Critical Analysis Students develop their own critical analysis of three assigned readings (covered prior to the due date). Articles and chapters can be taken from multiple topics to compare and contr

C HAP TER   3 Women’s o c cupational Health and  s a fety Katherine Lippel and Stephanie Premji Working_Women.indd 51 09/08/19 2:15 PM Working Women in Canada : An Intersectional Approach, edited by Leslie Nichols, Canadian Scholars, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/umanitoba/detail.action?docID=6282096.

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Copyright © 2019. Canadian Scholars. All rights reserved. 52  Working Women in Canada A primary reason why it is wrong to be blind to gender when examining occupational health and safety is that men and women do different jobs, some - times even within the same job titles (Armstrong & Messing, 2014; M essing, 1998). For example, among factory workers, male cutters were found to gen - erally use machines whereas female cutters tended to use scissors (Premji, L ippel,  & Messing, 2008). When men and women perform the same tasks they may still be exposed to different risks. In nontraditional jobs, women may perform the same tasks as men, but they may be the subject of violence and harassment ( Legault, 2001) and provided with personal protective equipment designed for men’s bodies. As Karen Messing (1998) has documented in her seminal work on women’s occupational health, the hazards of paid work tradi - t ionally done by women, who are disproportionately in fields such as teaching and nursing, tend to be less visible than those to which men are exposed in typically male-dominated professions such as construction, mining, and truck - ing. Women often work in caring professions involving emotional labour, and the constraints of that work are often invisible to regulators and the workers themselves. The hazards to which racialized immigrant women are exposed are even less visible as they are more likely to work in “ back of the house” jobs that either hide them from the public or carry an expectation of invisibility, such as cleaning ( Messing, 2014). The tasks that women perform as caregivers, cleaners, teachers, and nurses are often viewed as an extension of unpaid work in the household and, as such, their work is undervalued because it is perceived to come naturally to women and often presumed to be light. Lifting 50 pounds of bricks is perceived as heav y work. Lifting a 50-pound child seems natural, doesn’t seem to be work at all, and is certainly not seen as comparable to heav y work such as that done by bricklayers. When women become ill, it is important for medical practitioners to ques - tion them about the paid work they do, yet historically (Dembe, 1996), and even today, the medical profession may be unaware of or uninterested in the working conditions of women (Lippel, 2003). This lack of awareness or interest may be particularly salient in the case of racialized immigrant women because of assumptions about labour market activities based on factors such as gender, culture, religion, and age, for example, assumptions that racialized immigrant women are not working or that they are working in light jobs. Recognition of the link between women’s work and their health problems is important for diagnosis and treatment and for the determination of causality, which has implications for prevention and compensation. It is equally important for workplace parties and Working_Women.indd 52 09/08/19 2:15 PM Working Women in Canada : An Intersectional Approach, edited by Leslie Nichols, Canadian Scholars, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/umanitoba/detail.action?docID=6282096.

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Copyright © 2019. Canadian Scholars. All rights reserved. Chapter 3 Women’s oc cupational h e alth and  s a fety  53 regulators to recognize the hazards of women’s work so they can be prevented, and, if they become ill, so women can receive just compensation when disabled because of their work.

This chapter relies on an intersectional framework (Hankivsky, 2012). Inter - sectionality, which comes from the work of African American feminist scholars (Crenshaw, 1989), rejects a focus on any one category of analysis such as gender, racialized status, or social class. Instead, it favours the examination of different aspects of social identity in interaction, while linking microlevel dynamics to broader power relations. In the context of health research, Hankivsky (2012) has argued that a primary focus on gender and sex can undermine our under - standing of the complexities of experiences of different types of women. Indeed, women are not a monolithic group, and differences among women are often as significant as between men and women. At the same time, within particular groups there exist considerable gender differences. For example, in reporting on r esearch on temporary foreign workers and regulatory effectiveness of occupa - tional health and safety protections, scholars have discussed the importance of being aware of layers of vulnerability (Sargeant & Tucker, 2009), with gender as one of several variables that can increase or decrease that vulnerability. In the same vein, research on racialized inequalities in occupational health has found that in some cases, inequalities were more evident or more pronounced among women (Premji & Lewchuk, 2014). A study in Spain found that social class was an important determinant of health for workers of both genders, but pathways varied, since “among men, part of the association between social class positions and poor health can be accounted for [by] psychosocial and physical work - ing conditions and job insecurity. Among women the association between the worker, … class positions and health is substantially explained by working con - ditions, material well being at home and amount of household labour” (Borrell, Muntaner, Benach, & Artazcoz, 2004, p. 1869). Gender, class, migration, and racialization , as well as other factors such as religion, culture, age, sexual orien - tation, and geography, can therefore intersect in various ways to create highly uneven patterns of work and health. Racialized immigrant women are overrepresented at the very bottom of the occupational ladder in low-paid, high-risk, and precarious jobs that are highly racialized and feminized (Noack & Vosko, 2011). Their labour market experiences are also characterized by underemployment, informal employment, i ntermittent or chronic unemployment, unpaid work (e.g., volunteering), and, in some cases, time- and resource-intensive skills training and job searching in Working_Women.indd 53 09/08/19 2:15 PM Working Women in Canada : An Intersectional Approach, edited by Leslie Nichols, Canadian Scholars, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/umanitoba/detail.action?docID=6282096.

