Anglo-Australian male blue-collar workers discuss gender and health issues.

This qualitative research project investigated male blue-collar workers' understanding of health determinants, gender issues related to health, and workplace health promotion. It is theorised that social and cultural interpretations of masculine and feminine selves that are associated with biological male and female bodies have an important impact on men's health. Strong commitment to the male gender role may lead to stress and dysfunction and restrict the types of coping strategies available to some males. Blue-collar workers' insight into health determinants includes behavioural risk factors such as maladaptive behaviours, psychosocial risk factors such as low perceived power and self-efficacy, and social circumstances such as poverty, stressful work, and lack of control over one's life patterns. We conclude that opportunities exist to support and promote the health status of male blue-collar workers in the workplace.

Keywords: male blue-collar workers, gender role expectation, masculinity, socioeconomic status, health determinants

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The health of a population is determined by many factors that lie outside the traditional biomedical conceptualisation of injury and pathogens as the causes of illness.

Morbidity, mortality and hospital discharge statistics are poor indicators of what determines the health of a population. The "new" social epidemiology concerns itself with the social determinants of health, such as average income of the population being studied and relative poverty within the cohort, equity in access to health services, and existing health education facilities. Researchers have long related poverty and lack of education to poor health. However, policymakers both within and outside health departments are beginning to appreciate that people are not simply victims of their ignorance, and they have discarded the assumption that if given appropriate health education the poor and uneducated will change their behaviours and thus gain improvements in their health status. Instead, governments have realised that, in order to gain health benefits for a population, an "all tiers of government" and an "across portfolios" approach is required.

Mortality rates suggest that gender is also a determinant of health. Men's mortality rates are consistently higher than are women's for most of the leading causes of death in Australia. The life expectancy at birth in 1996-1998 for males was 75.9 years compared to 81.5 years for females (Australian Bureau of Statistics, 1998). Although researchers have investigated socioeconomic status as a health determinant, relatively little has been said about being male as a health determinant.

It is known that male blue-collar workers have a shorter life expectancy than women in relation to mostly preventable diseases and injuries (Australian Institute of Health and Welfare, 2000). Although there is already a large amount of research in relation to sex differences in health, there is still a need to link masculinity research with health research in order to improve our conceptualisation of men's health and to provide explanations of its social foundations (Connell et al., 1998).

The cultural construct of masculinity and its associated roles is a major factor for most preventable illnesses men may experience. Women and children may also be affected if one considers that men's risk-taking behaviour can also be a threat to a man's partner and family members.

Effective health-promotion programs for men rely on understanding men's health behaviours (Taylor, Stewart, & Parker, 1998). The literature contains a body of work on how masculinity constructs are created and maintained (Connell, 1995; Plummer, 2000; Strodl, 1994). However, it remains unclear how far men recognise the impact that being a man and masculinity have on their health. The literature shows that "men behaving badly" is not just a question of nature or nurture. It is much more a question of gender-role expectations, which are created, maintained and modified across the life course by society as a whole (Strodl, 1994).

Male blue-collar workers are at the bottom of the socioeconomic power gradient. They are associated with poorer than average health outcomes, increased mortality rates, disability, and serious chronic disease (Australian Institute of Health and Welfare, 2000). Jobs that place heavy demands on the worker and over which workers have little control (common among low-status workers and women) increase the risk of conditions such as coronary heart disease (Australian Institute of Health and Welfare, 1999; Syme & Balfour, 1997). Unemployment, anger, hostility, depression, anxiety, acute and chronic stress, and lack of social support have also all been associated with heart disease (Morris, Cook, & Sharp, 1994). This makes sense since social and economic circumstances have an impact on people's health throughout their life.

People at the lower end of the social ladder are twice as often at risk of serious illness and premature death as those near the top (Najman, 1994). Socioeconomic disadvantage can also to some extent create a desire for immediate gratification in the absence of other rewards and may lead to unhealthy behaviors, such as smoking and heavy use of alcohol (Australian Institute of Health and Welfare, 2000).

