OCCUPATIONAL HEALTH DISPARITIES

Program Description

The mission of the occupational health disparities program is to:

• Improve surveillance of vulnerable populations;
• Identify research methods, intervention approaches, and dissemination tools to better reach these populations.

Improving these tools and tailoring them to the unique characteristics of vulnerable and hard to reach populations allow occupational health researchers and practitioners to better identify health disparities and work towards their elimination.

Health disparities (HD) may be defined as differences in disease incidence, mental illness, or morbidity and mortality that exist among specific populations. The elimination of health disparities is a major goal of healthcare agencies and researchers and was one of two overriding goals for the Department of Health and Human Services Healthy People 2010 objectives.

One of the central features of the contemporary U.S. workforce is that it is increasingly diverse, reflecting the changing demographic characteristics of the country. Health disparities, including those resulting from work exposures, exist across racial and ethnic populations. These disparities arise both from overrepresentation of racial and ethnic minority workers in the most hazardous industries and from the incomplete penetration of occupational health and safety interventions to certain worker populations due to barriers created by social, cultural, and economic issues including language, literacy, and marginal economic status.

Socioeconomic Status

Disparities are most apparent and closely associated among populations with varying levels of socioeconomic status (SES). Significant evidence has demonstrated that a gradient exists between SES and health status, with individuals of higher SES having better overall health than those of lower SES. The most striking health discrepancies result in differences in life expectancy, as well as different rates of most cancers, certain birth defects, infant mortality, asthma, diabetes, behavioral and affective disorders, and cardiovascular disease. While access to healthcare may be an important variable that interacts with SES to influence health disparities, studies indicate that in industrialized nations having equal access to quality healthcare, an SES gradient still exists in all-cause morbidity and mortality. Countries that have universal healthcare systems, e.g., the United Kingdom and Scandinavia, still demonstrate SES-related health disparities. In fact, a landmark study conducted with British civil servants as subjects ostensibly demonstrated a health outcome gradient in four income groups. Although all workers had access to the same high quality healthcare, each group had progressively more positive health outcomes with increasing income level and job status. What is noteworthy about this gradient is that it exists across middle and upper income brackets of the British civil servant occupation force in addition to the lower income groups. These groups, although more affluent than lower SES groups, had worse health outcomes than the group in the highest SES category.¹

Discrimination

Health disparities are also found between different racial and ethnic populations. They are likely related to differences in SES but also may result from other factors such as discrimination. For example, African-American, Hispanic, and immigrant workers are disproportionately employed in some of the most dangerous occupations. African-American males are twice as likely as non-Hispanic white males to work in service occupations and as laborers, fabricators, and operators, yet are half as likely to be in managerial or professional specialty occupations. The result is that the African-American injury rate is about a third higher for both African-American males and females compared to white non-Hispanic workers. In addition to the disproportionate employment of African Americans in dangerous and low wage jobs, within individual workplaces African-American workers may also experience the additional stress caused by a discriminatory and racist work climate. Although few studies have systematically studied the nature and magnitude of racism in the workplace, a recent poll by the National Urban League found that 39% of African Americans felt that race and gender discrimination is widely accepted at their workplace.²

Work Organization

While the pathways through which SES and race/ethnicity influence health are complex and still not completely understood, one pathway receiving increased attention is the nature of work itself and how it can lead to social inequalities in safety and health. For example, research has found that low-income jobs are overrepresented in occupations such as service and sales workers, handlers/cleaners/helpers/laborers, machine operators/assemblers, and administrative support. Not only do these occupations potentially expose workers to chemical and physical hazards, but the job content may affect worker safety and health, through mechanisms such as low levels of autonomy, moderately high levels of physical demands, low skill levels, and limited interpersonal contacts.³

References

1. Marmot MG, Shipley MJ, Rose G. Inequalities in death—specific explanations of a general pattern? Lancet. 1984 May 5;1(8384):1003-6.
2. Daniels LA, ed.[April 2004] The State of Black America 2004: The Complexity of Black Progress (State of Black America). New York, NY: Natl Urban League/Pubns Unit.
3. Muntaner C, & Schoenbach C. Psychosocial work environment and health in U.S. metropolitan areas: a test of the demand-control and demand-control-support models. Int J Health Serv. 1994;24(2):337–53.