Introduction

Reducing inequalities in working conditions and work-related health based on sex/gender, race, ethnicity and (im)migration status is necessary to meet the goals laid out in current sustainable development agendas globally [1], within the European Union [2], and within the Swedish National Work Environment Strategy [3]. The goals reflect current and past trends in work-related health disparities. Over the last thirty years, differences have been reported in occupational health between males and females (i.e. sex differences between groups based on physiological characteristics), for example, the annual incidence of musculoskeletal disorders (MSDs) in Europe has been approximately thirty percent higher for females than males [4], with particularly pronounced differences in the upper extremity MSD rates [5–7]. In contrast, the relationships between occupational health and gender—that is, a person’s socioculturally constructed identity as man, woman, or non-binary—or race/ethnicity—that is, social constructs related to physical traits (i.e. race) and sociocultural characteristics (i.e. ethnicity) [8]—have not yet been systematically investigated across Europe or within Sweden. Swedish data suggest foreign-born (FB) workers have a lower work-related health status than Swedish-born (SB) workers [9] including higher rates of poor self-reported health and mental distress [10], and higher rates of sick leave absence [9, 11] and burnout [12]. The imbalances in work-related health related to place of birth are particularly concerning in the Nordic context given the steep increase in immigration rates in the last decade [13]. Research further shows that the labour market is segregated and segmented based on both sex/gender and race/ethnicity [14], and may include a more complex hierarchy of inequality based on intersections between sex/gender and race/ethnicity [15]. The expansion of the consideration of equality from strictly male-female (sex) differences to also include consideration of gender, and, further, of race, ethnicity and (im)migration reflects the reality of modern culture and immigration patterns and underscores the need for intersectionality, that is, the simultaneous consideration of different aspects of identity in understanding inequality in working conditions and health outcomes [16]. Labour market segregation is well documented in Europe, including Sweden [17, 18], and the resulting differential occupational exposures and risk factors between occupations are likely to contribute highly to disparate national health outcomes related to sex/gender and race/ethnicity. However, health disparities are still evident across workers within same occupational sectors, with similar evidence of inequalities based on both sex/gender [19–21] and race/ethnicity [22].

Warehouses play a key role in the global economy. Given the current competitive markets, companies must be able to deliver products quickly and with high-quality service with minimal costs making warehousing a key element in overall company business processes. To increase the performance of warehouse operations systems, digital technology use in warehousing is increasing. For example, mobile devices for the augmentation of processes and support of workers in order picking are now commonplace, and the use of collaborative robots, for example where parts are delivered to the workers who pack the orders (for example, Ocado and Modula vertical warehouse solutions [23, 24]), is on the rise. Changes in digital technology will lead to changes in facility design and, likely, in work environment conditions and worker health. Warehousing in online retail, defined as ‘retail sale via mail order houses or via Internet’ [25], in which orders are picked and packed for customers and, in some cases, for physical stores, has experienced rapid growth both in terms of numbers of employees and adoption of digital technologies. In Sweden, between 2015–2020, over 7000 new employees were hired into online retail, which represented a 3% increase in the share of total employees in retail trade (from 4% to 7%) [25, 26]. Changes to the way human work is organized and performed in warehousing are evident [27]. In a recent report, the Swedish Work Environment Authority described online retail operations systems as having been designed to create an optimal flow of goods to the customer, but with little consideration of the working environment for the employees [28]. The rapid growth of online retail has left work environment research lagging regarding assessment of the working conditions and health in online retail warehousing.

Unlike traditional retail work environments, warehouse work typically requires no interaction with customers. In Sweden, this can translate to reduced language proficiency requirements in warehousing compared to traditional retail jobs and subsequently increased accessibility for foreign-born workers. Further, the ‘behind-the-scenes’ nature of warehousing likely removes the traditional ‘light skinned, young, middle-class, heterosexual femininity’ architype that is preferentially employed in front-line service jobs [29–31]. Thus, an increase in both foreign-born and male employees would be expected in online retailing compared to traditional retail jobs. Labor statistics based on administrative sources from Statistics Sweden confirm this prediction. In 2020, 24% of online retail workers were foreign-born compared with 17% in traditional retail, and 50% of online retail workers were men compared with 38% in traditional retail. The diverse worker population in online retail warehousing is likely to face embedded practices of inequalities related to gender and/or race/ethnicity, as described in Acker’s (2006) inequality regimes, which can lead to differences in work environment conditions and health. In our recent review of work conditions in warehousing in relation to gender and race/ethnicity [15], we found evidence that gender and race/ethnicity influenced work organisation, work environment conditions, and employment conditions. The results also underline the need for research considering patterns of gender and race/ethnicity in working conditions and health in online retail warehousing.