According to the World Health Organization (WHO), addressing disease and lifestyle is not enough to improve overall health status. Attention also needs to be given to the social determinants of health (World Health Organization, 1996). The effects of social factors on health have become a recognised health issue for WHO and in individual countries (World Health Organization, 1996). While biological factors such as neuroendocrine and cardiovascular reactivity to stress have a greater impact on men's mortality than on women's mortality, they are not the only factors responsible for gender differences (Strodl, 1994). Risk taking and refusal to seek or accept health advice are also precursors to men's reduced longevity (Taylor et al., 1998) and can be related to culturally constructed masculinity as well as to homophobia, which can be read as a fear of being different, weak, or not up to the expectations of male peers (Plummer, 1999).

It has been argued that being at the bottom of the socioeconomic gradient creates conflict with cultural constructs of masculinity, so that while being masculine implies being in control, being socioeconomically wanting means passivity and lack of control. The result is a gender politics of alliance, dominance, and subordination (Connell, 1995), in which disempowerment may be compensated for by the pursuit of risky, stereotypically hypermasculine behavior.

In the present study blue-collar workers were defined as belonging to one of three specific categories of manual workers, defined by the Australian Standard Classification of Occupations as trades persons, plant and machine operators and drivers, and labourers (Australian Bureau of Statistics, 1986). According to 1996 Australian Bureau of Statistics (ABS) census data, male blue-collar workers form just over 10% of the Australian population as a whole (Australian Bureau of Statistics, 1997).

As part of a larger effort to investigate the use of the workplace as a setting for health promotion, the present study investigated what blue-collar workers between age 20 and 50 know about health, how they perceive their health behaviours, and what insight they have into the reasons for those behaviours.

Given that blue-collar workers are less likely to practice healthy lifestyle behaviours than white-collar workers (Morris, Conrad, Marcantonio, Marks, & Ribisl, 1999), there is a need for health policymakers and health-promotion practitioners to address the circumstances of male blue-collar workers. It is hoped that the present study will contribute to this initiative.

METHOD

PARTICIPANTS

The study targeted workplaces in several industrial settings to enable comparisons between industries and to identify differences, patterns, and commonalities in the data. Workplaces were selected for their high number of male blue-collar employees. All settings were in Brisbane, Queensland, Australia, and included local government law officers and state government workers employed in printing, building maintenance, vehicle maintenance, and hospital trades.

The subjects were Anglo-Australian men aged 20 to 50 years. The lower age limit of 20 years included people defined by the Australian Institute of Health and Welfare as young (Australian Institute of Health and Welfare, 2000). The lower age limit is likely to exclude those who have left school but might be novices in the workplace. The upper age limit of 50 years is somewhat arbitrary. It falls five years short of the minimum retirement age of 55 years in Australia, a time when many men face retirement and related changes in role expectations (Primary Health Care Group, 1996).

A total of seven focus-group discussions (FGDs) were conducted:

* one at a major public hospital with tradesmen painters, plumbers and electricians;

* three with local law officers at different local government centres of the same local government area (who policed parking meters, managed dog control in public places, and enforced other local government by-laws);

* one with panel beaters, car detailers, and mechanics in the state public works department;

* one with print industry workers in the state public works department; and

* one with building maintenance workers in the state public works department.

A number of groups contained five to nine individuals per focus group. Most groups contained between six and eight men. The total number of participants was 48.

The transcripts of the audiotaped FGDs were entered into a qualitative analysis software program, QSR NUD*IST N4, to assist in data management (QSR NUD*IST, 1997). The investigation was approved by the Human Research Ethics Committee of the University of New England, Armidale, NSW, Australia. The Department of Queensland Health provided technical and human resources for the study.

