Globalization and Women:
More Evidence Women are Losing Out

Working women worldwide are increasingly endangering their health by doing demanding jobs in which they have too little control, writes Judy Siegel-Itzkovich, who spoke to a leading Belgian researcher about job stress, absenteeism and coronary heart disease Improving women's education and enabling them to join the work force in large numbers took years and a great deal of feminist effort. But it seems there's a thorn in the rose.

Working women around the world are increasingly endangering their health in stressful jobs over which they have too little control - increasing their risk of heart disease, hypertension, clinical depression and other maladies.

Prof. Marcel Kornitzer, a senior cardiologist and epidemiologist at the Free University Brussels Medical School, will present his findings on health risks for women in the workplace before participants in a March 14 conference to be organized by the Israel Association for the Advancement of Women's Health. Entitled "Health Policy and Services for Women in Israel: Is the Health Care System Meeting their Needs?," the gathering will be part of Women's Health Week. Kornitzer, who will speak on "Women's Health in Perspective: Advancement or Retreat?", is one of the researchers participating in a large, eight-region study on 50,000 men and women across the European Union; called JACE, it is looking at job stress, absenteeism and coronary heart disease in Europe. The conference, said IAAWH executive director Dr. Amy Avgar, will be funded by the New York Federation, and the guest speaker's visit is to be sponsored by the American Physicians' Fellowship.

In an interview with The Jerusalem Post last week, Kornitzer, whose three sons live in Israel with their families, reported on preliminary findings: "We have already clearly seen that working women - especially those at lower socioeconomic levels but among higher-level occupational levels as well - experience a greater frequency of clinical depression, resulting in a greater amount of absenteeism.

"Women experience more job- related stress and a lower sense of control than men of equivalent occupation status. The combination of a high level of strain and a low sense of control is associated with increased heart disease." The Belgian cardiologist stressed that increased job insecurity due to globalization and high unemployment are taking their toll on workers, especially women, around the world - including Israel.

Because of globalization, international companies are buying local businesses that previously served as competition and swallowing them up, reducing the number of jobs. And even when they don't fear dismissal, many women have an inadequate amount of "control" in their work. This Kornitzer defines as "having too much work to do and not enough time or resources to do it, or being caught between their obligations at work with those to their families at home."

Such chronic frustration increases the risk of clinical depression in women - who tend to be more susceptible to depression in general, whether they are working outside the home or not, perhaps because of hormonal influences. Lifestyles, diet and other environmental factors can make a significant difference in rates of disease among populations, Kornitzer noted. For decades he has studied the French Walloons in southern Belgium, comparing them with the Flemish (Dutch) in the northern part of the country.

"It's a small country of 30,000 square kilometers and 11 million people with the same genetic background," he said. "But when you look at the epidemiology, it's like two countries. The Walloons have a 30% higher risk of coronary heart disease than the Flemish. This is due mostly to the fact that in the south, they eat much more butter, lard and other food high in saturated fat. The Flemish, because of ethnic differences, observe a different diet."

The smoking rate in all of Belgium is high - over 32%, compared to 28% in Israel, and most residents life very sedentary lives. High blood pressure is more frequently diagnosed among younger women than the men, he added, "because it is usually discovered when they come in for health checks during pregnancy. But high cholesterol levels are diagnosed more often among men than among women. Type II diabetes is growing by leaps and bounds, and this will be the epidemic of the future," Kornitzer said. This is largely due to the increase in obesity; over the past two decades, obesity rates have increased by 20 percent in his country.

Examining epidemiological records of Belgians aged 35 to 70 over the past two decades, Kornitzer said that there are clear sex differences in mortality from coronary heart disease. "Eighteen years ago, 60% of women died within four weeks of having a heart attack, compared to 50% in men. Today, 35 of women die within four weeks of an acute cardiac event, compared to 29% of the men."

This is due to women going for emergency treatment later than men, anatomical differences that make angioplasty somewhat more risky in women than men, more confusing heart attack symptoms (such as a "stomach ache") in women, and attitudes that still exist among some doctors who don't take younger women's symptoms seriously.

Avgar noted that this trend holds true in Israel as well. "We have found that women are 50% more likely than men to die within a year of having a heart attack." This is only partially explained by the fact that women generally develop coronary heart disease at later ages.

Another problem is that at older ages women are more likely than men to suffer from a multiplicity of diseases, including hypertension and type II diabetes, and this fact complicates treatment, Kornitzer explains. AS FOR work stresses, the Belgian physician said that claims that "type A" personalities - who have a lot of drive, ambition and perfectionism - are at higher risk of heart attacks are not really accurate. "We've narrowed this down and found that those at risk are people within this so-called type A group who have a lot of hostility and aggression. They express this in their body language and voice. Not all type As do."

Kornitzer and colleagues looked at sick-leave permits granted by doctors o 16,000 working men and 5,000 working women in Belgium. "These were people who were actually sick, not parents who asked for sick leave to take care of a sick child at home," he stressed. "When adjusted for age and socioeconomic level, we found that 25 or more of the women took at least 20 sick days over a year, compared to only 12 days for men. When looking at the questionnaires testing their sense of control at work (such as, is your work hectic? or is your work so time-consuming you have to take some of it home?), we found that the lower their sense of control, the more likely they were to need sick leave."

The researchers concluded that women need social support at work to carry out their jobs. If not, they are at risk of developing psychosomatic symptoms that make it more difficult for them to function. "I think that employers have to remodel the ergonomics of labor. They should bring in industrial psychologists to suggest ways for overburdened women to cope better. This would pay off economically. "One major Belgian bank that saw our research results, consulted with us and worked to remodel the workplace and provide more social support for their female employees." The bank is now funding a five-year follow-up to see how the changes have affected women's health and absenteeism.

Kornitzer added that while cellular phone, Internet and e-mail use makes work schedules more flexible, these technological advances also bring work into workers' personal lives. "These effects are worth studying scientifically as well." Kornitzer and Avgar said they are eager to organize a joint study of stress on women in the workplace, comparing the Israeli situation with those in two or three European countries. "The effects of the intifada violence and terror on Israeli women should not be overlooked," Kornitzer noted.

Avgar said that the current high unemployment rate in Israel may discourage employers from bothering to improve the lot of their workers, especially the women, because they can easily find replacements willing to work under stressful conditions. (The Jerusalem Post, January 2002)