Occupational safety and health of LGBTI workers

Introduction

Working conditions and occupational safety and health (OSH) of lesbian, gay, bisexual, transgender and intersex (LGBTI) workers are largely underinvestigated, possibly because the situation of LGBTI people at work has become the subject of social research only relatively recently. LGBTI individuals have acquired more visibility in a number of EU countries only in recent times, also reflecting a change in social attitudes, increased engagement by LGBTI non-governmental organisations, and equality and anti-discrimination legislation, which allows for protection against discrimination. EU competence for LGBTI equality appears after 1999, when the Amsterdam Treaty Art 13 empowered the EU to adopt measures to deal with discrimination based on other grounds, including sexual orientation.

Despite the increased visibility, significant data and research gaps on the working conditions and OSH of LGBTI workers still exist. Two main reasons can be suggested for this.

Firstly, large-scale surveys and other systematic collections of data among the working population are not routinely designed to identify LGBTI workers, and as a result they do not normally ask respondents about their sexual orientation, gender identity/expression or sex characteristics, which makes it difficult to carry out analysis and studies on aspects related to the working experiences, employment and working conditions (including OSH) of LGBTI workers.

Secondly, LGBTI workers’ continued exposure to discrimination, bullying, harassment and other psychosocial risks in the workplace leads them to use various strategies to reduce or manage the risk of victimisation, including (partial or total) concealment of their identity to minimise their visibility. This contributes to keeping LGBTI people as a hidden, hard-to-reach group that is not easy to investigate.

This article aims to contribute to fill the existing gap in research on working conditions and OSH of LGBTI workers. To do so, it presents findings from a recent EU-OSHA research project, and data from the EU LGBTI surveys carried out by the Fundamental Rights Agency.

The evidence presented in this article confirms that LGBTI workers are disproportionally exposed to a number of psychosocial and organisational risks in the workplace, with a significant negative impact on mental health and perceived health status. A favourable legal and policy framework can protect and promote the occupational health of LGBTI workers, although there are still areas for improvement and workplaces can certainly have an important role.

The article is structured as follows. Section 2 presents OSH-related risks of LGBTI workers, while section 3 analyses in detail discrimination as the main psychosocial risk to which LGBTI workers are exposed in the workplace, and its consequences on occupational health and career choice. Sections 4 and 5 analyse workplace harassment and bullying to which LGBTI workers are frequently exposed, and the concealment strategies they frequently put in place to protect themselves from discrimination and harassment. Section 6 presents other organisational risks and section 7 the findings from the statistical analysis carried out on data from the FRA’s EU LGBTI II Survey carried out in 2019. Finally, section 8 presents the legal and policy framework and concludes the article.

OSH-related risks of LGBTI workers

The World Health Organisation (WHO) and the Ottawa Charter for Health Promotion define health as: “… a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity"^[4]. This definition encompasses a holistic and comprehensive concept of health, which includes physical, mental and social health as interconnected areas. It implies that there is no health without mental health, and also that health should not be viewed as merely the absence of illness or disease, but rather as a state of positive physical, mental and social wellbeing. The WHO suggests that mental health should be conceptualised as ‘a complete state of wellbeing’ in which the individual realises his or her own abilities; can cope with the normal stresses of life; is able to establish and maintain social relationships; and can contribute to society by being productive^[5].

Evidence indicates that psychosocial risks (such as discrimination, bullying, harassment) in the workplace and the poor organisation and management of work (organisational risks)^[6] play a significant role in the development of mental health problems among workers, as they have been found to be associated with the risk of depression, poor health functioning, anxiety, distress, fatigue, job dissatisfaction, burnout and sickness absence.

LGBTI workers are more frequently exposed to psychosocial risks, including workplace discrimination, harassment and bullying practices, than non-LGBTI workers, as it will be discussed in the next section. The existing cultural and social norms that favour, promote and prioritise heterosexuality and heteronormativity, both at work and outside work, often result in discriminatory attitudes, prejudice or demeaning behaviour against LGBTI individuals. As a result, they are likely to experience more stress than non-LGBTI individuals, and it is this disproportionate experience of stress that can lead to an increased incidence of physical and mental health problems^[7]. In a survey carried out by the UK Trades Union Congress (TUC), over half of all LGBT respondents, and 7 out of 10 transgender respondents, mentioned that their experience of workplace harassment or discrimination had a negative effect on their mental health^[8].

