Abstract:

Why do schoolteachers get sick? The essay poses this question and points in some directions for answers. After discovering that the most prevalent diseases among Brazilian schoolteachers are the same as those in teachers the world over, the author concluded that the crux of the problem lies in the schoolteachers’ work, the constant in the equation. Their work thus needs to be understood better, and their work should be the center of attention. The author contends that teachers themselves are best equipped for this task, precisely because they know their own work the best. The article presents the main results of a nationwide Brazilian survey in which schoolteachers in Basic Education (preschool through 16) analyzed their own work, backed by a method known as Collective Work Analysis (CWA) that enabled them to expound freely and that valued their own words. CWA proved to be a powerful tool for work analysis by integrating aspects of teaching activity per se with the schoolteachers’ employment, which are usually analyzed separately, and which increased the study’s explanatory power. The study also revealed positive and negative sides of this work, offering various clues for understanding not only why schoolteachers get sick but also what keeps them healthy, two different but interrelated issues.

Keywords:
School Teachers; Occupational Health; Occupational Diseases

Introduction

What would happen if workers were asked to analyze their own work? Having a background in Wisner’s French school of ergonomics ¹1. Wisner A. Por dentro do trabalho: ergonomia, método e técnica. São Paulo: FTD/Oboré; 1987., I knew that detailed and systematic observation of workers’ activity can provide highly valuable results for understanding some of the problems experienced at work. In this case, as in most types of work analysis, the analysis is done by an expert from outside the target workplace, like an ergonomist, physician, psychologist, engineer, or sociologist, to cite the most frequent types.

But what if we asked workers themselves to analyze their work while away from their workplace, that is, without being observed, just talking about it: if the workers were the analysts, what kind of results would we get?

In an attempt to answer these questions, in the 1990s I began to perform what is now known as Collective Work Analysis (CWA). A paper by ergonomists Teiger & Laville ²2. Teiger C, Laville A. L'expression des travailleurs sur leurs conditions de travail. Paris: Conservatoire National des Arts et Métiers; 1989. encouraged me: they spoke of an experience with workers’ training in which their pedagogical technique was for workers to describe their own work. I wanted to expand on this idea, placing it at the center of a new way of analyzing work. Still, I had several doubts on how to proceed, and I was especially afraid of intimidating the workers. How would they react to such an unusual proposal (to analyze their own work), precisely when no one had ever asked them to reflect on anything at all? I thought I would have to create the equally unusual conditions for them to agree to participate and to be able to participate with as much freedom as possible.

With this concern, I started to prepare the conditions that would enable participants to express themselves and guarantee that they would not be jeopardized by their opinions, since I knew how dangerous it can be to analyze work, a field in constant dispute. From the onset, I thus adopted the Hippocratic principle of primum non nocere (“first, do no harm”). Inspired by the method known as Work Psychodynamics, as proposed by Dejours ³3. Dejours C. A loucura do trabalho. Ensaio de psicopatologia do trabalho. 6ª Ed. São Paulo: Editora Cortez; 2015. (and known at the time as the Psychopathology of Work), who worked with groups of workers, I decided to adopt the same approach, since I found it less intimidating.

The new method’s main characteristics were thus in place: a group of workers, assisted by external staff, analyzed their own work based on their description of it, having to answer the following question as thoroughly as possible: “What do you do at work?”. They were all volunteers, their identities were kept confidential, and there were no promises of changes (the only promise was that their analyses would be returned to them in the form of a publication).

The role of the staff participating in CWA is not to produce an analysis based on the results of their own observations, but to urge and encourage workers themselves to formulate their own analyses, drawing on what they have to say about their work.

The results of studies using CWA for more than 20 years with various categories of workers ⁴4. Ferreira LL. Análise Coletiva do Trabalho: quer ver? Escuta. Revista Ciências do Trabalho 2015; (4):125-35., from sugar cane cutters to airline pilots, answered many of my questions. Called on to analyze their work, workers do so with great dedication and enthusiasm, producing rich, dense analyses, regardless of their level of schooling. A few hours of meetings can produce more material than we could hope for with other types of workplace analysis, and high-quality material at that. The participants not only describe their work, but reflect on it, interpreting and judging it with reason and emotion. Importantly, they do not talk exclusively or even mainly about the negative or harmful parts of their work. They talk about the joys from their work, for a wide range of reasons. The speak of the skills they develop, the friendships, the difficulties they face and overcome, the results they achieve, and their social usefulness. In my view, CWA analyzes both the work itself and the results it enables ⁵5. Ferreira LL. Análise Coletiva do Trabalho. Rev Bras Saúde Ocup 1993; (78):7-19..

