsplatser och de anställdas hälsoupplevelser.

Avhandlingen använder både kvalitativa och kvantitativa metoder. I de kvalitativa studierna erbjöds all vårdpersonal på två äldreboenden att delta i fokusgruppsdiskussioner (Artikel I & II). Sammanlagt genomfördes 14 fokusgrupper. Kvalitativ innehållsanalys användes för att analysera de transkriberade fokusgrupperna. I de kvantitativa studierna användes enkätdata från Luleåkohorten(n= 836) som kompletterats med registerdata om deltagarnas arbetsplatser. Registerdata användes för att stratifiera deltagarna utifrån könssammansättningen på deras arbetsplatser (artikel IV) och för att skapa jämställdhetsindikatorer för arbetsplatserna vad gäller andel män och kvinnor, utbildningsnivå, lön och föräldraledighet (artikel III). Klusteranalys användes för att identifiera mönster av jämställhet på arbetsplatserna. Skillnader i psykiska besvär mellan klustren respektive de olika könssammansättningarna analyserades med logistisk regressionsanalys som justerats för sociodemografiska variabler och tidigare psykiska besvär.

Avhandlingen identifierar olika jämställdhetsmönster på arbetsplatsenoch hur de är relaterade till hälsoupplevelser. Resultaten från fokusgruppstudierna visade att de hälsorelaterade stressorerna hade en strukturell karaktär som ofta hade sitt ursprung i sociala processer utanför den egna organisationen. Hälsoresurserna var i hög utsträckning av relationell karaktär och skapades inom organisationen. Ojämställdhet sågs som ett strukturellt problem som inte kopplades till individuell hälsa. Ojämställdhet i arbetsfördelningen försvarades genom att fokusera på personligheter och individuella intressen. Kvantitativa analyser resulterade i sex kluster med olika jämställdhetsmönster på arbetsplatserna. Det mest jämställda klustret kännetecknades av arbetsplatser med jämställda löner och föräldraledighet och var relaterat till den lägsta förekomsten av psykiska besvär. I detta kluster hade också män och kvinnor samma förekomst av psykiska besvär. Bland kvinnorna fanns det skillnader mellan klusterna vad gäller psykiska besvär, men inte bland männen. Den högsta förekomsten av psykiska besvär bland kvinnor fanns i det traditionellt mest ojämställda klustret (artikel III) samt på arbetsplatser med en blandad könssammansättning (artikel IV). Variationen i den psykosociala arbetsmiljön var liten mellan arbetsplatser med olika könssammansättning men det fanns skillnader i sambanden mellan den psykosociala arbetsmiljön och psykiska besvär. De faktorer som hade starkast samband med psykiska besvär var höga krav och låg kontroll på arbetsplatser med en majoritet män, att bli ”sedd ner på” på könsblandade arbetsplatser, och socialt stöd på arbetsplatser med en majoritet kvinnor.

Genusperspektiv är viktiga för att lyfta fram betydelsen av genusrelationer i forskning om arbetsrelaterad hälsa. Ojämställdhet på arbetsplatser kan vara en del av förklaringen till kvinnors sämre självskattade hälsa. En mångdimensionell syn på jämställdhet är nödvändig för att förstå hälsokonsekvenser av specifika arbetsplatssituationer. Arbetsplatser utgör också viktiga arenor för hälsofrämjande åtgärder och jämställdhetsaspekter måste beaktas för att dessa åtgärder ska nå både kvinnor och män på arbetsplatserna. Hälsofrämjande arbete måste skifta fokus från individuella, beteendeinriktade hälsostrategier till strukturella lösningar som kan utmana grunden till problemen.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2013. , 66 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1542
Keyword [en]
gender equality, workplace, health experiences, focus groups, cluster analysis, gender, work environment, gender regimes
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
URN: urn:nbn:se:umu:diva-63973ISBN: 978-91-7459-542-0 (print)OAI: oai:DiVA.org:umu-63973DiVA: diva2:585599
Public defence
2013-02-01, sal 135, byggnad 9A, målpunkt X, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Funder
FAS, Swedish Council for Working Life and Social Research, Dnr 2007-2073Vinnova
Available from: 2013-01-11 Created: 2013-01-09 Last updated: 2013-01-11Bibliographically approved
List of papers
1. Health against the odds: experiences of employees in elder care from a gender perspective
Open this publication in new window or tab >>Health against the odds: experiences of employees in elder care from a gender perspective
2010 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 20, no 9, 1202-1212 p.Article in journal (Refereed) Published
Abstract [en]

