Carework as a Social Determinant of Health: An Intersectional Mixed-Method Investigation

About This Grant

PROJECT SUMMARY The carework sector is both a fundamental part of our economy and the backbone of our health and social safety net. Whether working in healthcare, education, or social services, 20% of U.S. workers provide essential care for the ill, the elderly, individuals with disabilities, and children. The U.S. care workforce is predominately women, with women from minoritized racial and ethnic groups disproportionately concentrated in the lowest-paying positions and sectors. Despite our dependence on this workforce for our nation’s well-being, we know comparatively little about how care work impacts the health of those who perform it. Research on this question is critical not only for designing interventions to support the health and retention of these workers, but also for elucidating broader mechanisms through which work functions as a social determinant of health (SDOH) for women and minoritized populations. We propose a mixed-methods investigation, combining quantitative analyses of the Panel Study of Income Dynamics (PSID) and National Health Interview Survey (NHIS) with qualitative interviews of care workers. Our approach will test whether care work is associated with a care work health penalty, conceptualize and measure how pathways such as devaluation and workplace conditions drive this penalty, and consider whether these pathways disproportionately impact minoritized groups. To help guide our research and dissemination to reach a wide audience, we will establish a community-based advisory board (CAB) and a policy advisory board (PAB). In Aim 1, we will use the NHIS and PSID to describe the health status of care workers and test whether there is a health penalty for being employed in care work relative to comparable non-care occupations over the life course. This analysis will assess a range of physical and mental health outcomes, including self-rated health and indicators of stress and burnout. Aim 2 will examine the pathways through which care work may lead to negative health outcomes, focusing on our four hypothesized mechanisms described above: intersectional devaluation, risk of injury and illness, a racialized and gendered “ethic of care,” and resource-constrained work environments. Qualitative interviews with 125 low-wage workers and higher- wage health care workers will be used to refine our conceptual model, identifying how these mechanisms manifest in the lived experiences of workers. Insights from these interviews will inform the refinement of quantitative measures in the NHIS and PSID datasets. Quantitative analyses will then test the relative contribution of each mechanism to the health penalty and investigate interactions with race-ethnicity. Finally, in Aim 3, we will measure the relationship between employment in low-wage carework occupations and health over the life course. We will also test interactions between low-wage carework, race-ethnicity, and mental and physical health outcomes. Qualitative interviews will explore how care workers experience these intersectional vulnerabilities in their workplaces, with particular attention to the compounded impacts of racism, sexism, and economic precarity.