In 2004, when I was asked to coordinate a broad research project, Workplace Conditions and Their Repercussions on Schoolteachers’ Health in Basic Education in Brazil, I did not hesitate to propose CWA as the fieldwork method: I knew how important it was to know the work in order to understand people’s health and illnesses (individually or as a professional category). That was precisely the lesson from Bernardino Ramazzini ⁶6. Ramazzini B. As doenças dos trabalhadores. São Paulo: Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho; 1992. more than 300 years ago, when he recommended that physicians include the following question in the patient history: “What kind of work do you do?” (quam artem exerceas). According to Ramazzini, the question was essential for a proper diagnosis.

This article is not intended to present all the results of the research project, already laid out in great detail in six published regional books ⁷7. Tavares DS, Ferreira LL, Maciel RH. O trabalho de professores na Educação Básica pública no Piauí. São Paulo: Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho; 2008.^,88. Ferreira LL, Iguti AM, Donatelli S, Lima CQB. O trabalho de professores na Educação Básica em São Paulo. São Paulo: Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho; 2009.^,99. Oliveira JA, Pesente JC, Ferreira LL. O trabalho de professores na Educação Básica em Mato Grosso do Sul. São Paulo: Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho; 2009.^,1010. Ferreira LL, Araújo TM, Batista JHL. O trabalho de professores na Educação Básica na Bahia. São Paulo: Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho; 2009.^,1111. Mendonça EMC, Souza DM, Ferreira LL. O trabalho de professores na Educação básica em Belém do Pará. São Paulo: Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho; 2009.^,1212. Donatelli S, Oliveira JA. O trabalho de professores na Educação Básica no Rio Grande do Sul: São Paulo: Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho; 2010. and in the final report Relations between Work and Health in Schoolteachers in Basic Education in Brazil¹³13. Ferreira LL. Relações entre o trabalho e a saúde de professores da Educação Básica no Brasil. São Paulo: Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho; 2010., with more comprehensive clues for interpreting the results.

Rather, I aim to discuss whether (and how) these results can help answer the following questions: “Why do schoolteachers get sick?” and “What can be done to minimize their illnesses and promote their health?”. The first section discusses how CWA was applied, and I then proceed to present some of the schoolteachers’ analyses of their work in order to help readers understand their comments on health. Finally, I provide some clues for answering these questions.

Stages in Collective Work Analysis in the project

The first step was to hold a meeting with the two national teachers’ unions, the National Confederation of Workers in Education (CNTE), representing public schoolteachers, and the National Confederation of Workers in Teaching Establishments (CONTEE), representing private schoolteachers, to explain the project and solicit their collaboration. In our experience, when trade unions are involved in a research project, the odds are better for the results to be used to benefit the workers. In addition, workers can only participate voluntarily in CWA, and trade unions are the organizations best positioned to get them onboard.

With the support of both teachers’ confederations, we agreed that the study should happen in at least one state in each of Brazil’s five major geographic regions with the assistance of local unions. Considering our logistic and funding limitations, the selected states were Piauí, São Paulo, Bahia, Pará, Mato Grosso do Sul, and Rio Grande do Sul. In each of these states we had the collaboration of one or more unions. We explained the project’s objectives and asked for their help in organizing the meetings with the teachers, namely inviting them to provide the meeting place and time. A total of 17 local unions participated ¹³13. Ferreira LL. Relações entre o trabalho e a saúde de professores da Educação Básica no Brasil. São Paulo: Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho; 2010..

The meetings were mostly held at the local union headquarters with three to 12 people attending per meeting. Two researchers participated in each meeting and were in charge of explaining the project’s objectives and the meeting rules to the participants: to analyze their work without any questionnaires, filming, or field observations, based only on their own description and remarks. The researchers were also in charge of opening the meeting, posing questions on the work and launching a veritable collective dialogue with everyone involved, and taping the meetings (with the participants’ consent).

Participation included schoolteachers from both the public and private school systems (except for Piauí, where only public schoolteachers were heard), including all levels of Basic Education, mainly primary and middle school (there were only a few vocational schoolteachers). We also heard teachers from the Adult Literacy Movement (MOVA) in Belém and from the Landless Rural Workers’ Movement (MST) in São Paulo. In all, from 2005 to 2009 some two hundred male and female schoolteachers working in both the countryside and cities in 25 Brazilian municipalities (counties) participated in the project ¹³13. Ferreira LL. Relações entre o trabalho e a saúde de professores da Educação Básica no Brasil. São Paulo: Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho; 2010..

