At the Intersections of Class, Sex, Race, and Nativity: Work and Nonwork Conditions and Health Status of the U.S. Working Classed

Abstract

While the incidence of occupational injuries and fatalities has fallen since the passing of the Occupational Safety and Health Act of 1970, there remains profound segregation and differential risk for occupational and health disparities among the workforce based on socially constructed identities and positions, such as by sex, race, nativity, and class. Systems of power (ideologies) are the root sources for these disparities and are infused in the very systems and structures in which people live and work. While there are different lines of research on the disparate exposures to and experiences of work or nonwork conditions that impact worker health, how these exposures collectively contribute to worker health inequities in relation to systems of power have been understudied in worker health equity research. Purpose. This dissertation focused on exploring the connection between worker health inequities and systems of power concepts that perpetuate inequities through work and nonwork conditions in order to advance worker health equity and worker health equity research. The specific aims were: Aim 1) To explore if and how health equity terminology has been used in occupational health and safety (OHS) and worker health equity research, as well as to determine if and how concepts of systems of power are included; Aim 2) To describe the employment conditions, working conditions, and nonwork conditions, and the health status of the U.S. working classed at the intersections of sex, race, nativity, and class; and Aim 3) To explore the association between general health and work and nonwork factors for female Latinx born-outside-U.S. working-classed workers. Methods. For Aim 1, a literature review (1990-2021) was conducted of the OHS and worker health equity research literature. For Aims 2 and 3, the 2015 National Health Interview Survey data were used to conduct secondary data analyses. An intersectional approach was applied as a conceptual contribution to expand how worker health inequities are examined. Descriptive statistics were used for Aim 2 to describe work and nonwork conditions and worker health outcomes for the U.S. working classed by sex, race, and nativity. Multivariable logistic regressions were used for Aim 3 to explore the association between general health and work and nonwork conditions for female Latinx born-outside-U.S. working-classed workers. Results. For Aim 1, there were varied uses of work- and worker-related health equity and no explicit definitions for worker health equity or its variations in the 18 articles qualified for the final review. Also, while the majority of articles did mention systems of power concepts, only three articles integrated systems of power concepts extensively. For Aim 2, intersectional analyses revealed that the female Latinx born-outside-U.S. grouping reported findings suggestive of more precarious work and nonwork conditions than for the other groupings across sexes, races, and nativity. These findings were obscured by aggregate analyses that examined the working classed as a whole. For Aim 3, among three work (work arrangement, job insecurity, workplace safety) and three nonwork (healthcare access, housing affordability, food insecurity) predictors, worry about housing affordability was the only statistically significant predictor of worse general health for female Latinx born-outside-U.S. working-classed workers, after adjusting for education level. Conclusion. Engagement with systems of power concepts is needed in worker health equity research. An intersectional approach exposed precarious work and nonwork conditions for certain systemically marginalized positions otherwise missed by aggregate analyses. Moreover, the findings warrant further conceptual and methodological reconsiderations for female Latinx born-outside-U.S. working-classed workers. There is a continued need for explicit definitions of health equity and its variations when using work- and worker-related health equity terminology. Situated knowledges or specific viewpoints that exist beyond disciplinary boundaries are necessary for understanding the various factors that impact the health of worker populations with different social identities and positions. Future worker health equity research will require researchers to venture beyond their disciplinary boundaries (ontological, epistemological, and methodological) in order to advance worker health towards a more equitable future.