A number of factors are likely to contribute to health issues among LGBTI individuals and workers. A study found that discrimination and other psychosocial risks in the workplace can negatively impact on LGBTI workers’ mental health^[9], while others have shown that such negative effects can result in decreased productivity in the workplace and lower job satisfaction^[10] and even in work disability^[11].

As a result, LGBTI individuals are at greater risk of poor mental health than the general population, which results in a higher incidence of suicidal thoughts, substance misuse, anxiety and deliberate self-harm^[12]. A study focusing on LGB workers only, showed that they have a lower level of well-being and a higher risk of developing mental health issues mostly associated with the stress generated by perceived practices of discrimination and stigmatisation, compounded, for those who opt not to disclose their sexual orientation or gender identity to protect themselves from undesired behaviours, by the concealment strategies they feel obliged to adopt^[13]. This is in line with other studies reporting poorer mental health among LGBTI workers attributed to greater exposure to a number of psychosocial risk factors^[14] or reporting high rates of attempted suicide among transgender persons^[15]. Another study found that LGBT individuals are two to three times more likely than the general population to mention enduring psychological or emotional problems, with the prevalence of suicide attempts, suicidal thoughts, depression and anxiety disorders^[7]. Poor mental health is even more common among bisexual and transgender individuals and mental distress is most pronounced among younger and over 55 individuals. The same study found also that LGBT individuals assess their physical health as significantly worse health than the general population^[7].

The evidence collected by EU-OSHA through field research on LGBTI workers and experts^[1] corroborates such findings. This EU-OSHA study shows that LGBTI workers mention prolonged exposure to increased psychosocial and organisational risks, in combination with exposure to physical risks, resulting frequently in poor mental and physical health, including musculoskeletal disorders (MSD). Poor mental health among LGBTI workers is frequently reported to have an impact also on workers’ physical health, resulting in a higher prevalence of MSDs (cervical tension, neck pain, back pain) than in the average of the workforce. In addition, the fieldwork displayed that discrimination and harassment, both at work and in society, have a very strong impact on the LGBTI workers’ health, in terms of constant stress or irritability, sleeping disorders and anxiety, which very often results in musculoskeletal pain, particularly in the neck and back. Furthermore, the findings display that LGBTI workers feeling insecure or being afraid of not being accepted usually make an extra effort to do their best at work, which in turn generates more stress and anxiety. In some cases, a mix of organisational risks and experiences of abuse and discrimination on the ground of sexuality, gender identity/expression or sex characteristics, are reported to have resulted in stress and mental overload, impacting on health in general. Unfortunately, situations of continued exposure to psychosocial risks for long periods are reported in the study, which result in accumulation of health risks over time that may increase the likelihood of poor health in the medium and long terms^[1].

Findings of the FRA’s EU LGBTI II Survey support this. As shown in table 1, one in seven LGBTI respondents (15 %) perceive their general health as fair, bad or very bad. The rate is highest among trans (26 %) and intersex respondents (25 %) and lowest among gay men (12 %) and lesbians (13 %).

A similar pattern is found when looking at the proportion of respondents who felt downhearted or depressed in two weeks before the survey. One in five (20 %) LGBTI respondents said that they felt downhearted or depressed more than half of the time over this period. Among intersex (33 %) and trans respondents (31 %) this percentage was highest and among lesbians and gay men the lowest (both 18 %).

Discrimination at work

The Employment Directive (2000/78/EC) forbids discrimination based on different grounds – including sexual orientation - in the context of employment, occupation and training. It distinguishes between direct and indirect discrimination. Direct discrimination because of sexual orientation occurs when one person is treated less favourably than another would be treated in a comparable situation on ground of their sexual orientation. Indirect discrimination occurs where an apparently neutral provision, criterion or practice would put persons having a particular sexual orientation at a particular disadvantage compared with other persons; unless that provision, criterion or practice is objectively justified by a legitimate aim and the means of achieving that aim are appropriate.

Globally, a large body of research using a variety of methodologies has consistently documented high levels of discrimination against LGBTI workers, which seem to represent the most commonly reported psychosocial risk in the workplace for LGBTI workers^[16][17].

