Few epidemiologic studies have used relational social class measures based on control over productive assets and others' labor to analyze inequities in health-affecting working conditions. Moreover, ...these studies have often neglected the gendered and racialized dimensions of class relations, dimensions which are essential to understanding population patterns of health inequities. Our study fills these gaps.
Using data from the 2002-2018 U.S. General Social Survey, we assigned respondents to the worker, manager, petit bourgeois, or capitalist classes based on their supervisory authority and self-employment status. Next, we estimated class, class-by-gender, and class-by-race inequities in compensation/safety, the labor process, control, and conflict, using Poisson models. We also estimated gender-by-race inequities among workers.
We identified substantial class inequities, with worse conditions for workers, which is the largest class within genders and racialized groups, but also disproportionately consists of women and people of color (POC), particularly women of color (WOC). For example, relative to workers, capitalists were less likely to report that safety is not a priority (prevalence ratio PR: 0.41, 95% confidence interval CI: 0.21, 0.82), repetitive tasks (PR: 0.36, 95% CI: 0.21, 0.61), and lacking freedom (PR: 0.11, 95% CI: 0.05, 0.24). We also identified inequities among workers, with women and POC, particularly WOC, reporting worse conditions than white male workers, especially greater discrimination/harassment (WOC PR: 1.70, 95% CI: 1.36, 2.13).
We identified substantial inequities in working conditions across intersecting classes, genders, and racialized groups. These inequities threaten workers' health, particularly among women and POC.
Recently, United States life expectancy has stagnated or declined for the poor and working class and risen for the middle and upper classes. Declining labor-union density-the percent of workers who ...are unionized-has precipitated burgeoning income inequity. We examined whether it has also exacerbated racial and educational mortality inequities.
From CDC, we obtained state-level all-cause and overdose/suicide mortality overall and by gender, gender-race, and gender-education from 1986-2016. State-level union density and demographic and economic confounders came from the Current Population Survey. State-level policy confounders included the minimum wage, the generosity of Aid to Families with Dependent Children or Temporary Assistance for Needy Families, and the generosity of unemployment insurance. To model the exposure-outcome relationship, we used marginal structural modeling. Using state-level inverse-probability-of-treatment-weighted Poisson models with state and year fixed effects, we estimated 3-year moving average union density's effects on the following year's mortality rates. Then, we tested for gender, gender-race, and gender-education effect-modification. Finally, we estimated how racial and educational all-cause mortality inequities would change if union density increased to 1985 or 1988 levels, respectively.
Overall, a 10% increase in union density was associated with a 17% relative decrease in overdose/suicide mortality (95% confidence interval CI: 0.70, 0.98), or 5.7 lives saved per 100 000 person-years (95% CI: -10.7, -0.7). Union density's absolute (lives-saved) effects on overdose/suicide mortality were stronger for men than women, but its relative effects were similar across genders. Union density had little effect on all-cause mortality overall or across subgroups, and modeling suggested union-density increases would not affect mortality inequities.
Declining union density (as operationalized in this study) may not explain all-cause mortality inequities, although increases in union density may reduce overdose/suicide mortality.
Life expectancy inequities between more- and less-educated groups have grown by 1 to 2 years over the last several decades in the United States. Simultaneously, employment conditions for many workers ...have deteriorated. Researchers hypothesize that these adverse conditions mediate educational inequities in mortality. However, methodological barriers have impeded research on the role of employment conditions and other hazards as mediating factors in health inequities. Indeed, traditional mediation analysis methods are often biased in occupational health settings, including in those with exposure-mediator interactions and mediator-outcome confounders that are caused by exposure. In this paper, we outline-and provide code for-a marginal structural modeling (MSM) approach for estimating total effects and controlled direct effects originally proposed elsewhere, which can be applied to common mediation analysis settings in occupational health research. As an example, we apply our approach to assess the extent to which disparities in employment quality (EQ)-a multidimensional construct characterizing the terms and conditions of the worker-employer relationship-explained educational inequities in mortality in a 1999-2015 US Panel Study of Income Dynamics sample of workers with mortality follow-up through 2017. Under certain strong assumptions described in the text, our estimates suggest that over 70% of the educational inequity in mortality would have been eliminated if EQ had been at the 80
percentile (100
= best) across exposure groups.
Changes in precarious employment in the United States Oddo, Vanessa M; Zhuang, Castiel Chen; Andrea, Sarah B ...