Following the meetings, the tapes were transcribed, leading to a preliminary report, complemented by some article and document searches. Next, this report was sent to the teachers’ unions, who referred them to the schoolteachers for additional clarifications. With these new observations from the teachers, we then wrote a final version and published it in book form.

The final stage of CWA, launching each book, relied basically on the participating teachers’ unions and reached a wide readership in some cases. For example, in the city of Salvador, capital of the State of Bahia, the book Schoolteachers’ Work in Basic Education in Bahia¹⁰10. Ferreira LL, Araújo TM, Batista JHL. O trabalho de professores na Educação Básica na Bahia. São Paulo: Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho; 2009. was released in 2010 with copies distributed to schoolteachers at a grand ceremony in the Castro Alves Theater, together with the film Carregadoras de Sonhos [Bearers of Dreams] ¹⁴14. Carregadoras de Sonhos [filme]. Deivisson Fiúza, diretor. Aracaju: Sindicato dos Trabalhadores em Educação Básica da Rede Oficial do Estado de Sergipe; 2010. 67 min., portraying the work of schoolteachers in the neighboring State of Sergipe.

Schoolteachers’ work in their own words

We can say without exception that we were very well received at the meetings, which sparked great interest among the schoolteachers, who participated enthusiastically and attentively. Having overcome and responded to the initial curiosity (Who were we? What did we want? How would each of them participate?), a friendly atmosphere quickly took over, amenable to dialogue with everyone participating. Oriented by the question, “What do you do at your work?”, the conversation flowed, with one person’s analysis confirming or refuting the last, sparking new explanations and interpretations that raised new topics for discussion. The technique of starting the meeting with everyone introducing themselves followed by a detailed description of each one’s work encouraged all the participants to reflect on their own work routines.

It was clear from the onset that teachers’ work was much more than giving classes. The work started long before classes (which teachers had to plan and prepare) and ended far later (because they had to grade the students’ work and report to the schools and/or to the parents and guardians by filling out records, forms, and notebooks, besides participating in meetings and other programs, often outside of official working hours). These activities took up time, forcing the teachers to work at home. There were no limits to their work, which did not end at the end of the workday, but invaded their entire lives.

However, this routine was influenced by conditions at the schools, which differ greatly across Brazil (reflecting the country’s geographic differences and especially its persistent socioeconomic inequalities): rural or urban schools, small or large, public or private, very rich or very poor, some with wonderful facilities but mostly with precarious installations (small, stuffy, noisy classroom, and cramped or nonexistent recreation areas); difficult access to some schools, especially in the countryside or under certain weather conditions (heavy rains or flooding, for example); conditions of the teaching materials and textbooks, which in some cases came late or not at all, and which were often inconsistent with the students’ realities; and lack or delays with school meals, always anxiously awaited by students, especially in poor areas. Classes with multiple grades, especially in the countryside, where students from different grades are concentrated in a single classroom, posed particularly challenging situations for schoolteachers who had to outdo themselves to give all the students the appropriate grade content. The lack of school staff at schools, especially public schools, meant that teachers had to cover for this extra work in addition to their own teaching. Everywhere we heard from them, in their own words, that they played the roles of doctors, nurses, psychologists, priests/pastors, peacekeepers, counselors, and social workers.

Their work routines were also influenced by the relations between schoolteachers and their employers: government (municipal, state, and federal) in the public schools and the school owners in the private system. First, due to their wages, which were low for the vast majority. Many schoolteachers held other teaching jobs in different schools (and even in different systems), and many were doing other work to complement their income, overburdening them even more. Their routines were also influenced by the teachers’ employment status: conditions for “temporary” teachers in the public system were much worse than for stable schoolteachers (who had entered the school system through public admissions). Likewise, conditions in the private system were worse for interns or teachers that were not even registered teachers, compared to regular teachers. There was also the issue of controls and demands on teachers. Many private schools required teachers to remain “on call” at their own homes and use their own personal computers to answers students’ questions online.