Workplace discrimination can take many different forms, ranging from ‘formal discrimination’ (e.g. in the areas of hiring, promotion opportunities or compensation/salaries) to ‘interpersonal discrimination’ (e.g. occurring in everyday workplace social interactions with colleagues and superiors and manifested in negative verbal and non-verbal behaviours)^[18]. Research shows that discrimination has negative effects on LGBTI people in terms of occupational health^[9], mental health and work disability^[11], and results in lower wages^[19], reduced job opportunities^[10], and lower job satisfaction^[20]. Widespread and continuing employment discrimination against LGBTI people has been documented in scientific field studies, controlled experiments, academic journals, court cases, state and local administrative complaints, complaints to community-based organizations, and documented in newspapers, books, and other media^[16][21].

Research evidence suggests that LGBTI workers are frequently discriminated against in a number of areas and forms and are therefore likely to experience more stress than non-LGBTI workers, as indicated in studies from outside the EU documenting the relationship between sexual minorities’ stress, mental health outcomes such as depression and anxiety, and increased health risk behaviours – including smoking^[22][17]. For example, discrimination at work is perceived by a large majority of transgender workers in the UK (58 %)^[23].

Research studies from the EU and beyond suggest that hiring discrimination is particularly common when gay men apply for jobs in male-dominated workplaces or when lesbians apply for jobs in female-dominated occupations. This might be because employers believe that lesbians or gay men do not have the ‘gender-typical’ characteristics that employers consider necessary for particular roles^[21][24]. A Swedish field experiment found that the rate of positive responses was higher for heterosexual male job applicants than for gay applicants. In the case of female applicants, the difference between heterosexual women and lesbians was even larger^[25]. According to an OECD study based on 11 OECD countries, LGBTI workers are 7 % less likely to be employed than non-LGBTI workers^[26]. Findings from the already mentioned EU-OSHA study^[1] suggest that discrimination is of particular concern for transgender workers. They are often excluded from recruitment opportunities and employment.

Because they find it difficult to get good jobs that are in line with their skills and qualifications they frequently end up accepting jobs with poorer working conditions and for which they are overqualified. Transgender workers in the process of aligning their biological sex with their gender identity mention a lack of acceptance and support by employers and colleagues, which can result in termination of a contract or reluctance to hire transgender workers in the first place. Another study from the U.S. also confirms that LGBT employees are likely to be fired because of their sexual orientation or gender identity^[16].

The research in the U.S. suggests that interpersonal discrimination takes frequently place in a subtle way, but nevertheless it can be especially harmful and can pose a significant threat to affected workers’ mental health^[27]. In addition, some LGBTI workers believe that their managers and colleagues feel uncomfortable working with them^[28], and experience jokes and mockery on a daily basis that can be defined as ‘microaggressions’^[29]. This is in line with findings of a large-scale audit study from 2011 among openly gay men in the United States^[30]. These forms of discrimination are also perceived by non-LGBTI colleagues, and can become a source of stress and discomfort for those who consider them unfair^[16].

The EU-OSHA study^[1] suggests that gay male workers are more likely to be discriminated against and harassed in some male-dominated jobs, face reduced social acceptance or limited career opportunities especially if they display traits or behaviours that are not seen as stereotypically masculine. Discrimination can have also intersectional nature. For example, lesbian workers frequently perceive discrimination on grounds of sexual orientation together with discrimination on grounds of gender. This results in difficulties in the job-seeking process, especially for some specific posts and it may restrict promotion opportunities. Intersectional discrimination is not uncommon among LGBTI workers who also belong to minority because of their ethnicity, race, migration background, religion and/or age.

According to FRA’s EU LGBTI II Survey data a substantial proportion of LGBTI respondents in paid work or self-employed felt discriminated in the labour market (see table 2). Every fifth LGBTI respondent (20 %) felt discriminated at work in 12 months before the survey. The share is again highest among trans (32 %) and intersex respondents (30 %). Among the other LGB groups the prevalence was relatively lower (between 17 % and 19 %). The EU27 average masks important differences between the Member States. While three in ten LGBTI respondent felt discriminated at work in Lithuania (30 %) and Bulgaria, Cyprus and Greece (all with 28 %) the proportion was the lowest in Slovenia (11 %), Denmark and Luxembourg (both 12 %). Comparison between the first and the second wave of LGBTI Surveys shows that there is little progress over time. The proportion of respondents who feel discriminated against at work was slightly higher in 2019 (21 %) compared to 2012 (19 %)^[31].

