Hidden Inequalities in the Workplace: A Guide to the Current Challenges, Issues and Business Solutions

The book presents a critical framework for assessing whether organisational practice and function reinforces unseen potential differences amongst individuals in the workplace. It offers a comprehensive understanding and awareness of managerial and organisational practices that perpetuate social exclusion and discrimination towards individuals in the workplace. The book draws together themes of non-declared medical or physical conditions, voluntary and involuntary disclosure of difference, dietary requirements, lifestyle, organisational engagement and cognitive bias. As a result, the book provides a unique blend of scholarly and professional research, and brings those who have been affected by social stigmas and discrimination in the workplace to the fore. Hidden Inequalities in the Workplace also offers practical and strategic insights for practitioners, students and policy-makers, and delves the strategic nature of policy intervention and thought-provoking dialogue

• Language: English
• Publisher: Palgrave Macmillan
• Release date: Aug 11, 2017
• ISBN: 9783319596860

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© The Author(s) 2018

Valerie Caven and Stefanos Nachmias (eds.)Hidden Inequalities in the WorkplacePalgrave Explorations in Workplace Stigmahttps://doi.org/10.1007/978-3-319-59686-0_2

2. The Challenges and Social Impact of Coeliac Disease in the Workplace

Valerie Caven¹   and Stefanos Nachmias¹  

(1)

Department of Human Resource Management, Nottingham Business School, Nottingham Trent University, Nottingham, UK

Valerie Caven (Corresponding author)

Stefanos Nachmias

2.1 Identifying, Stating and Justifying the ‘Problem’

Coeliac disease (CD) is a life-long chronic condition where the gut reacts to gluten-containing foods. Sufferers account for around 1% of the population worldwide (Coeliac UK 2014; Araújo and Araújo 2012), although it is estimated that there are many more who have not received a diagnosis. Left untreated, it can raise an individual’s risk of bowel cancer, cause growth problems, contribute to infertility and/or miscarriage, and there are connections to mental health issues (Mendoza and McGough 2005). The only ‘cure’ is strict adherence to a gluten-free diet which, if maintained, results in full remission (Hall et al. 2013).

While the physical and emotional effects of CD and their impact on the sufferer have to some extent been documented in terms of the psychosocial aspects (Ford et al. 2012), little is known about how CD sufferers manage in the workplace. Many sufferers have expressed feelings of anxiety and depression as a result of perceived stigma (Goffman 1963) and exclusion from social settings due to formal diagnosis (Black and Orfila 2011). However, research has failed to explore the emotional impact of diagnosis on sufferers’ working lives including the social context. For example, food plays a significant role in organisational culture; it is used as a morale booster, a form of reward or celebration, a means to build team working and to network (Thomson and Hassenkamp 2008). For CD sufferers, these food rituals have the potential to result in isolation and exclusion. The Equality Act 2010 provides the legal framework to promote equality of practices and enhance diverse activities within organisations. Despite the legal expectations , organisations also have a moral obligation to accommodate individual needs and ensure key policy providing guidance to individuals (Black and Orfila 2011). Awareness of dietary requirements , especially on religion grounds, is on the increase; however, we suggest that there is a lack of knowledge and understanding on the part of employers about both the ‘actual’ condition and their role in supporting the sufferer in its management.

The issue is compounded by the fact that CD is not specifically considered a disability or ‘chronic long term condition’ under the UK Equality Act (2010) which would require employers to make ‘reasonable adjustments’ to accommodate the sufferer. As the disease is managed via adherence to the gluten-free diet, for which 60% of coeliac sufferers (CSs) report, they experience some difficulty in maintaining (Araújo and Araújo 2012). There are evident difficulties in workplace provision whether through lack of facilities to buy or store home-prepared food. However, organisational support for CSs should go beyond the practical availability of food. It is important to consider the emotional and perceptual implications of being excluded from social events where food has a social, psychological and symbolic dimension (Holtzman 2006). There is a grey area as to what, if any, are the employers’ obligations and what may be reasonable for employees to expect in terms of equal treatment and consideration for their dignity at work. It is also important to explore whether there is any responsibility on the part of the employers towards the coeliac employee.

