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Being out at work

e.schaessens24 April 2020

An interview with Dr Julia Bailey by Sandra Medina and Angela Gichane (before the Covid-19 crisis)

Thank you for doing this interview with us.  Can you tell us about your job?

I am a sexual health doctor in South East London, and senior researcher in the eHealth Unit at UCL. I teach medical students, NHS staff and researchers, and am also a Graduate tutor and co-chair of the Equality Action Group.

What is your experience of being out at work?

I came out in 1987, when I was a medical student – 33 years ago! I’ve always been open about my sexuality (lesbian), but it doesn’t feel particularly relevant at work. I’ve never felt that that my sexuality was an issue working in primary care and in sexual health: these specialities tend to attract open-minded people, and I know of quite a few LGBQ (lesbian, gay, bisexual, queer) colleagues. Trans and Intersex people are less visible in academia and the NHS – we have a lot further to go in helping trans and intersex people feel seen, safe, welcome and included.

I haven’t experienced overt discrimination at work, but my sexuality has shaped (and limited) my choices. For example, I live in London to be part of the queer community, rather than risk feeling alienated in a small, conservative community.

Is visibility important?

A very important role model for me in my teens was the conductor of the Brighton Youth Orchestra (David Gray), who was a fantastically inspiring musician who was gay. His sexuality was well known, and there was no fuss about it (40 years ago).

At medical school there weren’t any visibly out members of staff, and no out students either – I found my community outside the medical school. I bumped into someone years later who told me that I had been an important role model for her at medical school, which was lovely to hear. As Dr Ronx (the queer, Black, androgynous A&E doctor) says, ‘You cannot be what you do not see’, and I think being visibly out is important.

How can tutors can support LGBTQIA* students?

It is really important that students can trust tutors, and that students feel able to talk about life beyond their studies (if they want to). I don’t proactively ask students about their personal lives, but I do tell them that I’m happy to discuss anything that affects their learning or wellbeing.

* LGBTQIA – lesbian, gay, bisexual, trans, queer, intersex, asexual/aromantic

Many people are quite confused about gender, sexuality, pronouns…. can you give us a summary?

Ah yes – I’ve written an e-learning module on this, and I train GP registrars and sexual health clinic staff. There is a lot of confusion, and concepts and language are changing over time …

Gender

In most societies worldwide people are seen as either ‘male’ or ‘female’ (i.e. binary categories).  These categories are decided (assigned) at birth, usually on the basis of genital appearance. A proportion of the population are intersex – i.e. their genetics, genitals and/or hormones are more complex than neat binary ‘male’ or ‘female’ categories.

Whilst sex and sex variation (male, female, intersex) are defined by genetics, gender identity is someone’s internal sense of gender (e.g. masculine, feminine, intersex, non-binary). Gender expression is the way that gender is expressed to others (e.g. through clothes, the body, behaviour…). Cis gender means that a person’s gender identity is the same as the gender they were assigned at birth (e.g. someone who was assumed to be female at birth, and who identifies as a woman). The terms Assigned Male at Birth (AMAB) and Assigned Female at Birth (AFAB) acknowledge someone’s gender history.

Non-binary or genderqueer people are those whose gender identity does not align with either ‘male’ or ‘female’, and who do not subscribe to conventional gender distinctions. Non-binary and genderqueer identities may be static or fluid. Some people may include aspects of ‘male’ and ‘female’ into their identities, others may reject binary gender categories entirely. Non-binary and genderqueer people may or may not look androgynous (not looking typically masculine or feminine).

Transgender or trans is a term for people who have a gender identity or gender expression that differs from their assigned gender. For example this could be someone who was assumed to be female at birth whose gender identity is male.

Pronouns (such as he, she, they) are very important in affirming someone’s gender identity.

Non-binary people may choose the pronoun ‘they’ as a gender neutral pronoun which is neither male nor female.  There are other gender neutral pronouns (e.g. ze, sie, hir, co, per, ey), and terminology concerning gender identity is evolving. It is important not to just guess or assume someone’s gender identity and pronouns.

Gender is distinct from sexuality. For example, ‘gay’, ‘lesbian’ or ‘bisexual’ are sexualities (sexual orientations), i.e. expressions of sexual attraction.  Gay men are typically attracted to male sexual partners; lesbians to female sexual partners; bisexual people are attracted to people of the same or different genders to them. LGBTQIA stands for Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual/Aromantic.  There are many, many other ways of expressing sexuality.

What would help trans and non-binary people feel welcome and included?

Getting people’s gender correct is really important, and it makes a huge difference to be asked rather than just guessing gender and pronouns (he, she, they) from someone’s appearance. This is especially important for trans and non-binary people, for whom mis-gendering can be relentless and horribly undermining.

