Black women are overrepresented in the toughest health care jobs, study finds

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Black women are more overrepresented in healthcare jobs than any other demographic group and are concentrated in its lowest-paying and most dangerous roles – disparities that are the product of structural racism and sexism, according to a new published study. this month in the journal Health Affairs.

Black women make up nearly 7% of the U.S. workforce, but nearly 14% of healthcare workers, the study found. In health care, the study notes, black women are more likely to work in the long-term care sector, which currently accounts for 23% of that workforce, and as licensed practical nurses or helpers, constituting 25% of these workers. According to the study, these roles “are characterized by low pay, no benefits, and unsafe working conditions.”

As co-author Janette Dill, an associate professor in the division of health policy and management at the University of Minnesota, put it: “They take care of people’s bodies, feed them, bathe them, and take the people in the bathroom – it’s very hard physical work.

Shantonia Jackson, a 52-year-old certified practical nurse at City View Multicare Center in Cicero, Ill., is responsible for caring for 30 to 60 residents at a time, she said. As a result, “there’s not enough time in the day” to give them all the care they deserve, said Jackson, who is black.

“It’s like nobody cares about people. … It’s like I’m a number,” said Jackson, who is also a member of the SEIU Healthcare union and an advisory board member for the Center for Equity, a national advocacy organization for long-term care workers.

City View administrators did not respond to requests for comment.

According to Dill, heavy workloads like Jackson’s are in part due to a mass exodus of healthcare workers from their jobs due to low pay and burnout amid the demands of the coronavirus pandemic.

Dill undertook the study with Mignon Duffy, an associate professor of sociology at the University of Massachusetts Lowell. To conduct the study, Dill and Duffy used data from the 2019 American Community Survey — an annual national survey conducted by the U.S. Census Bureau — to analyze the likelihood of employment for black women in different occupations and industries. healthcare industry. They controlled for a variety of factors that might otherwise explain career choice, including education, marital status, age or immigration status, the study notes.

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Their analysis found that black women have a higher likelihood of working in healthcare – 23% – than all other groups: white, Hispanic and Asian women, as well as women who identify with another race or ethnicity, have a predicted probability of 16 years. to 17% chance of working in the sector, and men of all racial and ethnic groups have a much lower chance of working in health care, ranging from 4 to 8%.

While white women make up a higher overall proportion of the health workforce – at 46% of the workforce – than black women, they have a lower overrepresentation rate than black women. in the sector relative to their overall labor force participation, the study notes. According to the study, white women are also more evenly distributed across different health care settings and are slightly underrepresented among the lowest paid nursing assistants and orderlies compared to their overall representation in the industry. .

According to the study, working in the healthcare industry carries many risks: healthcare workers have the highest overall rates of work-related injuries of any private industry in the country, and nurses and orderlies are more likely to be stressed. and workplace injuries than other healthcare workers, other studies have shown.

For black women, the risks are even higher: “Black women are more likely to work in nursing homes and other long-term care facilities that are most understaffed and under-resourced, posing a risk increased and exposure to injury or infection,” the study notes.

But while black women do some of the toughest work in healthcare, their paychecks don’t reflect it, according to the study, which cites research from the Paraprofessional Healthcare Institute – an advocacy organization and policy research focused on direct care workers – showing that home care workers earned an average hourly wage of $12.12 in 2019, while care aides earned an average hourly wage of $12.69 $ and orderlies in nursing homes earned $13.90 per hour.

This research also notes that 1 in 6 home healthcare workers live below the federal poverty line and nearly half live in low-income households. And about half of black and Hispanic direct care workers earn less than $15 an hour, according to a 2019 article published in the American Journal of Public Health. (While the American Community Survey tracks income, Dill and Duffy did not include it in their article to focus on “the representation and location of black women in health care,” Dill said.)

Jackson earns $16.90 an hour. Before the pandemic, she earned less than $15 an hour, which led her and hundreds of other Chicago nursing home workers to go on strike in November 2020.

But his higher salary still doesn’t reflect the rising cost of living, Jackson said: “The rent is going up, the [cost of] the food increases, but the wages do not increase.

Tracy Mills Jones agrees. Mills Jones, a 57-year-old long-term care worker in Palmdale, Calif., earns $16 an hour through the state’s Home Support Services program to care for two clients, including the one is her brother, she said.

“I change all the sheets, I change the diapers, I do all the work as an in-home care provider, and they only pay us super cheap,” said Mills Jones, who is black.

Sometimes her low salary means “I have to choose whether I’m going to eat or pay a bill,” she added.

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Mills Jones’ union, SEIU Local 2015, is leading a campaign to raise wages for California caregivers to as much as $20 an hour. For Mills Jones, this increase would be transformative, she said: “$20 [an hour] would make me a member of society. … I literally live from check to check.

A spokesperson for the Los Angeles County Department of Public Human Services said the agency “cannot release any personal information as to whether or not it is a provider.” (The Washington Post reviewed the state’s Mills Jones pay stubs.)

According to the study, higher-paying roles in health care are hard to come by for black women: they are less likely to be registered nurses than white and Asian women and women from other racial and ethnic groups, and they only have a 1-2% predicted probability of working as physicians, advanced practitioners, therapists, or technicians.

In their article, Dill and Duffy argue that these realities are a product of the legacy of slavery, when white people forced black women to work as unpaid servants in their homes.

From this story flowed a distinction between “spiritual” and “menial” housework, law professor Dorothy Roberts explained in an article that Dill and Duffy cite: Privileged white women did housework – including serving as hostesses and role models for children – who were seen as superior to other tasks, while black women were tasked with more labor-intensive tasks, including mopping floors, laundry and preparing meals.

Some of those assumptions about who does what kind of housework still haven’t changed, helping to keep black women locked into low-wage, dangerous health care work, according to Dill: “We have a cultural assumption that women of color will provide care for us and they will do it inexpensively and that is their role.

Jackson also sees the historical connection in his work: “People act like, since we did it in slavery, we can do it again, and we still don’t have to get paid…but it should be about be happy with your work. , to be proud to be able to help take care of a loved one,” she said.

The solutions to rectifying the disparities faced by black women in health care, argue Dill and Duffy in their article, lie in raising wages, creating more opportunities for career advancement, and tackling the racism in the workforce. They recommend raising the federal minimum wage to $15, citing a recent study that showed it would reduce household poverty rates among female health care workers by up to 27%.

Building better career paths could include top brass in healthcare organizations facilitating workers’ participation in training programs that will help them advance in their careers, they write. And tackling racism in the pipeline would require challenging “the feminization of care and the racialized association of some jobs with ‘menial’ – and therefore less valuable – work,” they write, adding that this should begin. in schools and that health care leaders and managers should spearhead equity and inclusion plans.

For Jackson, health care reform is essential for the future of the workforce: “I want this industry to change so that our young people can be there to take care of us, because the way the industry go now, no one will be there. ”

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