The emphasis in the UK of the employee having to ‘prove’ they have been treated unfairly in the eyes of the law is not an effective means of addressing the problem. Issues of stigmatisation , mistreatment and financial implications might prevent individuals disclosing any discriminatory activities. Organisations and individuals should not ignore the social and emotional aspects of unfair treatment and act to address any ‘hidden’ inequalities in the workplace. Existing research in the field is vague, and thus employers might not have the knowledge or awareness through which to develop policies or codes of practice to address any deficiency.

This chapter is timely as there is a growing attention around employers’ ‘duty of care ’. Organisations are expected to support the health and wellbeing of their employees. A survey by Coeliac UK (2007) found that pre-diagnosed sufferers took an average of 21.4 days sick (with this dropping by 3.6 days after diagnosis). By providing organisational support for sufferers, the number of sick days could be dramatically reduced. In addition, research has highlighted that employees who perceive that their organisation values their contribution and supports their wellbeing are more likely to display positive employee attitudes and behaviours (Eisenberger et al. 1986; Dulac et al. 2008; Rich et al. 2010). Employees who perceive their organisation provides a lack of social support are more likely to become disengaged with their work (Demerouti et al. 2001) and create the sense of unfairness in the workplace (Griffiths 2008). Although it is discriminatory for an employer to treat a coeliac employee differently from other employees in the UK, the onus is on the employee to prove that they have been treated unfairly and are left to pursue it via an employment tribunal (Griffiths 2008). This is costly in both financial and emotional terms, and the reality is likely to be that employees tend not to take actions in addressing any discriminatory behaviours.

Therefore, the chapter assesses current issues faced by CD sufferers and unveil any ‘hidden’ inequalities in the way organisations accommodate their individual needs. Some might argue that the proportion of CD sufferers is disproportional across the labour market. Nevertheless, the emotional and social dimensions of any unfair treatment should be addressed by employers and ensure that they make reasonable adjustments to address specific personal and work-related needs. It is also important to understand the way organisations design and introduce key practices that aim to support employee wellbeing and health in the workplace. Most importantly, the study allows the in-depth exploration of individual stories and their perceptions on current practices, a powerful tool to share ideas widely.

2.2 The Impact of CD on Working Life

Literature highlights a number of psychological, behavioural and cognitive issues related to CD working life. As Lee et al. (2012) argued in their longitudinal quality of life study of living with CD, while the impact on family, dining out and travel diminishes as time following diagnosis passes, the effect on work remains the same whether the diagnosis is recent or more than 10 years prior. This is in line with Black and Orfila’s (2011) findings which reported feelings of anxiety and depression due to exclusion in social settings (difficulty of adhering to the gluten-free (GF) diet), lack of awareness of the CD and its effects as well as management’s unwillingness to educate individuals. Most interesting is the ignorance or lack of understanding by non-coeliac employees, which might cause unintentional and indirect discrimination . This is further compounded by silence or resentment by the ‘involved’ party. Evidence of indirect discrimination occurs if a ‘provision, criterion or practice’ is imposed which members of one group are much less likely to be able to comply with, and which is not justified by the requirements of the job.

Despite the above evidence, the practical aspects of managing the condition in the workplace have been overlooked. No exploration of any obligations on the part of the employer has been carried out and most importantly what a coeliac employee can reasonably expect in terms of support from their employers. In fact, the Advisory, Conciliation and Arbitration Service (2017) argues that employers are not expected to provide religion-specific food (non-specific comments about food requirement upon health grounds) at work-related meetings ‘if it is not proportionate to do so’. Nevertheless, they highlight that organisations (when possible) should provide some alternative food available for employees. This is also compounded by the fact that CD is not specifically covered by the Equality Act 2010 which refers to conditions such as depression, diabetes and the like followed by the clause ‘…and any other long-term chronic condition’ (Equality Act 2010). Until this is tested in case law, it will remain outside the specific provision of the Act. Where employers’ obligation to their employees with CD has been the subject of legal action, it has been because the employee has had a specific protected characteristic covered by the Equality Act 2010, and CD has been considered as ‘an attendant condition’. For example, in the case of Duckworth v British Airways, a member of cabin crew working on long-haul flights, who was both diabetic (covered by the Equality Act 2010) and coeliac, became ill as a result of his in-flight meal containing gluten which exacerbated his diabetes and he was hospitalised. On his return to work, Mr. Duckworth applied for a transfer to short-haul flights to help manage his disability better. The case arose as his application was at first declined and then delayed unreasonably by British Airways. However, while recourse to law is not necessarily the solution, sometimes organisations feel more ‘encouraged’ to support diversity if there are legal rather than just moral requirements (CIPD 2012).

