Joan M. Eakin

Health and the social relations of work : a study of the health-related experiences of employees in small workplaces

On the basis of a qualitative study of health in small enterprises, this paper attempts to theorise the social production of illness and injury in the workplace. Particular features of working life in small workplaces, especially their personalised social relations and low polarisation of employer-employee interests, shape workers’ perceptions of the employment relationship and of health in relation to work. Strained authority relations at work can form a key social context in which health and injury are constructed. In situations of conflictful supervisory relations, bodily experiences can become ‘problematised’. Meanings attributed to health conditions and the quality of the employment relationship are transformed and merged, prompting a questioning of the legitimacy of power asymmetries in the workplace and recognition of the conflicting interests of labour and capital. Bodily experiences and ill-health offer possibilities for resistance and become mediators of broader social tensions. Unheeded illness claims deepen feelings of distrust and blame, further causing labour relations to deteriorate, and re-producing the social conditions for illness.

‘Playing it smart’ with return to work: small workplace experience under Ontario’s policy of self-reliance and early return

Abstract Although there is considerable research on the effectiveness of various approaches to promoting successful return to work after work-related injury or illness, little is known about the process in small workplaces. This paper reports on a study of the effects in small workplaces of a particular set of policies and practices in Ontario, Canada, called ‘early and safe return to work’, an approach that emphasises workplace self-reliance and return to work before complete recovery via ‘modified’ work accommodation. On the basis of qualitative analyses of documents and interviews with employers, injured workers and compensation/rehabilitation professionals, the study found that early and safe return to work can disrupt workplace norms and patterns of social interaction, and create hardship, albeit of different sorts, for both employers and workers. Employers experience conflict between their administrative role in the early and safe return-to-work process and the demands of running a small business, while injured workers find their participation governed more by the ‘discourse of abuse’ and the social dislocations of injury and modified work than by best rehabilitation practice. This situation can lead to an erosion of trust arising from what both employers and workers perceive to be the betrayal of moral understandings in the workplace, to the ‘hardening’ of co-operative intent, and to an increasing tendency to ‘play it smart’ with the system of early and safe return to work — responses that can subvert the objectives and intent of the policy, and compromise possibilities for mutually satisfactory solutions. The paper concludes with reflection on the implications of these findings for return-to-work policy and practice, particularly in relation to small workplaces.

The hazards of helping: Work, mission and risk in non-profit social service organizations

Non-profit organizations play an important role in the provision of health and social services. No longer temporary providers of emergency services, non-profit organizations appear to be permanent features of the social service landscape. Despite some of the intrinsic rewards that work in non-profit organizations offers, jobs in these organizations can be characterized by high demands, long working hours, low pay and exposure to violence and infectious disease, conditions which may be deleterious to worker health. This paper is based on an ethnography of three non-profit organizations: a homeless womens drop in, a drug treatment agency and a mens homeless shelter. We examine organizational ‘mission,’ a dominant discourse about the purpose and value of providing ‘help’ to marginalized clients, and the implications it has for work practices and for the way that workers understand work-related risk in these organizations. We describe how the notion of mission is continually reproduced, and trace its relationship to worker risk acceptance and risk taking. We suggest that the functions of such discursive commitments in organizations, and their implications for the well-being of workers, underscores the importance of understanding organizational culture and the social construction of risk when attempting to improve working conditions and protect worker health in social service non-profit organizations.

When Health Care Workers Experience Mental Ill Health Institutional Practices of Silence

Based on findings from an institutional ethnography in a large mental health organization, we explore how institutional forces shape the experiences of health care workers with mental health issues. We interviewed 20 employees about their personal experiences with mental health issues and work and 12 workplace stakeholders about their interactions with workers who had mental health issues. We also reviewed organizational texts related to health, illness, and productivity. In analyzing transcripts and texts, silence emerged as a core underlying process characterizing individual and organizational responses to employees with mental health issues. Silence was an active practice that took many forms; it was pervasive, complex, and at times, paradoxical. It served many functions for workers and the organization. We discuss the theoretical and practical implications of the findings for workers with mental health issues.

From Theory to Practice: A Determinants Approach to Workplace Health Promotion in Small Businesses

A determinants approach to workplace health promotion focuses on the sources of health and ill health in the workplace itself. Key practice requirements of such an approach include the capacity to shift focus beyond the individual to the work environment, to cross disciplinary and jurisdictional boundaries in identifying problems and solutions, to foster health promotion self-sufficiency within the workplace, to enable worker participation in the process, and to adapt practice strategies to a business setting. This article identifies the challenges of such practice by reference to the experiences of health promoters in a Canadian public health department who attempted a determinants-centered stress reduction program for small-sized businesses. Findings under-score the significance for workplace health promotion of the broader structural context in which the workplace and the intervention are located, of differing perspectives between health professionals and workplace parties, and of conflicting professional accountabilities. Possibilities for addressing these challenges are considered.

Factors Associated with Enrollment in an Employee Fitness Center

Employee fitness programs may be evaluated by comparing program participants with nonparticipants on program outcome variables. This study was designed to identify how participants in an employee fitness program may selectively differ from nonparticipants. Joiners were more likely to have engaged in prior fitness activity, to consider fitness a high priority, and to have more positive attitudes about keeping fit. Traditional factors such as demographic or health status variables were not different between joiners and nonjoiners. Although the fitness center was not systematically selecting the more fit employee, participants were different from nonparticipants in terms of attitudinal and behavioral factors which reflect a health promotion orientation.

Towards a 'standpoint' perspective: health and safety in small workplaces from the perspective of the workers

Abstract This paper seeks to demonstrate the nature and value of a ‘standpoint’ perspective in occupational safety and health research. Argued through the case of workers in small enterprises, the paper discusses the notion of ‘standpoint’; describes and accounts for the primacy of the managerial standpoint and the invisibility of workers in occupational safety and health research and practice; and draws on several of the author’s research projects on small workplace health and safety to illustrate the kind of knowledge that can emerge from taking the workers’ standpoint (including studies of the impact of injury and ill health on social relations in the workplace, of the experience of return to work, of small employers’ perspectives and practices, and of frontline service work in a government agency that administers a workers’ compensation scheme). The paper considers why a standpoint perspective matters in understanding occupational safety and health problems, and argues that the analytic integration of multiple standpoints is necessary to our understanding of the occupational safety and health system as a whole and the possibilities for change.

Educating Critical Qualitative Health Researchers in the Land of the Randomized Controlled Trial

Drawing on long experience as a sociologist in the health academy, I explore the challenges of practicing and teaching critical qualitative research in an environment dominated by very different scientific reasoning. I account for the transgressive positioning of qualitative research in the health sciences in terms of the role of social theory in interpretive research, rising interest in qualitative approaches among health professionals, research and educational doctrines that impede “value-added” analysis, and the ascendance of applied, post-positivist forms of qualitative research. Strategies for producing critical qualitative researchers who can both survive and thrive in the health arena include creation of institutional authority, prioritization of methodological depth over breadth, teaching pragmatic but non-compromising survival skills, and forging supportive communities of practice. I describe how one particular academic organization is engaging with these strategies and reflect on future prospects for educating critical qualitative researchers in the field of health.