The 2019 survey finds that the majority of discrimination incidents against LGBTI people are not reported to any organisation or institution. Six out of seven most recent incident of discrimination (86 %) at work because of being LGBTI weren’t reported. Discriminatory incidents were most likely reported if they concerned intersex and trans people (19 % in both cases) and least likely reported if they concerned bisexual men (10 %) (Figure 1).

LGBTI employees may work in more "LGBTI-friendly" occupations to avoid discrimination on grounds of sexual orientation or gender identity. For example, so-called ‘prejudice-based segregation’ has been identified, which is the tendency of sexual minorities to choose jobs where they expect to experience less intolerance and discrimination. The least prejudiced occupations seem to be librarians, artists, medical practitioners and teachers, whereas the most prejudiced included plant operators and trades workers as indicated by Australian data^[32]. Another study found that in the US LGBTI workers tend to segregate in sectors and jobs where the risk of discrimination and harassment is lower. Gay men tend to cluster in some specific women-dominated occupations while lesbians tend to work in some male-dominated occupations^[30]. Other factors that come into play in occupational segregation of gay and lesbian workers are task independence (the degree to which an occupation allows workers to perform their tasks without substantially depending on coworkers or supervisors) and social perceptiveness (the capacity to anticipate and accurately perceive others’ intentions and reactions)^[30]. Transgender workers appear to gravitate towards the IT sector, most probably because of the relatively isolated nature of the working environment in this sector^[1].

Gay men working in science, technology, engineering and mathematics fields in the U.S. tend to drop out from their job in that field sooner than heterosexual men, whereas lesbians are less likely to drop out than heterosexual women, a finding that the authors suggest is related to the genderedness of these fields and the gender stereotyping of lesbian and gay workers^[33].

The already mentioned EU-OSHA study^[1] confirms that gay male workers feel safer in sectors and jobs where women are overrepresented, as they feel less accepted in men-dominated sectors. Lesbian workers, on the other hand, seem to be more likely to be discriminated against in women-dominated sectors. LGBTI workers who find it difficult to access the labour market or to get a good job are forced to work in sectors which are less safe and have worse working conditions, including lower salary levels. Jobs in the public administration are regarded as the safest for LGBTI workers as they are associated with increased protection from discriminatory practices such as unfair dismissal and harassment. Conversely, some male-dominated sectors such as manufacturing or construction are particularly hostile for LGBTI workers, especially for transgender workers.

Workplace harassment and bullying

LGBTI workers are also more frequently exposed than non-LGBTI workers to workplace harassment and bullying. According to a study that took place in the United Kingdom, bullying in the workplace is experienced by 6 % of heterosexual workers, compared with 14 % of gay workers, 17 % of lesbian workers and 19 % of bisexual workers^[29]. Another UK-based survey found that 39 % of LGBTI respondents had been harassed or bullied by a colleague, 29 % by a manager and 14 % by a client or patient^[8]. In addition, a meta-analysis of 386 research studies of LGB people undertaken across 19 countries found that up to 55 % of them had experienced verbal harassment, 45 % sexual harassment and 41 % discrimination, higher levels than in the general population^[34].

Bullying and harassment are particularly targeting transgender workers. EU-OSHA study^[1] suggest that transgender workers are to a high extent subjected to verbal abuse, violence and workplace bullying. Another study found that 90 % of transgender workers experienced harassment or mistreatment at work or felt forced to take actions to hide their gender identity; half of them experienced a denied promotion because of being transgender, and a quarter said having lost a job because of being transgender^[15].

LBT women are also particularly exposed to a range of psychosocial risks including sexual harassment, unwelcome sexual messages or advances and physical assault^[8].

Harassment can also take the form of hostile or aggressive talks and arguments with superiors, and can result in isolation of LGBTI workers in the workplace and ultimately even to premature exit from employment. Physical violence and threats are usually less common, although present, and they can take place not only at work but also on public transport when commuting to work^[1].

According to EU LGBTI II a substantive part of workers experience negative comments or conduct at work because of being LGBTI. In the past five years, four in ten (43 %) had such an experience. Almost one in ten (8 %) say that they experience it often or always. The prevalence is highest among intersex and trans workers of whom 21 % and almost 14 % respectively experience negative comments or conduct often or always (Figure 2).