My pronoun is ‘she’, but I also feel non-binary/genderqueer – I find it liberating to move away from the assumptions and expectations that go with being either male or female. It grates to be identified as a lady: e.g. “Good evening ladies and gentlemen…”. ‘Lady’ does not describe me, and it feels irrelevant and distracting – what does my gender have to do with being in a lecture, meeting, restaurant etc.? I feel that the assumptions and expectations of ‘men’ and ‘women’ can be profoundly harmful and limiting, and we should all be free to express ourselves however we like. We’re a long way from that vision, and expression can be especially hard for people who are marginalised in more than one way (e.g. trans women of colour). We have a lot of work to do to ensure that trans, non-binary and intersex people feel safe to be themselves at work.

As tutors and colleagues, we can demonstrate inclusive attitudes to gender and sexuality by displaying LGB, trans, non-binary and intersex stickers, badges or lanyards, and including logos and our own pronouns in email signatures for example.

For email footers:

Out@UCL logo which acknowledges people of colour and trans people:

How can we create a more inclusive workplace?

I think that social events are a good idea, to help people get to know each other. We need to check whether there barriers to being involved:

  • Equality. can everyone afford to come?
  • Diversity: is the invitation genuinely open to everyone?
  • Inclusion: are there factors that will exclude some people, such as alcohol, caring responsibilities, noise levels, access…..

‘Core competence’ in gender and sexuality is important, so that all staff are familiar with issues that LGBTQIA staff and students may face. It’s important to avoid assumptions, and check people’s preferences in terms of gender, pronouns, and confidentiality for example.

We need to avoid assuming heterosexuality, and avoid the gender binary – for example, ask say “Good afternoon everyone” instead of ‘Good afternoon ladies and gentlemen’. You can’t guess someone’s gender or sexuality by appearance, and there are far more LGBTQIA people than widely assumed.

Thank you, do you have anything more to add?

Thank you Angela and Sandra, it has been really interesting talking to you. It has reminded me how important these issues are!

Sources of support for LGBTQIA staff and students

Anti-social working hours: Are they making women depressed?

guest blogger12 March 2019

The rise of globalisation and the 24/7 economy are fuelling demands for people to work long hours and weekends.  But what’s the evidence about how these ways of working link with depression? Gill Weston and colleagues from the International Centre for Lifecourse Studies in Society and Health at UCL and Queen Mary University of London found such working conditions are linked to poorer mental health in women.

Across the globe, the effects of overwork are becoming apparent.  In eastern Asian countries the risk of death due to overwork has increased.  In the UK, work-related stress accounts for millions of lost working days every year.

Within the EU, a significant proportion of people have to work unsociable hours – with nearly a quarter working most Saturdays and a third working at least one Sunday a month.  But despite this, there isn’t much clear evidence about the links between work patterns and mental health.

Some studies have found a connection between unsociable work patterns and depression.  But many of the studies only focused on men, some only looked at specific types of worker or workplaces and few took account of work conditions such as whether workers had any control over how fast they worked.

To address these gaps, we set out to look for links between long or irregular hours and depression using a large nationally representative sample of working men and women in the UK.  We particularly wanted to look at whether there were differences between men and women because research has shown that work is organised, experienced and rewarded differently for men and women, and because men and women react differently to overwork and time pressure.

We used data from Understanding Society, which surveys people living in 40,000 households across the UK.  In particular we focused on information about working hours, weekend working and working conditions collected from 11,215 working men and 12,188 working women between 2010 and 2012.  They had completed a questionnaire designed to study levels of psychological distress.

Who works the most?

We found men tended to work longer hours in paid work than women, and having children affected men’s and women’s work patterns in different ways: while mothers tended to work fewer hours than women without children, fathers tended to work more hours than men without children.

Two thirds of all men worked weekends, compared with half of all women.  Those who worked all or most weekends were more likely to be in low skilled work and to be less satisfied with their job and their earnings than those who only worked Monday to Friday or some weekends

Which workers have the most depressive symptoms?

Women, in general, are more likely to be depressed than men, and this was no different in our study.

Independent of their working patterns, we also found that workers with the most depressive symptoms were older, smokers, on lower incomes, in physically demanding jobs, and who were dissatisfied at work.

Are long and irregular hours linked to depression?

Taking these findings and other factors into account, when we looked at the mental health effects of work patterns on men and on women, the results were striking: while there was little or no difference in depressive symptoms between men who worked long hours and those who did not, this was not the case for women.

Those women who worked 55 hours or more per week had a higher risk of depression than women working a standard 35-40 hour week.

Similarly, weekend working showed differences for men and women.  Compared to workers who only worked on weekdays, men who worked weekends also had a greater number of depressive symptoms, but only if they had little control at work or were dissatisfied with work.  Whereas for women,  regardless of their control or satisfaction, working most or all weekends was linked to more depressive symptoms.

