Australian Blue-Collar Men’s Health and Well-Being

Why Are Men, Particularly Blue-Collar Men, At Risk?

In Australia, gender differences in life expectancy continue to be evident, with men expected to live to 79 years and women to 84 years (Department of Health and Ageing [DOHA], 2010a). Although biological factors (e.g., cardiovascular reactivity; Holt-Lunstad, Clayton, & Unchino, 2001) play a role in male mortality rates, some of these gender differences can be explained by considering that men, when compared with women, display less healthy lifestyles and less health promoting behavior, thus increasing their risk of disease, injury, and death (Courtenay, 2000; Levant, Wimer, Williams, Smalley, & Noronha, 2009). In relation to health promoting behavior, it is estimated that half of all premature deaths could be prevented by making lifestyle changes to diet, smoking, and exercising (U.S. Preventive Services Task Force, 1996). In Australian men, the major causes of premature death linked to lifestyle risk factors (e.g., exercise, diet, alcohol consumption, smoking) and risk-taking behaviors are coronary heart disease, lung cancer, colorectal cancer, suicide, motor vehicle accidents, and chronic obstructive pulmonary disease (Australian Institute of Health and Welfare [AIHW], 2008). In addition, the prevalence of type 2 diabetes, which is frequently linked to individuals being overweight/obese (Wang, Hoy, & Si, 2010), has also increased significantly among both men and women over the last 20 years (AIHW, 2010). Type 2 diabetes is also set to become the leading cause of disease burden in Australia by 2023 (AIHW, 2010).

While considering that individual health behavior is important, social, economic, and environmental factors are also increasingly being highlighted in relation to men’s health (White, 2006). Socioeconomic differences show clear links to morbidity and health problems (Schreuder, Roelen, Koopmans, & Groothoff, 2008). Particular socioeconomic groups are noted as more disadvantaged; one such group is male manual workers (i.e., “blue-collar”). For example, according to Kolmet, Marino, and Plummer (2006), male blue-collar workers are considered to be “at the bottom of the socioeconomic power gradient” as they are associated with “poorer than average health outcomes, increased mortality rates, disability, and serious chronic disease” (p. 82). Research also indicates that blue-collar men in comparison with men in the higher socioeconomic groups are at increased risk of premature deaths from diabetes, suicide, colorectal cancer, and melanoma (AIHW, 2010). This article considers the literature around the workplace context of blue-collar men and based on this make some practice strategy suggestions for health promoters (for a summary, see Figure 1).

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Figure 1

Literature Summary of Health Promotion Program Considerations for Blue-Collar Work Environments

What Is Unique About Blue-Collar Workers and Their Work Contexts?

Many blue-collar workers perform moderate to intense physical work. Research indicates that they link the physical nature of their work to musculoskeletal complaints and the “wear and tear” of their bodies, which in turn they associate with physical deterioration and certain health outcomes (Kolmet et al., 2006). However, it is not the physical demands of the job alone that is contributing to poor health among this cohort of workers. Some blue-collar industries, such as the construction industry, operate in stressful environments. Some authors have highlighted that the construction industry demonstrates a “competitive tendering process, under-resourcing, unrealistic timeframes for construction and procurement . . . and a perception that long hours are interpreted as high performance and loyalty” (MacKenzie, 2008, p. 29). According to Lingard and Francis (2009), these types of environments have embedded structural frameworks with expectations for long work hours, weekend work, and/or irregular work, which significantly affect workers’ ability to maintain a healthy work/life balance and healthy family relationships. The nature of project-based work (e.g., common to mining and construction industries), which sometimes occur in remote locations, means that unique subcultures with their own codes of conduct can develop (Loosemore & Tan, 2000). These cultures reflect the broader socioeconomic status of the majority of workers and, in many of these male-dominated industries, can result in an embedded culture that inadvertently promote poor diets and alcohol misuse and the promotion of traditional male characteristics of stoicism leading to stigmas (e.g., fear of appearing “weak”) associated with seeking help. For example, Kolmet et al. (2006) note that some socioeconomic disadvantages can create “a desire for immediate gratification in the absence of other rewards and may lead to unhealthy behaviours, such as smoking and heavy use of alcohol” (p. 83). In addition, the disempowerment that socioeconomic disadvantage brings for blue-collar workers may be compensated for by “the pursuit of risky, stereotypically hypermasculine behaviour” (p. 83), which in turn might be linked to less healthy lifestyles and less health promoting behavior.

