Gender (in)equality among employees in elder care: implications for health

International Journal for Equity in Health

Anne Hammarström²  Lena Aléx¹  Sofia Elwér² 

[1] Department of Nursing, Umeå University, SE 901 87 Umeå, Sweden;Department of Public Health and Clinical Medicine, Umeå University, SE 901 87 Umeå, Sweden

关键词: workplace;    work environment;    health experiences;    gender;    focus groups;    Content analysis;   

Others  :  829395
DOI  :  10.1186/1475-9276-11-1

 received in 2011-06-27, accepted in 2012-01-04,  发布年份 2012

【 摘 要 】

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.

【 授权许可】

   
2012 Elwér et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]World Health Organization: Mainstreaming gender equity in health: The need to move forward - Madrid statement. Geneva: WHO; 2002.
• [2]Sen G, Östlin P, George A: Unequal, unfair, ineffective and inefficient. Gender inequity in health: Why it exists and how we can change it. Final report to the WHO Commission on Social Determinants of Health; 2007.
• [3]Magnusson E: Conflict, danger and difference. Nordic heterosexual couples converse about gender equality and fairness. In Critical Studies of Gender Equalities. Edited by Magnusson E, Rönnblom M, Silius H. Göteborg: Makadam publishers; 2008.
• [4]Rönnblom M: Letting women in? Gender Mainstreaming in Regional Policies. NORA - Nordic Journal of Feminist and Gender Research 2005, 13:164-174.
• [5]Wetherell M, Stiven H, Potter J: Unequal egalitarianism: A preliminary study of discourse and employment opportunities. British Journal of Social Psychology 1987, 26:59-71.
• [6]Moller Okin S: Justice, gender and the family. New York: Basic Books; 1989.
• [7]Verloo M, Lombardo E: Contested gender equality and policy variety in Europe: Introducing a critical frame analysis approach. In Multiple meaning of gender equality: A critical frame analysis of gender policies in Europe. Edited by Verloo M. Budapest: Central European University Press; 2007.
• [8]MacKinnon CA: Feminism unmodified. Cambridge: Harvard University Press; 1987.
• [9]Payne S, Doyal L: Re-visiting gender justice in health and healthcare. In Gender and health care. Edited by Kuhlmann E, Annandale E. Palgrave Macmillan; 2010:21-35.
• [10]Acker J: Hierarchies, jobs, bodies: A theory of gendered organisations. Gender & Society 1990, 4:139-158.
• [11]Kanter RM: Men and women of the corporation. New York: Basic Books; 1977.
• [12]Messing K, Östlin P: Gender equality, work and health: A review of the evidence. Geneva: World Health Organisation; 2006.
• [13]Östlin P: Examining work and its effects on health. In Engendering international health: The challenge of equity. Edited by Sen G, George A, Östlin P. Cambridge (MA): MIT press; 2002.
• [14]Connell R: Gender. Cambridge: Polity Press; 2002.
• [15]Connell R: Glass ceiling or gendered institutions? Mapping the gender regimes of public sector worksites. Public Administration Review 2006, 66:837-849.
• [16]Courtenay WH: Constructions of masculinity and their influence on men's wellbeing: A theory of gender and health. Social Science and Medicine 2000, 50:1385-1401.
• [17]Doyal L: Gender equity in health: Debates and dilemmas. Social Science and Medicine 2000, 51:931-939.
• [18]Pinkhasov RM, Wong J, Kashanian J, Lee M, Samadi DB, Pinkhasov MM, Shabsigh R: Are men shortchanged on health? Perspective on health care utilization and health risk behavior in men and women in the United States. International Journal of Clinical Practice 2010, 64:475-487.
• [19]Östlin P, Eckermann E, Mishra US, Nkowane M, Wallstam E: Gender and health promotion: A multisectoral policy approach. Health Promotion International 2006, 21(Suppl 1):25-35.
• [20]Swedish Governmental report: Power to shape society and the own life: Gender equality politics towards news goals: Final report [In Swedish: Makt att forma samhället och sitt eget liv: Jämställdhetspolitiken mot nya mål: Slutbetänkande] Stockholm. 2005.
• [21]The Swedish Code of Statues SFS: Act Concerning Equality between Men and Women. The Swedish Ministry of Integration and Gender Equality; 1991. vol. SFS1991:433:
• [22]Hogstedt C, Lundgren B, Moberg H, Pettersson B, Ågren G: The Swedish public health policy and the national institute of public health. Scandinavian Journal of Public Health 2004, (Supplement 64):3-64.
• [23]Statistics Sweden: Women and men in Sweden. Örebro: Statistics Sweden; 2006.
• [24]West C, Zimmerman D: Doing Gender. Gender & Society 1987, 1:125-151.
• [25]Doyal L: What makes women sick: Gender and the political economy of health. London: Macmillan Press Ltd; 1995.
• [26]Karasek RA, Theorell T: Healthy work: Stress, productivity and reconstruction of working life. New York: Basic Books; 1990.
• [27]World Health Organization: The world health report 2002: Reducing risks, promoting healthy life. Geneva: World Health Organization; 2002.
• [28]Wærness K: The rationality of caring. Economic and Industrial Democracy 1984, 5:185-211.
• [29]Tronto JC: Women and caring: What can feminists learn about morality from caring? In Gender/body/knowledge. Edited by Jaggar AM. New Brunswick: Rutgers University Press; 1989.
• [30]Bäckman O: Med välfärdsstaten som arbetsgivare [With the welfare state as employer]. In Statens offentlig utredningar 2001:52 Välfärdstjänster i omvandling [Welfare duties in transformation]. Edited by Välfärdsbokslut MSK. Stockholm: Fritzes; 2001.
