Diversity in PersonalProtective Equipment (PPE)A whitepaper

Diversity in Personal Protective Equipment

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Diversity in Personal Protective Equipment
Contents
1

Introduction

2

Not just small men

3

Economies of scale

4

More than just comfort

5

Empowering the workforce

6

Conclusion

7

About the Author

8

Acknowledgements

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Introduction
PPE (Personal Protective Equipment) is not a modern concept. Human beings have been making equipment to protect themselves
for hundreds of millennia. There are numerous examples from across history – many related to warfare. Even in this field there areexamples of provision for a more diverse group, including women. Perhaps one of the most famous example is the suit of armour
provided by Charles VII of France for Joan of Arc. And yet, the provision of PPE that genuinely takes into account the needs of atruly diverse workforce remains poor.

Not just small men
Whilst Joan’s suit was custom made, most PPE that is available
for the workplace is based on generic anthropometric data.
Generally if you are outside of the 5th or 95th percentile, thenthe hope of finding anything to fit is low, whether male orfemale. There is anthropometric data for both men and womenfrom across all parts of the world. Whilst much of this datais old and does not fully reflect modern body frames, it does
cover men and women and shows quite clearly that womenare not just small men. Women’s feet aren’t just smaller but are
narrower, so a small size ‘male’ safety boot is unlikely to fit afemale foot. The same is true for a safety glove in ‘small’. If notdesigned specifically for women, the palm area will be too big
and the fingers too long and wide. Simply making somethinga bit bigger or a bit smaller does not address diversity needs.
Additionally, anthropometric data is limited to a few metrics
and does not provide a complete anatomically accurate picture.
The next challenge is that standards written for PPE often failto take into account a more diverse end user. Health and safety
is an industry which has a predominately male demographic,
although this is changing. The experts that develop thestandards come from this demographic, which means there
can be a lack of diversity on the committees that write PPE
standards around the world.
These committees do also have to rely on the existing
anthropometric data, which as mentioned, has its limitations.
The outcome is that the standards to which PPE manufacturers
have to comply often restrict the ability to make PPE that issuitable for women or different ethnic backgrounds.
The 2006 report ‘Personal Protective Equipment For Women –Addressing the Need’1 reported that the “CSA revised its safety
footwear standards to allow shoe-makers to manufacture
Grade 1 boots in narrower widths without sacrificing the levelof protection offered to workers with small feet…These changes
have had a positive impact in increasing the availability ofwomen’s safety footwear.”
Other examples of standards committees becoming morediverse are available. For instance, the UK Committee PH/3/11
Protective Equipment for Sports Players which mirrors theEuropean committee CEN/TC 162/WG 11 Body protection for
sports, includes input from both males and females and ischaired by a woman. The standards which they are responsiblefor developing are increasingly accounting for diversity of
all types. In fact, the UK National Standards Body, BSI, has a
project to identify all standards that need to have a ‘personal’
aspect to them – and this includes not only gender and cultural

diversity but also religious, disability, medical and other formsof body differences such as amputees.
It is in the area of respiratory protective equipment (RPE) where
we are seeing actual change to cater for diversity. Because
there is a critical need for respiratory products to fit the user
properly, there has been a large ISO project to produce a setof respiratory standards that reflects up-to-date research on
face shapes and gender. Data used showed that there wasa big difference in facial characteristics between Caucasian,
sub-Sahara and European facial types. In other words, the newstandard is written with the human in mind.
Part of the output was ISO 16900-1:2014 Part 1: Determinationof inward leakage. This standard isn’t referenced in the ‘official
journal’ (reference list for harmonized standards) but is defining
the way the respiratory standards are going. The ISO standard
specifies an increase in the number of test subjects from 10(as is normal for most European standards), to 25 in order toprovide greater representation of human diversity. Any testing
against the standard also needs to take into account different
breathing patterns while performing various physical tasks. Thisis also having an impact on tests where human subjects are notused (just models) with the introduction of five test headforms
for things like breathing tests to accommodate different faceshapes and sizes.
ISO 16900-1:2014 standard also refers to another standard –ISO/TS 16976-2:2015 Respiratory protective devices — Human
factors. Here the focus is on determining whether the RPE is fit
for purpose based on how and where it is used.
This means, for the first time human factors come into theequation, including:

•
•
•
•
•
•
•

Ergonomics
Work rate
Dead space in the device
Work of breathing
Thermal effects
Psychological effects
Speech transmission

One of the most important physiological factors is how much
air the wearer needs. The ISO standard uses a staggered
scale of work rates. This means that a respirator is classified
according to how hard the wearer can work without ‘overbreathing’ the device (breathing too hard for the device).

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Economies of scalecosts of PPE themselves, taking sickness leave or changing
jobs due to embarrassment or lack of consideration for normal
biological changes such as pregnancy and menopause.