Blue-collar workers themselves link a number of personal health issues such as tiredness, headaches, low energy, and increased alcohol use to the pressures of working long hours (MacKenzie, 2008). Researchers have found that the psychological job demands and the strain of working long hours, plus insufficient recovery time away from work, contribute to workplace accidents, stress, burnout, and low productivity (MacKenzie, 2008). These blue-collar workers are also at risk of job strain (LaMontagne & Sanderson, 2010)—this occurs in jobs with heavy demands over which individuals have little control (Kolmet et al., 2006). For example, project-based workers often work long hours to complete tasks in time-pressured environments, and this has the potential to contribute to job strain (Lingard & Francis, 2009). Researchers view job strain as a psychosocial risk and have found that it contributes to 13.2% of depression in Australian working males (LaMontagne & Sanderson, 2010). Depression is a major risk factor for suicide (Kaplan & Sadock, 1998), and it also has a significant economic cost—LaMontagne and Sanderson (2010) recently estimated that the cost of depression to the Australian economy specifically attributed to job strain alone was estimated at A$730 million over 1 year, and A$11.8 billion over a lifetime.

These factors combine to make male blue-collar workers vulnerable to physical and mental illness and heighten the imperative to implement health promotion activities that encourage work–life balance and that address health and well-being issues.

Applying a Gender Frame of Reference to Workplace Health Promotion

Health promotion programs that consider specific contextual settings, such as the workplace, have become a means to reach specific populations, such as blue-collar workers (Smith, 2007). Blue-collar workers (technicians and trades workers, machinery operators, drivers, and laborers) constituted a significant proportion (31.5%) of the 2006 Australian working population, with tradespersons alone comprising 12% (Australian Bureau of Statistics, 2006). A large portion of each day is often spent at work, as such it is a unique point of access and a convenient site for intervention with blue-collar workers. Research has found that implementing health promotion strategies in the workplace can contribute to healthier lifestyles, improved health, reduced absenteeism, increased job satisfaction, and increased productivity (Bagwell & Bush, 1999). This is echoed by the 2010 Australian National Male Health Policy, which advocates for interventions in the workplace (DOHA, 2010b).

Although the workplace may be an ideal setting for health promotion interventions, there are specific issues to consider. As noted, the majority of blue-collar workers are men, and thus the application of a gendered lens is relevant. Although men exhibit a range of masculine behaviors (Smith, 2007), dominant stereotypes that encourage stoicism, suppression of emotion, superiority, independence, and self-reliance (Smith, Braunack-Mayer, & Wittert, 2006) continue to have a powerful impact. Traditionally men are seen as the invulnerable gender that is less at risk for health problems, than women (Courtenay, 2000). They are also less likely to seek help for health and well-being issues, than women (White, Fawkner, & Holmes, 2006). However, Courtenay (2000) argues that rather than gender residing solely within the person, men and women actively participate to construct these socially based gender norms. He also notes that

a man who enacts gender as socially prescribed would be relatively unconcerned about his health and wellbeing and would place little value on health knowledge. He would see himself as stronger, both physically and emotionally, than most women. He would think of himself as independent, not needing to be nurtured by others. . . . He would not be interested in learning about health, nutrition, or cooking, and he would be unconcerned about his weight, diet, or hygiene. (p. 11)

From this perspective it can be argued that men who adhere to dominant norms of masculinity are more likely to adopt poor health behaviors and exhibit greater health risks (Courtenay, 2000). To counteract this, Smith (2007) encourages the acceptance of multiple masculinities. Smith notes that, of late, the “masculine transition into adulthood has become more complex and transitional statuses (leaving home, marriage and employment) have become weakened” (p. 22). He recommends that we need to encourage acceptance of a range of masculine attitudes if we want to target health promotion activities to the most vulnerable and marginalized men (including blue-collar men who, as noted, can be viewed as at the bottom of the socioeconomic power gradient; Smith, 2007).

