2Workers’ health, wellbeing and performance
13.The health impact of high heels has long been known. There are consistent descriptions, from 1740 to the present day, of the musculoskeletal damage they can cause. Indeed, in May 1880, The Lancet (a leading British medical journal) launched an editorial campaign against female shop assistants being required to wear heels, which it branded “Cruelty to Women”.11
14.We nevertheless considered it important to consider carefully the most up-to-date evidence about the impact that wearing high heels can have on employees’ health and wellbeing. This seemed to us to be important for two reasons: firstly because it is necessary to understand the impact of wearing high heels in order to consider the question of whether it should be lawful for employers to require staff to wear them, and secondly to ensure that this evidence is available to MPs when they come to debate the petition.
Medical evidence
15.The Committees received written evidence from the College of Podiatry. Individual podiatrists also shared their views with the Committees through our web forum. The College explained:
We believe that there is a strong body of clinical evidence that significantly indicates the medical and disabling effects of wearing a high heel shoe over a prolonged amount of time.12
16.The College told us that women who wore high heels for long periods of time had reduced balance, reduced ankle flexion and weaker muscle power in the calf. This significantly alters the mobility of the foot and puts the wearer at a much greater risk of associated disabling pathologies over a long period of time.13 Footwear is clearly documented in scientific literature as being a primary cause of foot pain and pathology with a direct link between women who wear ill-fitting footwear and disabling pain.14
17.Through our web forum, we received compelling anecdotal evidence about employers’ treatment of female workers suffering from foot problems. Commenting on our web thread, a podiatrist told us:
I have on a number of occasions been consulted by women who had biomechanical foot problems or injuries and who were still required by their employers to wear high heels at work. The footwear they were required to wear by their employers both exacerbated their problems and limited the effectiveness of treatment. This meant that the physically debilitating foot problem they had would either be prolonged into the medium term, or the inappropriate footwear could even cause long term damage.15
18.A review of the scientific literature, predominantly from the UK and USA, highlighted the direct causative relationship between wearing high heels for extended periods of time and:
- long-term changes to gait, which has a causative link to knee, hip and spine problems and osteoarthritis;
- stress fractures in foot bones from sustained body weight on the ball of the foot;
- Morton’s neuroma—a condition caused by foot bones pressing against the nerves in the foot over a sustained period, which causes constant pain. In our web forum, one sufferer described the sensation “as if you are walking on bruises and glass particles at the same time”16;
- ankle sprains, fractures and breakages due to trips and accidents;
- hallux valgus (bunions);
- blisters and skin lesions; and
- enduring balance problems which persist into old age.
19.We also note that workers over 40 are especially at risk if required to wear high heels, because balance quickly deteriorates from age 40, making wearers of high heels more susceptible to accidents, injury and corresponding time out of the workplace. This chimes with the conclusions of the British Medical Journal, which reported that “heel height habit was among the top two predisposing factors for falls in older adults even though no participant was wearing high heels at the time of falling”17 because of the long-term impairment of balance caused by sustained wearing of high heels. The Journal of Corporation Law reported that “[t]he surgical treatment of these hobbled feet … never restores them to normal.”18
20.Some disabled workers19 and workers with less commonly shaped feet are at a particular disadvantage where a dress code requires high heels,20 because—if they can get high heels on—their pain may be particularly acute while wearing them. For some disabled women commenting in our web forum, the prospect of wearing high heels on a daily basis is so unappealing that a requirement to wear them would stop them applying for that job.21 This accords with the evidence we heard from Azmat Mohammed, Director General of the Institute of Recruiters, who told us that high heel dress codes “definitely” affect the range of employees who come forward for job opportunities.22
21.We received evidence through the web forum from women who struggle to wear high heels because of:
- Multiple sclerosis23
- Cerebral palsy24
- Arthritis and osteoarthritis25
- Ehlers-Danlos syndrome26
- Morton’s neuroma27
- Spinal deformities28 or other back problems29
- Hypermobile joints30
- Irregular length metatarsal or phalange (foot and toe bones)31
- Flat feet32
- Wide feet33
- Small feet34
22.The health impact of high heels also has consequences for the economy. The College of Podiatry told us that in 2008, the cost of surgery and podiatry for chronic foot conditions associated with long term high heel use was estimated to be £29 million per annum.35
23.The evidence leaves the Committees in no doubt that dress codes which require women to wear high heels for extended periods of time are damaging to their health and wellbeing in both the short and the long term.