Women-dominated elder care in Sweden is a low-paid, low-status job with a high prevalence of sick leave. Our aim was to analyze health experiences of employees in elder care from a gender perspective. All caregiving staff at two establishments providing care to the elderly were invited to participate in the study. A moderator led seven focus group discussions. Qualitative content analysis was used to analyze the transcribed focus groups. We identified two central themes in relation to the employees' health. "Working against the odds" describes gendered workplace stressors of a structural character, to a large extent triggered by societal processes outside the organization. "Making work matter" refers to gendered health resources with a relational character, constructed within the organization. Health-promoting programs directed toward women-dominated workplaces need to include a gender perspective, and focus on creating structural, supportive environments to avoid the negative health effects of the stressors.

Keyword
Content analysis, focus groups, gender, health experiences, stress, distress, workplace
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-37426 (URN)10.1177/1049732310371624 (DOI)000280688100005 ()20519432 (PubMedID)
Available from: 2010-11-03 Created: 2010-11-03 Last updated: 2017-12-12Bibliographically approved
2. Gender (in)equality among employees in elder care: implications for health
Open this publication in new window or tab >>Gender (in)equality among employees in elder care: implications for health
2012 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 11, no 1Article in journal (Refereed) Published
Abstract [en]

Introduction: Gendered practices of working life create gender inequalities through horizontal and vertical gender segregation in work, which may lead to inequalities in health between women and men. Gender equality could therefore be a key element of health equity in working life. Our aim was to analyze what gender (in) equality means for the employees at a woman-dominated workplace and discuss possible implications for health experiences.

Methods: All caregiving staff at two workplaces in elder care within a municipality in the north of Sweden were invited to participate in the study. Forty-five employees participated, 38 women and 7 men. Seven focus group discussions were performed and led by a moderator. Qualitative content analysis was used to analyze the focus groups.

Results: We identified two themes. "Advocating gender equality in principle" showed how gender (in) equality was seen as a structural issue not connected to the individual health experiences. "Justifying inequality with individualism" showed how the caregivers focused on personalities and interests as a justification of gender inequalities in work division. The justification of gender inequality resulted in a gendered work division which may be related to health inequalities between women and men. Gender inequalities in work division were primarily understood in terms of personality and interests and not in terms of gender.

Conclusion: The health experience of the participants was affected by gender (in) equality in terms of a gendered work division. However, the participants did not see the gendered work division as a gender equality issue. Gender perspectives are needed to improve the health of the employees at the workplaces through shifting from individual to structural solutions. A healthy-setting approach considering gender relations is needed to achieve gender equality and fairness in health status between women and men.

Place, publisher, year, edition, pages
BioMed Central, 2012
Keyword
Content analysis, focus groups, gender, health experiences, work environment, workplace
National Category
Family Medicine
Identifiers
urn:nbn:se:umu:diva-54342 (URN)10.1186/1475-9276-11-1 (DOI)000300877300001 ()
Available from: 2012-04-24 Created: 2012-04-24 Last updated: 2017-12-07Bibliographically approved
3. Patterns of gender equality at workplaces and psychological distress
Open this publication in new window or tab >>Patterns of gender equality at workplaces and psychological distress
2013 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 1, e53246- p.Article in journal (Refereed) Published
Abstract [en]