Other researchers encourage the involvement of men in participatory program development (Thompson et al., 2005; Tsutsumi, Nagami, Yoshikawa, Kogi, & Kawakami, 2009) and strengths-based approaches that take into account the specific preferences and needs of men. These types of programs encourage collaboration (e.g., encourage men to actively participate in program design development) and are also focused on men’s strengths in problem solving (Du Plessis, Hoiles, Field, Corney, & Napthine, 2009; Glicken, 2005; Rochlen & Hoyer, 2005; White et al., 2006). Programs that enhance the self-efficacy of workers also have merit, as researchers have identified that self-efficacy is an important predictor in men’s health promoting behavior (Arras, Ogletree, & Welshimer, 2006).

Addressing Some Misconceptions and Expanding the Definitions of Masculinity

Although dominant masculine stereotypes exert a powerful role, men may construct a variety of masculinities (Courtenay, 2000; Smith, 2007). These might be acted on differently across the lifecycle as various health issues effect men’s health and well-being (e.g., prostate cancer in older men), and some researchers suggest taking a life course approach rather than a “one size fits all” approach (Verdonk, Seesing, & De Rijk, 2010). Courtenay (2000) also notes that men’s health-related beliefs and behaviors vary depending on the type of masculinity they are constructing, for example, whether it is “ethnic, gay, professional or rural masculinities” (p. 12), and the context in which they are enacting their “maleness” (e.g., with peers at work or at home with their partner).

Competitiveness is often viewed as a masculine trait, and generally speaking, men find competitive physical activity more engaging than women (Verdonk et al., 2010). In some instances, men might initiate competitive behavior in relation to workplace health activities. However, a recent Dutch study conducted with male employees in relation to physical activity noted that men “may be put off when a focus on health and body shape is too obvious” (Verdonk et al., 2010, p. 12). To encourage participation by a range of men enacting masculinity in a variety of ways, these authors note the importance of including both individual- and group-designed interventions—this would allow for those who want to partake to do so on their own terms; they also call for interventions and policies to be more inclusive and “explicitly relax the constraints of rigidly defined gender roles” (Verdonk et al., 2010, p. 12).

Although men might appear nonchalant about their health, research indicates that Australian blue-collar workers do care about their health and have insight into a range of factors affecting their health (Kolmet et al., 2006). However, according to Kolmet et al. (2006), these men’s investment in their gender role could partially explain why there is an observed mismatch between behavior and knowledge. They also note that blue-collar men’s lifestyle choices may sometimes be a manifestation of work and family commitments (e.g., pressures of working long hours) as well as expectations of a diminished longevity as a result of the physical nature of their work. These researchers caution that social media campaigns implemented in the workplace that focus solely on behavior and lifestyle should acknowledge these limitations, lest they be in danger of blaming the victim (Kolmet et al., 2006).

Challenges to Implementing Workplace Health Programs in Blue-Collar Contexts

In addition to the particular cultural issues (e.g., gender and workplace norms) that affect individual behavior, structural issues within the industry need to be considered when designing health programs in blue-collar workplaces. Long working hours, project-based work, and living and working away from home are just some of the factors that need to be considered when implementing workplace health promotion programs.

The nature of project-based work is that it can involve living away from home. For blue-collar workers this could magnify the lifestyle challenges, which in turn, potentially affects their health and well-being. The implementation of health programs by health promoters also becomes more difficult with diverse geography. As such it is important to consider the development of integrated and holistic programs that aim to improve overall lifestyle of workers. Because they are working away from home, many workers lack social and emotional support from family and friends (Lingard & Francis, 2009). They may also lack the opportunity to be involved in community groups (e.g., football clubs). These community connections are a key determinant of mental health. Even if they are not working away from home, working long hours (often 6 days a week) can place strain on family relationships and reduce the amount of time available for engaging in healthy activity, such as exercise, or spending time with family/friends.