Why might women suffer more than men while working these antisocial hours?

There might be a number of reasons why women might be more affected than men:

  • Women who work long hours are in a minority – just four per cent of them in our sample worked 55 hours or more per week. This may place them under additional pressure.
  • Women working longer hours tend to be in male-dominated occupations, and this may also contribute to stress.
  • Women working weekends tend to be concentrated in low-paid service sector jobs, which have been linked to higher levels of depression.
  • Many women face the additional burden of doing a larger share of domestic labour than men, leading to extensive total work hours, added time pressures or overwhelming responsibilities.

What should be done about these risks?

Our findings should encourage employers and policy-makers to think about how to reduce the burdens and increase support for women who work long or irregular hours – without restricting their ability to work when they wish to.  More sympathetic working practices could bring benefits both for workers and for employers – of both sexes.

Long work hours, weekend working and depressive symptoms in men and women: Findings from a UK population-based study by Gill Weston, Afshin Zilanawala, Elizabeth Webb, Livia Carvalho, and Anne McMunn is published in the  Journal of Epidemiology and Community Health, which is published by the BMJ.

Work stress and ill health – what’s the link?

guest blogger2 October 2018

Lots of studies have suggested stress can be a cause of ill health – and that leads to people ceasing to work before they reach retirement age. But most have offered only a snapshot on the issue. José Ignacio Cuitún Coronado and  Tarani Chandola from the University of Manchester describe a major new study, which has shed new light on how work stress can affect an employee’s health over a longer period.

Many animals have the ability to adapt to environmental changes and pressures so that they’re better prepared the next time they happen. Bears can put on fat as winter approaches, for instance, to help them stave off hunger and stay warm.

And human beings can do this too. Stressful situations trigger chemical responses which can help to give us extra resources when things are tough. Our neuroendocrine systems, for instance, trigger hormonal responses which enhance our physical performance when we need it most.

But these valuable systems can have a down-side. In our research, we wanted to look at how repeated exposure to stressful situations might contribute to health problems, particularly in people nearing the end of their working lives. We call this stress-induced effect ‘Allostatic Load’ – the wear and tear” on the body that accumulates as an individual is exposed to repeated or chronic stress because of fluctuating hormonal responses.

Given that many governments are looking for ways to extend working lives, there’s particular interest in finding out how stress can affect the health of older workers. We were able to tap into a rich source of information – the English Longitudinal Study of Ageing (ELSA), which has followed a representative sample of almost 10,000 over-50s since 2002.

These participants have been interviewed regularly and one of the things they’ve been asked to report is whether they’ve experienced a sense of imbalance between the effort they put into their jobs and the rewards they get out.

This gave us a sample of 2663 older adults, all over 50 and living in England, who’d reported these feelings at least once and who’d been assessed as having had an adverse reaction to them. We wanted to know whether repeated episodes had a bigger effect than just one, and whether the effect would be just as strong for past episodes as it was for more recent ones.

Health testing

Between 2004-5 and 2014-16 the group were asked about stress at work, but they also underwent physical tests to see how the various systems in their bodies were bearing up.

They were visited by nurses who carried out a battery of tests including taking hair samples to assess levels of the stress-related hormone cortisol, carrying out blood pressure checks to provide information on their cardio-vascular systems, white blood cell counts to assess their immune systems and cholesterol checks on their metabolic systems. Participants also had measurements taken of their waist to height ratios – a good indicator of coronary heart disease risk factors.

Overall, we found the more occasions of work-stress a participant had reported, the greater their ‘Allostatic Load’ index – that is, the greater the amount of biological wear and tear.

Moreover, the evidence suggests that employees who had experienced stress more recently, towards the end of their working lives, had higher levels of health risk when compared to those who had experienced it earlier in their careers.

This suggests there is an association between repeated reports of stress at work and biological stress mechanisms, which in turn could lead to stress-related disorders such as coronary heart disease, type 2 diabetes or depression. This also suggests that previous cross-sectional studies which reported small or inconsistent associations may have suffered because they were only measuring one effect at one time.

Work-related stress is one of the reasons for labour market exit – and our findings would suggest that earlier, snapshot studies may have underestimated the true effect of work-related stress on health over a lifetime.

As this is an observational study, we cannot make any causal claims. There may be other factors that we have not taken into account that may explain the association between stress and disease risk. For example, sleep problems may be relevant – though they may also be part of the journey from stress to ill-health.

But equally it is possible that cumulative exposure to work stress is resulting in damage to employees’ physical health, which is then leading to disability and an early exit from the world of work. So, if we want to extend working lives then reducing work-related stress could be one of the keys to achieving that goal.

