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Women's health and safety: putting back strain on the map, a TUC report on women's back strain at work.

Issue date

Trades Union Congress

Women’s health and safety

Putting back strain on the map

A TUC report on women’s back strain at work for National Back Care Week and National Health and Safety Week 1999

Foreword

Women now make up just about half of all the people at work, but successive TUC reports have shown that their health and safety problems are undervalued and under-researched. The TUC wants to see women workers use their own experiences to demand better standards of health and safety from their employers.

Women’s jobs can be just as back-breaking as men’s, and this report demonstrates that we have only just begun to address this huge health problem.

The TUC is proud to be working with BackCare, the new name for the National Back Pain Association, in promoting a month of campaigning in October 1999. We want to raise the profile of women’s back strain at work, so that we can prevent it.

John Monks

TUC General Secretary

Executive summary

This report shows that:

· 44 million working days each year are lost by women because of back pain;

· just over a quarter of a million women suffer work-related back strain every year;

· more than a quarter of women workers (28%) have to lift or move heavy loads for more than a quarter of their time at work;

· young women are more likely to suffer back strain than young men (35% to 30%) and over half of young women at work have to lift or move heavy loads at work;

· back strain affects women in the South West and Wales more than anywhere else; and

· women working in nursing are as likely as male construction workers to have to lift or move heavy loads at work (84% in both cases) - and as a result 80,000 nurses injure their backs every year, with 3,600 invalided out of the profession.

The TUC welcomes the Government’s Back in Work campaign (being run jointly by the Department of Health and the Health and Safety Commission). Meanwhile, the TUC is calling for:

· better risk assessments to identify the elements of women’s jobs which cause back strain;

· more analysis by employers of the costs to them, their women workers and the taxpayer of work-related back strain - and compulsory inclusion of the facts about the costs of poor health and safety in company reports to shareholders;

· action by employers to reduce the risks of back strain for women workers;

· discussions between employers and union safety reps about preventing back strain; and

· access for all women with work-related back strain to a personal back-to-work plan and speedy and effective treatment.

In particular, the TUC believes that union safety reps should work with their female colleagues to identify the level of work-related back strain among the workforce using "body mapping" techniques - and TUC/BackCare materials are being provided to safety reps in tens of thousands of workplaces to stimulate the use of "body mapping" in British workplaces.

Women’s back strain

Back pain is not generally gender specific, but there are particular jobs which women predominantly do which leave them over-exposed to the risks of back strain. Research into women workers’ health and safety has revealed a number of startling conclusions:

44 million working days each year are lost by women because of back pain

Almost ten million women, about two fifths, suffer from back pain every year, according to the Office for National Statistics (The prevalence of back pain in Great Britain, 1998) and for four fifths of the sufferers, their back pain started more than a year ago. Women generally suffer back pain for longer than men, who tend to suffer from short, sharp attacks. The figure for days lost comes from the Department of Social Security’s Days of certified incapacity for back related problems, 1996/7.

Just over a quarter of a million women suffer work-related back strain every year, according to the Health and Safety Executive. About as many 16-44 year olds suffer as 45-59 year olds (about 81,000 in each case) suggesting that older women workers are twice as likely to suffer from back pain than younger workers.

More than a quarter of women workers (28%) have to lift or move heavy loads for more than a quarter of their time at work.

The main reason why people at work (and women in particular) suffer back strain is because of manual handling. Using the Health and Safety Executive’s 1995 self-reported work-related illness survey, we can see how many women are carrying out the sort of tasks likely to lead to injury. Forty-three per cent of women workers have to lift or move heavy loads in their job, and of those, 82% have to twist or stoop when doing so.

Among women workers generally, 6% always or nearly always have to lift heavy loads, a further 5% have to do so about three quarters of the time, and an extra 7% about half the time. Coupled with the 10% who have to lift or move heavy loads for a quarter of the time, over a quarter of women workers seem to be engaged in substantial amounts of straining physical labour.

But the real at-risk group is the 18% of women workers who have to lift or move heavy loads who are doing so while stooping or twisting always or nearly all the time, a further 9% doing so about three quarters of the time, and the 13% doing so half of the time. Altogether, this represents nearly one in eight of the female labour force, or about one and a half million women workers.

Young women are more likely to suffer back strain than young men (35% to 30%) and over half of young women at work have to lift or move heavy loads at work.

