Beatrice Boulanger didn’t get any training.8 As a home helper for older people, she ‘learned everything on the job’. But her duties included a lot of lifting, often of overweight people. One day, as she was helping a woman out of the bath, her shoulder gave way. ‘Everything around the joint was crumbling,’ she told occupational health magazine Hazards. ‘The doctors had to cut off the head of my humerus.’ Boulanger eventually needed a full shoulder replacement. And she can no longer do her job.
Boulanger is not a one-off. Women working as carers and cleaners can lift more in a shift than a construction worker or a miner.9 ‘We only got a sink upstairs three years ago,’ a cleaner at a cultural centre in France told the Equal Times.10 ‘Before that, we had to carry buckets of water upstairs, and down again when the water was dirty. Nobody realised.’ And unlike the construction workers and miners, these women often don’t go home to rest, but instead go home to a second unpaid shift where there is more lifting, more lugging, more crouching and scrubbing.
In her 2018 retrospective of a lifetime spent researching women’s occupational health, Karen Messing, a geneticist and professor of biological sciences at Montreal University, writes that ‘there has still been no biomechanics research on the effects of breast size on lifting techniques associated with back pain’11 despite that fact that engineer Angela Tate of Memorial University alerted scientists to male bias in biomechanical studies back in the 1990s. Messing also points to women’s reports of work-related musculoskeletal pain still being treated with scepticism despite accumulating reports that pain systems function differently among women and men.12 Meanwhile, we’ve only just noticed that nearly all pain studies have been done exclusively in male mice.
The gender data gap in occupational health is sometimes attributed to the fact that men are more likely than women to die on the job. But while it is true that the most dramatic accidents are still dominated by male workers this isn’t the full story, because an accident at work is by no means the only way your job can kill you. In fact, it’s not even the most common way your job can kill you – not by a long shot.
Every year, 8,000 people die from work-related cancers.13 And although most research in this area has been done on men,14 it’s far from clear that men are the most affected.15 Over the past fifty years, breast-cancer rates in the industrialised world have risen significantly16 – but a failure to research female bodies, occupations and environments means that the data for exactly what is behind this rise is lacking.17 ‘We know everything about dust disease in miners,’ Rory O’Neill, professor of occupational and environmental policy research at the University of Stirling, tells me. ‘You can’t say the same for exposures, physical or chemical, in ‘women’s’ work.’
This is partly a historical problem. ‘For many long-latency diseases, like cancer,’ explains O’Neill, ‘it can be decades before the pile of bodies gets big enough to reach a conclusion.’ We’ve been counting the bodies in traditional men’s jobs – mining, construction – for several generations. Specifically, we’ve been counting male bodies: when women did work in those industries, or had similar exposures, ‘they were often discounted from studies as “confounding factors”.’ Meanwhile, in most female-dominated industries, the studies simply weren’t done at all. So even if we started the studies now, says O’Neill, it would take a working generation before we had any usable data.
But we aren’t starting the studies now. Instead, we continue to rely on data from studies done on men as if they apply to women. Specifically, Caucasian men aged twenty-five to thirty, who weigh 70 kg. This is ‘Reference Man’ and his superpower is being able to represent humanity as a whole. Of course, he does not.
Men and women have different immune systems and different hormones, which can play a role in how chemicals are absorbed.18 Women tend to be smaller than men and have thinner skin, both of which can lower the level of toxins they can be safely exposed to. This lower tolerance threshold is compounded by women’s higher percentage of body fat, in which some chemicals can accumulate.
The result is that levels of radiation that are safe for Reference Man turn out to be anything but for women.19 Ditto for a whole range of commonly used chemicals.20 And yet the male-default one-level-to-rule-them-all approach persists.21 This is made worse by the way chemicals are tested. To start with, chemicals are still usually tested in isolation, and on the basis of a single exposure. But this is not how women tend to encounter them, either at home (in cleaning products and cosmetics), or in the workplace.
In nail salons, where the workforce is almost exclusively female (and often migrant), workers will be exposed on a daily basis to a huge range of chemicals that are ‘routinely found in the polishes, removers, gels, shellacs, disinfectants and adhesives that are staples of their work’.22 Many of these chemicals have been linked to cancer, miscarriages and lung diseases. Some may alter the body’s normal hormonal functions. After a shift of paid work many of these women will then go home and begin a second unpaid shift, where they will be exposed to different chemicals that are ubiquitous in common cleaning products.23 The effects of these chemicals mixing together are largely unknown,24 although research does indicate that exposure to a mixture of chemicals can be much more toxic than exposure to chemicals on an individual basis.25
Most of the research on chemicals has focused on their absorption through the skin.26 Leaving aside the problem that absorption through thicker male skin may not be the same as for women, skin is by no means the only way women working in nail salons will be absorbing these chemicals. Many of them are extremely volatile, which means that they evaporate into the air at room temperature and can be inhaled – along with the considerable amounts of dust produced when acrylic nails are filed. The research on how this may impact on workers is virtually non-existent.
But the data, although full of gaps, is mounting. Anne Rochon Ford, a women’s health researcher, tells me about how they started to realise there might be a problem in Canada. ‘One of the central Toronto community health centres that is very close to Chinatown was seeing a lot of women coming into their clinic who had a particular cluster of conditions that are traditionally associated with chemical exposure,’ she explains. It turned out they were all nail-salon workers. Several studies of air quality in nail salons have shown that they rarely exceed occupational exposure limits, but these limits are based on data that doesn’t account for the impact of chronic, long-term exposure. And this is particularly an issue when it comes to endocrine disrupting chemicals (EDCs) because, unlike most toxins, they can be harmful even at very low concentrations and they are found in a wide range of plastics, cosmetics and cleaners.27
EDCs mimic – and therefore can disrupt – reproductive hormones, ‘triggering changes in how cells and organs function, with an impact on a diverse array of metabolic, growth, and reproductive processes in the body’.28 The data on EDCs and their impact on women is limited.29 But what we do know is enough to give us pause, and should certainly be enough to trigger a full-scale data-collection programme.