Opinions
Supporting the health of working women in Japan: summary report in English
2021 Volume 3 Issue 1 Article ID: 2020-0028-OP
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2021 Volume 3 Issue 1 Article ID: 2020-0028-OP
Norito Kawakami
We will publish here “Proposal: Supporting the Health of Working Women” by the Japan Society for Occupational Health Policy and Legislation Committee. The Japan Society for Occupational Health is the largest academic group on occupational health in the country, with the aim of promoting academic research on industrial hygiene, preventing health-related diseases, and maintaining and promoting the health of workers, thereby contributing to the development of academic and social development in Japan. The Society works to contribute to creating a society where all workers can work equally well. The health of working women is one of the important issues in the early days of industrial hygiene. In the United Nations’ Sustainable Development Goals, published in 2015, working women’s health is linked to three goals (SDG3: good health and well-being, SDG5: achieve gender equality, SDG8: decent work and economic growth), and it is a high priority goal for the national and international community. This proposal is advised by the society and prepared by the Policy and Law system Committee, and it examines and compiles from a multifaceted aspect what the health conditions of working women are in today’s society, where the way of working changes significantly, and what is necessary to ensure the health of working women. We hope this proposal will serve as a basis for considering the maintenance and promotion of working women’s health, which is an important basis for women’s activities in society and, furthermore, leads to the realization of a comfortable employment environment with good health for all workers regardless of gender.
Japan Society for Occupational Health Policy and Legislation Committee
Chair Person: Reiko Kishi
In Japan, after the Second World War, in 1947, the Labor Standards Law provided a provision to protect equal pay for men and women and motherhood. As a result, various policies and legal systems have been developed for women workers. These included the women’s protection policy to protect women and mothers from the working environment, such as overtime work, holidays, and late-night work, and a 6-week postpartum work ban. However, based on factors characteristic of Japanese companies, such as life-long employment, seniority-based wages, and expansion of unions among companies, while the employment of male workers has been stable and income has increased, the structure “male-centered at work and female-centered at home” has significantly cut down on women’s opportunities for social advancement in Japan.
On the other hand, the United Nations’ Treaty on the Elimination of Discrimination against Women was adopted in 1979 and ratified in Japan in 1985. In response, the Equal Employment Opportunity Law for Men and Women was enacted in order to measure the social roles of men and women and equal employment opportunities. Furthermore, with the background of changes in the industrial structure such as non-regular employment and the expansion of industries with a high proportion of women, such as the service industry, female workers are rapidly increasing, expanding the work area to work, extending service years, and wishing to work after delivery workers’ attitudes toward work also changed. The Parental Leave Act was enacted in 1992 and the part-time labor law enacted the following year. In 1999, the Basic Law on Gender Equality was enacted, and in that context the Act on Promotion of Women’s Achievement was enacted in August 2015.
Until now, in Japan, male-centered workplaces during the period of high economic growth remained the same, while safety and health measures at each workplace had long been promoted for men-centered measures. Comparing the status of regular workers in Japan with that of foreign countries, they have long working hours and overworking measures have been promoted for many years, but the importance of dealing with overwork death and overwork suicide and work-life balance still remains and has been pointed out. It is a situation that can be said to be specific in developed countries.
In Japan, at present, it cannot be said that there are sufficient occupational safety and health environments for women to be active in the workplace. Therefore, the Japan Society for Occupational Health takes up the important issues related to the health and safety (prevention of health problems) of working women and summarizes the issues and measures on health promotion and health management of women in the modern workplace from a new perspective. A working group consisting of experts in each area was called up and launched, and discussions were made toward the preparation of committee proposal. Finally, based on as much scientific evidence as possible, we made proposals for women workers and working women, especially those with Japanese knowledge. Or in Japan, where there is not enough research at present, we highlighted this gap.
Among developed countries, it is predicted that, particularly in the future in Japan, the population decline and the declining birthrate and aging of the population will significantly progress. In recent years, labor shortages have also advanced. Therefore, to improve the health of working women and to devise working conditions and working environment so that women can continue working, or to create an environment that allows women who are not currently working to enter the workforce, are important issues common to Japanese industry and society, regardless of whether it is a large company or a small company, and it can be said that it is a concern of the whole nation. The Japan Society for Occupational Health actively propose, here, the feasible issues and approaches that can be considered under the current situation and a new legal system to the administration, related organizations and groups, and academic members to secure the health of women workers and working women. We hope that the proposals will help to improve the various issues that are present, and that it will be useful to many of you through the long-term development of society. The full Japanese version which is the basis of the English version is available at https://www.sanei.or.jp/images/contents/370/Proposal_HWW_Policies_and_Regulations_Committee.pdf (HP), and is already included in the magazine. So, it would be appreciated if you could refer to it.
Looking at trends in the population data for Japan’s workforce over the past 15 years, the number of men has decreased, while the number of women in the workforce has gradually increased. In 2016, women made up 43.4% of the workforce, and the workforce participation rate of women was 50.3%, representing half of the population over 15 years old. Comparing data from 1970 and 2014, the average life expectancy for women has increased from 74.66 to 86.83 years of age, the average age of first marriage has risen from 24.2 to 29.4, and the age of first childbirth has risen from 25.6 to 30.6 years, illustrating the trend towards later marriage and childbirth. Looking at Figure 1, which shows the workforce participation rate of women by age group, forms a M-shaped curve where rates from 25–29, and 30–34, ages are lower when many women are involved in childbirth and raising children. While the lower valleys of this curve have risen from the bottom in recent years, the data still differs from that of Sweden, France, Germany, and America, where no such curve is apparent, and while 90% of unmarried women from 25–39 in Japan are still participating in the workforce, this drops to just 60% of married women.