Roughly the same proportions of men and women suffer back strain (about two fifths), but the age distribution of back strain differs markedly. In the younger and older age groups, women are more likely to suffer back strain than men, whereas among the middle-aged, men are far more likely to suffer. The table below shows the proportions suffering from back strain in 1998:

Gender Age

16-24

25-44

45-54

55-64

65 plus

Male

30%

36%

51%

47%

35%

Female

35%

37%

43%

47%

42%

This is partly a reflection for women of their exposure to heavy lifting and moving. Just over half of 16-24 year Olds have experienced such work, compared with about 43% of 25-54 year Olds and just 29% of 55-60 year Olds. The effects, of course, are likely to be cumulative, so although exposure tails off, suffering continues to grow as workers age.

However, a slightly different picture emerges in terms of age when looking at the proportions of those engaged in heavy lifting or moving who do so while twisting or stooping. Here, the proportions continue to increase throughout working life, from 74% of 16-24 year olds to 97% of 55-60 year olds (the same trend is apparent among men). This suggests that younger women workers are undertaking more physical labour, but that the older workers who are still doing such heavy work are also more likely to be carrying out complicated work.

Back strain affects women in the South West and Wales more than anywhere else.

According to the Office of National Statistics, back strain affects higher proportions in the South West and Wales (42%) than anywhere else, with London having the lowest rate at 38%. However, the proportion in Scotland with back strain is growing fastest, up from 35% in 1996 to 39% in 1998.

Women working in nursing are as likely as male construction workers to have to lift or move heavy loads at work (84% in both cases).

As a result 80,000 nurses injure their backs every year, with 3,600 invalided out of the profession. Other occupations with high exposures to heavy lifting were material moving and storage (80%), other processing (79%), metal processing (78%) and farming, fishing and forestry (77%).

Jobs at risk

The main risk factors for women workers are:

· heavy lifting (especially when combined with twisting and stooping), commonly found in nursing and other caring professions, but also in teaching small children, farming and cleaning;

· repetitive tasks involving pushing, pulling or twisting of the body such as supermarket checkout work, production line work, cleaning and machining;

· prolonged keyboard work without breaks, for example in clerical work and call centres; and

· long periods of standing or sitting, such as in shop work, bank telling, telephone work and so on.

More worrying is the lack of action being taken. According to the then National Back Pain Association member survey in 1997, only 17% of women with back pain have had workplace training in how to protect their backs.

A TUC survey of safety reps about musculo-skeletal disorders generally (the hidden workplace epidemics, 1998) showed how few employers recorded the reason why workers with back strain were off sick, how rarely they assessed the costs of such sick leave and how few employers provided rehabilitation or access to treatment for sufferers.

Union action

The TUC has developed a ‘Women, Work and Health’ initiative to draw attention to the health and safety experience of women workers, and to campaign for a gender sensitive approach to health and safety. An early outcome of the initiative was a report on reproductive health and safety submitted to a joint TUC-Maternity Alliance conference in 1998. This revealed that the main health hazard facing pregnant women was back strain.

Pregnant women are, in fact, more likely than any other worker to be badly and permanently affected by back strain because of the changes to the spine which take place during pregnancy. Under the EU Pregnant Workers Directive (implemented in the UK through the amended Management Regulations), such risks need to be addressed specifically.

Subsequently, the TUC’s survey of women safety reps, a "what women want" exercise reported to an international seminar on research into women’s health and safety, showed that the second most important issue facing women workers (after stress at work) was manual handling. The report of the survey indicated that the TUC ought to give a special focus to women’s back strain in its campaigning on musculo-skeletal disorders, as well as to work on violence and stress.

For 1999 National Health and Safety Week, therefore, the TUC has produced guidance for safety reps in the form of a leaflet, and an accompanying poster to be displayed in workplaces. Both stress the need for women workers’ voices to be heard, and champion the idea of "body mapping" to deal with this problem (see next section).

Body mapping and the future

The TUC welcomes the Government’s Back in Work campaign (being run jointly by the Department of Health and the Health and Safety Commission). Meanwhile, the TUC is calling for:

· better risk assessments to identify the elements of women’s jobs which cause back strain;

· more analysis by employers of the costs to them, their women workers and the taxpayer of work-related back strain - and compulsory inclusion of the facts about the costs of poor health and safety in company reports to shareholders;

· action by employers to reduce the risks of back strain for women workers;

· discussions between employers and union safety reps about preventing back strain; and

· access for all women with work-related back strain to a personal back-to-work plan and speedy and effective treatment.

Further details of these policies are contained in better jobs for better workers: a millennial challenge, the TUC’s submission to the Government’s strategic appraisal of health and safety.