Impaired performance
24.A second theme which emerged from the evidence was that high heels impair the wearer’s ability to perform at work. There are three main reasons for this: firstly, high heels can leave the wearer in significant pain which, as with other conditions causing chronic pain, makes it difficult to focus; secondly, high heels are ill-suited to the duties required to be performed; and thirdly, high heels affect breathing patterns and concentration and may thus reduce executive presence.
Chronic pain
25.The Committees received evidence of the extreme pain and suffering caused by wearing high heels for prolonged periods of time. Commenting in the web forum, members of the public repeatedly told us that their feet would bleed,36 that their feet would hurt so much that they were unable to walk or lead a normal life,37 and that some women required corrective surgery which left them out of work for extended periods.38 We were told that even in pregnancy women are not always excused high heels.39 We heard that the pain was so great that some women became unable to concentrate on the task in hand, putting them at a disadvantage compared to male colleagues in flat shoes,40 and that they dreaded going to work because of the pain.41
26.We heard that employers sometimes failed to take workers’ pain seriously. Ms Thorp told us:
Girls would be in tears because their feet were bleeding … and you’d just get laughed at: ‘Well, go home, have a bath and come back tomorrow.’ There is no leniency.42
27.In written evidence, the College of Podiatry shared its research into the length of time women can endure high heels without pain. Through a survey, they found that women complain of foot pain on average 1 hour, 6 minutes and 48 seconds after putting on ill-fitting high-heeled shoes. A fifth of survey respondents said that their feet began to hurt after just 10 minutes’ wear. The College found in 2013 that 90% of 2,000 women surveyed had self-reported foot problems.43
Footwear ill-suited to the task
28.The Committees received many contributions via the web forum from women describing the duties they were expected to perform at work while wearing high heels. These included carrying food, drinks and stock up and down stairs; carrying heavy luggage; moving furniture; conducting emergency evacuations of aircraft; commuting between different locations or to and from work; climbing ladders; walking long distances through large airports; showing clients to meeting rooms; and standing throughout the day. A number of women explicitly told us that they were less effective in their role because they were forced to perform their duties wearing high heels.44
29.In written evidence, Portico (the agency whose dress code led to this petition) confirmed that it had not undertaken a health and safety assessment of its dress code requirement to wear high heels.45 Portico is probably not alone in not having considered its dress code through the lens of health and safety law. Azmat Mohammed of the Institute of Recruiters told us:
[E]mployers are legally obliged to do health and safety assessments anyway, but it doesn’t really go into that much detail in terms of shoes and footwear.46
Scarlet Harris of the TUC gave similar evidence:
There is a lot of focus on the safety aspect in health and safety legislation. There is a lot of legislation around personal protective clothing, for example, and shoes that you must wear, like steel-capped toes, where you are protecting your feet. There is very little about the health and wellbeing side, which should actually be part of that legislation—it is part of the legislation but there is less focus on it.47
Impaired vocal projection and reduced executive presence
30.Even when women are not expected to perform physically demanding tasks in their high heels, we received written evidence, from Helen Sewell, suggesting that high heels nonetheless put the wearer at a disadvantage, because:
- High heels cause shallower, more frequent breathing due to tightening of the abdominal muscles. Breathing in this way sends the body into “fight or flight” mode, causing blood to rush to the legs and arms, away from the brain.
- The physical instability caused by wearing high heels reduces the wearer’s presence and authority when communicating.
- Shallower breathing inhibits effective vocal projection, sometimes leading to vocal cord damage and sickness absence. 48
31.The College of Podiatry’s evidence that, on average, women report pain after 1 hour, 6 minutes and 48 seconds of wearing ill-fitting high heels—with a fifth of respondents reporting pain after 10 minutes’ wear—puts in context the suffering of women required to wear high heels throughout the working day. There is also evidence that a requirement to wear high heels has a disproportionate effect on women who have a disability and on older women. Employers who require their female employees to wear high heels must be either unaware of the pain and impairment they cause, or simply choosing to ignore it. Either way, they are seriously failing in their duties towards their employees.
Psychological wellbeing
32.Many women used our web forum to describe how mandatory high heel dress codes made them feel in the workplace. The picture these contributions paint is a stark one. Workers find dress codes which require them to wear high heels to be “humiliating and degrading”,49 and “demeaning”50. Some commenters felt “sexualised”51 by their employer’s insistence on high heels.
