Sickness absence in gender-equal companies A register study at organizational level

This register-based study evaluates possible connections between company gender equality and sickness absence from work. Swedish research on gender differences in sickness absence has shown that women have higher levels of sickness absence, especially long-term absence [1]. These differences in sickness absence have been a topic of considerable debate in the national media over a long period, but explanations for the differences have varied. Between 2000 and 2002 the most common explanation was that sickness absence was mainly due to unhealthy work practices and poor adaptation of the working environment to women by employers. In the period 2003-2004 there was a shift, with the most common explanation for the gender difference now being; overutilization of the insurance system and system disorders due to the medicalization of labour politics and regional politics [2]. The medicalization of politics was found to imply that workers were sick listed instead of being reported as unemployed. The explanation for some of the gender differences was also that women are more likely to take sickness absence when they have problems of a personal nature. In the current study, we use sickness absence as an overall term, whilst sickness leave refers to the first 2-14 days of sickness absence and sickness benefit to the period from day 15 onwards. Here we have looked exclusively at sickness benefit, as these data are available in public registers used in this study.

All types of inequities in the distribution of health in a population are of major concern to public health and of major interest to public health research. Sex differences in health are well known, and the gender system is often considered one of many important social determinants of health [3‐5]. There are at least two main routes when discussing gender differences: one is that biology is the main reason for the differences, the other is that they are due to major differences in the lives of men and women [6‐10]. In the current study, we evaluate the possible impact of a lack of gender equality at work on health. Biological differences are not discussed in this paper.

In a global perspective, women live longer than men, but are more often sick, have reduced opportunities for education and paid employment, lower social status in families, communities and society, they have limited access to and control over resources, limited decision-making power, and are more exposed to sexual and gender-based violence as a result of unequal gender norms [11].

Gender theory research has highlighted the existence of strong societal structures that can be summarized by the term gender order. Gender order is characterized by a disassembled relationship between what is considered feminine and masculine, and of a hierarchy in which the phenomena and characteristics associated with men are usually held higher than those perceived as female. Even if the specific terms that signals male or female change over time, but the gender order is reproduced [12‐15].

The idea of promoting health by increasing gender equality is not new [8, 16]. The United Nations, too, believes that increased gender equality can promote social equity. Further, in 2005, 170 heads of state set time-bound targets - the Millennium Development Goals - ranging from halving extreme poverty to promoting gender equality [17]. However, the idea of gender equality as a self-evident goal for all might be an overly narrow view. A Swedish survey of public health workers showed that different systems of belief play important roles in the judgment of fairness and desire for change regarding differences in health between men and women [18].

To evaluate the impact of gender equality on health at company level, we used the OGGI index [29] to measure gender equality and days on sickness benefit to measure health.

The OGGI index is a policy driven index that is aimed at evaluating the compliance to the "National Swedish Plan for Gender Equality" adopted by the Swedish Parliament in 2006 [30]. The overall aim of the policy is:

The first three of the four interim goals of the plan were transposed to key words as follows: 1) equal power and influence 2) economic equality of men and women and 3) equal distribution of unpaid work. These were connected to six variables in the official registers as outlined in Figure 1.

Differences in days on sickness benefit, both between men and women and between the sectors, are expected. The increase in days on sickness benefit in gender-equal companies is hardly good news, and supports the theory of expanded roles[33] regarding women. The increase in men's days on sickness benefit in gender-equal companies supports the convergence hypothesis. The convergence theory [3, 34] implies that gender equality will affect men and women differently. According to this theory, with greater gender equality men will show increased morbidity and reduced mortality, with the opposite outcome for women. The difference in days on sickness benefit found in this study could also be an effect of a change in the normative system regarding what is accepted as a reason for absence. Perhaps gender-equal companies are forerunners and allow a more caring atmosphere, which could encourage men to acknowledge poor health and consequently take greater sick leave. The classic masculine stereotype is of denying signs of sickness up to the point of very serious illness, which may partly explain higher male mortality.

A study of Swedish municipalities found that gender equality correlated with poorer health for both men and women [8]. This result agrees with the present study, but we also found that the differences between men and women are smaller in gender-equal companies. Other research has shown that the relationship between gender equality and health depends to a great extent on sex, life sphere and type of inequality. This thus seems rather to require a combination of the convergence and stress expansion theories [35]. To understand the findings, the study also requires more nuanced explanations than the convergence theory alone can provide.

The number of days on sickness benefit is decreasing in the total population for various reasons [36], and the differences between men and women are converging. We claim that such a development would be beneficial for both men and women. If parental obligations were shared equally by couples, women would be able to pursue careers similar to those of men, which would be beneficial for women in terms of lifetime income levels, pensions and career development. Men, on the other hand, would benefit if they were more attentive towards their own ill health, staying at home when sick instead of going to work. These changes in behaviour regarding health/ill health might also alter the gendered patterns of mortality in the long term and lead to a convergence between men and women [34].

Temporary parental leave has been shown to be a good proxy for gender division in the household [37]. Although it is one of the variables in our index, a wider perspective is of course required when measuring gender equality at work. There is an interdependence between the household and workplace conditions, as the household division of gender equality of course also affects the individual at work, and vice versa. Thus companies alone cannot be blamed for shortcomings in the division of parental leave; however, they do have a responsibility to facilitate families to make a reasonable division. Companies successful in this respect unambiguously deserve a high grade on any measurement of gender equality in the workplace.

Other social determinants/conditions can also have affected our results. In Sweden, young women have a higher average educational level than men, with 48% of women between 25 and 44 years of age having completed higher education. The corresponding figure for men is 37% [38]. In our study, it is only in the gender-equal companies in the Computer sector that women have a higher education level than men. Another factor is the large difference in the number of days of parental leave taken by employees in the Computer sector and the Grocery production sector. Especially for women, where we find more than double the number of days taken in the Computer sector (21.81 days compared to 8.7 in the Grocery sector), this is probably due to the fact that women with higher education tend to have their children later in life[39]. However, this could of course also be due to less possibilities of staying at home with children in a sector where the average income is low, or to other reasons not observed in this study.

Although there are significant associations between company gender equality and days on sickness benefit, and even though the risk for sick leave is greater in gender-equal companies than in gender-unequal companies, the ratios between men and women in the Computer sector are 2.15 for gender-equal companies and 3.23 for unequal companies. For the Grocery production sector, the ratio for gender-equal companies is 1.82 and for unequal companies 2.22. This could be due to a convergence between men and women of patterns of days on sickness benefit in gender-equal companies, suggesting that gender equality will affect men and women differently. If the differences in health patterns between men and women can be influenced by increased gender equality, this could be a useful instrument for HR officers and policymakers in the future. The findings of this study could help improve our understanding of the complex patterns that result in differences between men's and women's sickness absence. The OGGI index could become a useful tool for future monitoring of changes in gender relations at company level.

Institutional address:

Umeå University, Dept of Public Health and Clinical Medicine, Epidemiology and Global Health, SE-901 87 Umeå, Sweden