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Income inequality: What is its toll on workers’ health?

“Mounting evidence” exists that income inequality is “a contributing factor to poorer health for the workforce,” two researchers conclude.

Income inequality has also been accompanied by changes in the workplace that increase workers’ stress in ways that negatively affect their health.
REUTERS/George Frey

The rise in income inequality over the past three decades or so is taking a major toll on the general health of American workers — and not just because stagnant or falling wages have made it increasingly difficult for many workers to afford high-quality health care.

For, as a commentary published recently in the American Journal of Public Health points out, income inequality has also been accompanied by changes in the workplace that increase workers’ stress in ways that negatively affect their health.

Those changes include a less stable job market, work weeks that repeatedly exceed 40 hours (for individuals working full time as well as for those working two or more part-time jobs), work schedules with unpredictable or irregular hours, greater “job intensification” (employers requiring workers to take on more tasks and responsibilities with less pay), lack of paid sick leave and higher out-of-pocket health costs (which erode discretionary income).

“The role of poverty is now understood to have deleterious effects on health throughout the life cycle that go well beyond access to and quality of health care,” write the commentary’s co-authors, Jessica Williams of the Harvard School of Public Health, and Dr. Linda Rosenstock of the University of California, Los Angeles (UCLA). “What is still being debated is whether and to what degree income inequality affects health independent of poverty and individual income.”

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Williams and Rosenstock believe that debate has been resolved and that income inequality has a significant  — and separate — impact on worker’s health. Here are some of the evidence they use to support that argument:

  • Poor psychosocial working conditions and long hours have been found to be associated with cardiovascular disease and cardiovascular events in many studies. A review of studies published between 1982 and 2002 found higher rates of cardiovascular disease among workers with job strain. Job strain was also found to be a predictor of death and having a second heart attack within five years of returning to work after a first heart attack. Job insecurity has also been found to be associated with higher rates of cardiovascular disease. Irregular and long hours have been associated with [heart attacks] as well.
  • Poor mental health has been linked to job strain, low decision latitude, low social support, high psychological demands, effort-reward imbalance (i.e., lack of reciprocity between costs and gains), and job insecurity, even after controlling for personality factors. For example, depression and depressive symptoms have been found to be associated with job strain, lack of social support, low reward, overcommitment, and job insecurity in both cross-sectional and longitudinal samples. Similarly, poor psychosocial working conditions have been found to be associated with anxiety symptoms and disorders.
  • Although obesity can be attributed to many factors, several studies … have shown its relation to work organization. Studies have found positive association between negative psychosocial working conditions and having unhealthy weight, body mass index, and waist circumference. Weight gain has been found to be associated with lack of job control, lack of skill discretion, and job demands, even after controlling for many additional factors in longitudinal samples.

The health-care industry: ‘a microcosm of the problems’

Williams and Rosenstock note that the health-care industry — where large salary gaps exist between the highest-paid workers (such as surgeons) and the lowest-paid (such as nurses’ aides) — is a ‘microcosm of the problems facing the larger work force with respect to inequality and working conditions”:

As the costs of medical care have risen in the United States, both as a level and as a share of gross domestic product, political, and consumer pressure on the [health-care] industry has increased — pushing increased efficiency and improved care delivery. A growing numbers of low-wage workers [who are disproportionally represented by women and racial and ethnic minorities] are being asked to do more with less …

Across the spectrum, patient care workers face relatively high rates of injury owing to physical hazards such as patient lifting, needle sticks, and chemical hazards. Workers in health care are also likely to work nonstandard shifts, to work overtime, and to face psychosocial hazards such as violence in the workplace that further contribute to poor health.

The health care workforce faces a broad array of health problems directly related to work, but, as the vast majority of this workforce earns low wages, they face the increasing pressures of income inequality.

Need to put aside political differences

The health-care industry is just one example, however, of a much broader — and growing — problem.

 “Mounting evidence” exists that income inequality is “a contributing factor to poorer health for the workforce,” Williams and Rosenstock conclude. “Although political differences may divide the policy approaches undertaken, addressing income inequality is likely to improve the overall social and health conditions for those affected.”

You’ll find an abstract of the commentary on the American Journal of Public Health website, but, unfortunately, the full article is behind a paywall.