RESULTS

HEALTH EXPECTATIONS

The data suggest that health expectations are consistent with the health determinants identified by the participants. Expected health outcomes related to aging were linked with "wear and tear" caused by the physical work performed by the participants, stress involved in meeting work and family demands, and overall lifestyle. Paradoxically, the amount of physical work performed by men at work and as part of their domestic obligations (for example, yard chores) was given as the reason why participants perceived their health status as better than that of women.

Some health expectations were related to the process of aging. Participants expect a slowing down of physical and mental performance and an increase of illnesses. Age 40 was thought to be the age when performance begins to decrease and illnesses begin to take their toll.

EXPLOITING MASCULINE VALUES FOR HEALTH

Participants discussed differences in health expectations for men and women. These discussions moved from misconceptions about why the differences exist to a realisation that gender-role expectations determine people's behaviours and that gender roles have changed over time. Many participants identified a need for a review of gender-role expectations.

The traditional Western concept of masculinity was recognized as having been challenged as a result of changes in the role of women in Western society. AngloAustralian male blue-collar workers in this study confirmed what Australian retirees from white-collar working backgrounds a generation older are reported as saying, namely that traditional male culture has a negative effect on their health and wellbeing as well as on their relationships with others (Macdonald et al., 2001).

Our data should make clear to health-promotion practitioners that it is becoming acceptable for men to be concerned about their health. The data also suggest that men are willing to share the joys and burdens of family commitments previously allocated exclusively to women, even though at a price. Working men would also like to have access to similar leave entitlements that working women have.

Given that all focus-group discussions were conducted with government employees who are covered by Equal Employment Opportunity (EEO) and Family Friendly Workplace (FFW) policies, it is noteworthy that no one in the groups made supportive reference to these policies. One participant suggested that workers prefer a higher pay rate to FFW policies providing workplace-supported childcare.

The data do not suggest that participants have completely abandoned orthodox masculinity or have redefined the ideal male and his role in society, including the role of men who are marginalised by being of relatively low socioeconomic status. There are many clues in the data that suggest otherwise. However, the data indicate that male blue-collar workers who identify with Anglo-Australian values are willing to discuss their role as men in society and how they might improve their health status and relationships with others.

WORKPLACE HEALTH PROMOTION SUSTAINABILITY AND THE PARTICIPATORY WORKPLACE

Effective and sustainable Workplace Health Promotion (WHP) relies on employees being involved in needs identification, priority setting, implementation of policies, and ongoing evaluation of the work situation (Crisp & Swerissen 2002). Even if for some employees these processes may at first appear daunting, the focus group discussions in the present study indicated that facilitating these processes in a non-threatening environment can help build the capacity of blue-collar workers to contribute to effective participation in workplace decision making.

The data support a salutogenic approach to WHP that allows workers to build on their knowledge about health and health determinants. This approach also allows for the identification of men's health needs and how these needs can be met. A prerequisite to such a process is a participatory workplace culture (O'Connor-Flemming & Parker, 2001). It would be inconsistent policy to expect workers to participate in workplace health-promotion processes while being controlled centrally in their work practices in a way that oppresses and creates feelings of helplessness (Bechthold, 1997). A participatory culture that begins with an underlying belief in democratic principles can establish and sustain a healthy, high-performance work culture that is able to cope with the constantly changing business environment (Auer, Repin, & Roe, 1993; Bechthold, 1997).

EQUAL EMPLOYMENT OPPORTUNITY AND FAMILY-FRIENDLY WORKPLACE POLICIES

The data were also revealing about the nature of work and family policies currently in effect in Australia. Although all focus groups were conducted with government employees bound by equal employment opportunity and family leave policies that are equitable to both men and women, the data revealed perceived inequities in these policies. It is unclear from the data how familiar male blue-collar workers are with their entitlements, for example, to take family or other appropriate leave to care for family members in times of need. It may also be the case that where both husband and wife are working it is still culturally more acceptable for the wife to request and take such leave.