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Copyright © 2019. Canadian Scholars. All rights reserved. 54  Working Women in Canada an attempt to improve their situation (Access Alliance, 2014). Many racialized i mmigrant women work in factories, cleaning, or low-prestige service-sector jobs (for example, as personal support workers) where they face musculoskeletal and psychosocial risks and health problems, among others (Premji & Shakya, 2017).

Their difficult working conditions are rooted in complex labour market and s ocial barriers to decent employment, such as the lack of recognition of foreign credentials, discrimination by employers, and religious and cultural gendered role expectations ( Premji et al., 2014). Government and settlement agency pol - icies and programs can also serve to stream racialized immigrant women into low-paid and high-risk jobs. An example is the Quebec government–sponsored Petites Mains (Little Hands) sewing machine operator training program for low-income racialized immigrant women: sewing is a racialized and feminized occupation that involves highly repetitive work and low pay. Repetitive work can lead to musculoskeletal problems such as tendonitis, and pay may be based on productivity, such as piecework, which provides incentives to work intensively (Premji, Lippel, & Messing, 2008). These barriers are persistent and, in many cases, racialized immigrant women face cumulative long-term exposure to poor working conditions (Premji et al., 2014). In addition, their social and economic position means that they often lack the agency and support structures, such as unions, to address their conditions. In this chapter we will first document the importance of retaining an inter - sectional lens when studying occupational exposures and their consequences for women’s health and safety. We will then turn to women’s right to compensation under workers’ compensation legislation to see how the trivialization of women’s work may lead to discrimination and denial of benefits, even though regulators and decision-makers may be unaware that the premises on which they rely are vehicles of discrimination. We start with a review of some of the common risks and health problems found in women’s jobs and how these may be experienced differently by different groups of women.

INTERSECTIONAL A N ALYSIS AS A kEY T O E F FECTI vE P RE vE NTION Women’s paid work and its associated hazards are often ignored by scientists such as epidemiologists and medical doctors, and science determines regulatory attention in many cases. If a substance such as asbestos is shown to be dangerous to workers’ health, there is a greater chance that regulators will limit exposures Working_Women.indd 54 09/08/19 2:15 PM Working Women in Canada : An Intersectional Approach, edited by Leslie Nichols, Canadian Scholars, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/umanitoba/detail.action?docID=6282096.

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Copyright © 2019. Canadian Scholars. All rights reserved. Chapter 3 Women’s oc cupational h e alth and  s a fety  55 and, in some cases, ban the use of the product; however, if there is little research, it is unlikely they will turn their attention to the product.