Trends in workforce participation rates of women, by age group (based on data from the Labor Records survey)
In 2016, workers in irregular employment (as opposed to regular employment, which consists of full-time work at a single institution, typically for the length of one’s career) were 22.1% male, and 55.9% female, with men making up around 70% of regularly employed workers, and women comprising around 70% of irregular workers. Many irregular workers are considered to be in unstable employment, receive lower wages than regular workers, and face problems such as their eligibility for social insurance. In 2016, Japan was ranked 111th out of 114 countries for its gender gap, the lowest ranking the country has received to date, and the shortage of female parliament members and managers in the financial and political fields, and in tech and other such fields was also noted. In 2010, Japan was ranked 29th out of the 34 countries in the OECD for its relative poverty rate, with a large income gap even compared to other developed countries. Relatively high poverty rates among single women and mother-child households were also particularly noted. The 2016 Basic Survey on Wage Structure found that the ratio of scheduled wage of workers in regular employment, is 100 for men versus 75 for women.
Development of systems and laws required by the social landscape has helped to promote the participation and advancement for women in the workplace, including the passage of the Act on Promotion of Women’s Participation and Advancement in the Workplace, which was passed in 2015. However, in Japan it has long been the case that health and safety measures were created with only male workers in mind, and it cannot yet be said that enough measures have been put into place to deal with the unique problems and gender differences which face women. Traditional protections for mothers have included limitations on working for pregnant and expecting mothers as stipulated by the Labor Standards Act, and maternal healthcare measures as stipulated by the Gender Equality in Employment Act. However, with greater social progress for women, roles and choices in employment have expanded, and this greater diversity in work has meant the expansion of industries and types of work for which considerations must be taken. These include medical differences between the sexes (strength, muscle, cardiac fitness, etc.), physical or chemical elements which could affect potential mothers, life-events for women (pregnancy, childbirth, menopause), mental health concerns, and health problems caused by overwork. Going forward these concerns will need to be addressed with legislation-centric efforts.
2. Examining based on generation, age, and life stage Current statusIt’s important to think of life stages for women which can include marriage, childbirth, and child rearing. The age at which the percentage of women in the workforce begins to drop (30–34 years) does also coincide with the age at which many workers are being promoted. One out of every four women who quit her job for the birth of a child says that she quit her work because of the difficulty she faced in raising their child while working, which speaks to the immense difficulty for women who try to continue working after childbirth. According to the Labor Records survey, 17% of men in their 30s, who are of child-raising age, are working over 60 hours per week, a higher average than that of any other age group.
Examining the rate of parental leave taken by generation, shows that among women born before 1964, the vast majority (81.5%) of women didn’t take parental leave. Among women born between 1965 and 1969, the number of women who didn’t take parental leave dropped down to 52.3%. Among women born after 1970, the number of women who did take parental leave (the majority of them taking parental leave of under 12 months in length) has risen to above 70%. For those women born before 1969, not taking parental leave was the norm, making them the “no parental leave generation,” but for women born after 1970 the opposite is true — they are the “parental leave taking generation,” with the average woman having taken parental leave. The number of people taking advantage of the systems in place changed over time due to a change in attitudes. Examining the data based on employee numbers shows that both in companies with 100 to 299 employees, and in companies with 300 or more employees, these work-life balance supporting systems such as parental leave and shorter working hours are well known, and there are plans in place for women to continue working. Small-scale retail companies, and financial insurance companies with over 300 employees were especially proactive in implementing work-life balance supporting systems such as parental leave and shorter working hours.
3. Employment status and health concerns for working women Current statusPart-time workers, who make up the largest group of those in non-standard employment (48.8%, according to the 2016 Labor Records Survey), make an average of 57% of the income of a full-time worker (according to the 2013 Basic Survey on Wage Structure), and these low wages are linked to poverty. The risk of poverty is especially high for single mothers, whose average salary, ¥1,810,000 a year according to the 2011 National Survey on Single Mother Households, drops to ¥1,250,000 if the mother works part-time. At this salary, household income is nearly at poverty level (relative poverty is defined as an annual income of less than ¥1,220,000, according to the 2013 Comprehensive Survey of Living Conditions).
In this country, it’s thought that many health problems among female at-risk workers go unrecorded, because the majority of married women with children work short hours so that they can continue to fit within the category of “dependent” and receive benefits from their spouses’ places of employment, as well as tax and social welfare benefits. However, there is a trend towards reducing these company benefits and protections, as well as a rise in the divorce rate and the number of unmarried mothers, and a rise in the number of both men and women, especially those younger in age, who are working in full-time non-standard employment. These trends mean that the number of people who will be eligible to receive benefits may be reduced.
4. Current status of Japanese working women’s health by sex (biological) and gender (socio-cultural)-based analysis (1) Differences between men and women in the workplaceIn Japan, as for the working condition there can be seen differences between men and women in workforce participation rate by age and marital status, types of occupations, types of jobs, types of employment, educational background, employment rank, wages, working hours, household income, rates of parental or nursing leave usage, and changes to or ending of employment due to private or family matters such as marriage, household work, pregnancy, infertility, child rearing and nursing. As for the health condition in the workplace, there can be seen differences between men and women in the rate of receiving health exams, the results of the health exams, smoking rates, alcohol consumption rates, the rate of receiving health exams due to long hour-work, the number of work related injury or illness, the application or certification rate of worker’s compensation, and the claim rate of bullying or harassment so on.