Scandinavian journal of work, environment & health,
2021-Apr-01, Volume:
47, Issue:
3
Journal Article
Peer reviewed
Open access
Objective This longitudinal study aimed to measure precarious employment in the US using a multidimensional indicator. Methods We used data from the National Longitudinal Survey of Youth (1988-2016) ...and the Occupational Information Network database to create a longitudinal precarious employment score (PES) among 7568 employed individuals over 18 waves (N=101 290 observations). We identified 13 survey indicators to operationalize 7 dimensions of precarious employment, which we included in our PES (range: 0-7, with 7 indicating the most precarious): material rewards, working-time arrangements, stability, workers' rights, collective organization, interpersonal relations, and training. Using generalized estimating equations, we estimated the mean PES and changes over time in the PES overall and by race/ethnicity, gender, education, income, and region. Results On average, the PES was 3.17 standard deviation (SD) 1.19, and was higher among women (3.34, SD 1.20), people of color (Hispanics: 3.24, SD 1.23; non-Hispanic Blacks: 3.31, SD 1.23), those with less education (primary: 3.99, SD 1.07; high school: 3.43, SD 1.19), and with lower-incomes (3.84, SD 1.08), and those residing in the South (3.23, SD 1.17). From 1988 to 2016, the PES increased by 9% on average 0.29 points; 95% confidence interval (CI) 0.26-0.31. While precarious employment increased over time across all subgroups, the increase was largest among males (0.35 points; 95% CI 0.33-0.39), higher-income (0.39 points; 95% CI 0.36-0.42) and college-educated (0.37 points; 95% CI 0.33-0.41) individuals. Conclusions Long-term decreases in employment quality are widespread in the US. Women and those from racialized and less-educated populations remain disproportionately precariously employed; however, we observed the largest increases among men, college graduates and higher-income individuals.
BackgroundWe used a relational social-class measure based on property ownership and managerial authority to analyse the longitudinal relationships between class, self-rated health (SRH) and mental ...illness. To our knowledge, this is the first study using a relational social-class measure to evaluate these relationships longitudinally.MethodsUsing Panel Study of Income Dynamics data from 1984 to 2017, we first assigned respondents aged 25–64 to the not in the labour force (NILF), worker, manager, petit bourgeois (PB) or capitalist classes based on business ownership, managerial authority and employment status. Next, using Cox models, we estimated the confounder-adjusted associations between 2-year-lagged class and incidence of poor/fair SRH and serious mental illness. We also tested whether the associations varied by gender, whether they persisted after more-fully adjusting for traditional socioeconomic-status measures (education and income) and how they changed temporally.ResultsWe identified large inequities in poor/fair SRH. NILFs had the greatest hazard, followed by workers, PBs, managers and capitalists. We also identified large inequities in serious mental illness; NILFs and workers had the greatest hazard, while capitalists had the lowest. Class inequities in both outcomes lessened but remained considerable after confounder and socioeconomic-status adjustment, and we found some evidence that the class–SRH relationship varied by gender, as being NILF was more harmful among men than women. Additionally, class inequities in the outcomes decreased somewhat over time.ConclusionWe identified substantial class inequities in SRH and mental illness. Our findings demonstrate the importance of using relational social-class measures to deepen understanding of health inequities’ root causes.
IntroductionOver the last several decades in the U.S., socioeconomic life-expectancy inequities have increased 1–2 years. Declining labor-union density has fueled growing income inequities across ...classes and exacerbated racial income inequities. However, the relationship between declining labor-union density and mortality inequities remains understudied.ObjectivesUsing Panel Study of Income Dynamics (PSID) data, we examined the longitudinal union-mortality relationship and estimated whether declining union density has exacerbated racial and educational mortality inequities.MethodsOur sample included respondents ages 25–66 to the 1979–2015 PSID with mortality follow-up through age 68 and year 2017. To address healthy-worker bias, we used the parametric g-formula. First, we estimated how a scenario setting all (versus none) of respondents’ employed-person-years to union-member employed-person-years would have affected mortality incidence. Next, we examined gender, racial, and educational effect modification. Finally, we estimated how racial and educational mortality inequities would have changed if union-membership prevalence had remained at 1979 (versus 2015) levels throughout follow-up.ResultsIn the full sample (respondents=23,022, observations=146,681), the union scenario was associated with lower mortality incidence than the non-union scenario (RR: 0.90, 95% CI: 0.80, 0.99; RD per 1,000: -18.7, 95% CI: -36.5, -0.9). This protective association generally held across subgroups, although it was stronger among the more-educated. However, we found little evidence mortality inequities would have lessened if union membership had remained at 1979 levels.ConclusionTo our knowledge, this is the first individual-level U.S.-based study with repeated union-membership measurements to analyze the union-mortality relationship. We estimated a protective union-mortality association, but found little evidence declining union density has exacerbated mortality inequities, although we did not incorporate contextual-level effects.