Yet the schoolteachers’ routine work depended primarily on their students, so it is not surprising that the students were the most important topic at the CWA meetings. Small children in public daycare centers or teens in preparatory courses for university admissions exams, boys or girls in reading classes in regular schools or students in young adult education, poor students in public schools or disrespectful students in elite private schools, children with special needs or learning difficulties, violent, demotivated, or apathetic students in public or private schools in the cities or countryside, focused, friendly, funny, and smart students, all types of students, in short, each in his or her own way posed challenges for their teachers, who were not only busy working with the students but were also concerned for them, both inside and outside the classroom. For the students and because of them, they accepted overworking in order to prepare good classes and interesting activities, invent new activities, discover strategies to deal with unruly students, and bend over backwards to get and hold the students’ attention. For the students and because of the students, the teachers accepted doing things beyond their duties, such as caring for the students’ health, buying them school materials, and even taking them to the doctor. And they reflected on their role as teachers. For the students and because of them, the teachers tried to fill the gaps in their own training (and answer their concerns about the various theories of education, methodologies, and teaching practices imposed by the schools, which changed frequently and were often impracticable) as best they could, whether by taking graduate courses or studying alone at home with whatever material they could find.

Meanwhile, the students were also the main source of joy and satisfaction for the schoolteachers, who rejoiced at their progress, feeling that their work had been useful and their effort worthwhile. Yet the students were also a source of sadness and worries, due to their needs (economic and psychological), their unruliness, their disrespect, their physical or psychological violence, or their difficulties in following their studies. The following quote by a teacher from Bahia speaks for itself: “They [the school administration] organized a meeting and invited a speaker. She said that public schools exist to prepare law-abiding citizens, but that the winners go to private schools. She said, ‘We enroll our kids in private schools because we want them to be winners. Winners are what? They’re doctors, lawyers, engineers. That really shocked me, you can’t imagine. We know how hard it is for a kid from public school to become a doctor. But I’m working to achieve that goal. Even knowing how difficult it is, I still hope it will happen. I asked her, ‘You mean, the only right for poor people is an education, but it’s not going to be a decent education, because you’ve decided that!’” ¹⁰10. Ferreira LL, Araújo TM, Batista JHL. O trabalho de professores na Educação Básica na Bahia. São Paulo: Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho; 2009. (p. 65).

Various facets of health according to the schoolteachers

When answering the question, “What kind of work do you do?”, it is almost unavoidable to ask, “What does the work do to you?”, discussing the effects of work, including its effects on health. The teachers also made various references to health, reflecting the multiple definitions of the term “health”.

A first reference was to the search for medical or psychological care in case of illness. Many teachers confessed that they went to work even when they were sick, because they didn’t have time to go to the doctor, because they couldn’t miss work because of their commitment to the students or out of fear of being misinterpreted by the school administration, when teachers’ attendance is considered a performance factor. When teachers were holding two jobs and got sick, some only missed work at the public school, while at the private school they went to work even when they were sick. The issue of work absences was interpreted by some as a mechanism for self-preservation: “When teachers are missing work, it’s because they can’t stand the pressure. It’s a way of not resorting to verbal or even physical aggression with their students, because they’re suffering aggression themselves”, said one teacher from São Paulo ⁸8. Ferreira LL, Iguti AM, Donatelli S, Lima CQB. O trabalho de professores na Educação Básica em São Paulo. São Paulo: Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho; 2009. (p. 8).

They also mentioned how difficult it is for many teachers to having their health problems acknowledged by physicians as resulting from work, the difficulties faced by teachers undergoing professional rehabilitation in the schools (removed from the classroom without an appropriate substitution system, overloading the substitute teachers and fueling hostility among coworkers).

Another approach to the health issue was associated directly with the possibility of holding on to one’s job, manifested as fear of unemployment: “I think that 90% of the health problems are the result of stress, caused by pressure, the fear of losing your job”, said a teacher from the State of Rio Grande do Sul ¹²12. Donatelli S, Oliveira JA. O trabalho de professores na Educação Básica no Rio Grande do Sul: São Paulo: Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho; 2010. (p. 62). This fear appeared to account for their acceptance of various unhealthy practices, such as overworking, giving in without complaining about the conditions imposed by employers, even when they were unreasonable. There are many “temporary” teachers in both the private and public school systems who lack job stability, so fear of unemployment was a serious source of health problems.