(2) Differences of time use between men and women, and current status of women’s healthAccording to the Comprehensive Survey of Living Conditions and the National Health and Nutrition Survey, women spent more time on housework-related tasks, while they slept less than men. According the Patient Survey of 2014, the diseases or health conditions which had the large number of physician visits or hospitalization were pregnancy, childbirth, gynecologic disease, dental disease, mental disorder, anemia, and thyroid disease among women aged 30 to 39. As for women aged 40 to 49, dental disease, mental disorder, gynecologic disease, hypertension, and breast cancer, as for 50 to 64, hypertension, dyslipidemia, diabetes, mental disorder, musculoskeletal disease had the large number of physician visits or hospitalization.
(3) Differences in work-related diseases between men and womenHealth problems related to pregnancy, childbirth and menstrual disorder are women-specific. Many factors were reported which had hazardous effect on pregnancy and childbirth; these included long working hours, night shift, standing position, physical, chemical, biological substances. Menstrual disorder can be affected by long working hours and night shift. Musculoskeletal disorders, cardiovascular disease, malignancies, and mental disorders affect both sexes, however there reported gender differences of work-related causative factors. Musculoskeletal disorders are the common health impairment among nursing caregivers, and key-punch operators, which are women-dominant occupation, and there were gender differences of symptom and job contents. As for cardiovascular issues, gender differences have been observed in the effects of the Demand–Control model of work, and in the Effort Reward Imbalance model. As for malignancies, the link of breast cancer and night shift has been observed in studies in other countries, but still unknown in Japan. As for mental health, there have been found to be gender differences in both stressors and the stress reactions.
(4) Labor losses related to menstrual disorders and cancerAccording to the 2015 survey by Health and Global Policy Institute, menstrual disorders, breast cancer, and uterine cancer were calculated to have caused medical expenses of 1.42 trillion yen, and labor losses amounting to 4.95 trillion yen. Additionally, there were reported to be 181,000 women (as compared with 144,000 men) who were working while undergoing treatment for cancer.
ProposalIn formulating and reviewing policies and legislation related to occupational health and safety (OSH), biological sex difference and socio-cultural gender difference should be taken into consideration. The government should considers the special aspect that Japan’s occupational health administration is strongly related to the health promotion of the general population and promote occupational safety and health with reference to the guidelines of the ILO’s guidelines for gender mainstreaming in OSH. In addition to that the government should establish a department that handles the women’s health in a comprehensive and professional manner, which can develop gender-sensitive OSH indicators, accumulate data, and promote the gender-sensitive OSH research and education.
Guidelines for gender mainstreaming in occupational safety and health (ILO)
Guideline 1: Taking a gender mainstreaming approach to reviewing and developing OSH legislation
Guideline 2: Developing OSH Policies to address gender inequalities in OSH practice
Guideline 3: Ensuring consideration of gender differences in risk management
Guideline 4: OSH research should properly take into account gender differences
Guideline 5: Developing gender sensitive OSH indicators based on sex-disaggregated data
Guideline 6: Promoting equal access to occupational health services and health care for all workers
Guideline 7: Ensuring the participation of both men and women workers and their representatives in OSH measures, health promotion and decision-making
Guideline 8: Developing gender-sensitive OSH information, education and training
Guideline 9: Designing work equipment, tools and personal protective equipment for both men and women
Guideline 10: Working time arrangements and work-life balance
5. International trends, and the global perspectiveThere has been a change in the way men and women are working together to create a safe and healthy work environment. While previous views emphasized a view of women as the weaker element of society, in need of special protections, there has been a move to a newer view — one which emphasizes that both men and women share equal rights and responsibilities, and should work together to create safe and healthy work environments.
Another important change has been the expanded approach to industrial safety and health, which views men and women as equals, and takes a wider approach to improving the working conditions of each person, including working hours, work style, and even responsibilities at home and work-life balance. One example of this is the current reality of how difficult it is for women to achieve measurable success within a company where long work hours are the norm, if they can’t work long hours due to housework or child rearing. Limiting the amount of overtime work done just by women is also problematic, as it also limits the opportunities for men to participate in child rearing and housework. It’s important that any solution to these issues reduces overtime work for both men and women.
As for the number of women working extended hours, it has been shown that in 2015, comparing Japan with England and Germany shows that the percentage of women working extended hours is also relatively high in the same manner it is for men (Figure 2).
Percentages of workers working extended hours. Data from: JILPT “2017 Data Book on International Labor Comparions” (Japan: Ministry of Internal Affairs and Communications, “Labor Records Survey”; Jan, 2016; ILOSTAT Database [http://www.ilo.org/ilostat/])
① Extended work hours
As for the practical application of working hour systems, comparing the work style of Japanese women to that of women in England and Germany shows that the percentage of women working fulltime was 91.4% for Japan, 69.0% for England, and 61.2% for Germany; the percentages of women working with flex-time schedules were 7.1%, 12.8%, and 31.7%, respectively, and the percentages of women working short hours were 2.4%, 22.7%, and 13.6 percent, and the percentages of women working from home were 0.0%, 5.7%, and 5.5%. As for the workday, 94.8% of women in Japan began work during the hours of 8 or 9 AM, as opposed to England and Germany, where many begin work in the hours of 6 or 7 AM, and the percentage of women starting work after 10 AM is also greater, representing a more diverse range of times. In Germany, almost 50% of women workers begin work before 8 AM.
The end times for work reflect the length of working hours in the countries as well, with 14.3% of women in Japan finishing work after 7PM. By contrast, 57.7% of women in Germany finished work before 5 PM. Respondents who agreed with the statement “I would like to work less” were categorized as ‘working excessively’, by which metric 26.0% of women in Japan, 18.2% of women in England, and 6.7% of women in Germany fit in the category. This means that roughly one in four women in Japan is working excessively. It seems likely that the improvements due to further implementation of information management systems will help make it possible for more women to take advantage of opportunities to work from home, but there will need to define the management method of working hours.