33.During the first oral evidence session, we explored these feelings about high heels and other gender-based dress code requirements (such as a requirement for women to wear make-up) in more detail with our first panel of witnesses: Nicola Thorp, Ruth Campion and Emma Birkett. Ms Thorp told us that her dress code:
made [her] not want to work for the companies any more. It made [her] not want to aspire to higher levels of employment in companies like that because [she] thought, “If this is what we have to do at this level, what will we have to do to work higher up in the company?”52
34.We heard from Ms Campion how she found her dress code as an air hostess made her feel “extremely uncomfortable, particularly because it was being done for the business.”53 She explained:
For me personally, it was a bit dehumanising and humiliating to be made specifically to wear items of uniform that sexualised my appearance or enhanced my sexuality54—no aspect of the men’s uniform was designed to enhance their male sexuality. They looked very smart—they all looked immaculate—but none of them was enhancing their sexuality to somehow improve the image of the airline or the service we were providing.55
Ms Birkett told us:
I felt offended, in retail, by the request to get better sales by flaunting myself, whereas I was a very good salesperson and I could use my skills and my product knowledge to do that. I felt offended that [the employer] would think less of my skills and more of the clothes that I was wearing.56
She explained that her employer had encouraged her and her colleagues to wear shorter skirts and unbutton their blouses more at Christmas time, when a higher proportion of male shoppers was anticipated.57
35.The witnesses also shared their experiences about how dress codes are enforced at work, and the broader working environment for women. This was consistent with the evidence we had received through the web forum—experiences like Christine’s seemed to be commonplace: “My boss … made comments on a daily basis about our bodies.”58
36.Gender-based dress codes also seem, on the evidence we heard, to go hand in hand with a work environment in which women—especially young women—are objectified and left vulnerable to sexual harassment and unwanted sexual attention.59 Ms Birkett told us:
I certainly did get a lot of unwanted attention, more so in the reception job than the retail job. I was asked out on dates by customers; they wanted to know when I finished my shift. That was uncomfortable.60
37.Ms Campion told us about the harrassment which young female flight attendants can suffer:
The harassment suffered by some of these colleagues was absolutely unbelievable, particularly online. People would take the name off their name badges and send a lot of Facebook messages and stuff like that, to try to find them … They would get a lot of messages on social media from passengers who had flown with them and perhaps got the wrong idea about how friendly they were. People would try to find out which hotel we were staying in all the time. There would be a fair amount of grooming towards girls half or a third of their age about taking them out and stuff like that, which was highly inappropriate.61
38.Sexual harassment is not the only type of workplace harassment which might be linked to gender-based dress codes. One in four trans people, and one in five LGB people, have reported being discriminated against at work.62 Gender-based dress codes may exacerbate this. In written evidence, Stonewall explained that:
Dress codes which are based on gender can have a negative impact on employees who do not conform to gender stereotypes, whilst potentially skewing perceptions on what it is ‘to be a man’ or ‘to be a woman’ in the workplace. Often the items of clothing stipulated for wear by a man or woman in gender-based dress codes are neither necessary to reflect the ethos or brand of an organisation, nor needed for safety purposes.63
39.It is clear from the evidence we have received that certain requirements in dress codes for female workers—for example, requirements to wear make-up, high heels and skirts above the knee—make some workers feel very uncomfortable, even sexualised by their employer. These workers may feel discriminated against and deterred from seeking to progress within their company. In some cases, such requirements in dress codes may also expose workers to unwanted sexual attention from customers and clients or from management.
