Special Issue: Achieving Health Equity in the Workplace

Source: American Journal of Industrial Medicine, Vol. 57 Issue 5, May 2014
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Articles include:
Introduction to a special issue: Eliminating health and safety inequities at work

Work organization, job insecurity, and occupational health disparities
Changes in employment conditions in the global economy over the past 30 years have led to increased job insecurity and other work organization hazards. These hazards may play a role in creating and sustaining occupational health disparities by socioeconomic position, gender, race, ethnicity, and immigration status. … There is consistent evidence that workers in lower socioeconomic or social class positions are exposed to greater job insecurity and other work organization hazards than workers in higher socioeconomic positions. Likewise, racial and ethnic minorities and immigrants are exposed to greater job insecurity. Limited research examining the effects of interventions targeting work organization hazards on disparities has been conducted; nonetheless, intervention strategies are available and evidence suggests they are effective. Job insecurity and work organization hazards play a role in creating and sustaining occupational health disparities. Employment and workplace policies and programs have the potential to reduce these hazards, and to reduce disparities. …

Characterizing the low wage immigrant workforce: A comparative analysis of the health disparities among selected occupations in Somerville, Massachusetts
This study estimates job-related risks among common low wage occupations (cleaning, construction, food service, cashier/baggers, and factory workers) held by predominantly Haitian, El Salvadorian, and Brazilian immigrants living or working in Somerville, Massachusetts…. Construction workers reported significantly higher health risks, and lower access to occupational health services than the other occupations. Compared to cashier/baggers, the reference population in this study, cleaners reported significantly lower access to health and safety and work training and no knowledge of workers’ compensation. Factory workers reported significantly lower work training compared to cashier/baggers. Food service workers reported the least access to doctors compared to the other occupations. We found significant variability in risks among different low wage immigrant occupations. The type of occupation independently contributed to varying levels of risks among these jobs. We believe our findings to be conservative and recommend additional inquiry aimed at assuring the representativeness of our findings….

Examining occupational health and safety disparities using national data: A cause for continuing concern
Occupational status, a core component of socioeconomic status, plays a critical role in the well-being of U.S. workers. Identifying work-related disparities can help target prevention efforts. … Employment in high-injury/illness occupations was independently associated with being male, Black, ≤high school degree, foreign-birth, and low-wages. Adjusted fatal occupational injury rate ratios for 2005–2009 were elevated for males, older workers, and several industries and occupations. Agriculture/forestry/fishing and mining industries and transportation and materials moving occupations had the highest rate ratios. Homicide rate ratios were elevated for Black, American Indian/Alaska Native/Asian/Pacific Islanders, and foreign-born workers. These findings highlight the importance of understanding patterns of disparities of workplace injuries, illnesses and fatalities. Results can improve intervention efforts by developing programs that better meet the needs of the increasingly diverse U.S. workforce. …

Promoting integrated approaches to reducing health inequities among low-income workers: Applying a social ecological framework
Nearly one of every three workers in the United States is low-income. Low-income populations have a lower life expectancy and greater rates of chronic diseases compared to those with higher incomes. Low- income workers face hazards in their workplaces as well as in their communities. Developing integrated public health programs that address these combined health hazards, especially the interaction of occupational and non-occupational risk factors, can promote greater health equity. Examples of successful approaches to developing integrated programs are presented in each of these settings. These examples illustrate several complementary venues for public health programs that consider the complex interplay between work-related and non work-related factors, that integrate health protection with health promotion and that are delivered at multiple levels to improve health for low-income workers. Whether at the workplace or in the community, employers, workers, labor and community advocates, in partnership with public health practitioners, can deliver comprehensive and integrated health protection and health promotion programs. Recommendations for improved research, training, and coordination among health departments, health practitioners, worksites and community organizations are proposed…..

Effects of social, economic, and labor policies on occupational health disparities
This article introduces some key labor, economic, and social policies that historically and currently impact occupational health disparities in the United States. … Many populations such as tipped workers, public employees, immigrant workers, and misclassified workers are not protected by current laws and policies, including worker’s compensation or Occupational Safety and Health Administration enforcement of standards. Local and state initiatives, such as living wage laws and community benefit agreements, as well as multiagency law enforcement contribute to reducing occupational health disparities. There is a need to build coalitions and collaborations to command the resources necessary to identify, and then reduce and eliminate occupational disparities by establishing healthy, safe, and just work for all….

Discrimination, harassment, abuse, and bullying in the workplace: Contribution of workplace injustice to occupational health disparities
This paper synthesizes research on the contribution of workplace injustices to occupational health disparities. … Members of demographic minority groups are more likely to be victims of workplace injustice and suffer more adverse outcomes when exposed to workplace injustice compared to demographic majority groups. A growing body of research links workplace injustice to poor psychological and physical health, and a smaller body of evidence links workplace injustice to unhealthy behaviors. Although not as well studied, studies show that workplace injustice can influence workers’ health through effects on workers’ family life and job-related outcomes. Injustice is a key contributor to occupational health injustice and prospective studies with oversample of disadvantaged workers and refinement of methods for characterizing workplace injustices are needed….

Race-based job discrimination, disparities in job control, and their joint effects on health
To examine disparities between job control scores in Black and White subjects and attempt to discern whether self-rated low job control in Blacks may arise from structural segregation into different jobs, or represents individual responses to race-based discrimination in hiring or promotion. … Black subjects exhibited lower mean job control scores compared to Whites adjusted for age, sex, education, and income. This difference narrowed to 1.86 when adjusted for clustering by occupation, and was greatly reduced by conditioning on race-based discrimination. Path analyses showed greater reported discrimination in Blacks with increasing education, and a stronger effect of job control on health in Black subjects. Individual racially-based discrimination appears a stronger determinant than structural segregation in reduced job control in Black workers, and may contribute to health disparities consequent on work. …

Occupational health disparities: A state public health-based approach
This report used employment and public health surveillance data in Michigan to characterize work-related race/ethnic health disparities. … Blacks and Hispanics were over-represented in lower wage–higher manual–labor occupations and in highest risk occupations. Blacks were at greater risk of silicosis, work-related asthma, and work-related burns than whites, and Hispanics had higher rates of work-related acute fatal injuries and pesticide injury than non-Hispanics. Michigan employment data indicated that blacks and Hispanics were overly represented in lower paid and more hazardous jobs. Occupational health surveillance data confirmed disparate risks for some illnesses and injuries. This approach can be used in other states to bring awareness to policy makers and direct interventions….