② Irregular or shift work
In a study of the lifestyle habits of workers in wholesale and retail jobs with irregular work schedules, (1) it was found that for men who began such a job, there was little change in the time at which they would eat dinner, but that dinner times became later for women, and (2) it was also found that more women than men reported that after they began a job with irregular work schedules they felt that “there’s been a change in the times of my eating schedule,” “I eat worse than I did before,” and “I sleep worse than I did before,” all of which indicates that among workers with irregular work schedules it is women who are experiencing problems with lifestyle. A study of how nurses on shift schedules in Japan can recover from exhaustion reported that, while there was individual variation, the length of intervals between shifts, the timing of shifts, and how breaks were taken were areas in need of improvement. For these issues, it was indicated that having at least an 11-hour interval between shifts, having proper intervals after night shifts and before the following shift, and having an adequate amount of time for breaks which was spent well are all effective ways to help workers recover from exhaustion.
(2) Working women and mental healthAmong those of working age in Japan, there are roughly 1.67 times as many women as men who are currently receiving treatment for some type of mood disorder. The reasons for this are not solely physical and biological factors, but they also involve psychosocial factors. A study which asked about causes of serious stress in the respondents’ work lives found that while “Interpersonal Relationships (including sexual harassment and power harassment)” was listed as the fifth most common cause for men (26.3%), it was listed as the third most common cause for women (36.7%) (Table 1).
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(Data is from table 29 of the Ministry of Health, Labor and Welfare’s 2016 Survey on Industrial Safety and Health)
Further research and implementation of strategies needs to take place in regards to women’s mental health. It would be especially beneficial if such efforts were to focus on a multiple and diverse range of roles and the interpersonal stress that accompanies these roles.
Promotion of the work-life balance measures for working women requires efforts which are not one-size fits all, but which are based on the true state of women’s work and personal lives, and which can fit with the varied lifestyles and behavioral traits of individuals. Methods used for improving work environment, and evaluating the effects of these methods also require similar careful consideration based on gender differences.
With regard to harassment, there are many cases of harassment where female workers are victims, and countermeasures to combat this are also important. In order to prevent harassment, it is essential to create concrete definitions of unacceptable behavior, foster public awareness of correct information regarding the issue, and work with the perpetrator to prevent further offences. Now legislation is also being implemented to address workplace bullying (moral harassment) as well as sexual harassment and maternity harassment. The prevention of power harassment requires that persons in supervising roles must improve their communication skills, and aid in diffusing interpersonal conflict within the workplace, helping opposing parties in the workplace to reconcile.
(3) Work-related musculoskeletal disorders among working womenCervicobrachial disorder was a common work-related disease among women from the late 1950s to the 1970s who worked as key-card punchers, typists, financial record registrars, telephone operators, and in other fields common with women at the time. Following this, the disorder has continued to be an issue for assembly line workers, pickers and sackers, sewing technicians, nurses, childcare workers, workers at facilities for children needing special care, school lunch preparation workers, beauticians, sign-language interpreters, caregivers, microscope operators, dentists, visual display terminal (VDT) operators, and for workers in other fields which use repetitive motions, or work performed in midair, or in one of the many fields which keep the upper body still for long periods of time. Additionally, work-related lower back pain makes up 60% of reported work-related injuries, making it the largest problem for worker health. Incidents of work-related back pain which persisted even after 4 days of absence are rising sharply (Figure 3) among workers in the health care sector where women make up a larger percentage of the workforce (this includes jobs such as elderly care, care-takers for children with special needs, childcare workers, and healthcare workers).
Incidents of work-related back pain, organized by type of work (pain which continued after 4+ days of absence). (Based on data drawn from the Ministry of Health, Labor and Welfare’s Survey on the Incidence of Work-Related Injury)
Among the types of work represented, office work had the highest number of women (29% of all working women employed). This profession involves a large amount of VDT based work. Even if the same job were to be done by a male worker, substandard work environments (i.e., desks, chairs, or devices that are ill-suited, inadequate cooling systems) and long amounts of time doing seated work are thought to increase the risk of work-related musculoskeletal disorders (WMSD) at especially high rates for women as opposed to men.
When viewed by industry, the largest industry employing female workers was in Healthcare/Social Welfare (23% of all working women employed), where nurses and caretakers experience high rates of WMSD. Considering that Japanese society has a decreasing birth rate and an aging population, preventing these injuries is a high priority for the country. Fewer new workers mean more work for those who are present. This heavier work load combined with the lifting of patients and other work done in difficult positions, and the mental stress unique of human health care work, puts them at risk for WMSD. Night shifts, accumulated fatigue from shift work, and overwork can all further increase risk. Based on these findings, the Preventive Guidelines for Reducing Work Related Back Pain, which were updated in 2013, state that women can only lift roughly 60% of the weight that men can. The guidelines also state that “As a general rule, no person shall be lifted with manpower alone” (known as the ‘no-lifting rule’). This rule was based on an assessment of both patients and care providers, and it calls for nursing which makes use of the patient’s remaining functions, and for the proactive use of nursing machinery. In other countries the addition of mechanical lifts and improvements to the working environment have been proven to have positive financial affects as well, but this type of cost-effectiveness analysis is nonexistent in Japan.
ChallengesAlmost no large-scale epidemiologic studies have been conducted on WMSD and work styles, the amount of time worked, the type of work done, and other factors, while also considering gender differences. Actual application of the policies in the Preventive Guidelines for Reducing Work Related Back Pain, including risk assessment, no-lifting rules, and other policies laid out for healthcare and social welfare worker, is still inadequate.
In order to support the implementation of countermeasures at business establishments, it is necessary to indicate the labor loss (e.g., closed days x remuneration, compensation for work-related accidents, recruitment costs) due to WMSD numerically, and to verify and show such costs and their effects.
