The Gender Gap in Personal Protective Equipment

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Chris: Welcome to CCOHS podcasts.

Today, we are speaking with Occupational and Public Health Consultant Anya Keefe on personal protective equipment and how it's not gender neutral.

Anya has been working for 35 years in occupational disease prevention, policy, and research. She has consulted for a number of academic and research institutions, government and regulatory agencies, charitable organizations, and private industry. Anya is also the author of a report on the challenges that Canadian have with PPE titled Canadian Women's Experiences with Personal Protective Equipment in the Workplace published in November, 2022.

Hi Anya, thank you for joining us.

Anya Keefe: Thank you for the invitation Chris. It's a real pleasure to be here.

Chris: When it comes to the hierarchy of controls, personal protective equipment is positioned as the last line of defense. You've discussed the lack of representation and the need to consider gender and sex into the production and availability of personal protective equipment. Would be correct to say the negative consequences of a one-size-fits-all approach to PE are not just affecting women workers?

Anya: Well, the short answer to that would be yes, but the much longer answer is that, as I noted in my research report, PPE and other workplace tools and objects, are designed on the basis of anthropometric data. So, body measurements. Detailed anthropometric surveys of civilian populations are rarely performed and the normative data that's historically used to design and size and fit PPE, were generated by the military and much of that data was collected in the 1950s and 60s. So there are a few things that we know about that data. So the first is that, that population is that they tend to be young and fit and historically they were predominantly men. What we also know, from research studies comparing men and women, is that there are anthropometric differences between the sexes. And that women are not simply scaled-down versions of men. We also know that over the last 50 to 60 years, there's been a substantial increase in body weight in the general population and that the population has become much more ethnically diverse due to increased immigration from Asia, Africa, South and Central America. All of which is to say that the data collected on military populations is not representative of the civilian population generally, or of the working population specifically.

Data collected on men is not representative of women. And data collected over 50 years ago is no longer representative of the population today. So coming back, full circle to your question, a one-size-fits-all approach, not only affects women, but it also affects men whose bodies don't conform to the military norms of decades past.

Chris: Why is gender an issue when we talk about PPE?

Anya: A great question, and my answer is going to be somewhat lengthy.

So gender is an issue when it comes to PPE for a number of reasons. The first is that research shows that there are biological differences in how male bodies and female bodies, respond to chemical, physical and biological exposures. So what that means is, that men and women in the same occupation, working side by side, can be differentially affected by the same level of exposure. Another reason that gender is an issue is the lack of representative anthropometric data that's used to design PPE. So, as I noted earlier, anthropometric surveys conducted around the world, clearly show that there are some key differences in the dimensions of men and women's bodies. And that women are not merely scaled-down versions of men. So for example, there was a study that I looked at when I was preparing the report that compared male versus female measurements in North America, Italy, and the Netherlands. And what they found was that women are proportionally larger in the hips than men despite being smaller in most other ways. And that when you look at the measurements most relevant to the design of coveralls, for example, there was very little overlap between male and female anatomical proportions. So what that means is that you can't take protective clothing and other PPE that's designed on the basis of male proportions, and just simply scale them down linearly to fit women. If male proportion protective equipment is just scaled down to fit, say, a woman's height, the breadth of her shoulders or the circumference of her upper chest, the clothing is likely going to be too tight in the hips. So as a result, in order to get coveralls that fit their hips, women are wearing coveralls, that are too long or too big in the shoulders and too big in the chest. This creates potential problems with integration with other PPE and also not to mention that it creates a potential tripping hazard if coveralls are too long or they're too oversized. Or if women are constantly finding the need to adjust the fit.

Chris: Can you share with us some of the findings from your survey?

Anya: So in the survey that we did of Canadian women and we had asked women about their experiences of PPE, what we heard was that very few women are wearing PPE that is specifically designed for them, and that much of what is sold, and I'm putting this in air quotes, as women specific PPE does not offer the same functionality and level of protection. So nearly 60 percent of the participants reported using PPE that was the wrong size at least some of the time. And nearly forty percent reported that they used a workaround to make their PPE fit. So what they meant by work around was that they're using rubber bands, safety pins or duct tape to secure gloves, to shorten their sleeves or their pant legs, to ensure that their pant legs aren't dragging, and creating a tripping hazard. And one of the more troubling workarounds was that they're using these rubber bands, safety pins, duct tape, to shorten fall arrest gear. And one of the reasons that that's particularly troubling, is that alterations to PPE like fall arrest, means that it no longer meets the standard to which it was certified.