For example, research on occupational cancer has been shown to focus on jobs done by men, and many studies fail to include women—even, in some cases, women working in those jobs. For example, a woman who worked in a ura - nium mine told us she had been excluded from the studies documenting the health consequences of radon exposure in the mine where she worked, as the researchers wanted to study a homogeneous population. Our knowledge about occupational causes of cancers affecting women is much scantier than about can - cers affecting men, a trend that was first noted in the early 1990s and contin - ues to this day (Hohenadel, Raj, Demers, Hoar Zahm, & Blair, 2015; Hoar Zahm, Pottern, Lewis, Ward, & White, 1994). While scholars have attempted to document this type of systemic discrimination by which women’s cancers are made to be invisible (Paiva, 2016), noting in particular that workers from racialized minorities (Hoar Zahm et al., 1994) and immigrants (Paiva, 2012) are particularly invisible, there is still little research on occupational cancers affect - ing women, a problem made worse by the fact that there is less and less research on occupational causes of cancer affecting workers in general (Raj, Hohenadel, Demers, Zahm, & Blair, 2014). Sometimes, because they have been little stud - ied, women’s work-related health problems are erroneously attributed to genetic, hormonal, or psychological causes or even to imagination. For example, women’s symptoms of organic solvent exposure have been wrongly attributed to “hysteria” (Brabant, Mergler, & Messing, 1990). Because traditional women’s work looks less dangerous, there are fewer stud - ies on the effects of that work, but when researchers focus on women’s jobs they find there are significant risk factors to which workers are exposed (Messing, 1998). Women’s, particularly racialized immigrant women’s, work in factories often involves very highly repetitive motions, be it in food production, micro - electronics, or textile production, so that while the work appears to be light, the cumulative effect of manipulating the weight of each processed object multi - plied by the high number of repetitions is an important risk factor for a variety of musculoskeletal disorders such as tendonitis, epicondylitis, or carpal tunnel syndrome (Vézina, Tierney, & Messing, 1992; Lippel, 2003). The same is true of work involving prolonged standing, which takes its toll on the health of retail sales clerks and cashiers in supermarkets, but which is perceived to be banal by clients, judges, and policy-makers. Health care is a dangerous occupation because workers are exposed to a variety of hazards: biological hazards such as exposure to infectious diseases; Working_Women.indd 55 09/08/19 2:15 PM Working Women in Canada : An Intersectional Approach, edited by Leslie Nichols, Canadian Scholars, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/umanitoba/detail.action?docID=6282096.

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Copyright © 2019. Canadian Scholars. All rights reserved. 56  Working Women in Canada ergonomic hazards that arise when lifting patients without adequate equip - ment; chemical hazards associated with the administration of chemotherapy; physical hazards related to exposure to radiation; and hazards associated with working with the public. Health-care workers, including nurses, nurse’s aides, and personal support workers in long-term care (Banerjee et al., 2012) are par - ticularly vulnerable to occupational violence, including various forms of assault committed by patients and their families (Lippel, 2018). In 2017 the Ontario Ministry of Labour reported that the health-care sector represented 11.7% of the labour market while 56% of lost-time injuries due to workplace vio- lence o ccurred among registered nurses (Ontario Ministry of Labour, 2017).

R acialized and linguistic-minority women are overrepresented in lower- r anking, front-line nursing professions, where there is a disproportionate risk of violence, as they were in the Banerjee et al. (2012) study. For example, vis - ible minorities made up 15% of the labour force but 21% of nurse’s aides in Canada. At the same time, they were underrepresented among managers (9%) and head nurses (8%), positions with authority to address problematic condi - tions (Premji & Etowa, 2014). The same working conditions may be experienced differently by different groups of women and may be added to other sources of strain to negatively impact health. For example, the experience of underemployment, which is much more common among immigrant women than Canadian-born women (Galarneau & Morissette, 2009), has been linked to negative health impacts (Premji & Shakya, 2017) and to an increased risk of work injury (Premji & Smith, 2013). The jug - gling of work activities with skills training, job searching, and volunteering, and with a heav y household and childcare workload (amplified in the postmigration context of social isolation and in the absence of economic resources) can simi - larly increase workers’ total health burden (Premji & Shakya, 2017). Long and difficult commutes by residents of low-income neighbourhoods largely devoid of good employment opportunities can add to the physical and mental strain associated with their employment and other activities (Premji, 2017). Further - more, social marginalization increases vulnerability to expressions of racism and sexism as well as to harassment and exploitation, for example in the form of excessive expectations (de Castro, Fujishiro, Sweitzer, & Oliva, 2006). Under - standing issues of importance to women’s occupational health therefore requires an understanding of the experiences of diverse groups of women. Effective pre - vention of occupational injury and disease requires knowledge and acknowledge - ment of the specificities of women’s working conditions and an understanding of disparities in workplace exposures to hazards. Working_Women.indd 56 09/08/19 2:15 PM Working Women in Canada : An Intersectional Approach, edited by Leslie Nichols, Canadian Scholars, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/umanitoba/detail.action?docID=6282096.