(4) VDT work and health problems in working womenVDT-based work can be a large cause of fatigue and stress and its effects on women are especially pronounced. Going forward to many different types of displays will continue to be introduced in even greater numbers. Issues such as improving work station quality, stricter monitoring of the amount of time worked and ophthalmologic measures (preventing dry eye and headaches and refractive correction) are thought to be issues of great importance. In order to create a better working environment for women working with VDT, Japan will need to create new VDT work guidelines which are effective and have legal bearing. Company leadership will need to invest in improving work environments and in proactively implementing work-management strategies.
※1: Internet of Things
The Internet of things: A mechanism with structures in which many things are connected via a network to exchange a large amount of information.
(5) The safety of working women, considered from the standpoint of ergonomicsAccording to the International Labor Organization (ILO), every year roughly 2,300,000 workers, including both men and women, lose their lives due to work related accidents or illness, and of these, 360,000 deaths are estimated to have been caused by major accidents. Today, with women making up over 40% of the world’s workforce, there is a growing interest in the effects of gender differences on workplace risk.
① The Safety of Working Women as Viewed Through Work Related Injury Statistics
Gender is not publicly shared in workplace related injury statistics in Japan, which makes it difficult to understand workplace accidents specific to women. However, there is an international tendency for men to be more at risk for work related injury than women, a trend which is evident in the data from each country.
Internationally, more attention is being placed on the biological differences between the sexes (such as differences in body measurements, physical strength, and biomechanics) and on sociocultural differences having to do with the body and with organizational human engineering, and debates are taking place as well, In Japan, however, research on the subject and implementation of preventive measures have yet to take place in a meaningful way.
(6) Chemical substances and health problemsBeginning in 2013, the Japan Society for Occupational Health began listing chemical substances hazardous to reproductive health in the Recommendation of Occupational Exposure Limits, classifying them in one of three groups based on the strength of evidence for reproductive toxicity. Currently, there are 41 substances on the list. In the Regulations on Labor Standards for Women there are restrictive regulations for female workers to prevent exposures to chemical substances hazardous to maternal health, and in 2012, the guideline moved from specifying general toxic substances, to pointing out 26 substances that have reproductive toxicity. Since 2016, the Industrial Safety and Health Act requires the employer to conduct mandatory risk assessments of the workplace where any of the 640 chemicals specified in the list for which Safety Data Sheets are required to be issued is used. For substances outside of this list, best endeavors for conducting risk assessments are being requested by the law (non-mandatory requirement). For all workplaces in which chemical substances are in use, risk management should be performed appropriately according to these legislative frameworks and based on relevant scientific information as well.
The National Government should disclose/provide gender information for all the occupational safety and health statistics available and need to support and enhance research activities on female (maternal) health problems due to occupational exposure to chemical substances. Employers must conduct health risk assessment and management appropriately for all chemicals used in the workplace to protect female employees. Risk assessments should be carried out basically in a quantitative manner considering the characteristics of reproductive toxicants such as the existence of highly sensitive periods (pregnancy for example). There need to be more learning and training opportunities for industrial health staffs to acquire these skills and knowledge. Besides, the employer should consider protecting the worker’s right to know, and also implementing appropriate measures to protect their employees from passive smoking in the workplace.
(7) Prevention and countermeasures against various work-related diseases and complications which can affect maternityIn Japan there have been almost no reports of epidemiological studies in recent years which have looked at the risk of pregnancy complication due to labor load. The Ministry of Health, Labour and Welfare’s investigative enquiry “The Committee for Considering the Mental and Physical Health of Working Women” did send out surveys, and also held hearings, which have led to some small changes as various industry groups have begun formulating plans which identify the areas requiring care in their industry, and also putting plans into place for accommodative work assignments. In Japan, the high rates at which women workers eat out, the smoking situation at workplaces, and the stress these workers experience have been shown to be linked to threatened premature delivery and hypertensive disorders during pregnancy. On the other hand, results are mixed as to whether there is a link between working and potential miscarriages. It has been reported that the stress of working, including interpersonal and environmental stress at work, can affect child rearing, and make it difficult for mothers to balance their home and work lives. It has also been reported that social support at work can reduce stress for mothers, that environmental stress at work is linked to the rate of physical abuse towards children by mothers, and that changes in the mental health of the mother from the pregnancy period to the duration of a year and half after delivery can be linked to the risk for child abuse. However, there are yet to be rigorous studies on pregnancy and stress or social support for child-raising mothers which show a high evaluation index of validity or a good evaluation index, meaning that the evidence is still quite poor.
With women moving into many new types of work, detailed research will now be needed on the effects of changes in the work environment on the mother’s health, and the considerations that will need to be made. It would also be ideal if legislation were enacted to promote understanding for women undergoing infertility treatments, and to support a healthy work-life balance for mothers. Developing a system for quantifiable evaluation of the healthy growth of children, and a reliable system for evaluating the stress of pregnancy and child rearing will be another challenge going forward. Prevention methods for power harassment related to maternity or motherhood in the wider sense are necessary, along with stress checks, and evaluations of social support systems. There also need to be concrete supportive measures taken, from educating both working men and women on special consideration given for childbirth and labor, to strengthening the amount of support provided by childcare workers and other child rearing professionals, and other such training.
(8) The healthcare/social welfare industries, and the health of working womenRisk factors for those working in the healthcare and social work industries include psychosocial factors (e.g., work stress, harassment, depression, burnout), biological factors (exposure to blood, and infectious pathogens), chemical factors (e.g., organic solvents, disinfectants, anti-cancer drugs, and latex), physical causes (e.g., ultra-violet light, infrared rays, ionizing radiation), and issues with ergonomics (e.g., lifting heavy objects, working for a long time in the same position, improper position during work leading to back pain, shift work).