CD sufferers are prevented from joining the Police Service or Armed Forces due to the difficulty of maintaining a GF diet while on deployment (www.​gov.​uk accessed 20/12/2016 AFCO form 5); however, those who are diagnosed once in the military are offered alternative positions or, in some cases, a medical discharge dependent upon their job role and suitability for redeployment. This leads to questions about the time of diagnosis —whether it is prior to or post joining an organisation—and can add a further dimension of complexity. If an employee is diagnosed prior to taking their employment, they are likely to understand what adjustments are needed or will know how to manage their condition. They are not required to disclose any information to a potential employer. However, if the diagnosis comes after accepting the employment, there can be additional difficulties. As previous research shows that the first year or so after diagnosis presents specific challenges in adapting to the radical change in dietary lifestyle required with quality of life scores initially improving but then declining for as long as four years following diagnosis (Lee et al. 2012). Employers have a moral responsibility to take actions to accommodate their needs and support CD sufferers’ wellbeing. There are not specific legal requirements for employers to comply.

2.3 Socialising, Catering and Marginalisation

Anecdotal evidence also leads us to believe there is discrimination against CD sufferers in the workplace in being excluded from joining in corporate hospitality. This is due to lack of GF options, the condition being referred to as an ‘eating disorder ’ or being told to take their own food as they were considered ‘too difficult’ to cater for and the like. This could be a real source of establishing ‘hidden’ inequalities and highlighting the organisation’s inability to accommodate individual needs. Food and eating are symbolic in the workplace as they represent celebrations of success, cement team ‘togetherness ’ and cohesiveness (Ortlieb and Sieben 2011), and other organisational ‘rituals ’ (Flores-Pereira et al. 2008). Rosen (1985) was among the first to acknowledge the symbolism of organisational celebrations featuring eating. Nevertheless, social exclusion diminishes the value of socialisation and create a sense of stigmatisation and marginalisation amongst colleagues. As Sturdy et al. (2006, p. 907) argued, business dinner is a ‘liminal space between work and private spheres’ thus providing us with a linkage between an employers’ obligations to the coeliac employee.

Cunha et al. (2008) go a step further and conceptualise food within organisations in four ways: food as need, social interaction, culture and as a metaphor. This provides us with a framework to examine the needs of the coeliac employee in the workplace. Firstly, food as need refers to meal breaks and the availability of GF food or the facilities to safely store and reheat food from home. Secondly, food as social interaction whether it be business-related entertaining, networking opportunities or the exchange of news and knowledge at the coffee machine. Thirdly, the cultural aspects of food at work in terms of cakes for celebrations, birthdays, for example, or food to symbolise religious festivals, or food as reward; food as metaphor is used by Cunha et al. (2008) in a number of ways—to explain the organisation as a consumer of worker flesh or to reflect the organisation’s ‘health’ whether it be anorexic or over-weight to name two.

Taking the theme of the organisation (employer) as a consumer of worker flesh then that highlights the need for the worker to be healthy—hence our argument for the need for employers to consider the needs of their CD sufferers. In order to determine what is known about the management of the condition in the workplace, we conducted a search of the academic literature via library and other databases using a range of keyword terms including ‘coeliac’, celiac (in order to ascertain if work had been carried out in the USA) and ‘employment’ which yielded no results; likewise a search of the factsheets, reports and on-line discussion/advice forums offered by the Chartered Institute for Personnel and Development (the professional body for human resource managers in the UK), again produced no results. While Coeliac UK provides a wide and informative range of guidance and advice covering school meals, eating out and holidaying abroad, once more, there is no formal guidance for either the coeliac employee or his/her employer. Further to that, the lack of resources could be an indication that any forms of food or mental disorder are not covered by the legal framework. These are seen as less important items on the organisational agenda. This might be seen a ‘bold’ statement; however, organisations have the moral imperative to valuing individual differences (van Dijk et al. 2012).