40.We are also concerned about the extent to which gender-specific dress codes reinforce rigid gender stereotypes which might make workers, especially some LGBT+ workers, feel uncomfortable.
11 “Cruelty to Women”, Lancet, 8 May 1880, page 729
15 Katherine Kpabitey, 11 June 2016 at 17:46
16 Cara, 11 June 2016 at 18:30
17 Barnish MS, Barnish J, “High-heeled shoes and musculoskeletal injuries: a narrative systemic review”, BMJ Open 2016 (reference number 6:e010053. Doi:10.1136/bmjopen-2015–010053), page 4
18 Linder M, “Smart Women, Stupid Shoes, and Cynical Employers: The Unlawfulness and Adverse Health Consequences of Sexually Discriminatory Workplace Footwear Requirements for Female Employees”, 22 Journal of Corporation Law 295 (1997), page 296
19 For guidance on the definition of disability for the purposes of the Equality Act 2010, see: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/85038/disability-definition.pdf
20 Liz, 15 June 2016 at 12:51; Kate, 10 June 2016 at 17:41; Dr Julie Ackroyd, 9 June at 19:59; Charlotte Williamson, 9 June 2016 at 17:57; Missy M, 9 June 2016 at 22:58; Christine, 9 June at 12:39; Jane Gristock, 9 June 2016 at 8:58
21 Babs Wilson, 9 June 2016 at 23:25; PJ, 9 June at 22:45; Laura, 9 June 2016 at 11:08
22 Q85
23 Hilary Danelian, 9 June 2016 at 13:50
24 Missy M, 9 June 2016 at 22:58
25 Susan Wood, 9 June 2016 at 12:03; Christine Abdelmoutaleb, 9 June 2016 at 11:32
26 Laura, 9 June at 11:08
27 Sally Edwards, 9 June 2016 at 04:27
28 Mrs Norman, 9 June 2016 at 08:41
29 Diane, 9 June 2016 at 08:11
30 Cate, 10 June 2016 at 17:41
31 Jill, 9 June 2016 at 16:32
32 Kay, 9 June 2016 at 02:05
33 Elizabeth, 9 June 2016 at 14:44
34 Cathy Clarke, 10 June 2016 at 00:12
36 I, 9 June 2016 at 02:46; Louise, 14 June 2016 at 22:18; Danielle, 10 June 2016 at 23:16; Shannon Jones, 10 June 2016 at 20:53; Anonymous, 9 June 2016 at 22:26; Natasha Covill, 9 June 2016 at 14:30
37 Melissa Sadler, 16 June 2016 at 12:54; Cynthia Vanzella, 16 June 2016 at 00:22; Mia Houghton, 11 June 2016 at 19:51
38 Jackie, 11 June 2016 at 10:26; Heidi Hughes, 9 June 2016 at 08:49; Cynthia Vanzella, 16 June 2016 at 00:22; Natasha Covill, 9 June 2016 at 14:30; Claire Hickey, 12 June 2016 at 22:21; Nicky Watkins, 9 June 2016 at 08:55
39 Meme, 10 June 2016 at 15:08; Jasmine, 9 June 2016 at 06:56; Cally Sims, 9 June 2016 at 08:54; Dani, 9 June 2016 at 13:00
40 Jennifer Moore, 9 Jun 2016 at 11:03; Ildiko Mihalyi, 10 June 2016 at 07:01; Ana, 13 June 2016 at 14:16; oral evidence Q22
41 Rana El-Hoshi, 9 June 2016 at 01:40; Abbey, 9 June 2016 at 09:17
42 Q8
44 Victoria Williams, 9 June at 13:15; Eilidh McMillan, 9 June 2016 at 06:12; Tecla Vilona, 9 June 2016 at 12:39; Alexandra Nieto, 12 June at 21:49; Laura Middag, 16 June 2016 at 12:52; Ksenia Stepanova, 9 June 2016 at 10:15; Rebecca Turnbull, 9 June at 05:54; Katie Meir, 9 June 2016 at 11:40; Rachel McGuigan, 9 June 2016 at 12:43; P, 9 June 2016 at 09:14; Elizabeth Jenkins, 9 June 2016 at 06:02; Chloe, 15 June 2016 at 17:56; Elisabeth, 15 June 2016 at 15:00; Laura Arnold, 15 June 2016 at 14:27; Dani, 9 June 2016 at 13:00; Sara Brown, 9 June 2016 at 13:11; Katherine 9 June 2016 at 14:12; TCW, 9 June 2016 at 21:14; Annie Hall, 9 June 2016 at 10:35; oral evidence Q14 and Q16
46 Q80
47 Q77. This accords with Emma Birkett’s evidence at Q27 that she was not aware of any health and safety assessment of the high heels component of her dress code which might have been carried out by her employer.
49 Megan Foster, 9 June 2016 at 16:17; Carl, 10 June 2016 at 02:23
50 Una McIlvenna, 9 June 2016 at 07:59; H, 9 June 2016 at 09:58; Rebecca Russell, 9 June 2016 at 01:32; Natasha Covill, 9 June 2016 at 14:30
51 Kim Farrington, 9 June 2016 at 07:08; Josephine Bellm, 10 June 2016 at 21:33; Janet, 9 June 2016 at 11:33
52 Q5. See similarly, Fawcett Society (WDC0007) para 11; and web forum: Kathryn, 11 June 2016 at 01:26; and Camille, 12 June 2016 at 01:20: “It never occurred to her to wear flats as she assumed that her job and the opportunities she had for advancement would be affected.” Nicola Thorp also told the Committee about a retail job which she had left because of the dress code: Q7; Azmat Mohammed said high heel dress codes affect the range of employees who come forward for job opportunities: Q85
53 Q6
54 Q6
55 Q21
57 Q35 and Q36
58 Christine, 11 June 2016, 11:19. See similarly: Camille, 12 June 2016, 01:20: “To ensure grooming standards floor manager will often do a store walk and critique staff members on their appearance.”
59 Q89; web forum: Mary Frost-Payne, 9 June 2016 at 07:10; Camille, 12 June 2016 at 01:20
60 Q41
61 Q43–44
23 January 2017