Working conditions and musculoskeletal pain in public sector employees : A study of female dominated workplaces in health care and educational services

In Sweden, musculoskeletal disorders constitute a considerable public health problem, also in public sector employees and especially among women, and these complaints often result in long-term sick leave and disability pension. The overall aim of this thesis was to investigate public sector employees, to elucidate specific factors both at their workplaces and in the private sphere, that are associated with (ill) health, in particular with musculoskeletal pain. The empirical data were obtained by use of questionnaires given to all employees at the included workplaces, which covered the following work areas: home care services for the elderly, hospital medical care, administrative services, schools, and catering/cleaning services resulting in a set of 2,523 individuals in 2000 01, response rate 92% (87% women) and in 1,180 individuals in 2002 03, response rate 74% (86% women) in Jämtland County, Sweden. The four studies concern in particular the associations between personally estimated musculoskeletal pain and occupational factors such as physical workloads (heavy lifts, awkward work positions), perceived physical strain and psychosocial strain (mental demands, decision latitude, and social support), and appraised leadership styles. Also, the association between pain and different aspects in the domestic sphere, amount of hours spent on household chores and spillover between work and family life is of concern, as are factors in the workplace that might promote health. A larger proportion of women (41%) than men (27%) reported high levels of musculoskeletal pain. Substantial pain was most frequently experienced in the neck and shoulders. However, there was considerable musculoskeletal co-morbidity, and most of those who experienced symptoms did so in more than one body region. The gender difference in pain level was especially pronounced among those with >= 90 days of sick leave. High physical load and adverse psychosocial factors were common among all the employees, albeit more so among those working in home care and catering/cleaning services, and the latter employees also reported the highest level of musculoskeletal pain. Among the men, high mental demands constituted the factor that was most extensively associated with a high level of pain. Women with full-time jobs had lower levels of pain than those working part-time. The total number of working hours was greater for the women than for the men, even though most of the women had part-time employment. However, the proportion of women with a high level of pain was not higher among those with total work of more than 60 hours per week. More women than men reported high physical strain in both paid and unpaid work, and in the women such strain was strongly associated with musculoskeletal pain and fatigue. Moreover, the association with pain and fatigue was strengthened if the women also experienced a work-home conflict. Leadership behaviours and styles of immediate superiors appraised as poor by subordinates were related to high levels of musculoskeletal pain. The results indicated that having a manager who was considered to exhibit a poor change orientation style seemed to be most important for the associations with intense musculoskeletal pain. In addition, good relationships between subordinates and their immediate managers and high levels of decision latitude among the subordinates were health-promoting aspects. In general, the male employees rated their working conditions as better than the females did, particularly with respect to decision latitude. Due to the numerical female domination of the studied sector the number of men included was quite low, why the results are not fully comparable with regard to gender. Nonetheless, some of the observed differences between the working conditions of women and men do elucidate the inequalities and inequities in that context, and above all the findings provide a deeper understanding of working life in the public services