So, coming back to the point that you made, which is that PPE is considered the last line of defense, and it should only be used in situations where other control measures are not practicable, it is widely used by employers and it was widely used for a number of reasons. One is because it's a simple and inexpensive way to control exposure and in other situations it provides supplementary protection when other controls are not adequately protected. So for example, even though there are engineering controls that are very protective for asbestos abatement, workers are still required to wear personal protective equipment. So, as a result, it's really, really important that the personal protective equipment fits each affected worker properly, that it provides maximal and effective protection, and that the workers can trust that their PPE will protect them from exposure and help prevent them from being injured.

Chris: What are the implications of poorly fitting PPE?

Anya: There are a number of implications but the main one is that it can contribute to workers being injured in the workplace. So some examples would be respirators that don't fit, they can expose workers to airborne contaminants, protective clothing that's oversized can interfere with workers mobility and present a tripping hazard. And gloves that don't fit, that are oversized can be caught in machinery, or it can expose skin too chemicals. What we heard from the women who responded to our survey was that they reported experiencing injuries, illnesses, or near misses that they perceived were caused by their PPE failing to provide the intended protection. And they also described a range of injuries that were caused by defective PPE, incompatible PPE, and poorly fitting PPE.

The scientific literature that I looked at. I also found research studies reporting lost time injury statistics from Canada and other jurisdictions around the world, and those studies showed that women in certain industrial sectors or occupations are at a higher risk of certain types of injuries and illnesses compared to men. So for example, studies are reporting that women are reported to have higher rates than men of musculoskeletal injuries injuries that required first aid or medical treatment. And injuries like fractures, surface wounds, burns, and poisoning.

I also came across several research studies, that reported that female workers experienced much higher rates of injuries associated with falls on level surface compared to the male counterparts. What wasn't clear from the research is the extent to which those observed sex and gender differences are worker related, work-related or some combination of both. So, in other words, are we seeing these different rates of injury because of biological or behavioral differences between men and women, or because men and women are differently exposed to hazards in the workplace and if it's the latter, what role does inadequate ill-fitting or poorly designed PPE play?

So what we heard in our survey, and our findings were consistent with the findings of surveys conducted in the UK and in the United States, was that women are frustrated and dissatisfied with their PPE. We also found that women who are employed in construction, transportation, natural resources, utilities, and emergency services, were most likely to wear PPE that was the wrong size. To not wear all the required PPE or to use the workarounds that I described earlier. Now what these sectors have in common is that they are all high-hazard sectors and they are also sectors where women have been reported to be at higher risk for serious injuries. So, I'd also like to add that although our report focused on women, this is an issue that affects everyone whose body dimensions are outside the anthropometric norms that are used in the design of PPE and as a result, these these issues may also disproportionately affect some ethnic groups. Particularly those employed in high-hazard industries and occupations.

Chris: Thank you for raising some very good points about the importance of needing to look at personal protective equipment, through a gender inclusive lens. Is there a final takeaway from your project that you would like to leave our listeners with?

Anya: I think the final message I'd like to leave your listeners with is that this is not a new issue. Researchers and worker advocates first drew attention to the specific problems that women face in finding appropriately sized and sufficiently protective personal protective equipment nearly 50 years ago.

One of the pieces of information that I was fortunate enough to access in preparing this report was a transcript of a presentation given at an international ergonomics conference in 1984 in Toronto. And at that conference Dr. Jean Stellman, from Columbia University, presented on these issues and concluded her presentation with a series of recommendations that identified a need for three key things. The first was more anthropometric studies, particularly of smaller female workers.

The second was for manufacturers to incorporate anthropometric data on female dimensions into the sizing and design of their products and to produce more PPE based on those measurements. And the third was for improved standards, development, and certification procedures, incorporating female anthropometric data. So, in the time since those recommendations were made, we haven't made a lot of progress in those areas. And the participation rate of women in the Canadian workforce has increased by approximately 20%. So as our survey and other similar surveys have found, there still is a demand for safe well-fitting and appropriately designed PPE for women. And despite those early efforts, many PPE standards continue to be based on male anthropometric data. And because much of the women's specific PPE or even the unisex PPE is designed on the assumption that women are merely scaled-down men. I believe that the health safety and well-being of women are unnecessarily, being put at risk and one of the recommendations, or key recommendations, that came out of the report was that sex and gender needs to be considered in all aspects of occupational health and safety legislation, policy, standards development, and practice.

Chris: Thank you very much for speaking with us today, Anya.

Anya: My pleasure. Thank you again for the invitation.

Chris: You can find more information and resources on personal protective equipment by visiting c-c-o-h-s dot c-a and searching PPE.

Thanks for listening.