Finally, the teachers talked about illnesses, especially voice problems, musculoskeletal disorders, and psychological disorders. They were generally mentioned spontaneously as an unavoidable consequence of their work. When they mentioned the need to raise their voices to be heard by the students, either because the classroom was located in a noisy place or the students themselves were noisy, or when they talked about using chalk or whiteboard felt pens or even sudden changes of temperature that were common where they worked, the topic of hoarseness or voice changes came up and was discussed (and they also traded home recipes for voice problems). Likewise, aches and pains in their arms, hands, legs, feet, and back, with various diagnoses, were also attributed to work, such as intensive performance of certain movements and/or the need to remain in uncomfortable positions for long hours. Fatigue was another recurrent theme, always related to long and intense workdays and chronic shortage of sleep. They reported weight changes resulting from hastily eaten meals (due to the daily rat race), as well as infectious and contagious diseases from contact with students, especially the younger kids.

Still, the most emphatic reports were definitely symptoms of malaise and mental distress or even psychological disorders (described by the teachers as nervousness, stress, anxiety, anguish, depression, fear, burnout, mental exhaustion, madness), related to feelings of frustration, guilt, discouragement, low self-esteem, or overwork.

Several reasons were identified for this kind of mental distress, including students’ lack of interest, lack of institutional support and recognition for their effort, and the schools’ abusive control of their teaching work.

Students’ lack of interest/commitment/discipline was one of the most frequently cited problems. To get the students’ interest, teachers spent most of their time trying to convince them of the importance of what they were teaching and the need to study. They developed and tested personal techniques for this, often without great success. Many gave up in frustration, either by developing ploys to avoid dealing with the situation or staying on the job but without any great personal investment. Both solutions proved unsatisfactory from the point of view of their self-esteem.

“What stresses and depresses us is to want to do [something for the students] but not to be able. You feel defeated, and you’re incapable today, incapable tomorrow, and incapable the day after tomorrow, and that makes you feel defeated. My anguish in the classroom is this situation of defeat” ⁸ (p. 81).

As for support for performing their work, the overall situation that appeared was nearly complete lack of such support. Even when facing new situations for which they had not been trained (such as students with special needs, students with behavioral disorders, or violent students), teachers complained of lack of support from the schools, who left it up to them to decide what to do and how to do it. Worse still, teachers were held accountable for their students’ failures. In many cases, especially in the private school system, there was control over the teachers’ work rather than support, which the schools denied to them. Every part of teachers’ behavior, even the way they dress, was part of the school’s performance assessment and determined the bonuses and punishments teachers received (in the final analysis, their wages and keeping their jobs).

Finally, there were several examples of schoolteachers that had been disrespected, harassed, and even physically or morally assaulted by students or parents. The teachers had not even received any help from the administration, coworkers, or law enforcement in these situations. They were alone and defenseless.

“The school has the philosophy that the student is the client, so the student gives the orders. The father shows up and says, ‘He [son] is going to do it such and such a way, period’. The teacher has no say. So, students do what they please, and if we report to the administration, the administration says, ‘Calm down, teacher!’ And the student just gets a pat on the head” ⁹9. Oliveira JA, Pesente JC, Ferreira LL. O trabalho de professores na Educação Básica em Mato Grosso do Sul. São Paulo: Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho; 2009. (p. 57).

These observations provided the basis for a sketch of the situations that produced the most suffering in teaching work. It was not the material difficulties per se. Teachers working under precarious conditions proved their creativity in coping with such hardships, and although they suffered, they did not falter or get sick because they knew they were doing useful work. Meanwhile, teachers in schools with good material conditions suffered terribly from disrespectful students, of the kind “My dad pays you”, from the students’ parents, like “Do you realize who you’re talking to?”, and from the schools themselves, as shown in the previous quote. The teachers were not asking for trouble-free work, but just to be able to overcome their difficulties or to hope to overcome them.

Most exasperating for teachers were the situations in which they were pressured to do what they thought was wrong or when they were not allowed to do what they thought was right (due to shortages in school infrastructure, teaching tools, time, training, and/or support), when confronted with situations they did not know how to handle (violence, extreme poverty), when they were blamed for the problems in education, when they failed to see recognition for their effort or work, when they felt their work was not valued either socially or financially, and when they felt alone in solving their professional problems, with no support from collective bodies.

An important observation is in order here: our study mainly heard fully active schoolteachers who were theoretically in good health, meaning that when they referred to physical or mental diseases or disorders, they were talking about the experience of others, of coworkers, of something that had happed in their own past, or of their fear of illness. As for this fear, some teachers confessed that they would “rather not even hear about diseases, that teachers are depressed, that teachers are always on sick leave, that teachers are drawing workman’s compensation”, as one young female teacher said ⁹ (p. 73).