Among the many types of jobs in the healthcare and social work industries, issues are most often reported by nurses, both in Japan and abroad. According to a fact-finding survey on working conditions for nursing staff conducted in 2013 by the Japan Federation of Medical Worker’s Unions, among 32,372 nursing staff (including public health nurses, midwives, registered nurses, and assistant nurses, and made up of 91.4% women) three out of every four people surveyed responded that they would like to quit their job. Reasons included “there aren’t enough people, which makes the work hard,” which had the most responses, with 44.2% of respondents agreeing, “The pay is too low” at 33.9%, and “I can’t take vacation like I want to” at 33.1%, “overnight shifts are hard” at 31.6%. Looking at the top four reasons for quitting shows a pattern of a large labor burden paired with inadequate pay. With nurses already wishing to quit, adding in marriage, pregnancy, and delivery to the mix can be enough for them to leave.
Among nursing staff, 29.8% had experienced the threat of miscarriage, and 9.2% had experienced miscarriage, both of which are 5.5% higher than they were in a survey conducted in 1988. Additionally, 87.9% of nursing staff had “never been able to take menstrual leave,” and 34.5% said that while pregnant they were “not exempted from night shifts or other duties.” Support received by nursing staff included “overtime exemptions,” “working at adjusted hours,” “morning sickness leave,” “hospital visit leave,” and “job rotation to lighter duties,” although the percentage of workers who had received these benefits was extremely small.
Among shift workers, 1 in every 23 people is working over 60 hours a week, and across Japan, 20,000 nursing staff are working at levels which put them in danger of death by overwork (“Karoshi”)2). The rate of chronic fatigue among nursing staff has risen to 73.6%, and overtime work is part of the cause for this trend. While the number of nursing staff working over 60 hours of overtime a month (considered to be the line for risk of death by overwork) did decline from 4.3% in 2008 to 0.8% in 2013, it cannot yet be said that this risk has been fully averted.
While the majority of doctors were male in the past, more recently 30% of doctors of prime working age are now female, and the number of women balancing careers as doctors with childbirth and child-raising is growing. However, with one in every four female doctors working 80+ hours of overtime each month, the risk of health problems caused by overwork is still a concern.
Nursing care professionals experience very different work and working environments than other health professionals, as they take on heavy manual labor such as moving patients, and assisting in toileting and bathing, they maintain a deep level of involvement with their patients and their families, they have double-shift work that can make for extremely long overnight working hours, many of them work for smaller sized operations where health and safety measures are inadequate, many are in irregular employment, and there are a large number of middle-aged workers in employment. Such conditions have led to a number of health and safety issues, including back pain and work-related injuries, mental health issues leading to problems which are then dangerous for patients, and other issues.
2. Workplace approaches to addressing these issuesIn Japan the percentage of women in irregular employment is quite high, and irregular employment has been linked to inadequate healthcare. Those returning to work after giving birth do not typically take maternity leave before giving birth, and reasons for this included the environment where they worked, and concerns about the opinions and disapproval of those around them. According to Tomoko Ito, it has also been reported that the loss of income makes it difficult to take parenting leave. Additionally, the current 3.16% of men taking parental leave (according to the 2016 Preliminary Survey on Average Employment), is a far cry from the 13% goal that has been set for 2020. Sick leave during the first pregnancy accounts for 25% of increased gender gap in sick leave.
In order to create work environments where women can continue to work, gender-sensitive assessments need to be conducted at workplaces. However, regulatory compliance is given priority to the workplace.
Creating workplaces where women can continue to work, unhindered by unconscious gender discrimination (gender biases) should be done with the help of experts, and with the further participation of women on health committees.
The leaders of small workplaces have recognized these effects. When education is carried out in line with the business leaders’ own declared policies, it can have a large effect on the health of workers. Health education for all workers which acknowledges gender differences is possible in all companies regardless of the scale or style of employment. Public institutions, such as the Center for Occupational Health, and its regional offices are accessible, but they remain relatively unknown, and have few users. Efforts need to be made to promote them to the public and improve utilization.
1. From the perspective of policy and legal system, even among developed countries, Japan is predicted to continue to experience an even larger trend towards low birthrates and the aging of our population, which means that improving policies and legislation surrounding working women is an important part of creating a society which can accept a variety of work styles, and building working environments which are easy to work in for both men and women. When it comes to the health and safety of workers, we must deepen our understanding of gender differences and challenges which are unique to women, and use that knowledge to strengthen policies and enhance legislative measures.
The country should involve business leaders in the process as it works to solve a large range of issues currently affecting working women, from work styles to the health of working women. In order to do this, we propose that the creation of a new administrative body (such as a ministry or government office) should be explored. For women and the next generation of children, the creation of a ministry or government office (with a name such as the Ministry of Women and Children), instead of the bureaus which have been created up until this point would be ideal, allowing it to work laterally by cooperating with other ministries and offices. This is because the challenges of employment and health for women have a strong effect on their families and children, including the health and education of those children. The M-curved shape of employment graph is improving, but in Japan there are still problem for families who can’t find a spot for their child in preschool, which means that there are many women who want to return to work but are unable to.
It would be an important policy for Japan to implement them. It follows that to seriously consider issues in the lives of women, the system for lateral collaborative work between the central government ministries and agencies, research institutions, and academic societies should be strengthened, and related research departments and agencies should be developed.
It is our hope that the Minister in Charge of Promoting Women’s Active Participation would lead to more involvement with women’s active participation and the health of working women, and that they could exhibit strong leadership on these issues.
