Do Different Patterns of Employment Quality Contribute to Gender Health Inequities in the U.S.? A Cross-Sectional Mediation Analysis

Abstract

Compared to recent generations, workers today generally experience poorer quality employment across both contractual (e.g., wages, hours) and relational (e.g., participation in decision-making, power dynamics) dimensions within the worker–employer relationship. Recent research shows that women are more likely to experience poor-quality employment and that these conditions are associated with adverse health effects, suggesting employment relations may contribute to gender inequities in health. We analyzed data from the General Social Survey (2002–2018) to explore whether the multidimensional construct of employment quality (EQ) mediates the relationship between gender and health among a representative, cross-sectional sample of U.S. wage earners. Using a counterfactually-based causal mediation framework, we found that EQ plays a meaningful role in a gender–health relationship, and that if the distribution of EQ among women was equal to that observed in men, the probability of reporting poor self-reported health and frequent mental distress among women would be lower by 1.5% (95% Confidence Interval: 0.5–2.8%) and 2.6% (95% CI: 0.6–4.6%), respectively. Our use of a multidimensional, typological measure of EQ allowed our analysis to better account for substantial heterogeneity in the configuration of contemporary employment arrangements. Additionally, this study is one of the first mediation analyses with a nominal mediator within the epidemiologic literature. Our results highlight EQ as a potential target for intervention to reduce gender inequities in health.

The determinants of mental well-being of healthcare professionals during the COVID-19 pandemic

“…Gender-based differences in labor division affect workplace positioning, where poor working conditions, irregular schedules, temporary contracts, and demanding tasks correlate with poor mental health (Barnay, 2016). The division of labor generates inequality, with women often facing more precarious employment conditions than men (Peckham et al, 2022). The feminization of specific activities, traditionally associated with low wages and limited professional development, further aggravates the situation for women (Campos-Serna et al, 2013).…”

Multiple Job Holding, Job Changes, and Associations with Gestational Diabetes and Pregnancy-Related Hypertension in the National Birth Defects Prevention Study

“…Some health surveillance systems collect information about jobs worked in the last week or month, missing measurement of changes in employment during a worker's pregnancy [8,10]. The present study adds nuance to understandings of employment conditions by accounting for holding multiple jobs or changing jobs, and in this way might help clarify inconclusive findings in the health literature (we use the term "employment conditions" to refer to "the formal and informal arrangements between workers and employees that determine both contractual (e.g., wages, hours) and relational (e.g., participation in decision-making, power dynamics) components of one's job" [11]).…”

Work, Health, and the Ongoing Pursuit of Health Equity

“…The authors use study designs and logics derived from epidemiology, community-based (participatory) research, and the social sciences, employing qualitative, quantitative, and mixed-methods approaches to gather their data and undertake their analyses. As we considered the research, we categorized it into three general but not mutually exclusive content groupings, as follows: Studies that highlight the ways in which work interacts with other social phenomena to influence health [ 1 , 2 , 3 , 4 , 5 ]; Studies that focus on the context in which work happens and emphasize the importance of that context in shaping work or health [ 6 , 7 , 8 , 9 ]; Studies that encourage us to think more expansively about work [ 10 , 11 ]. …”

“…Studies that highlight the ways in which work interacts with other social phenomena to influence health [ 1 , 2 , 3 , 4 , 5 ];…”

“…This may be particularly important as greater proportions of the population engage in self-employment. In another example, Peckham and colleagues [ 4 ] explore employment quality as a contributor to the longstanding phenomenon in which women generally report poorer health than men. Using counterfactual logic, they find that, if the distribution of employment quality across genders were more similar, women’s health would improve.…”