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Copyright © 2019. Canadian Scholars. All rights reserved. Chapter 3 Women’s oc cupational h e alth and  s a fety  57 INTERSECTIONAL A N ALYSIS AS A kEY T O E F FECTI vE W OR kE RS ’ C OM PENSATION Workers’ compensation is one of the earliest social security systems in C anada, dating back to the beginning of the 20th century. It provides health care, r ehabilitation benefits, and salary replacements for workers injured or disabled on the job. In a country like Canada, with little state support for those unable to work because of injury or illness, access to workers’ compensation is particularly important as it is one of the few programs that provides income support that is proportional to a worker’s preinjury earnings (Lippel, 2012). Compensation for work-related disability is often more difficult to access for problems frequently affecting women as opposed to the usual claims filed by men. Musculoskeletal disorders and psychological injuries are among the health problems most often associated with women’s work, while men are more likely to be exposed to violent accidents causing more visible physical injuries. First, workers are less likely to claim compensation for gradual-onset injuries (such as musculoskeletal injuries that evolve slowly over time) than for traumatic work ac cidents. In a representative sample of Quebec workers, 80% of workers who had lost time from work because of musculoskeletal problems that they attrib - uted solely to work did not claim compensation (Stock et al., 2014), while 33.5% of those who suffered injury through a traumatic event (such as a fall, being hit by an object, or being involved in a motor vehicle accident) at work failed to report their injuries to the compensation board (Vézina et al., 2011). Among racial - ized immigrant women, lack of information about workers’ compensation and fear of reporting because of low income, insecure status, and lack of proficiency in the majority language, which can be sources of exploitation by employers, contribute to underreporting (Premji, Messing, & Lippel, 2008). Accordingly, factors r elated to labour market and workplace dynamics can combine with the challenges associated with the establishment of work-relatedness for occupa - tional diseases to minimize reporting of musculoskeletal disorders by women— p articularly racialized immigrant women—employed in repetitive work. Given that costs of compensation drive prevention strategies by regulators, these pat - terns of underreporting disproportionately eclipse negative health consequences of women’s jobs (Cox & Lippel, 2008). Additionally, musculoskeletal disorders and psychological problems are often met with skepticism by regulators and decision-makers and are often con - tested by employers. Musculoskeletal disorders are among the most frequently compensated injuries in Canada, yet they are also among the claims that are Working_Women.indd 57 09/08/19 2:15 PM Working Women in Canada : An Intersectional Approach, edited by Leslie Nichols, Canadian Scholars, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/umanitoba/detail.action?docID=6282096.

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Copyright © 2019. Canadian Scholars. All rights reserved. 58  Working Women in Canada the most likely to be denied or contested because they are invisible injuries in many cases, affecting muscles and tendons, causing incapacitating pain that can - not be perceived on an x-ray. Australian studies documented the difficulties and prejudice that women encountered when trying to access workers’ compensation benefits in that country (Reid, Ewan, & Low y, 1991). In Quebec, several musculoskeletal disorders are presumed by law to be r elated to exposure to repetitive work, including tendonitis, bursitis, and teno - synovitis. However, research has shown the process to access compensation for those disorders to be highly litigious, and one study (Lippel, 2003) found that claims by women were disproportionately rejected by the appeal tribunal, in many cases because women’s work, while being highly repetitive, was perceived to be light and therefore unlikely to be a cause of disability. The same study found that when medical doctors participated in the decision-making as advisors to the tribunal, women’s success rates declined. Although there was no explicit dis - criminatory discourse, this statistical association led to the conclusion that when decision-making is dominated by reasoning of physicians, it is less likely that compensation will be granted, particularly when the work being done has not been extensively studied, a situation disproportionately affecting women. Lippel ’s 2003 study examined decisions rendered by the workers’ compen - sation appeal tribunal between 1994 and 1996 to measure the effect of a major decision rendered in 1993 that had denied benefits to women with tendonitis doing highly repetitive work, including coding postal codes, which involved on average 7,920 keystrokes per hour at Canada Post. In a previous study (Lippel, Messing, Stock, & Vézina, 1999), ergonomists, a physician, and a legal scholar joined together to try to understand that 1993 decision. They found that the judgment denying benefits relied heavily on epidemiological studies that did not fit well with the parameters of women’s work and that the legal decision-maker had applied requirements of scientific certainty that health science profession - als require, even though the law only requires that the evidence of causation of an illness by work be more probable than the evidence supporting the denial of causation. The decision involving the Canada Post workers led to a decade of decisions that raised the bar for compensation for all workers, a practice that disproportionately affected women, including a large number of racialized i mmigrant women, whose repetitive work involved a high number of gestures but less forceful individual movements. The series of studies on musculoskeletal disorders and workers’ compensa - tion was conducted in partnership with three Quebec trade union federations, represented by members of their health and safety committees and women’s Working_Women.indd 58 09/08/19 2:15 PM Working Women in Canada : An Intersectional Approach, edited by Leslie Nichols, Canadian Scholars, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/umanitoba/detail.action?docID=6282096.