Disparate health outcomes related to sex/gender and race/ethnicity are likely a result of a combination of societal, organisational, and individual level factors. A framework for a hierarchical set of factors underlying sex/gender inequalities and musculoskeletal health was previously proposed which included the effects of differences due to: occupation, work tasks within occupation, loads within work tasks, load effects, reporting behaviours, and treatment attitudes [6, 32]. The present study expands that theoretical framework to include both physical and psychosocial work environment conditions in relation to both sex/gender and race/ethnicity and focuses specifically on the factors, work tasks, and, loads in tasks, in the assessment of inequalities in online retail warehousing. Differences in allotment of tasks according to gender and/or race/ethnicity, as part of the work organisation among employees with the same job title, can result in differences in tasks performed by groups of workers and subsequently differences in occupational exposures and risks. For example, research shows that women typically perform tasks that are repetitive and less variable than those performed by men [33, 34], and that FB workers have more physically demanding work and more awkward working postures [10] and are more likely to perform tasks with a higher risk than domestic-born workers [9]. Even among workers performing the same tasks, the loads experienced may differ between workers. For example, the physical loads experienced by an average sized woman will likely differ compared with an average size man when performing work at a fixed workstation or with a specific tool. Loads experienced could be higher for women given workstations and tools are typically designed based on the anthropometrics and capacity of an average male [35, 36]. Differential experiences of psychosocial loads have also been documented, for example, between FB and domestic-born workers where FB workers reported lower workplace decision latitude [10, 37] and social support [10, 38].

According to Acker’s theory of inequality regimes, ‘loosely interrelated practices, processes, actions and meanings’ exist in all organisations and create hierarchies of gendered and racialized class relations [39]. Acker’s theory considers that relationships and power balances between members in an organisation are therefore not only hierarchically ordered according to occupational rank, e.g., CEO, manager, middle management, production workers, but are also gendered and racialized. We use the term ‘inequality’ to refer to “systematic disparities between participants” [39] that are associated with employee sex/gender and race/ethnicity. Systematic disparities can occur at all levels of organisational processes and practices, for example, in preferential recruitment that targets a certain category (e.g. sex, gender, race, ethnicity) of worker deemed most suitable for a task, in systematic promotion and wage disparity practices, and/or in informal interactions between employers and employees. We used the term race/ethnicity to encompass aspects related to where a person is from and their sociocultural identity, including pre-conceived notions a person encounters regarding their origin and abilities as related to their physical appearance. In the quantitative analyses, we use place of birth (PoB) as a proxy for race/ethnicity. While PoB and sociocultural identity typically interact, we acknowledge that race, ethnicity, place of birth, (im)migration status and language development are differentiated both in theory and lived experiences (cf. [8, 40]). Specifically, we accept that “race is a socially constructed bodily concept, whereas ethnicity is a socially constructed cultural concept” [8], and that country of birth and (im)migration status are directly measurable quantities. In this study, comparisons related to PoB and race/ethnicity will specifically reflect differences in experiences between Swedish- and foreign-born workers.