Americans' working lives have become more precarious over the past several decades. Worsening employment quality has been linked to poorer physical and mental health and may disproportionately impact ...marginalized working populations. We examined differences in the quality and character of worker-employer relationships among older workers in the United States (US) across intersecting gender-racial/ethnic-educational subgroups. Using longitudinal data on employment stability, material rewards, workers’ rights, working-time arrangements, unionization, and interpersonal power relations from the Health and Retirement Study (1992–2016), we used principal components analysis to construct an employment quality (EQ) score. We estimated intersectional differences in EQ, overall and over time, using generalized estimating equations. Overall, EQ was greatest for white men with college degrees and poorest for Latinx women with < high school degrees. Over time, EQ tended to remain unchanged or slightly worsen across intersectional strata; the greatest EQ reduction was for Latinx women with college degrees, while the greatest improvement was for white women with high school degrees. There are enduring and growing inequities in EQ for older marginalized adults in the US, which may contribute to growing health inequities.
The fringe banking industry, including payday lenders and check cashers, was nearly nonexistent three decades ago. Today it generates tens of billions of dollars in annual revenue. The industry's ...growth accelerated in the 1980s with financial deregulation and the working class's declining resources. With Current Population Survey data, we used propensity score matching to investigate the relationship between fringe loan use, unbanked status, and self-rated health, hypothesizing that the material and stress effects of exposure to these financial services would be harmful to health. We found that fringe loan use was associated with 38 percent higher prevalence of poor or fair health, while being unbanked (not having one's own bank account) was associated with 17 percent higher prevalence. Although a variety of policies could mitigate the health consequences of these exposures, expanding social welfare programs and labor protections would address the root causes of the use of fringe services and advance health equity.
Assaults on science have led scientists to demand “politics-free/values-free” science that safeguards science against error by grounding it in “politically neutral” evidence. Considering racial ...disparities in lead poisoning, HIV/AIDS, and COVID-19, we show the solution is doomed. Politically charged beliefs are essential for assessing public-health research; thus, the beliefs’ truth affects the research's accuracy. However, science's sociopolitical uses systematically distort politically charged beliefs. Since errors assimilate into our scientific corpus and inform new hypotheses, scientists need accurate sociopolitical theories of distorting forces to identify errors. Analyzing Black-Panther opposition to violence research, we argue since racial disparities structure society and science has been distorted to buttress racial inequities, knowledgeable anti-racist scientists exert corrective forces on research. They hold accurate politically charged beliefs about sociopolitical forces shaping science and health, and are committed to eradicating distortions. Thus, rather than quarantining politically charged beliefs, scientists should sharpen their sociopolitical theories and normative commitments.
The organization of employment in the U.S. has changed dramatically since the 1970s, causing decreased power and security for workers across many dimensions of the employment relationship. ...Multidimensional employment-quality (EQ) measures can be used to capture these changes and test their association with health. However, most public-health EQ studies have used cross-sectional, unidimensional data. We addressed these limitations using a longitudinal, multidimensional EQ measure and data on 2779 1985–2017 Panel Study of Income Dynamics respondents. First, using a multichannel sequence-analysis approach, we identified gender-specific clusters of mid-career (ages 29–50) EQ trajectories based on respondents’ employment stability, material rewards, working-time arrangements, collective organization, and power relations. Next, we examined cross-cluster variation in respondent characteristics. Finally, we estimated the gender-specific associations between cluster-membership and post-sequence-analysis-period prevalence of poor/fair self-rated health (SRH) and moderate mental illness (Kessler-K6≥5). We identified five clusters among women and seven among men. Respondents in poor-EQ clusters were disproportionately people of color and less-educated; they also tended to report worse health. For example, among women, the prevalence of poor/fair SRH and moderate mental illness was lowest among standard-employment-relationship-like-non-union workers and the becoming self-employed, and greatest among minimally-attached, returning-to-the-labor-force, and precariously-employed workers. Meanwhile, among men, the prevalence of the outcomes was lowest among stably-high-wage workers and the wealthy self-employed, and greatest among exiting-the-labor-force and precariously-employed workers. Given the potential role of EQ in health inequities, researchers and practitioners should consider EQ in their work.
•Identified employment-quality trajectory clusters using multidimensional measure.•Estimated association between clusters, self-rated health, and mental illness.•Found five clusters among women and seven clusters among men.•Those with poor employment quality often people of color and less-educated.•Adverse health outcomes more common among those with poor employment quality.
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