Investigating and Mitigating the Harmful Impact of Precarious Employment on the Health and Well-Being of New York City Food Workers

Much of the United States (US) food chain – from production to processing, wholesale, retail, and services – is characterized by precarious employment, defined as work with little employment security, inadequate income, and limited rights and protections. Studies show that precarious employment is associated with adverse mental and physical health and well-being outcomes. Separate research indicates numerous health issues in certain segments of the food workforce; little scholarly work has explored the contribution of precarious employment as an upstream driver of these health issues. Gaps remain in our understanding of 1) the health needs and status of workers across the entire food chain; 2) the mechanisms through which precarious employment influences food chain workers’ health and well-being, and how they navigate these processes, in a US context; and 3) which policies and employer practices, particularly from workers’ perspectives, might mitigate the harms of precarious employment. The global health and economic crisis caused by COVID-19 provided an opportunity to explore these topics when they were profoundly magnified.This multi-methods project aimed to address the three research gaps described above. In collaboration with National Institute for Occupational Safety and Health researchers, we conducted binomial logistic regression of 2018-2019 data from the Behavioral Risk Factor Surveillance System (BRFSS) to quantify the association between food-related work and health outcomes, adjusting for relevant covariates (Aim 1). Food chain workers had higher odds of barriers to healthcare access (most notably in lack of health insurance, Odds Ratio (OR)=2.14), smoking (OR=1.5), poor self-reported health (OR=1.59), depressive disorder (OR=1.22), and several chronic health conditions than all other workers. Compared to non-food chain workers in the same sector, food workers in manufacturing, commercial services, and institutional services all had higher odds of barriers to healthcare access, smoking, lack of exercise, and poor self-reported health; institutional services workers had an added burden of higher odds of poor mental health (OR=1.57), obesity (OR=1.78), and hypertension (OR=2.15). The qualitative arm of the project drew on in-depth interviews among 19 precariously employed, English- and Spanish-speaking food chain workers in New York City. I explored how workers experienced and navigated their precarious employment, the ways it influenced their well-being, and how this intersected with their perceptions of the social value of their labor, in light of the “essential worker” concept introduced during COVID-19 stay-at-home-orders (Aim 2). Precariously employed food workers coped with different manifestations of constrained power in their employment relationships, which had a range of negative influences on their well-being, including their quality of life, emotional states, mental well-being, and relationships. Workers had nuanced attitudes towards the value of their labor in society, but many expressed the idea that they felt their labor and they were invisible, marginal, or undervalued. I also sought workers’ perspectives on what kinds of existing supports were most useful to them in mitigating the effects of precarious employment, and what changes they would like to see (Aim 3). Workers cited a mix of employer practices, features of “non-standard employment” (e.g., schedule flexibility), collective representation, and public supports (paid sick leave, public health insurance, and free or low-cost culinary training) as supportive of their well-being. Workers’ needs and desires included higher wages, better benefits (especially paid sick leave and health insurance) that do not rely on employment arrangement and immigration status, and better access to information on labor laws and social services. They also cited a demand for more voice as workers and more recognition of their humanity. Taken together, the results strengthen the case for public health and food justice researchers to turn our attention to the well-being of food chain workers. People of color, women, and immigrants are overrepresented both in precarious employment and in food jobs, making this a health equity concern. On a theoretical level, focusing on work itself when studying and advocating around the health implications of precarious employment can provide an opening to more concrete critiques of labor market hierarchies and power structures that contribute to health inequities. To promote the health and well-being of precariously employed food workers, we should address immediate gaps both in wages and social benefits, i.e., by raising the minimum wage and adjusting it for inflation, increasing eligibility for and awareness of paid sick leave, and increasing enforceability of labor rights – holding employers accountable for these protections where feasible. However, there is a simultaneous need for policy approaches that decouple vital resources such as health insurance from employment to ensure social protection for all, and for transformative strategies that help shift the massive imbalance of power between workers and employers in the US

Workers’ Health under Algorithmic Management: Emerging Findings and Urgent Research Questions

Algorithms are increasingly used instead of humans to perform core management functions, yet public health research on the implications of this phenomenon for worker health and well-being has not kept pace with these changing work arrangements. Algorithmic management has the potential to influence several dimensions of job quality with known links to worker health, including workload, income security, task significance, schedule stability, socioemotional rewards, interpersonal relations, decision authority, and organizational trust. To describe the ways algorithmic management may influence workers’ health, this review summarizes available literature from public health, sociology, management science, and human-computer interaction studies, highlighting the dimensions of job quality associated with work stress and occupational safety. We focus on the example of work for platform-based food and grocery delivery companies; these businesses are growing rapidly worldwide and their effects on workers and policies to address those effects have received significant attention. We conclude with a discussion of research challenges and needs, with the goal of understanding and addressing the effects of this increasingly used technology on worker health and health equity