Another cause for perceived or real inequity is that men generally work longer hours, which the data and ABS statistics show to be the case. In the year 2000-2001, male full-time workers worked an average of 42.1 hours per week while women who were employed full-time averaged 37.9 hours per week. For part-time workers, the difference between men and women is minimal, with men working on average of 15.6 hours and women working 15.8 hours per week. However, there are considerably fewer men working part-time than women (ABS, 2002).

The findings indicated that male blue-collar workers are willing to share the burden of meeting family commitments. They indicated further that participants in the present study are denied this opportunity due to their work commitments. Finding a way to effectively meet the demands of both work and family is a prerequisite for men to make healthy choices about themselves. For our subjects, working conditions for women are more suitable to meet family commitments.

It would be important for health-promotion practices to strive for suitable policy changes in employing organisations. Caution is required so that such policies would not further disadvantage men or women. If LEO requires women to be treated the same as men, then women must be offered equality on male terms, whereas so-called "family friendly workplace" policies that reinforce the premise that women have primary responsibility for childcare further enforce gender stereotyping. The orthodox male norm, it would seem, needs to be challenged (Strachan & Burgess, 1998). The data supported this argument and also indicated that in many cases women earn more than their partners. It can be reasonably assumed from the research that men generally do not deny women their career opportunities. Questioning and, where necessary, changing current policies and practices in the workplace would provide an opportunity to break down traditional gender-role expectations and reach real gender equity.

RETIREMENT ISSUES

There is a significant difference between the data of the present study and those collected for the New South Wales Committee on Ageing (Macdonald, Brown, & Buchanan, 2001). The data from the present study indicated that blue-collar men expect considerable wear and tear to their bodies and that by retiring at age 55 years they may anticipate a renewal of their lives that would include meaningful activities and a widening of social networks. Data from former white-collar workers, however, suggest that retirement even at 65 years of age can be disappointingly empty and that a return to work is desirable (Macdonald, Brown, & Buchanan, 2001).

Some data exist on what happens to retired white-collar men. What happens to older male blue-collar workers is, however, not so clear. In suggesting that men should be able to retire at age 55, our data may reflect blue-collar workers' wishful thinking that is grounded in their real-life experience of physical deterioration but not supported by current age pension eligibility. Although ABS figures do not differentiate between blue- and white-collar male workers, they suggest that half of the older men who retire early do so because of ill health (ABS, 1994), which in some circumstances could make them eligible for a disability pension.

The need for further research on issues related to what keeps people at work and to the affordability of retirement has been noted (Roseman, 1996). The differences in the data between the present study and those regarding former white-collar workers indicate different expectations about retirement along the socioeconomic gradient. With more women pursuing lasting careers and general changes occurring in gender-role expectations, there is need for research into retirement issues that is both gender- and SES-specific. A longitudinal men's health study similar to the Federal Government's Australian Longitudinal Study on Women's Health currently being conducted by the University of Newcastle and the University of Queensland should provide some initial data in this area.

RESOLVING CONTRADICTIONS

Our groups often provided conflicting and contradictory data before arriving at a consensus. Some groups had to work through outdated beliefs or information and stereotypical misconceptions about masculinity and men's health before arriving at meaningful insights or making interesting suggestions. There are many real and perceived barriers against workplace health promotion as well as contradictory concepts of what are healthy behaviours and what are the causes and conditions of illnesses. The FGD experience in the present study suggests that workplace health promotion programs will have to be creative and allow participants to work through these barriers, misconceptions, and contradictions before workers will be in a position to identify mediating factors that may enable them to meet work and life commitments that include good health-related choices. The workers themselves have novel ideas worth considering.

The data showed a variety of issues raised at different workplaces. This suggests that to avoid contradictions that could result in cynical attitudes by workers, there should not be any such thing as a generic "one size fits all" WHP program. The data suggest that every workplace would benefit by allowing workers and management to identify their own expectations regarding effective WHP programs.