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Copyright © 2019. Canadian Scholars. All rights reserved. Chapter 3 Women’s oc cupational h e alth and  s a fety  59 committees. This partnership, l ’Invisible qui fait mal (the invisible that hurts), facilitated dissemination of our results (Lippel, 2003) not only to scientific audi - ences but also to decision-makers and policy-makers in workers’ compensation, and to worker representatives in the unions. Several years later Lippel (2009) repeated the study published in 2003 by looking at decisions rendered by the same appeal tribunal in 2006 and found there were no longer statistically sig - nificant differences in the success rates of men and women suffering from mus - culoskeletal disorders who filed workers’ compensation claims, a finding that suggests that the situation improved over time. Similar methods have been used to examine access to workers’ compensation for mental health problems such as depression related to work. Lippel ’s first study (1999) comparing men’s and women’s claims in appeals for mental health diag - noses found that women’s claims were disproportionately denied by the appeal tribunal. We then looked at appeal decisions in Quebec rendered between 1986 and 1994. After examining the medical evidence described by decision-makers and the factual situations they were relying on to make their decisions, we con - cluded that decision-makers had trivialized the stressful nature of women’s work while acknowledging the stressful nature of men’s work, even though many of the factual situations were analogous. We also found that decision-makers relied heavily on personal issues in women’s lives to deny claims, while not mentioning personal issues of the men who filed claims. This study was repeated to examine decisions rendered between 1998 and 2002 by the same tribunal, and again for decisions rendered in 2007 and 2008 (Lippel, 2017). No significant differences were found in success rates of men and women in these subsequent studies and, as was the case with our studies on com - pensation for musculoskeletal disorders described above, we conclude that the partnership with unions facilitated sensitization of decision-makers and union representatives to the importance of avoiding gender bias in the compensation process. Despite these advances, studies have shown that the hazards in women’s work continue to be understudied (Hohenadel et al., 2015), underestimated (Paiva, 2016), or misunderstood, as exemplified by a study (Premji, Lippel, & Messing, 2008) on Quebec workers’ compensation appeal decisions involving piecework that found that employers and the tribunal lacked understanding of the complex reality of piecework as lived by the workers, a lack of understanding in many cases amplified by language barriers. Recent regulatory reforms in Ontario relating to compensation for mental injuries attributable to workplace stress provide another illustration of the need Working_Women.indd 59 09/08/19 2:15 PM Working Women in Canada : An Intersectional Approach, edited by Leslie Nichols, Canadian Scholars, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/umanitoba/detail.action?docID=6282096.