A concrete political measure which could be implemented is rethinking the conventional system of household-based taxation and social security, and moving to an individual worker-based system for wages, benefits, taxes, and health-care cost system, as well as providing further governmental assistance to working women for childbirth and child rearing. Both of these policies are necessary to help erase the gender gap, and create a more sustainable pension system. There should also be efforts to create more flexible hiring practices, for women and some men, to make it easier for them to get hired part way through a career, instead of straight out of school, and also to provide more chances for workers to move from irregular to regular work.
2. For Examining based on generation, age, and life stage, while the country and local government are carefully monitoring the implementation and observance of laws and systems at companies, and are strictly punishing violations and nonperformance, they should also be proactive in providing support and incentives to companies who are making exemplary progress.
Policies to encourage the involvement of women in health and safety committees should be implemented, and it is especially important to support this change in small and mid-sized companies, and for those employed in irregular work. Examples of successfully improved work environments and tools for appraising and improving should be gathered, analyzed, and widely distributed, and training for labor inspectors should be increased, with an emphasis on new ways of improving workplaces for both men and women to promote gender equality and on cultivating their abilities.
Based on our observations in “II: The Health of Working Women, Viewed in Context of Work Environment”, we have several concrete proposals for our government. Such activities are not only the responsibility of the central government, and it is a necessity that local authorities, including regional governments, labor and management from individual companies, and experts and researchers on industrial health, all come together to examine these problems from a variety of standpoints, and work together to move forward with important improvements.
(1) Long work hours, irregular work schedules, shift work, and the fatigue they can cause working women need to be considered, and in addition to simply reducing working hours, there also need to be more advancement of policies to make effective use of different work styles such as flex-time, shorter working hours, and working from home. For irregular and shift-based work, systems regulating the intervals between work should be introduced, and incentives and other methods to proactively encourage companies to make these changes.
(2) With regards to mental health, there is a need for policies developed specifically for women which address labor and living conditions, as well as their psychological and behavioral traits. There should be clear criteria established for defining workplace bullying (moral harassment) in legislation, and stress check-up programs for working women should also (1) evaluate the effectiveness of any work environment improvements undertaken, and any necessary further improvement, and (2) provide wider opportunities for advisory meetings.
(3) With regards to work-related musculoskeletal disorders, there should be proactive implementation of the policies laid-out in the ‘Preventive Guidelines for Reducing Work Related Back Pain,’ and cost-benefit analysis should be conducted on such measures to help encourage their adoption.
(4) In VDT work, there have been many new styles of terminal added in the past few years, and the work environment in this sector is undergoing huge changes. To ensure that working women will be provided with easy to use work environments, the Guidelines for Health and Safety in VDT Work which were released by the government in 2002 should be updated immediately to create effective and mandatory guidelines for VDT work.
(5) For safety based on ergonomic principles, we recommend that a Japanese edition of “Ergonomics in Women’s Work” should be developed as an important gender-aware workplace health and safety policy point of the next Plan for the Prevention of Workplace Injuries. Work injury risk-assessments for use in policymaking should be analyzed separately by gender, types of accidents should be separated into (better) categories for statistical evaluation, and data should be made open and free to use.
(6) For chemical substance management, it is necessary to disclose/provide gender information for all the occupational safety and health statistics available and to support and enhance research activities on female (maternal) health problems due to occupational exposure to chemical substances. Employers must conduct health risk assessment and management appropriately for all chemicals used in the workplace to protect female employees. Risk assessments should be carried out basically in a quantitative manner considering the characteristics of reproductive toxicants such as the existence of highly sensitive periods (pregnancy for example). There need to be more learning and training opportunities for industrial health staffs to acquire these skills and knowledge. Besides, the employer should consider protecting the worker’s right to know, and also implementing appropriate measures to protect their employees from passive smoking in the workplace.
(7) Concerning prevention and countermeasures against the various diseases which can affect mothers (infertility, complications with pregnancy, restriction of fetal growth, etc.), more must be done in a wide sense to protect mothers who want to become pregnant, have their child, and raise their child while continuing to work (including single-parent families). This can be accomplished through these steps: (1) Further gathering of evidence relating to work environment related factors of recent years, mental and physical health problems, and evidence relating to the healthy development of children. (2) Using the above evidence to develop solutions for improving work environment, and developing strategies and holding instructional courses for lowering stress levels for workers of both genders. (3) Increasing public awareness of the effects of better work conditions on the child rearing environment. (4) Increasing the amount of support provided by preschool teachers and other childcare workers, as well as increasing training for those professionals through the government, companies, academic societies, and related researchers and professionals.
(8) For the health of working women in the healthcare and social welfare industries, the government should work to better understand the current situation regarding injuries to women (including back pain, etc.), and should work to distribute information on preventative measures. Additionally, in workplaces where there are a large number of female employees, policies for supporting mothers should be strengthened, and methods should be explored for preventing overwork by women who are working to balance work, house work, childcare and other responsibilities.
Requests for companies and officesWe would like to call for company leaders to enact changes in their organizations for each of the points listed here.
1. Companies should develop strategies to combat fatigue in working women caused by long work hours, irregular work schedules, and shift work, (strategies such as different work styles such as flex-time, shorter working hours, and working from home, can be accomplished effectively alongside the development of new government policies). Companies should work expeditiously to develop the planning and information systems necessary for these strategies, and they should also develop methods for effective management of time worked.
2. With regards to mental health strategies, companies should work with industrial health and safety experts to ensure that their employees are achieving work-life balance in busy schedules which may also include childcare or nursing for elderly relatives, the interpersonal relationship skills of managers should be improved to prevent the occurrence of power harassment, and special attention should be paid to when women are able to return to work.