Research in the field of occupational health often uses a risk factor approach which has been criticized by feminist researchers for not considering the combination of many different variables that are at play simultaneously. To overcome this shortcoming this study aims to identify patterns of gender equality at workplaces and to investigate how these patterns are associated with psychological distress. Questionnaire data from the Northern Swedish Cohort (n=715) have been analysed and supplemented with register data about the participants’ workplaces. The register data were used to create gender equality indicators of women/men ratios of number of employees, educational level, salary and parental leave. Cluster analysis was used to identify patterns of gender equality at the workplaces. Differences in psychological distress between the clusters were analysed by chi-square test and logistic regression analyses, adjusting for individual socio-demographics and previous psychological distress. The cluster analysis resulted in six distinctive clusters with different patterns of gender equality at the workplaces that were associated to psychological distress for women but not for men. For women the highest odds of psychological distress was found on traditionally gender unequal workplaces. The lowest overall occurrence of psychological distress as well as same occurrence for women and men was found on the most gender equal workplaces. The results from this study support the convergence hypothesis as gender equality at the workplace does not only relate to better mental health for women, but also more similar occurrence of mental ill-health between women and men. This study highlights the importance of utilizing a multidimensional view of gender equality to understand its association to health outcomes. Health policies need to consider gender equality at the workplace level as a social determinant of health that is of importance for reducing differences in health outcomes for women and men.

Keyword
gender equality, workplace, psychological distress, cluster analysis, gender, work
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-63972 (URN)10.1371/journal.pone.0053246 (DOI)
Funder
FAS, Swedish Council for Working Life and Social Research, Dnr 2007-2073
Available from: 2013-01-11 Created: 2013-01-09 Last updated: 2017-12-06Bibliographically approved
4. Workplace gender composition and psychological distress: the importance of the psychosocial work environment
Open this publication in new window or tab >>Workplace gender composition and psychological distress: the importance of the psychosocial work environment
2014 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, 241- p.Article in journal (Refereed) Published
Abstract [en]

Background: Health consequences of the gender segregated labour market have previously been demonstrated in the light of gender composition of occupations and workplaces, with somewhat mixed results. Associations between the gender composition and health status have been suggested to be shaped by the psychosocial work environment. The present study aims to analyse how workplace gender composition is related to psychological distress and to explore the importance of the psychosocial work environment for psychological distress at workplaces with different gender compositions.

Methods: The study population consisted of participants from the Northern Swedish Cohort with a registered workplace in 2007 when the participants were 42 years old (N = 795). Questionnaire data were supplemented with register data on the gender composition of the participants' workplaces divided into three groups: workplaces with more women, mixed workplaces, and workplaces with more men. Associations between psychological distress and gender composition were analysed with multivariate logistic regression analysis adjusting for socioeconomic position, previous psychological distress, psychosocial work environment factors and gender. Logistic regression analyses (including interaction terms for gender composition and each work environment factor) were also used to assess differential associations between psychosocial work factor and psychological distress according to gender composition.

Results: Working at workplaces with a mixed gender composition was related to a higher likelihood of psychological distress compared to workplaces with more men, after adjustments for socioeconomic position, psychological distress at age 21, psychosocial work environment factors and gender. Psychosocial work environment factors did not explain the association between gender composition and psychological distress.

Conclusions: The association between gender composition and psychological distress cannot be explained by differences in the perception of the psychosocial work environment and thus the work environment hypothesis is not supported. Workplaces with a mixed gender composition needs further research attention to explain the negative development of psychological distress during working life for both women and men at these workplaces.

Place, publisher, year, edition, pages
London: BioMed Central, 2014
Keyword
Workplace, Gender composition, Gender, Psychological distress, Psychosocial work environment, Gender segregation
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-63935 (URN)10.1186/1471-2458-14-241 (DOI)000332730500002 ()
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, Dnr 2007-2073
Note

Originally published in thesis in manuscript form.

Available from: 2013-01-10 Created: 2013-01-09 Last updated: 2017-12-06Bibliographically approved

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