Health promotion programs are sometimes viewed by employers as an additional expense that companies cannot afford, particularly in relation to concerns around employer productivity and efficiency and in climates where project completion deadlines are looming (Veitch, Owen, Burns, & Sallis, 1997). However, there is an increasing body of knowledge that points to the return on investment gains that can be made when investing in the workforce (Chapman, 2005; Goetzel & Ozminkowski, 2008). Maximizing productivity is also often raised as a barrier to onsite interventions, particularly in those programs that involve group formats. In the Australian construction and manufacturing context, the workplace often consists of large numbers of subcontractors that each have their own policies, procedures, and company cultures. Unlike office-based white-collar environments, this “multiple employer workplace environment” often diffuses the capacity to coordinate, manage, and measure workplace health initiatives as the environment and workforce continually changes. This makes it particularly challenging to keep track of individuals in the workforce, to achieve consistency with group-based initiatives and sustain longer term interventions.

To be effective, it is recognized that health promotion programs should go beyond communication and education strategies to effect medium- to long-range change in the target population (Engbers, Van Poppel, Paw, & Van Mechelen, 2005). However, given the high proportion of short-term projects in the construction industry, the continuity of medium- to long-range initiatives that specifically address behavior change can be lost. Implementation of programs should therefore involve long-term engagement with benevolent workgroups and employers, as well as documentation of these program outcomes, to further our understanding in this space. Ideally, it would involve a whole-of-industry approach so that regardless of workers’ movements between jobs, they would continue to receive the same health messages and the opportunity to engage in health programs. Another aspect of a holistic program would be to reach workers beyond these workplace barriers through the creative use of alternative strategies such as using virtual and online media, including social media and smart-phone applications.

Ensuring key stakeholder engagement can be problematic. The number of potential stakeholders can make it challenging to realize a consensus around program initiatives. Commercial construction is an example where many different trades and specialist workforces are presented and represented by numerous employer and trade union stakeholders on any given project site. Although industry-wide stakeholder consultation and involvement may be challenging to achieve, it is also critical that each group take ownership of the initiative in the design phase and beyond. Without this the chances of a health and well-being program being sustained over a lengthy time period may be limited.

Ultimately, both perceived and real barriers, such as responsibility for workplace health interventions, and liability and risk management issues, often place the consideration of developing and implementing health and well-being programs in the “too hard” basket. However, given continued consultation with stakeholders and a clear understanding of the reality of blue-collar workers’ roles and environments, gains can be made in successfully implementing workplace initiatives.

Conclusion and Further Recommendations

In summary, it is evident that male blue-collar workers (including Australian blue-collar men) are at risk of having a decreased life expectancy and poor health and well-being outcomes. It is also evident that blue-collar men, though they often face unique constraints, are more interested in their health than what was previously presumed and can therefore contribute unique insights into their health (Kolmet et al., 2006). A range of factors, including individual differences (e.g., age, self-efficacy, concepts of health), masculinity, socioeconomic constraints, and industry structural issues, potentially affect these health and well-being outcomes. However, the manner and extent to which these factors interact to effect health and well-being outcomes appear to have not been documented in a systematic manner and as such presents an opportunity for further research and modeling. Needless to say, there is evidence to suggest that from a public health perspective there is a need to influence the health and well-being outcomes of blue-collar working men—this commitment is particularly reflected in the Australian Federal Government’s 2010 National Men’s Health Policy (DOHA, 2010a). However, it is hoped that the considerations highlighted in this article encourages industry, health promoters, and leaders across the world to follow suit and to develop more sustainable occupational health, safety, and well-being policies within blue-collar industries.

The call for a greater focus on workplace-based health intervention programs is, as such, a timely occurrence that presents unique challenges for health promoters. Although this article has elucidated some of the unique constraints evident in the blue-collar workforce, and associated industries such as construction, further work in program development should also be based on best practice evidence, such as the information presented in peer-based systematic reviews (Engbers et al., 2005; Steyn, Parker, Lambert, & Mchiza, 2009).

In addition to using best practice evidence in program development, a dearth of literature, particularly in relation to blue-collar workers and the use of randomized controlled trials in this field (Viester, Verhagen, Van Dongen, Bongers, & Van der Beek, 2012), necessitate health promoters to evaluate their workplace programs and publish their findings. It is only through documentation and continual refinement that a literature on best practice and the evidence base for implementing effective workplace programs in blue-collar contexts can be built.