Concealment at work

 

FRA’s EU LGBTI II survey data reveal that in EU27 a quarter of LGBTI respondents (25%) are not open about their identity at work (see figure 3). Only one in five (22 %) are very open about it at work. Bisexual men are most likely to hide being LGBTI at work (52 %). In contrast, one in eight lesbians (12 %) is not open at work. When looking at the prevalence of discrimination of LGBTI people at work it is important to consider that potential extent of discrimination may be even higher because a considerable part of LGBTI people choose not to be open about their identity.

The need to conceal their identity can not only influence the career choices of LGBTI people, but can also be an additional emotional and psychosocial burden. Those who decide to conceal their sexuality or gender identity usually do so to feel safe and to protect themselves from harassment and discrimination, to increase their chances of promotion or to retain their current job. This may be particularly the case in sectors where LGBTI workers are not well accepted. Nevertheless, this decision comes with increased stress and impacts on LGBTI workers’ health^[1]. On the other hand, LGBTI workers who opt to disclose being LGBTI risk exposing themselves to labour exclusion, discrimination and harassment or poorer working conditions^[1][36]. On the other hand, it is also worth to mention the advantages of disclosing such as: increased trust with colleagues, less need to hide and freedom to be oneself in the workplace^[36].

Organisational risks

LGBTI workers – similarly to other minority or vulnerable groups of workers – also face a number of organisational risks.

Promotion and career prospects of LGBTI workers appear to be more limited than those of non-LGBTI workers in similar jobs and roles, and even within the same workplace, limiting their chances of climbing the organisational hierarchy^[1]. According to the already mentioned OECD study based on 11 OECD countries, LGBTI workers earn 4 % less and are 11 % less likely to hold a high managerial position than non-LGBTI workers^[26].

When it comes to earnings, a German study shows that homosexual and bisexual men and women earn less per hour than heterosexual men and women, and these differences persisted even when statistically controlled for differences in qualifications, occupational status, professional experience, working time models and sectors^[37]. Wage discrimination has been found also in a study for the European Development Bank based on the UK data^[19]: LGBTI workers tend to earn less than their heterosexual counterparts^[1]. However, EU-OSHA study finds a different pattern: while gay men tend to earn less than comparable heterosexuals, lesbians tend to earn the same as heterosexual women. Gay men tend to earn less than heterosexual because they are more likely than heterosexual to work in women-dominated sectors, where salaries are lower. The experience of lesbian women can be quite the opposite, as they appear to be more likely than heterosexual women to work in well-paid male-dominated sectors^[1]. These findings are confirmed by a meta-analysis of 24 studies from Europe, North America and Australia – gay men and bisexual women and men were found to earn less than their heterosexual counterparts. In contrast, lesbians seem to earn more than heterosexual women^[38].

Finally, precariousness, labour insecurity and fixed-term contracts seem to be more common among LGBTI workers than among the general working population, although more factors could be at play in this case (e.g. personal characteristics such as age or type and sector of job)^[1].

Effect of workplace experiences on LGBTI workers’ health

The logistic analysis doesn’t assume a linear relationship between the predictors and the outcome so the results presented in Table 3 are in the form of odds ratios^[39].

The results indicate that workplace experiences are statistically significantly related to general health. Keeping other factors constant, experiencing discrimination and microaggressions at work on average relates to worse self-assessed health. In contrast, LGBTI respondents are less likely to self-assess their health as fair or (very) bad if they were (or saw someone else being) supported, defended or protected at work because of being LGBTI and if there is more awareness about them being LGBTI at work.

When it comes to other predictors, the analysis in broad lines confirms the findings of the literature – higher education and having a partner relate to a better self-assessed general health. In contrast, worse self-assessed general health positively relates to living in a household that has difficulties with making ends meet and to avoiding certain places or locations for fear of being assaulted, threatened or harassed because being LGBTI. Age doesn’t have any statistically significant effect. Among LGBTI groups, being a gay man or bisexual man relates to better self-assessed health than being a lesbian woman, while the opposite is true for bisexual women and trans and intersex people.

The relationship between the dependent variables and respondents’ mental health are generally similar to the results for general health that were just described. There are however some noticeable differences – higher age and higher education are statistically significantly related to a lower chance of feeling downhearted or depressed. Fair or (very) bad general health is strongly related to worse mental health.