DISCUSSION

As suggested by some researchers (Labonte, 1998), Anglo-Australian blue-collar workers have insight into the whole spectrum of health determinants. Our participants identified issues related to socioeconomic, psychosocial (social networks and sense of purpose in life), behavioural (eating habits, physical inactivity, alcohol and tobacco use), and physiological risk factors. Participants also identified gender issues as health determinants in their own right. Misconceptions and contradictions arose when discussing the impact of gender issues on people's health, but the participants generally agreed that subscribing to the orthodox model of masculinity has negative health consequences and that gender roles have changed over time. They identified the need for a review of gender-role expectations in society as a whole.

Some health expectations of the men studied are related to the ageing process. Participants expect a slowing down of mental and physical performance and an increase of illnesses. Age 40 is suggested by younger participants as the age when performance begins to drop and disease processes begin to occur in the body. This observation is consistent with the age when performance drops for most elite male and female athletes. Older participants made no specific reference to the age of 40, however but pointed out that a healthy lifestyle when young may prevent bad health later in life and suggested that greater care needs to be taken when one gets older.

The key message of this study is that Anglo-Australian male blue-collar workers are well informed and have a broad, holistic view of health, which at times, however, can lead to contradictions; that participants are sufficiently well informed to know about the contradictions of their lives; and that they have made a critical, albeit sometimes cynical, analysis of the contradictions and conclude not unreasonably that "everything in moderation" is a wise adage to follow. Problems arise for them in the structural and cultural barriers against responding to their health concerns, which include work exhaustion, ongoing family obligations, access to debriefing sessions with employers, restraints imposed by male role expectations, healthy eating habits, and satisfying interpersonal relationships.

The assumption that working-class men are at a disadvantage because they are less educated and therefore ignorant was not supported by our findings. These men's investment in their gender role is a more likely explanation of why there is a mismatch between their awareness and knowledge and their behaviour. The participants in this study expressed this very clearly. Lack of control over their lives means living in a rut, but getting out of the rut can be perceived as a scary experience.

LIMITATIONS OF THE STUDY

There are obvious limitations to this study, since the data reflect a range of experiences expressed by male blue-collar workers working for government organisations that probably provide better employment conditions than do many private employers. Therefore, the data cannot be relied on to reflect the experiences of workers that are even more marginalised by unreliable employment conditions and exploitative management practices.

The study used convenience sampling to map the characteristics of individual workplaces. Because of this, participants knew each other, and hence peer social pressures were likely to have influenced responses from some participants on some occasions in the FGDs. The data indicated the participants' concerns about marginalisation and their need for being protected from being stigmatised regarding gender and sexual matters. (No assumptions can be made about the sexual preferences of the study participants, although most participants indicated being married or single and having a girlfriend.)

The significance of this study is that it provides initial insights into the knowledge base of health-related issues in this particular demographic group. The data presented here widen our understanding of these men's health issues and have significant implications for health service provision, particularly for health education and health promotion.

Health workers should not make the assumption that male blue-collar workers practice lifestyles that imply they do not care about their health. The lifestyle choices are rather a reflection of the limitations set by the work and family commitments workers face and their knowledge of an already diminished life expectancy. For this reason, designing pamphlets or posters with messages advising on "healthy" lifestyles without recognising the men's current limitations can be perceived as victim blaming. Similarly, men's health information events conducted at workplaces or at sports or community clubs may provide an opportunity to answer or clarify some biomedical questions men have while offering little or no chance for sustainable improvements in the lives of the men attending these events.

Further insights into this group will shed light on how health education and promotion would be well served by being cognisant of the awareness that exists in this group and the complexities surrounding socioeconomic status and gender issues, especially misconceptions about these issues that can easily be overcome.

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MICHAEL KOLMET

University of New England, Armidale, NSW, Australia

RODRIGO MARINO

University of Melbourne, Melbourne, Victoria, Australia

DAVID PLUMMER

University of the West Indies, Trinidad and Tobago, West Indies 

Correspondence concerning this article should be sent to Michael Kolmet, 8 Marica Street Bellbowrie, QLD, 4070, Australia. Electronic mail: [e-mail].