Body mapping

In particular, the TUC believes that union safety reps should work with their female colleagues to identify the level of work-related back strain among the workforce using "body mapping" techniques - and TUC/BackCare materials are being provided to safety reps in tens of thousands of workplaces to stimulate the use of "body mapping" in British workplaces.

"Body mapping" involves asking people engaged in the same general work (eg checkout operators, keyboard workers, cleaners) to mark on a "map" of the body any places where they frequently experience pain - perhaps distinguishing between sharp pains and dull aches by using different colours.

Once these "maps" have been put together to get a snapshot of the entire workforce in a particular job, the safety reps can analyse them to identify any common patterns.

If there is a generally high level of back pain, or if a particular site on the back stands out (probably indicating that a particular action is causing the problem), the safety reps should discuss the issue further with the workforce (in case they can readily identify a cause) and then take the matter up with management. A full ergonomic study may need to be done, but whatever the outcome, "body mapping" offers workers the opportunity to carry out their own pseudo-epidemiological study.

Case studies

Alison, a nurse, injured her back badly at work and was unable to carry on nursing. For two years she endured a restricted life just waiting for hospital appointments, until she was referred to a pain management programme. She set herself the goal of doing voluntary work for a charity which led to an offer of paid work. Her new employer understands her need to walk up and down every so often and take mini-breaks from her work.

Denise, a bank employee, suffered acute back pain and was advised to swim and keep mobile. She received intensive physiotherapy, hydrotherapy and occupational therapy and was later referred to a pain management course. She still works for the bank.

Janet worked as a produce assistant in a small supermarket in south west London. Her job was to re-stock frozen and chilled produce from roll cages and from the chill store. The chiller had a 14cm lip at the entrance. With no ramps the cages had to be lifted over this ledge to get them in and out. The problem became particularly acute when the milk delivery changed from boxes to specially designed roll-cages, which weighed around 350kg when full.

After reporting problems with her back, she was moved to fresh produce and was assured there would be assistance to help her with heavy lifting. She received no help, and still had to lift heavy loads - regularly handling 25kg sacks of potatoes. Unable to cope with the pain any longer, she left her job. The shopworkers' union - USDAW - pursued a legal claim for her injuries and she was awarded £22,000. She now works as a receptionist, but her future employment prospects are limited because of her continuing disability.

Rosie worked at a large supermarket as a delicatessen counter assistant. She first injured her back while trying to lift 40lb blocks of cheese in the cold store. After a couple months off, she returned to work. A few months later she strained her back again, whilst lifting a large, heavy ham out of the deli display to serve a customer. The injury was made worse when she was asked to lift bread trays from racking above head height in the patisserie section. She was dismissed as a result of her back problems four years ago, and has not worked since.

A better way to do it

But different ways of working can be introduced to limit the incidence of back pain amongst female employees. In one supermarket chain a problem was identified with women working at the deli counter. The need to stretch and bend to reach produce at the front of the counter was causing some workers to suffer from back pain. The problem was worse for shorter women, who sometimes had to take their feet off the floor to reach into the display.

USDAW reps and an environmental health officer from the local council solved the problem by:

· introducing a removable, hygienic duck-board for use by shorter staff re-arranging the display to move heavier items nearer the back of the counter; and

· re-designing the counter to give access from the front for cleaning and stock rotation.

Further information

The TUC’s Women, Work and Health initiative has generated several publications which might be of use:

Protecting the future, 1998, about reproductive health and safety

No more "men only" health and safety by Pete Kirby, 1998, reporting on the results of a survey of women safety reps

Violent times by Julia Gallagher, 1999, on how to prevent violence at work

A woman’s work is never safe by Jacqueline Paige, 1999, on women’s health and safety

Gender sensitive health and safety by Julia Gallagher, 1999, on the research that has been or needs to be done, and the need for a gender dimension to health and safety policy

Guidance for union workplace safety reps on women’s health and safety, Restoring the balance, was issued in 1999, as were the poster and leaflet for the October 1999 month of campaigning. For a copy of the latest poster and leaflet, send a large SAE to Women’s Back Care Campaign, TUC, Congress House, Great Russell Street, London WC1B 3LS. Earlier 1998 guidance for safety reps on the cost-benefit assessment of back strains and RSI, Ending the strain drain, is also available.

For more information on BackCare contact BackCare, 16 Elmtree Road, Teddington, Middlesex TW11 8ST.

Contact: Owen Tudor on (020) 7467 1325 or otudor@tuc.org.uk

TUC, Congress House, Great Russell Street, London WC1B 3LS

telephone 020 7636 4030 fax: 020 7636 0632

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