The overall aim of this 3-year study is to describe working conditions and musculoskeletal health in online retail warehousing including the extent to which differences based on sex/gender and race/ethnicity exist in working conditions and health, and to examine factors at the organisational and individual levels underlying eventual inequalities in working conditions and health. Fig 1 shows the conceptual model underlying the current study, and illustrates the link between working conditions and health and the potential for differences in working conditions and health based on sex/gender and race/ethnicity. In the model, examples are given of specific factors that will be investigated in the present study. We use the term ‘working conditions’ as an overarching term for the factors represented on the left side of the model (Fig 1), which includes the employment conditions of the warehousing workers as well as the facility design, work organisation and work environment conditions of the warehouse operations system. Employment conditions refers to the type of employment (regular versus temporary; full-time versus part-time), the extent of work (full-time or part-time), wage levels and benefits. Facility design includes the physical components of the operations system underlying the operations process flow including digital production technologies. Work organisation considers how work is organized between employees, including the allotment of tasks. Facility design and work organisation both influence the physical and psychosocial work environment conditions, which interact with one another.

Download:

• PNG
  larger image
• TIFF
  original image

Fig 1. Working conditions and health in relation to sex/gender and race/ethnicity.

Conceptual model outlining the linkages investigated in the current study between working conditions and health including consideration of individual worker characteristics.

https://doi.org/10.1371/journal.pone.0297569.g001

The present study aims to both describe the extent to which differences in working conditions and health exist based on sex/gender and PoB (as a proxy for race/ethnicity) as well as to provide an understanding of why any differences exist by assessing inequality regimes. To achieve this goal, the study will integrate results from quantitative analyses of work environment conditions and health and qualitative analyses of the organisation’s inequality patterns in employment conditions and work organisation to (i) identify and describe factors within the organisation that affect working conditions, and (ii) understand how the organisation creates and maintains these conditions. A mixed methods approach involving both quantitative and qualitative tools is therefore required. By both identifying patterns of inequality and assessing how the patterns occur, the results will provide evidence regarding the possibilities and obstacles for increasing equality in working conditions and health.

The specific study aims are to:

1. Describe working conditions and work-related musculoskeletal health in online retail warehousing.
2. Determine the extent to which working conditions and work-related musculoskeletal health differ between employees with respect to sex/gender and PoB in online retail warehousing.
3. Describe the extent to which sex/gender and/or PoB inequalities in working conditions and musculoskeletal health are related to organisational processes and practices in online retail warehousing.

Materials and methods

Inequalities in working conditions and health will be assessed on the basis of sex/gender and PoB at three online retail warehouses located in Sweden using a mixed-methods approach including questionnaires, technical measurement, focus-group interviews with production employees, and semi-structured interviews with managers, and union and health and safety representatives.

Discussion

This study employs a novel approach that combines established techniques from gender research for assessing organisational perspectives on sex, gender, race, ethnicity and (im)migration status, with a quantitative analysis of the consequences of said perspectives. Together, this mixed methods approach permits consideration of gendered and racialized processes that can lead to differences at the level of the individual worker in terms of employment conditions, facility design (e.g., differences in experiences with digital technologies), work organisation (e.g. task allotment), work environment conditions (physical and psychosocial), and MSD health, as outlined in Fig 1.

Warehousing comprises a range of work tasks which differ in terms of complexity and workload. Thus, it is important to consider potentially inequalities in task distribution based on sex/gender and race/ethnicity and subsequent health effects. In this study, we will include warehouses employing 20–200 production employees. We believe this is a sufficiently size to provide access to an adequate number of male and female and Swedish- and foreign- born workers to permit assessment of inequality regimes based on both sex/gender and race/ethnicity. Further, we hypothesize there will be sufficient inequalities in task distribution and thus job exposure to have the potential to impact occupational musculoskeletal health.

We will aim for a response rate of 60–70% for the questionnaires, which is also in line with previous field experiments. To maximize our chances of reaching this response rate, we will offer the questionnaire in paper and digital format (computer and mobile phone compatible) and will strongly encourage warehouses to permit employees to respond during working hours. Based on prior field research, we believe it is realistic to recruit 20 workers at each warehouse to participate in the technical measurements of physical workload, and 20 workers to participate in focus group interviews. As stated above, these predicted sample sizes are expected to allow stable estimates to the research questions.

The main limitation of the study is a limited generalizability of the findings given that we only investigate three warehouses while the range in types and sizes of warehouses is large. However, we believe that findings from our case studies will be useful to other similarly sized warehouses with diverse employee populations and will inspire warehouses to consider their own organisational practices in terms of inequalities in sex/gender and race/ethnicity.