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Copyright © 2019. Canadian Scholars. All rights reserved. 60  Working Women in Canada to remain vigilant with regard to gender equality. Quebec has never e xcluded chronic stress from the definition of compensable injury, unlike several other Canadian provinces, including Ontario (Lippel & Sikka, 2010). Because the majority of claims for mental health problems related to chronic stress are sub - mitted by women (Commission des normes, de l ’équité, de la santé et de la s écurité du travail, 2016), an exclusion of this type of claim from the purview of the law disproportionately affects women workers. In 2017 Ontario revised that exclusion (Stronger, Healthier Ontario Act, 2017), although the changes and related policy suggest that access to compensation for mental health problems a ttributable to chronic stress will be more difficult than access to compensation for other health problems, allowing for different evidentiary thresholds for dif - ferent illnesses, a proviso that could again adversely affect women. As previously noted, violence against nurses is a particularly acute problem in Ontario, as admitted by the Ontario Ministry of Labour (2017). Thus, there is a certain irony in the fact that another recent regulatory reform in Ontario, in 2016, recognized post-traumatic stress disorder for first responders in its list of scheduled diseases presumed to be work-related but did not include nurses in the list of professions benefiting from the presumption. The occupations listed were all stereotypically male, including firefighters, ambulance service managers, paramedics, police officers, and prison guards (An Act to Amend the Workplace Safety and Insurance Act, 2016). Nurses were finally included in the presump - tion in 2018 (Plan for Care and Opportunity Act, 2018). In 2018 violence in the workplace was on the agenda of the International Labour Conference, where there were discussions to adopt an international con - vention on the issue. There is evidence that LGBTQ workers are particularly vulnerable to occupational violence (Ferfolja, 2010; Rabelo & Cortina, 2014; Sangganjanavanich & Cavzos, 2010), and Canada, among other countries, sought to promote better protections for LGBTQ workers (International Labour Conference, 2018). Although much of the proposed convention was adopted, the provisions mentioning LGBTQ workers were not, as some delegations were adamantly opposed to their mention in the convention and the recommendation (International Labour Conference, 2018). This example illustrates the challenges of promoting inclusive regulatory protections in international venues such as the International Labour Conference. At times lack of recognition by the workers’ compensation legislation itself can negatively impact certain groups of women more than others. In Quebec domestic workers employed by individuals in private homes are excluded from the definition of worker under the legislation that addresses compensation and Working_Women.indd 60 09/08/19 2:15 PM Working Women in Canada : An Intersectional Approach, edited by Leslie Nichols, Canadian Scholars, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/umanitoba/detail.action?docID=6282096.

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Copyright © 2019. Canadian Scholars. All rights reserved. Chapter 3 Women’s oc cupational h e alth and  s a fety  61 rehabilitation for occupational injuries and illnesses in that province. This means that domestic workers are not eligible for workers’ compensation unless they pay their own premiums, as individuals who employ domestic workers are not obliged to pay workers’ compensation premiums. This contrasts with the situation of all other workers in Quebec, who are automatically covered without paying premiums themselves. In 2008 the Commission des droits de la personne et des droits de la jeunesse (CDPDJ [Commission for Human and Youth Rights]) ruled that the exclusion of domestic workers was discrimina - tory on the triple bases of sex, social class, and ethnicity, as the work is largely done by low-income, racialized women. Despite this ruling, in 2018 domes - tic workers remain excluded from workers’ compensation legislation in the province despite a long-standing campaign by community organizations and unions. Thus far we have talked about challenges to equitable access to workers’ compensation. We now turn briefly to the application of compensation rules when compensation coverage is accepted. One issue of importance is the right to support for returning to work after an injury, in particular the right to vocational rehabilitation. If a worker is unable to return to preinjury employment because of a permanent impairment resulting from her injury, she has the right, in most provinces, to support from the workers’ compensation board to get help in returning to the labour market. Women often occupy jobs that are underpaid in relation to the skills they require. Workers who are immigrants, both men and women, are often obliged to take jobs for which they are overqualified. In both cases, the pay they earn does not reflect their true earning capacity. Work - ers’ compensation provides benefits based on earnings at the time of the injury and provides rehabilitation sufficient to enable workers to attain the same earn - ing capacity. When workers are underpaid at the time of their injury, they are less likely to access a robust rehabilitation program because their qualifications allow them, at least theoretically, to earn the same low salary they were earning before their injury. These compensation mechanisms leave women and immi - grant workers of both sexes with insufficient support to return to meaningful employment that allows them to use their skills. For example, a plumber and a childcare worker both obtained college certificates in their professions. If each is injured at work and becomes unable to continue in their chosen profession, the plumber, who has a higher salary than the childcare worker, will be more likely to receive retraining, while the undervalued childcare worker will be considered able to earn the low preinjury pay she received from her work with children by occupying other low-wage but less interesting jobs (Cox & Lippel, 2008). Working_Women.indd 61 09/08/19 2:15 PM Working Women in Canada : An Intersectional Approach, edited by Leslie Nichols, Canadian Scholars, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/umanitoba/detail.action?docID=6282096.

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Copyright © 2019. Canadian Scholars. All rights reserved. 62  Working Women in Canada In summary, workers’ compensation provides benefits to those who are i njured or become ill because of their work, but the way systems are designed or applied allows for lesser protections for women in some circumstances because of the nature of the work they do, the nature of the injuries they suffer from, or the undervalued work they do at the time of injury (Cox & Lippel, 2008). The same is true of other categories of workers, for example, recent immigrants who are employed in jobs for which they are overqualified. CONCLUSION While this chapter shows that many challenges persist for obtaining equal treat - ment of men and women in occupational health and safety and workers’ com - pensation, the news is not all bad. Partnerships between researchers and civil society, including unions, in the case of l ’Invisible qui fait mal, have been shown to provide better conditions for ensuring that the right research questions are asked and that the research results have an impact. Policies by funding bod - ies such as the Canadian Institute for Health Research’s policy on the integra - tion of gender and sex in research designs when appropriate have helped push forward a better integration of gender issues in occupational health research.