Exactly because they were active teaching, they frequently referred to what they had done to cope with the problems from teaching and to stay healthy and working, most often expounding on the “tricks” they had learned or invented in the profession. “Inexperienced teachers shout and get stressed out”, said a teacher from the State of Pará ¹¹11. Mendonça EMC, Souza DM, Ferreira LL. O trabalho de professores na Educação básica em Belém do Pará. São Paulo: Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho; 2009. (p. 55), “but after they’re been in the market for a while, they know how things work. When they have a voice problem, they don’t give a lecture class, but they organize some alternative classroom activity”. Another teacher, who taught in a violent area of the city of São Paulo and had had several traumatic experiences at school in his 15 years of teaching (like witnessing a police officer shot to death in front of the school, a female coworker being killed by students in a parking lot, and another female teacher having a nervous breakdown in the middle of a class), told us he had developed various strategies to cope with what he called “negative stress, the kind that hurts you and is due to standoffs with students”: his strategies were to “relax and prepare to deal with the students”. He came to school every morning an hour before classes started and often “played with a toy airplane” he always kept in his backpack ⁸8. Ferreira LL, Iguti AM, Donatelli S, Lima CQB. O trabalho de professores na Educação Básica em São Paulo. São Paulo: Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho; 2009. (p. 67).

Another example was a teacher from the State of Piauí ⁷7. Tavares DS, Ferreira LL, Maciel RH. O trabalho de professores na Educação Básica pública no Piauí. São Paulo: Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho; 2008.: at odds about what to do with a student that was constantly spitting on other students, wreaking havoc on everyone and her classwork, and with no help from the school administration to solve the problem. She invented a spitting contest, which the “spitting” student won, and from then onward he stopped spitting and her classes were a whole lot easier.

In general, the strategies reported above were individual, although some cases of collective handling of problems were also cited, such as involving students in new activities in order to improve their behavior and fuel their interest in the classes.

The latter cases began to shift from the area of diseases to that of health and the teachers’ joys at work. This vast field includes respect for teachers’ knowledge, the possibility of doing what they think is right, and the possibility of refusing to do what they think is wrong. This is where there are numerous sources of work satisfaction: the contact with children and young people, an aspect described by schoolteachers as “reinvigorating” or “pleasurable”; following students’ progress, which makes schoolteachers feel useful and gives meaning to their work; the fact that they are remembered by the students, probably because, as one teacher said, “I made a mark on their lives, I did something good” ¹¹11. Mendonça EMC, Souza DM, Ferreira LL. O trabalho de professores na Educação básica em Belém do Pará. São Paulo: Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho; 2009. (p. 57); recognition for their work from peers and the hierarchy, from students themselves, as one teacher from a rural school told us proudly: “I have boxes of thank-you notes from students” ¹⁰10. Ferreira LL, Araújo TM, Batista JHL. O trabalho de professores na Educação Básica na Bahia. São Paulo: Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho; 2009. (p. 36); and finally, feeling backed and able to share their difficulties.

“There’s something to this profession, it’s that we like the profession. One of the things that nourishes us is the human relationship with children and young people. It’s a fantastic thing! The wages are too low, we have less and less autonomy, we get sick, but we manage to win out” ¹⁰10. Ferreira LL, Araújo TM, Batista JHL. O trabalho de professores na Educação Básica na Bahia. São Paulo: Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho; 2009. (p 71-2).

Our study demonstrated that despite an overall picture with all types of difficulties, our schoolteachers in Basic Education - more than 2 million Brazilian ¹⁵15. Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira. Censo Escolar da Educação Básica 2016. Notas estatísticas. http://download.inep.gov.br/educacao_basica/censo_escolar/notas_estatisticas/2017/notas_estatisticas_censo_escolar_da_educacao_basica_2016.pdf (acessado em 27/Fev/2018).
http://download.inep.gov.br/educacao_bas... - have shown enormous determination to overcome and to stay in the struggle for better education and a better future for their students, nearly 50 million Brazilians ¹⁵15. Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira. Censo Escolar da Educação Básica 2016. Notas estatísticas. http://download.inep.gov.br/educacao_basica/censo_escolar/notas_estatisticas/2017/notas_estatisticas_censo_escolar_da_educacao_basica_2016.pdf (acessado em 27/Fev/2018).
http://download.inep.gov.br/educacao_bas... . It is an extremely encouraging picture that should serve as the basis for the improvements in education that Brazil needs and that represents the teaching profession’s vitality and health.

