A Conceptual Model of Work and Health Disparities in the United States

Abstract

Recent research in medicine and public health highlights differences in health related to race, ethnicity, socioeconomic status, and gender. These inequalities, often labeled "disparities," are pervasive and pertain to the major causes of morbidity, mortality, and lost life years. Often ignored in discussions of health disparities is the complex role of work, including not only occupational exposures and working conditions, but also benefits associated with work, effects of work on families and communities, and policies that determine where and how people work. The authors argue that work should be considered explicitly as a determinant of health disparities. Their conceptual model and empirical evidence, built on previous contributions, describe how work contributes to disparities in health on multiple levels. The examples focus on the United States, but many of the key conceptual features can also be applied to other countries. The model emphasizes behaviors and characteristics of institutions rather than individual workers. This approach avoids a focus on individual responsibility alone, which may lead to victim blaming and failure to emphasize policies and institutional factors that affect large populations and systematically create and maintain racial, gender, and socioeconomic disparities in health.

Agricultural Exceptionalism at the State Level: Characterization of Wage and Hour Laws for U.S. Farmworkers

“…Employment conditions have a major effect on health and health inequalities via social, economic, and physical pathways; work can be considered a direct determinant of health disparities (Benach, Muntaner, & Santana, 2007;Lipscomb, Loomis, McDonald, Argue, & Wing, 2006). Farmworkers suffer myriad health consequences of their work.…”

Wage Theft as a Neglected Public Health Problem: An Overview and Case Study From San Francisco’s Chinatown District

“…1---4 Yet, despite a growing body of literature documenting numerous adverse impacts of low income status on health, 1,5,6 the issue of wage theft has been largely neglected in public health. Wage theft-or the nonpayment of wages and benefits to which workers are legally entitled-takes many forms, among them nonpayment of earned overtime, underpayment of the minimum wage, delayed or nonpayment of back wages, misclassification of employees as independent contractors, confiscation of tip money, and failure to grant mandated breaks or paid sick leave.…”

Immigrant workers and worker's compensation: The need for reform

“…A number of researchers have documented the workforce segmentation that has historically been the lot of racial and ethnic minorities within the United States, and that now often relegates Latino workers both to the highest risk sectors, and to the hardest job assignments within a workplace [Anderson et al, 2000;Lipscomb et al, 2006;Friedman and Forst, 2008;Marin et al, 2009]. For unauthorized workers, immigration status can be a potent source of potential abuse and exploitation by supervisors that may, in fact, contribute to more accidents.…”

“…These include a lack of understanding of workers' compensation coverage, and lack of ability to communicate in English [Lashuay and Harrison, 2006]. Workers' lack of understanding of the legal system and lack of union membership, only exacerbate the willingness of some employers to fire vulnerable workers [Lipscomb et al, 2006]. A study of even unionized, largely immigrant hotel workers found that only 20 percent of those who had experienced work-related pain had filed workers' compensation claims, for fear of getting ''in trouble'' or being fired [Scherzer et al, 2005].…”