Interdisciplinary research bringing together health scientists, social scientists, and policy specialists promotes more effective change by providing evidence to decision-makers in a language they can understand. However, there remains work to be done, particularly in bringing to light the work and health issues of racial - ized immigrant women, a shift that requires their involvement in knowledge and policy development. The impact of this invisibility is significant because a lack of visibility results in a lack of recognition and compensation, and there - fore a lack of incentive for employers to address the health problems in women’s jobs. As the occupational health problems of women—particularly marginalized women—continue to be invisible in mainstream research and policy discussions, it is important to bring into focus how structural inequalities intersect in com - plex and cumulative ways to shape everyday experiences of work and health.

kEY R EADINGS Armstrong, P., & Messing, K. (2014). Taking gender into account in occupational health research: Continuing tensions. Policy and Practice in Health and Safety , 12(1), 3 –16 .

Cox, R., & Lippel, K. (2008). Falling through the legal cracks: The pitfalls of using workers’ compensation data as indicators of work-related injuries and illnesses. Policy and Practice in Health and Safety , 6(2), 9 –30. Working_Women.indd 62 09/08/19 2:15 PM Working Women in Canada : An Intersectional Approach, edited by Leslie Nichols, Canadian Scholars, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/umanitoba/detail.action?docID=6282096.

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Copyright © 2019. Canadian Scholars. All rights reserved. Chapter 3 Women’s oc cupational h e alth and  s a fety  63 Messing, K. (1998). One-eyed science: Occupational health and women workers . Philadelphia:

Temple University Press.

Premji, S., & Shakya, Y. (2017). Pathways bet ween under/unemployment and health among racialized immigrant women in Toronto. Ethnicity and Health , 22(1), 17–35.

DISCUSSION Q UE STIONS 1. D iscuss three things that need to be considered to provide better protection of women’s health and safety at work.

2.

G ive t wo examples of ways in which workers’ compensation legislation can fail to pro - vide adequate support for women who are injured or made ill by their work.

3.

D iscuss how intersectionality can help us understand women’s work and health experiences.

REFERENCES Access Alliance Multicultural Health and Community Services. (2014). Like wonder women, goddesses, and robots: How immigrant women are impacted by and respond to precarious em - ployment . Toronto: Author.

An Act to Amend the Workplace Safety and Insurance Act, 1997 and the Ministry of Labour Act with Respect to Posttraumatic Stress Disorder, SO c. 4, 2016, 14(2).

Armstrong, P., & Messing, K. (2014). Taking gender into account in occupational health research: Continuing tensions. Policy and Practice in Health and Safety , 12(1), 3 –16 .

Banerjee, A., Daly, T., Armstrong, P., Szebehely, M., Armstrong, H., & Lafrance, S. (2012). Structural violence in long-term, residential care for older people: Comparing Canada and Scandinavia. Social Science and Medicine , 74(3), 39–398.

Borrell, C., Muntaner, C., Benach, J., & Artazcoz, L. (2004). Social class and self-reported health status among men and women: What is the role of work organisation, household material standards and household labour? Social Science and Medicine , 58(10), 1869 –1887.

Brabant, C., Mergler, D., & Messing, K. (1990). Va te faire soigner, ton usine est malade: La place de l ’hystérie de masse dans la problématique de la santé des femmes au travail.

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Copyright © 2019. Canadian Scholars. All rights reserved. Chapter 3 Women’s oc cupational h e alth and  s a fety  65 Lippel, K. (2017). Workers’ compensation for work-related mental health problems: An overview of Quebec law. In L. Lerouge (Ed.), Psychosocial risks in labor and social security law (pp. 291–304). Cham, Switzerland: Springer.

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Copyright © 2019. Canadian Scholars. All rights reserved. 66  Working Women in Canada Premji, S., & Shakya, Y. (2017). Pathways bet ween under/unemployment and health among racialized immigrant women in Toronto. Ethnicity and Health , 22(1), 17–35.

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