Final remarks

The Brazilian scientific literature on the diseases and disorders affecting schoolteachers is extensive, as observed at the beginning of the research project ¹⁶16. Leite MP, Souza AN, coordenadoras. Condições de trabalho e suas repercussões na saúde de professores da Educação Básica no Brasil. Campinas: Universidade Estadual de Campinas; 2007. discussed here, showing that teachers suffer from voice disorders, musculoskeletal disorders, and especially psychological disorders. Yet it is not only a Brazilian problem. A quick search in the international literature (which consists literally of thousands of studies, either with broad or more specific scopes, using qualitative or quantitative methods, conducted by academia, research institutes, trade unions, or government agencies) shows that schoolteachers in the North America ¹⁷17. Fisher MH. Factors influencing stress, burnout, and retention of secondary teachers. Curr Issues Educ (Tempe) 2011; 14(1). https://cie.asu.edu/ojs/index.php/cieatasu/article/view/658.
https://cie.asu.edu/ojs/index.php/cieata... , Latin America ¹⁸18. Organización de las Naciones Unidas para la Educación, la Ciencia y la Cultura. Condiciones de trabajo y salud docente. Estudios de casos em Argentina, Chile, Ecuador, México, Peru y Uruguay. Santiago de Chile: Oficina Regional de Educación para America Latina y el Caribe, Organización de las Naciones Unidas para la Educación, la Ciencia y la Cultura; 2005., Europe ¹⁹19. Esteve JM. O mal-estar docente: a sala de aula e a saúde dos professores. Bauru: Editora da Universidade do Sagrado Coração; 1999.^,2020. Angelillo M, Di Maio G, Costa G, Angelillo N, Barillari U. Prevalence of occupational voice disorders in teachers. J Prev Med Hyg 2009; 50:26-32., Africa ²¹21. Peltzer K, Shisana O, Zuma K, Van Wyk B, Zungu-Dirwayi N. Job stress, job satisfaction and stress-related illnesses among South African educators. Stress Health 2009; 25:247-57., Asia ²²22. Pengying Y, Fengyin L, Liping L. Neck/shoulder pain and low back pain among school teachers in China, prevalence and risk factors. BMC Public Health 2012; 12:789.^,2323. Shukla A, Trivedi T. Burnout in Indian teachers. Asia Pacific Education Review 2008; 9:320-34., and Oceania ²⁴24. Leão SH, Oates JM, Purdue SC, Scott D, Morton RP. Voice problems in New Zealand teachers: a national survey. J Voice 2015; 29:645-58. suffer from the same problems.

The question is thus not about which diseases affect schoolteachers, but about why they get sick, which necessarily involves an analysis of their work (the constant in the equation). What in schoolteachers’ work accounts for their disorders/diseases and what in their work is a source of health? What can be done for teachers’ work not to make them ill, and that can be a source of health? (two different and not immediately obvious problems).

These are the most complicated questions we have ahead of us and which have not been resolved in any country of the world, even in the mostly highly developed nations whose education is now considered an example of efficacy, such as Finland ²⁵25. Hakanen JJ, Bakker AB, Schaufeli WB. Burnout and work engagement among teachers. J Sch Psychol 2006; 43:495-513. or Singapore ²⁶26. Wang JCK, Pyun DY, Koh KT, Kwon HH. Teacher burnout and teaching effectiveness in Singapore. Singapore: National Institute of Education; 2016. (Research Brief Series, 16-013)..

Based on our study’s results, we conclude this paper by suggesting some clues to the answers:

(1) The inescapable need to hear teachers in order to answer these questions. To discuss the relations between schoolteachers’ work and health without listening to them about their work is tantamount to making a medical diagnosis based only on lab results, without taking a careful patient anamnesis (a much more expensive and much less efficient solution). However, it does not suffice just to hear the patients. It is necessary to listen to them patiently, attentively, and respectfully, welcoming their views, learning from them about their practices, their difficulties, and their ways of resolving them. Proceeding thusly, we will realize that in their analyses, work and health appear integrated and not as a set of isolated factors bearing no relation to each other (as the topic is usually presented by the experts). The teachers’ analyses thus have much greater explanatory power. This is a lesson from CWA.