• [31]Gustafsson RÅ, Szebehely M: Arbetsvillkor och styrning i äldreomsorgens hierarki - en enkätstudie bland personal och politiker [Work conditions and control in the hierarchy of the elderly care]. In Rapport i socialt arbete [Report in social work]. Stockholm: Stockholm University; 2005.
• [32]Elwér S, Aléx L, Hammarström A: Health against the odds: Experiences of employees in elder care from a gender perspective. Qualitative Health Research 2010.
• [33]Pfefferle SG, Weinberg DB: Certified nurse assistants making meaning of direct care. Qualitative Health Research 2008, 18:952-961.
• [34]Häggström E, Skovdahl K, Fläckman B, Kihlgren AL, Kihlgren M: To feel betrayed and to feel that you are betraying the older residents: Caregivers' experiences at a newly opened nursing home. Journal of Clinical Nursing 2004, 13:687-696.
• [35]McGibbon E, Peter E, Gallop R: An institutional ethnography of nurses' stress. Qualitative Health Research 2010, 20:1353-1378.
• [36]Demakakos P, Nazroo J, Breeze E, Marmot M: Socioeconomic status and health: The role of subjective social status. Social Science & Medicine 2008, 67:330-340.
• [37]Korvajävi P: "Doing gender" - theoretical and methodological considerations. In Where have all the structures gone? Doing gender in organisations, examples from Finland, Norway and Sweden. Volume 33. Edited by Gunnarsson E, Andersson S, Rosell AV, Lehto A, Salminen-Karlsson M. Stockholm: Center for women's studies; 2003::45-76.
• [38]McNeely E: The consequences of job stress for nurses' health: Time for a checkup. Nursing Outlook 2005, 53:291-299.
• [39]Forssén ASK, Carlstedt G, Mörtberg CM: Compulsive sensitivity - A consequence of caring: A qualitative investigation into women carer's difficulties in limiting their labours. Health Care for Women International 2005, 28:652-671.
• [40]George A: Nurses, community health workers, and home carers: Gendered human resources compensating for skewed health systems. Global Public Health 2008, 3(Suppl 1):75-89.
• [41]Schaefer JA, Moos RH: Effects of work stressors and work climate on longterm care staff's job morale and functioning. Research in Nursing & Health 1996, 19:63-73.
• [42]Ron P: Relations between work stressors and well-being among nursing assistants in nursing homes. Aging Clinical and Experimental Research 2008, 20:359-367.
• [43]Eriksen W, Tambs K, Knardahl S: Work factors and psychological distress in nurses' aides: A prospective cohort study. BMC Public Health 2006, 6:290. BioMed Central Full Text
• [44]de Jonge J, Le Blanc PM, Peeters MC, Noordam H: Emotional job demands and the role of matching job resources: A cross-sectional survey study among health care workers. International Journal of Nursing Studies 2008, 45:1460-1469.
• [45]Storm P: Kvinnor och män i avlönat omsorgsarbete. Hur kön kommer till uttryck i tal och handling på ett sjukhem. [Women and men in paid caring work. Expressions of gender in talk and action at a nursing home]. In Rapport i socialt arbete. Stockholm: Stockholm University; 2008.
• [46]Sörensdotter R: Omsorgsarbete i omvandling. Genus, klass och etnicitet inom hemtjänsten [Caring in transition. Gender, class and ethnicity in home help]. Stockholm University, Department of Social Anthropology; 2008.
• [47]Pörn I: An equilibrium of health. In Health, disease and causal explanations in medicine. Edited by Nordenfeldt L, Lindahl B. Dordrecht: Reidel Publishing Company; 1984:3-9.
• [48]Antonovsky A: Unraveling the mystery of health. San Francisco: Jossey-Bass; 1987.
• [49]Morgan DL: The focus group guidebook. Thousand Oaks, CA: Sage Publications; 1998.
• [50]Graneheim UH, Lundman B: Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today 2003, 24:105-112.
• [51]UMDAC & Division of Epidemiology and Public Health Sciences: Open Code. 3.4th edition. 2007.
• [52]Magnusson E: The rhetoric of inequality: Nordic women and men argue against sharing house-work. NORA - Nordic Journal of Feminist and Gender Research 2011, 16:79-95.
• [53]Acker J: Inequality regimes - Gender, class, and race in organizations. Gender & Society 2006, 20:441-464.
• [54]Nordberg M: Constructing masculinity in women's worlds: Men working as preschool teachers and hairdressers. NORA - Nordic Journal of Feminist and Gender Research 2002, 10:26-37.
• [55]Morrell R, Jewkes R: Carework and caring: A path to gender equitable practices among men in South Africa? International Journal for Equity in Health 2011, 10:17. BioMed Central Full Text
• [56]Härenstam A, Aronsson G, Hammarström A: The future of gender inequalities in health. In Gender inequalities in health A Swedish perspective. Edited by Östlin P, Danielsson M, Diderichsen F, Härenstam A, Lindberg G. Boston: Harvard University Press; 2001:269-304.
• [57]Emslie C, Hunt K: 'Live to work' or 'work to live'? A qualitative study of gender and work-life balance among men and women in mid-life. Gender, Work and Organization 2009, 16:151-172.
• [58]Loscocco KA: Work-family linkages among self-employed women and men. Journal of Vocational Behavior 1997, 50:204-226.
• [59]Wuest J, Hodgins MJ: Reflections on methodological approaches and conceptual contributions in a program of caregiving research: Development and testing of Wuest's theory of family caregiving. Qualitative Health Research 2011, 21:151-161.
• [60]Baum F: The new public health. Third edition. Oxford: Oxford University Press; 2008.
• [61]Kidd PS, Parshall MB: Getting the focus and the group: Enhancing rigor in focus group research. Qualitative Health Research 2000, 10:293-308.