Allostatic Load and Effort-Reward Imbalance: Associations over the Working-Career, by José Ignacio Cuitún Coronado, Tarani Chandola and Andrew Steptoe, is published in the International Journal of Environmental Research and Public Health.

This blog article is courtesy of the Work Life blog, which is a blog about the relationship between work and  health and well-being of people, whether they are preparing for  working life, managing their work / life balance or preparing for retirement and life beyond retirement. Led by the ESRC International Centre for Lifecourse Studies, University College London

Working with a long-term illness – does employment status make a difference?

guest blogger27 September 2018

Across the developed world, a growing share of the population suffers from chronic disease such as diabetes, arthritis or heart problems – in the EU, around 45 per cent of those aged 55-64 had such a disease in 2015. And that affects their ability to work: just half of those with chronic illnesses are employed, compared to three quarters of those without. But how do the self-employed cope with such conditions, when compared with those in employment? Maria Fleischmann and colleagues from the RenEWL project find these differences in work status can make a major difference.

We know that when people become chronically ill, changes in their working conditions can help them to continue working. And we also know that good working conditions – being able to control how you use your time and how you do your job, whether you make the decisions and whether you feel valued, for instance – can help all of us to stay in paid work for longer.

And of course, if you become ill you’re more likely to feel the need to take time off or maybe to give up work altogether. We wanted to compare how the employed and the self-employed adjust their working conditions when facing a diagnosis of chronic disease.

Existing research tells us that many older people work for employers, and have to ask for their approval when it comes to making adjustments to their working conditions. The self-employed, meanwhile, are much more able to make their own decisions and tend to feel they have more control over their working lives.

We looked at people’s ability to control their work: physical demands, working hours, psychological demands such as how fast they had to work, and social aspects such as whether they felt valued.

And we had a great source of data for this – the English Longitudinal Study of Ageing (ELSA), which has followed a total of almost 9,000 over-50s since 2002.

From that group we were able to find and study 1389 participants who reported no chronic diseases when they were interviewed in 2004-5 – the second wave of interviews – and who were in work.  We were then able to look at what happened to them before the seventh wave of interviews, in 2013-14.

A little over 40 per cent of our sample were in managerial or professional occupations, a quarter in intermediate occupations, and almost 30 per cent in routine and manual occupations.

After diagnosis

At each interview, respondents were asked whether they had been diagnosed by a doctor with lung disease, asthma, arthritis, cancer, high blood pressure, diabetes or high blood sugar, stroke or heart problems.

During the study period 510 of the 1389 sample members were newly diagnosed with one of those conditions. We were able to look at how they fared at work for four years after that, and we found some striking differences between how the employed and the self-employed seemed to have been treated.

The physical demands of our participants’ jobs were pretty similar before their diagnosis, for instance. But afterwards significant numbers of those who were employed said that those demands had actually increased when they were diagnosed. The self-employed, meanwhile, told us the opposite had happened to them – they reported significantly lower physical demands at work immediately after diagnosis. This effect continued for some time, though it grew less pronounced.

How could that be? We think maybe the increase in physical demands among the employed could be due to perception – similar demands might be perceived as more strenuous by the chronically ill. The self-employed, meanwhile, have more freedom to adjust those demands when they feel they need to.

The self-employed reported that their working hours dropped by an average of 2.8 hours per week on diagnosis, while those who were employed did not see a change. This effect was not statistically significant, though.

Employees found that their level of autonomy at work also dropped marginally, while for the self-employed there was no significant change. We did not find any major changes in psychological or social conditions in either group.

So, what did we learn? Essentially, that improvements in working conditions after diagnosis of chronic illness were restricted to the self-employed. So employers may need to ask themselves some hard questions – do they want to hold on to workers who become unwell? If they do, then they should consider the levels of flexibility they offer, and they should think about making adjustments for those workers if they don’t want to lose them.

In an ageing society, older people are expected to work ever longer and therefore to remain at work even when they begin to suffer from health problems. Our findings should also encourage policy-makers and governments to think about how chronically ill older adults are treated at work.

Changes in autonomy, job demands and working hours after diagnosis of chronic disease: a comparison of employed and self-employed older persons using the English Longitudinal Study of Ageing (ELSA)by Maria Fleischmann, Ewan Carr, Baowen Xue, Paola Zaninotto, Stephen A Stansfeld, Mai Stafford and Jenny Head, is published in the Journal of Epidemiology and Community Health.

This blog article is courtesy of the Work Life blog, which is a blog about the relationship between work and  health and well-being of people, whether they are preparing for  working life, managing their work / life balance or preparing for retirement and life beyond retirement. Led by the ESRC International Centre for Lifecourse Studies, University College London,