The final barrier to better choice of PPE for a more diverse
workforce is economic. The provision of a suitable selectionof PPE to meet all sizes and sexes is market driven – theeconomics of cost versus return. In simple terms, historicallythere was no money to be made in PPE for a diverse minorityof the workforce. Take for example women. A boom of womenentered the workforce in the 1960s and continued to surge
through 1999 where it peaked at 60% of the workplace being
comprised of female employees2. Now the global labour
force participation rate for women is 50 per cent, comparedto 76 per cent for men3. Where women are the predominant
workforce, the provision of PPE designed for women issignificantly better, for example in healthcare or the equine
industry, or in countries where women are more evenly
represented across all industries, such as Sweden.

Samantha Lushtak recalls when she was pregnant having topurchase three pairs of safety shoes. “My employer (at the time)
had a policy which was to buy one pair annually unless theyclearly needed to be replaced. Because my feet were growing
and my body was changing so rapidly, I needed wider and wider
shoes with more and more arch support, and ultimately needed
something that would slip on instead of lace-up (an ergonomic
concern). By the second pair of shoes, I was purchasing themfor myself out of pocket to avoid the awkwardness of
explaining what was going on to my facilities manager.”
Samantha was also in charge of her emergency response
team and had to ban herself from taking part in the drills andresponding to incidents because the level B suits got too hot
to allow her to use them and her face was changing so muchthat she couldn’t be confident in her self-contained breathingapparatus mask fit a few months after her fit test.

The challenge arises in those industries where women are
under-represented. Here, the market forces have meant thatthe economics of providing a comprehensive selection of PPE
for women have simply not been there. Where the female
workforce is restricted to a single supplier, as is often the casewith employer procurement contracts, finding PPE that fitscorrectly becomes challenging. Whilst most of the large PPE
suppliers in high income countries do now provide some sizing
for women, the choice is limited. This means that the ‘personal’
in PPE becomes null and void, as women are unable to try on
a range of PPE to find the equipment that best fits them and iscomfortable.

Here the internet has provided an effective solution. Employers
which allow their workforce to source their own PPE (withguidelines on cost and requirements) can greatly increase theengagement and compliance of the workforce as the individual
can take control of the sourcing of PPE that best fits them.
Sourcing from countries with a better range, or even different
industries – the equine industry has a good range of steel toe
cap boots for instance, can be both practical and cost effective.

More worryingly still are the reports of women covering the4

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More than just comfort

Fit is an essential component to the effectiveness of PPE.
Fit will also have an impact on comfort and this in turn, will
impact compliance levels. Any human – male or female, will
be unhappy about wearing something that is uncomfortable.
Worse still, ill-fitting equipment can increase safety risks andactually cause physical and even mental ill-health. Overalls,
trousers, gloves which are too long or big can create tripping,entanglement, dexterity and contamination risks, as legs/
sleeves are rolled, taped or even tied up: “I stuffed cotton in thefingers, put tape at the wrist, and tacked the top with staples tostop sparks from getting down the sleeve...”2

these, 38 per cent had curtailed their duties and 4 per cent hadchanged roles as a result of PPE issues.
Body protectors and stab vests can bring additional challenges.
The 2017 TUC guidance document ‘Personal Protective
Equipment and women4 reported “In 1997 a women police
officer was stabbed and killed while using a hydraulic ram
to enter a flat. She had removed her body armour because it
was too difficult to use the ram while wearing it. Two years
later a woman police officer disclosed she had to have breast
reduction surgery because of the health effects of wearing her
body armour”. Whilst stab vests may come with ‘formed’ panels
for women’s breasts, they take a ‘one size fits’ all approach, andother measurements such as torso length are not adapted.
Furthermore, they don’t take into account biological changes– breasts can become larger and more tender during themenstrual cycle and pregnancy - and finding a ‘comfortable’
vest after a mastectomy can be impossible.

Ill-fitting and heavy boots, breathing apparatus and bodyprotectors can give rise to acute and chronic musculoskeletal
disorders. Poor fitting PPE can also be used as a source ofbullying, harassment and intimidation. In 2016, in the UK, thetrade union Prospect, Women in Science and Engineering(WES), the Institution of Mechanical Engineers (IME) and theTrade Union Congress (TUC) conducted a survey exploring
the issue of PPE for women. It found that not only did PPE
hamper their work, create discomfort and injury but 28%
of respondents reported that they had been subjected toderogatory comments as a result of ill-fitting PPE such as:•••

The same TUC guide also reported on the Coastguard service’s
one piece overalls “they make it very inconvenient for female
coastguards to use the toilet while wearing them. There is adouble zip at the front which is great for males, but for female
coastguards it is very impractical to go to the bathroom. It
isn’t just a matter of having to take off the overalls to use thebathroom. The overalls form a base layer over which several
other pieces of PPE are often worn, such as foul weather
clothing, life jackets, climbing harnesses etc. and it is a major
operation to have to strip these all off in order to remove theoveralls.” Again, these challenges can be heightened during
the menstrual cycle, pregnancy and menopause when there
is often a need to visit the toilet more frequently to change
sanitary wear or from pressure on the bladder.