In this article we present a less complex model which does not include country where respondent lives as an explanatory variable. Exclusion of this variable doesn’t affect the main results. To verify our findings we calculated several other models with different sets explanatory variables and we obtained the same results even when variable country where respondent lives was included. The model also doesn’t include a variable capturing whether respondents are open about their LGBTI identity at work. We controlled for this variable but it became insignificant once awareness about being LGBTI at work was added to the model. Because the latter had a larger effect on the dependent variables we decided to keep this in the model. We added the variable avoiding places to the model to account for previous victimization in other areas of life. While this measure has its limitations, other research conducted by FRA suggests that people who have experienced physical violence and/or harassment are more likely to avoid situations they perceive as potentially unsafe^[40]. Avoidance behaviours can also result from experiences of family members and friends, or incidents reported in the media.

In conclusion, the analysis carried out on FRA’s EU LGBTI II Survey confirms the statistically significant relationship between workplace experiences and worker’s health as reported by the scientific literature, and also the positive effect of social support and more in general of a tolerant and inclusive working

environment. As it will be shown in the next section, legislation and policy initiatives can certainly be of great help to protect and promote OSH of LGBTI workers.

Policy initiatives and supporting practices for LGBTI workers

Work provides people with purpose, financial resources and a source of identity, which promotes increased positive mental wellbeing. But work can also contribute to the development of mental ill health through poor working conditions and work organization issues^[41]. As shown earlier in this article, discrimination and other negative experiences of LGBTI people in the workplace, which result in increased OSH risks and impact negatively mental and physical health of LGBTI workers are a concern that needs to be addressed.

Ensuring a psychologically safe and healthy workplace for LGBTI workers is a legal imperative set out in Framework Directive 89/391/EEC. The Council Directive 89/391/EEC^[42], also known as the ‘Framework Directive’, was adopted in 1989 to introduce a set of measures aimed to improve the safety and health of all workers. The Framework Directive established the minimum requirements in the area of occupational safety and health (OSH) across the European Union (EU) and introduced the obligation for employers to improve health and safety of their employees through prevention of OSH risks in the workplace. To achieve such objective, employers need to introduce measures based on the assessment of risks and the existing legislation. Article 15 of the Framework Directive states that ‘particularly sensitive risk groups must be protected against the dangers that specifically affect them.’

In 1996, the European Commission (EC) produced a ‘Guidance on Risk Assessment at Work’^[43] which identified a number of ‘sensitive risk groups’^[44]. The underlying idea was that specific groups of workers face specific OSH risks, and risk management measures need therefore to pay attention to such specific risks and involve the design of specific preventive and protective measures according to the OSH requirements of the specific groups of workers^[45], including LGBTI workers.

Health and safety of workers is also impacted by more general labour and anti-discrimination legislation and policy initiatives, which in turn impact on working conditions, including in the area of OSH, as their implementation may contribute to prevent psychosocial risks in the workplace, including discrimination. Directive 2000/78/EC establishes a general framework for equal treatment in employment and occupation (the ‘Employment Equality Directive’) prohibiting ‘discrimination on the grounds of religion or belief, disability, age or sexual orientation as regards employment and occupation while ensuring that workers are treated equally in terms of training, employment and working conditions. The Gender Equality Directive (recast) (Directive 2006/54/EC), as interpreted in light of the CJEU case law, covers discrimination on the grounds of gender identity with respect to transgender persons who underwent, are under-going or intend to undergo gender reassignment. Equal treatment and equal opportunities for all workers ‘regardless of gender, racial or ethnic origin, religion or belief, disability, age or sexual orientation’, are further corroborated by the more recent ‘European Pillar of Social Rights’^[46], dating back to 2017 ^[47]. In addition, the EU Occupational Safety and Health (OSH) Strategic Framework 2014-2020^[48] mentions that ‘OSH policy can contribute to combating discrimination and promoting equal opportunities in EU policies’.

More recently, in November 2020, the European Commission launched the ’Union of Equality: LGBTIQ Equality Strategy 2020-2025’^[49], which builds on the 2015 ’List of Actions to Advance LGBTI Equality’^[50] and aims at promoting LGBTIQ equality through targeted actions across four pillars^[51] and mainstreaming LGBTIQ enhanced equality into all EU policies, legislation and funding programmes. One of the areas covered by the strategy is the area of discrimination in employment and in the workplace, and specific actions fostering "diverse and inclusive work environments [...] to create equal opportunities in the labour market and improve business outcomes", beyond the legislation and regulatory framework prohibiting discrimination, are foreseen^[52].