2.4 Blurring of the Boundaries Between ‘Public’ and ‘Private’

While personal health and wellbeing may be considered a private sphere and an area which individuals are unwilling to discuss publicly, for example, in the workplace, there may be occasions where the public and the private collide. Those who have not yet received a diagnosis and who are suffering from ‘tummy troubles’ may be taking periods of sick leave thus drawing attention to their ill health. Those who are newly diagnosed may be struggling with the major adjustment to their diet and lifestyle that accompanies a diagnosis of CD. While evidence clearly shows an improvement in quality of life following a diagnosis (Kurppa et al. 2014; Gray and Papanicolas 2010), there is additional evidence which indicates that the adjustment period may cause psychological distress, regret at being diagnosed, feeling isolated and stigmatised, reduced enjoyment of food and, in some cases, avoidance of social occasions which involve eating (Whitaker et al. 2009).

The blurring of the boundaries between the public spheres and private spheres can lead to stigmatisation (Goffman 1963, p. 9), defined as the ‘situation of the individual who is disqualified from full social acceptance’, in other words, as we argue in this chapter, the coeliac who feels excluded from organisational functions in some way because of their dietary requirements. Goffman goes on to add that the bearer (of the stigma) must have a concern for what others think about their condition and thus ‘internalise the social norms to which they fail to conform’ (Perez 2014, p. 1) highlighting both the psychological and sociological aspects of stigmatisation . Perez (2014, p. 2) critiques Goffman’s focus on emphasising the stigmatised rather than those who are stigmatisers, ‘framing individuals as victims and stripping them of agency rather than drawing attention to the broader structural concerns that lead to stigmatisation’. However, we feel that Goffman’s definition is emblematic of its time, and it is from this as a starting point we can start to build a case for improved organisational awareness of CD and its management.

2.5 The Need to Acknowledge Social Stigmas and Exclusion

Despite the shift in thinking, the current legislative framework has achieved little change in improving organisational justice (Ahmed 2007). Legislation plays a key role in tackling unfair discrimination and delivers the progress that is needed to create an inclusive society (Özbilgin et al. 2008). Physical and emotional effects have not been fully addressed at organisational level. Anecdotal evidence leads to the argument that current management practices (appraisal, performance management, wellbeing) are not in line with the principles and perspectives of diversity. Of course, large organisations might be more proactive in establishing appropriate practices; however, there is a lack of a generic framework to provide guidance and actions for different organisations. This is interesting as organisations have now been encouraged to effectively address their moral and strategic obligations through the development of explicit strategies to valuing individual differences at organisational level (CIPD 2012).

In examining the theoretical and conceptual developments, understanding individual’ specific needs contribute towards creating a ‘positive’ culture that promotes efficiency and organisational justice (Niederle and Vesterlund 2013). In theory, managing diversity means enabling every member of the organisation to perform work tasks by satisfying specific needs including CSs’ needs. In practice, there is no single approach that organisations can adopt to eradicate discrimination (Kumra and Manfredi 2012), especially in relation to ‘hidden’ inequality and social stigmas. To achieve that, changing organisational knowledge and awareness is essential in addressing discrimination and leveraging employee differences to benefit the organisation. This is because 83% of organisations in the UK had an articulated diversity strategy; however, most covered only the basic legal requirements and had not implemented improvement actions (CIPD 2012). Factors like organisational size, individual capabilities, time, resources and knowledge might prevent many organisations from identifying and addressing any discriminatory practices amongst individuals, especially where there are no specific legal requirements.

Diversity actions to the management of the condition in the workplace should be able to address ‘hidden’ assumptions and ignorance barriers moving away from a ‘box ticking’ exercise (Greene and Kirton 2011). Awareness of employee ‘special’ needs is now a strategic imperative in contemporary organisations (Bezrukova et al. 2012) with the capability to respond more effectively to the increasing numbers of CSs and the need to conform to social norms and avoid stigmatisation. It is not a legal requirement or a moral obligation to understand the changing workforce, but a requisite for any successful work strategy (Kumra and Manfredi 2012). This reinforces the need to explore current management practices and assess CSs ’ perceptions and emotions with regard to current workplace practices. There is a disconnect between the legal expectations and moral obligations. Evidence, as detailed above, suggests that there is a lack of knowledge that leads to instances of bullying, stigmatisation and social exclusion, and that these run counter to policies and practice of ensuring dignity for all at