‘You look like a kid playing dress up’‘Are you wearing your Dad’s clothes’‘Here comes the elephant’

Heat stress is a well-known risk associated with PPE use,
especially in hot and humid climates. For women this can beheightened as the monthly menstrual cycle increases core
body temperature and can become even more serious during
the menopause. The Prospect/WES/IME/TUC report found that
21 per cent of women wore PPE during the menopause. Of
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Empowering the workforce
which removes obstacles and barriers, such as discriminationor embarrassment (real or perceived). These principles areclearly seen in the new global standard on health and safety
management – ISO 45001. Organizations that implement thisstandard will empower their workforce to participate in good
health and safety and in many cases the workforce will comeup with effective solutions to PPE challenges.
Additionally, ISO 45001 has an emphasis on creating a healthand safety management system which works for the worker– as opposed to simply working for the organization. It has
a much greater emphasis on considering the individual andmanaging risks beyond just safety. It requires an organization
to identify hazards such as social factors including workload,
work hours, victimization, harassment and bullying.
The standard also requires organizations to consider humanfactors – how work is performed and designed; the needs andcapability of the worker; and the culture of the organization.
So a ‘one size fits all’ approach is inconsistent with good healthand safety. Finally, with its focus on continual improvement,
ISO 45001 also requires “that opportunities to adapt work,
work organizations and work environments to workers” areassessed and implementing where possible.

For employers, PPE is at the bottom of the hierarchy ofcontrols - the last option for protecting workers from healthand safety risks. Therefore, the most effective solution todeal with PPE that does not meet the needs of a diverse
workforce is to remove the need for PPE wherever possible.
Where it isn’t possible, it is the organizational culture andeffective consultation and participation of the workforce

Conclusion
health and safety. This is more than simply completing risk
assessments for young workers or those with a mobility
restriction. It needs to take into account differences in risk
perception, attitudes to authority, time orientation, indirectcommunication, personal space, non-verbal communication,
gender and even political history.

Increasing diversity is a factor which health and safety will haveto take greater account of. Increasing participation of women in
the workforce, an ageing population with its associated healthneeds plus growing ethnic diversity as a result of migration andbirth rates means that responding to diversity is something allorganizations will have to adapt to. In fact one study5 estimatedthat there will be no ethnic or racial majority in the USA by
2042. ‘Diversity’ is more than this though. Different working
patterns, for example shifts, the dependent self-employed (gigeconomy) or those with a portfolio career are all dimensions ofdiversity.

Organizational socialization – the process of conveying theorganization’s goals, norms, and preferred ways of doing
things to its workers, or more simply ‘identification with theorganization’ is therefore essential to managing diversity
successfully. This does not mean pressuring workers to
conform to a single norm but rather diversity as the norm. But
how do organizations do this? Here there is no surprise; it starts
with leadership and in particular transformational leadership.
Developing capability in emotional intelligence across theorganization is also important as this creates empathy andreduces conflict. The final element is ‘inclusion’ – involving andempowering workers.

Human diversity should be seen in the same way as biodiversity
in nature – as a positive source of exchange, innovation andcreativity. We know that the most lush and productive regionsof the world are the ones with the greatest biodiversity. Itshould therefore stand to reason that the most productive andflourishing organizations are those that successfully embrace
diversity. Similarly we are moving to a society which champions
protecting the environment and being responsible consumersof natural resources, so organizations should become
custodians of their human resource.

Transformational leadership, emotional intelligence and worker
inclusion – these are at the heart of good occupational healthand safety, so embracing diversity for organizations with aproactive approach to health and safety should be a naturalpart of its ecology.

However we need to understand the ecology of the system toensure that we don’t create imbalance. It is therefore importantto understand the impact diversity has on occupational

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About the author
Kate Field (CMIOSH) is BSI’s Global Champion for occupational health and safety (OHS). Kate acts
as expert and ambassador on OHS supporting the delivery of excellence and expertise across the
193 countries BSI operates in.
With a health and safety career spanning two decades, Kate has authored regulatory and technicalguidance, written articles for a range of publications and is a successful global, keynote speakerand presenter.

Acknowledgements
With thanks to the following for their contributions:
Andreea Vieru, Programme Manager, BSI Standards
Hilary Roberts, Global Head of Marketing, Product Certification, BSI Assurance
Ian Richardson, Standards Publishing Manager, BSI Standards
Nathan Shipley, PPE Group Certification Manager, Product Certification, BSI Assurance
Samantha Lushtak, Consultant, BSI EHS

1 A Change Agent Project by the Ontario Women’s Directorate and the Industrial Accident Prevention Association
2 Toossi, M., & Morisi, T. L. (2017, July). Women In The Workforce Before, During, And After The Great Recession
3 ILO Women in Work Trends in 2016
4 https://www.tuc.org.uk/research-analysis/reports/personal-protective-equipment-and-women
5 Johnson KM, Lichter DT. Growing diversity among America’s children and youth: Spatial and temporal dimensions. Population and Development Review. 2010;36(1):151–176. doi:10.1111/
j.1728-4457.2010.00322.x

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