At global level, the International Labour Office (ILO) currently carries out a number of initiatives to promote equality among workers such as the Gender Identity and Sexual Orientation: Promoting Rights, Diversity and Equality in the World of Work (PRIDE) projects^[53] in the framework of its initiatives aimed at removing any discrimination in employment or occupation^[54], or the initiatives in the area of Gender Equality^[55].

In spite of these legal provisions and policy initiatives, available evidence including the already mentioned EU-OSHA recent study^[1] displays that access to employment and working conditions and OSH of LGBTI workers are frequently worse than the average of the general workforce. Systematic patterns of exclusion and discrimination, a disproportionate exposure to a range of psychosocial risks in the workplace, and occupational segregation in specific sectors or jobs, sometimes associated with poor working conditions and OSH risks, in which they feel ’safer’ are frequently observed among LGBTI workers. Such increased exposure to psychosocial risks can have a significant impact on LGBTI workers’ health, both mental and physical (including musculoskeletal health).

To conclude, it is worth to point out that the successful management of OSH issues among LGBTI workers requires both workplaces and public bodies to embed in their policies and practices interdisciplinarity, worker participation, awareness raising and prevention. A number of areas of intervention to address existing issues can therefore be identified, and relevant possible actions - as pointed out by existing EU-OSHA research^[56][1][57] - are listed here below.

At the governmental level, EU-OSHA research^[1] suggests that EU Member States:

• promote a ‘diversity’ perspective among public authorities and labour inspectorates;
• develop, or strengthen, existing awareness-raising and training initiatives;
• raise awareness of, and promote, prevention activities among private companies, particularly those targeting specific groups of workers; • show companies the positive effects of employing a diverse workforce;

• specifically target public officials at all levels of government on LGBTI topics, and the principles and obligations regarding equal treatment and non-discrimination contained in national legislation, EU law and international human rights instruments (including case-law of the European Court of Justice and the European Court of Human Rights);
• involve LGBTI organisations in the planning and implementation of such actions;
• conduct ‘diversity audits’;
• increase knowledge on the main work-related health risk factors that affect LGBTI workers and improve the visibility of this group;
• develop non-binary safety and health legislation and administrative procedures;
• develop equal treatment and diversity policies for all grounds of discrimination in their public administration at all levels;
• provide ‘best practice’ examples to other employers;
• promote research data collection on LGBTI workers, including longitudinal studies.

Along the same lines, FRA research^[58] encourages EU Member States to:

• develop comprehensive action plans involving all necessary stakeholders (labour inspectorates, trade unions, employers’ organisations and civil society organisations) and including measures such as discrimination testing, diversity audits, diversity management training, and promoting adhering and committing to diversity charters. Member States could lead by example by applying these measures within their own public administrations96.
• ensure that equality bodies are adequately mandated and resourced to fulfil their role in line with the European Commission’s Recommendation on standards for equality bodies97.

At the workplace level, as pointed out by EU-OSHA research^[59][1][60], there is a need for actions aiming to :

• avoid stereotyping people and making assumptions about what the risks are and who is at risk in order to make sure all workers are taken into account (including LGBTI workers);
• adapt work and preventative measures to workers. Matching work to workers is a key principle of EU legislation;
• when designing or planning work, consider the needs of a diverse workforce rather than waiting for LGBTI workers to be employed and then having to make changes;
• build a culture of inclusion and zero tolerance of discrimination within companies;
• promote a participative approach to OSH prevention activities, giving voice to LGBTI workers within the workforce;
• develop ad hoc tools to manage a diverse workforce;
• develop LGBTI company policies that take into account the diverse realities of LGBTI workers’ lives;
• link occupational safety and health into any workplace equality actions, including equality plans and non-discrimination policies;

• provide relevant training and information regarding safety and health risks to risk assessors, managers, supervisors, safety representatives as well as the LGBTI workers;
• ensure that occupational safety and health training is tailored to the LGBTI workers’ needs and circumstances.

The actions listed above would encourage a healthier organisation in which practices impacting negatively on OSH are reduced to a minimum, and which, if they do occur, are addressed swiftly and fairly, to create a healthier and safer working environment for LGBTI workers.