3. In order to prevent work-related musculoskeletal disorders, company leadership and managers should work with industrial health and safety experts to develop work management systems and work environments which are sensitive to the unique needs of women. This can include issues such as only doing continuous work for appropriate lengths of time, developing work environments around ergonomic principles, developing strategies for preventing stress to workers, etc. The effects of the work being done and the methods used on the mind and body should be noted as well: employees should be educated on the risks present so that they can work proactively to avoid injury for themselves, and the results of this work in each company should be studied.
4. With injury prevention in VDT work, VDT work has been shown to be a large cause of fatigue and burden, and it has an especially large effect on women. Because of this, improvements in work stations, stronger management of time worked, and ophthalmologic measures (such as preventing dry eye and headaches, and refractive correction) are especially important. In order to create better VDT work environments for women, company leaders should provide the necessary resources and be proactive in managing the work of employees. With more and more new types of display being used, measures such as improvements in work stations, stricter management of time worked, and ophthalmologic measures (preventing dry eye and headaches, and refractive correction) should be developed and implemented.
5. When viewing the safety of working women through the principles of ergonomics, individual companies should work together with related academic societies, either spearheading the effort or working cooperatively to gather data on ergonomic best practices which acknowledge both biological and sociocultural gender differences, and work to spread this information and develop methods to educate others.
6. For preventing health disorders due to chemicals, it is necessary to strengthen effective measures in the workplace paying attention to exposure to chemicals at work and female (maternal) health and gender differences. At the same time, “the worker’s right to know” as an international standard should be protected as outlined in the international agreement on chemical safety as drafted by the ILO. Appropriate measures should also be taken to prevent passive smoking in the workplace.
7. Concerning prevention and countermeasures against various work-related diseases which can affect mothers, companies must do more in a wide sense to protect mothers who want to become pregnant, have their child, and raise their child while continuing to work (including single-parent families). This can be accomplished by (1) improving work conditions based on evidence on the relation between the factor of work environment, mental and physical ill health and the development of the child, (2) developing strategies and planning instructional courses for lowering stress levels for workers of both genders, and (3) better understanding of the important effects of work conditions on the child rearing environment.
8. For the health of working women in the healthcare and social welfare industries, medical institutions and companies need to have a better understanding of the risks of work-related injury for women in the healthcare and social welfare fields, and use this knowledge to develop better preventative measures. Additionally, companies with many female workers should support the health of their employees by strengthening their supportive policies for mothers, and they should also realize the multiple roles their employees hold as wives and mothers, and effectively monitor to ensure that they are preventing overwork.
9. For making concrete changes to a work environment, company leadership should enlist the help of industrial health and safety experts, conduct a preemptive risk assessment which acknowledges gender differences, and endeavor in both the work they are doing, and in protecting the health of female employees, to create a work environment where women can continue to work long term. For health and safety boards, women should be on the board, and strongly encouraged to join to raise the number of women involved. Leadership and management should work together with industrial health and safety experts to develop work management strategies and work environments which are sensitive to the needs of women. This can include issues such as only doing continuous work for appropriate lengths of time, developing work environments around ergonomic principles, developing strategies for preventing stress to workers, etc. The effects of the work being done and the methods used on the mind and body should be noted as well, employees should be educated on the risks present so that they can work proactively to avoid injury for themselves, and the results of this work in each company should be studied. Examples of successfully improved work environments and tools for appraising and improving should be gathered, analyzed, and widely distributed within society as a whole. It is especially important for small workplaces that as they receive support from public institutions for their own self-directed efforts, that these efforts also include support for the health of workers which acknowledges gender differences.
Our expectations for academic societiesFor the Japan Association of Industrial Health, and for other academic societies, it is our greatest hope, and our request, that you will join us in working to achieve the next level of progress on this topic; working to create better training for industrial safety experts, who are working with doctors and nurses, and also for industrial technicians. That you will help change the way these topics are viewed so that we can create better work environments for men and women, and help to further polish their professional abilities.
This paper was originally published in Sangyo Eiseigaku Zasshi 2018;60(5):A86-A114 in Japanese. With the permission of the editorial board for Japan Society for Occupational Health, the summary was translated into English for publication.
Members of the Policy and Legislation Committee, Working Committee for Protecting the Health of Working Women and Collaborators
◆Japan Society for Occupational Health Policy Legislation Committee (As of August 1st, 2018)
(Alphabetical order, honorifics omitted, ◎Chair Person, 〇Vice Chair Person)
Igarashi C, Ito A, Uehara M, Kajiwara T, Kato G, Kawakami N, ◎Kishi R, Saito M, Shibata E, Sugawara T, Nakagawa H, 〇Hashimoto H, Hisanaga N, Hiro N, Matsui H, Moriguchi J, Yano E, Wada K.
◆Working Group for Protecting the Health of Working Women (As of August 1st, 2018)
(Alphabetical order, honorifics omitted, ◎Leader, Policy and Legislation Committee Members)
Araki Y (Working Women Health Study Group), Kitahara T (Work-related Musculoskeletal Research Group), Kobashi G (Working Women Health Study Group), Nagai S (Working Women Health Study Group), Nishikitani M (Non-regular Employment research group), Nohara R (Working Women Health Study Group), Hara N (VDT Working Study Group), Matsuura M (Industrial Psychology Research Group), Miki A (Industrial Health Research Group for Health Care Workers), Miyakawa M (Committee for Occupational Exposure Limits), Shinada K (Expert Community of Occupational Oral Health), Tsukada T (Industrial Fatigue Study Group), Yatomi M (Occupational Medicine Committee), Hashimoto H, Kajiwara T, Kishi R, ◎Matsui H, Uehara M.
◆Collaborators (Alphabetical order, honorifics omitted)
Ebara T (Nagoya city University, Occupational and Environmental Health), Kawakami T (ILO South Asia, Decent Work Technical Support Team, New Delhi)