(2) The need to delve deeper into the theoretical discussion on the relations between work and health in order to know what we are talking about. Instigated by the results of CWA, I have focused on the concept of work, since in CWA, work does appear as just a professional activity or simply a job, but as both. This led me to develop the concept of the work’s two sides: activity and employment. By activity I am referring to what is specific to each work and differs from other kinds of work. As an activity, teachers’ work is different, for example from that of doctors or metalworkers: the objects and objectives are different, it uses different tools, it requires different actions, and it mobilizes in different ways the potentialities of the teacher’s body, mind, and emotions when compared to the doctor or metalworker. And since there is no work activity outside of a collective body, the degree and type of relations that are established between the different actors in the production process also mobilize moral values through judgment on the fairness or unfairness of these relations. Thus, what I am calling activity is really a vast field. The concepts of “concrete work” in Marx ²⁷27. Marx K. O Capital: crítica da economia política. Livro I: o processo de produção do capital. Rio de Janeiro: Civilização Brasileira; 1971., of “real work” and “prescribed work” in the French school of the Ergonomics of Activity ²⁸28. Daniellou F, Laville A, Teiger C. Ficção e realidade do trabalho operário. Rev Bras Saúde Ocup 1989; (68):7-13., of “living work” as used by Dejours ²⁹29. Dejours C. Travail vivant. Paris: Payot; 2009., or of the “real activity” developed by Clot ³⁰30. Clot Y. A função psicológica do trabalho. Petrópolis: Editora Vozes; 2007. are pertinent concepts for this field. Meanwhile, what I am calling employment has to do with the relations of subordination between employer and employee and the employee’s remuneration (direct and indirect). While schoolteachers and doctors have different activities, their employment may be similar: both can be public employees or wage-earners, and in terms of pay, a teacher may earn the same as a metalworker. These two sides of work are like the two sides of the same coin: actually, activity influences employment, and employment conditions influence activity, and both have effects on workers, both for health and for disease. The teachers talked about this all the time, for example when they told of the pressure of being subject to work situations that they disagreed with, while fearing for their jobs, or when they reported the conflicting feelings caused by work, and that the teacher from Piauí described so well:

“If in my next reincarnation I come back to this Earth, I would want to be a teacher again, because I like what I do. I just have one frustration in life: my salary” ⁷7. Tavares DS, Ferreira LL, Maciel RH. O trabalho de professores na Educação Básica pública no Piauí. São Paulo: Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho; 2008. (p. 35).

It would be important for this concept of work as activity and employment to be improved and for its explanatory value to be tested further in the field of relations between work and health.

(3) Caution is recommended with over-generalizations: the subject is vast, complex, and with an enormous diversity of practical situations.

(4) One should not insist on silver bullets for health problems that dispense with a detailed analysis of the work. Quality-of-life programs, workplace gymnastics, and stress control are always palliative and have a limited reach, especially when they give people themselves the full responsibility for their health, which is not only objectively false, but also produces harmful effects (i.e., whoever fails to follow the prescriptions not only remains sick, but is guilty of their own sickness).

(5) It is essential to take into account that schoolteachers’ work is absolutely sensitive to what goes on in society. Everything that goes on in society has repercussions on students, the teachers’ reason for being. Thus, in times of economic crisis and rising unemployment, students are the first to be affected, and this in turn affects schoolteachers’ work. In moments of political crisis, with the politicians’ loss of moral authority and social violence on the rise, students are also affected, which affects the schoolteachers’ work. Thus, schoolteachers’ health can be affected for better or worse when factors are altered that have nothing to do directly with health. Increasing or decreasing schoolteachers’ income, favoring or hindering their overall training, expanding or shrinking their retirement pensions, introducing or denying improvements in schools can have a much greater effect than specifically medical interventions. Likewise, all policies that tend to improve students’ conditions, such as meal plans, better transportation, and medical and psychological care can also indirectly improve the health of schoolteachers.

(6) An important suggestion is to hear the students. As we have already said, schoolteachers’ work revolves around their students. It would thus be interesting for students to be heard about their activity, perhaps in a similar way to the approach to teachers. An CWA for students would be a good idea, especially if compared with the CWA for schoolteachers.

Acknowledgments

The author wishes to thank the Jorge Duprat Figueiredo Foundation for Security and Occupational Medicine (Fundacentro), which backed the research project on Workplace Conditions and Their Repercussions on Schoolteachers’ Health in Basic Education in Brazil (2004-2010), and the Department of Basic Education of the Brazilian Ministry of Education, which provided financial support.

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