Evaluating employment quality as a social determinant of health in a changing economy

University Of Washington, Seattle WA

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Abstract

Project Summary This proposal address a major gap in our understanding of health disparities by considering the effects of employment conditions on population health. This research is particularly important as economic, social, technical, and political drivers are fundamentally transforming the nature and organization of work?especially the shift away from job security toward more ?flexible? and competitive employment practices. In particular, there has been a decline in the so-called Standard Employment Relationship (SER; i.e., permanent, full-time, regularly-scheduled work, with secure wages and benefits) and concurrent rise in non-standard employment arrangements. Modifications in employment structures affect a significant portion of the U.S. workforce, but disproportionately impact women, people of color, immigrants, younger workers, and lower-skilled and lower- educated workers. Most studies of the relationship between work and health have focused on physical, chemical, and psychosocial exposures; however, the terms and conditions of the employee-employer relationship, identified as employment quality (EQ) characteristics, are increasingly being recognized as important work-related determinants of health. Prior health research has struggled with the conceptualization and measurement of EQ. While previous U.S. studies have mostly used single-dimensional approaches (e.g., non-permanent contracts), there is an emerging consensus that EQ should be conceived of as a multidimensional construct. However, studies using multidimensional constructs of EQ have been restricted to Europe and Canada, despite the fact that generalizability of European research to the U.S. context is limited due to large differences between the respective labor markets and social safety nets. To advance the conceptualization and measurement of EQ in the U.S., we propose to first develop a multidimensional construct of EQ using latent class analysis (LCA). The LCA procedure will assign workers into classes based on a set of objective indicators of employment arrangements. To operationalize EQ, we will leverage two representative population surveys containing rich information on a broad range of employment conditions of U.S. workers: the General Social Survey and the American Working Conditions Survey. We will then test whether EQ is associated with workers? health and well-being, as well as important individual- and organizational-level characteristics. We will also examine if the distribution of EQ has changed between 2002 and 2014, and compare our results to prior European LCA studies that used similar EQ indicators. A particular focus of this research is to examine the potential mechanisms by which EQ may contribute to population health disparities, including by 1) characterizing the distribution of EQ across different sociodemographic groups, and 2) testing whether there is an interaction with attributes of EQ that produce differential health effects in these groups. This work is an essential step to further elucidating the role of employment in producing health and health disparities in complex modern economies.