Hustle: Experiences of making work ‘work’ for non-standard and precariously employed workers in New York City

Non-standard employment (NSE) has negative implications for workers' health. As part of a larger comparative case study, this article explores US-based workers' experiences in NSE and its influences on their health and well-being in a context of a shrinking social safety net and individualistic cultural values. We conducted interviews with workers in NSE in various occupations in the New York City area (N = 40). We used deductive and inductive thematic analysis and considered variations across levels of employment precarity. All participants experienced the ‘hustle of NSE,’ a dynamic frame comprising: i) tension between payoffs (flexibility, opportunity to work for more pay, and satisfaction with their work) and tradeoffs (job instability and insecurity, and having to work more) that both implicate participants' health and well-being in mostly negative ways; ii) reliance on personal and family resources and opportunities to manage NSE; and iii) low expectations for improvements in employer-based practices and policies or basic worker and social protections despite having clarity about problems and desires. Workers assessed their work and life circumstances and behaved in a way to try to obtain the best results for themselves and their families. When comparing across employment precarity levels, workers' health and well-being experiences varied by participants' immigration status. Understanding health and well-being consequences of NSE contributes to examining individual costs of labor market flexibility. Achieving health equity must include labor, employment and welfare state policies that are more inclusive of gaps created by NSE and precarious employment, especially for workers in marginalized social locations

Initiatives Addressing Precarious Employment and Its Effects on Workers' Health and Well-Being : A Systematic Review

The prevalence of precarious employment has increased in recent decades and aspects such as employment insecurity and income inadequacy have intensified during the COVID-19 pandemic. The purpose of this systematic review was to identify, appraise, and synthesise existing evidence pertaining to implemented initiatives addressing precarious employment that have evaluated and reported health and well-being outcomes. We used the PRISMA framework to guide this review and identified 11 relevant initiatives through searches in PubMed, Scopus, Web of Science, and three sources of grey literature. We found very few evaluated interventions addressing precarious employment and its impact on the health and well-being of workers globally. Ten out of 11 initiatives were not purposefully designed to address precarious employment in general, nor specific dimensions of it. Seven out of 11 initiatives evaluated outcomes related to the occupational health and safety of precariously employed workers and six out of 11 evaluated worker health and well-being outcomes. Most initiatives showed the potential to improve the health of workers, although the evaluation component was often described with less detail than the initiative itself. Given the heterogeneity of the 11 initiatives regarding study design, sample size, implementation, evaluation, economic and political contexts, and target population, we found insufficient evidence to compare outcomes across types of initiatives, generalize findings, or make specific recommendations for the adoption of initiatives

Non-Standard Employment and Unemployment during the COVID-19 Crisis : Economic and Health Findings from a Six-Country Survey Study

The COVID-19 crisis is a global event that has created and amplified social inequalities, including an already existing and steadily increasing problem of employment and income insecurity and erosion of workplace rights, affecting workers globally. The aim of this exploratory study was to review employment-related determinants of health and health protection during the pandemic, or more specifically, to examine several links between non-standard employment, unemployment, economic, health, and safety outcomes during the COVID-19 pandemic in Sweden, Belgium, Spain, Canada, the United States, and Chile, based on an online survey conducted from November 2020 to June 2021. The study focused on both non-standard workers and unemployed workers and examined worker outcomes in the context of current type and duration of employment arrangements, as well as employment transitions triggered by the COVID-19 crisis. The results suggest that COVID-19-related changes in non-standard worker employment arrangements, or unemployment, are related to changes in work hours, income, and benefits, as well as the self-reported prevalence of suffering from severe to extreme anxiety or depression. The results also suggest a link between worker type, duration of employment arrangements, or unemployment, and the ability to cover regular expenses during the pandemic. Additionally, the findings indicate that the type and duration of employment arrangements are related to the provision of personal protective equipment or other COVID-19 protection measures. This study provides additional evidence that workers in non-standard employment and the unemployed have experienced numerous and complex adverse effects of the pandemic and require additional protection through tailored pandemic responses and recovery strategies

Experiences of insecurity among non-standard workers across different welfare states : A qualitative cross-country study

In recent decades, economic crises and political reforms focused on employment flexibilization have increased the use of non-standard employment (NSE). National political and economic contexts determine how employers interact with labour and how the state interacts with labour markets and manages social welfare policies. These factors influence the prevalence of NSE and the level of employment insecurity it creates, but the extent to which a country’s policy context mitigates the health influences of NSE is unclear. This study describes how workers experience insecurities created by NSE, and how this influences their health and well-being, in countries with different welfare states: Belgium, Canada, Chile, Spain, Sweden, and the United States. Interviews with 250 workers in NSE were analysed using a multiple-case study approach. Workers in all countries experienced multiple insecurities (e.g., income and employment insecurity) and relational tension with employers/clients, with negative health and well-being influences, in ways that were shaped by social inequalities (e.g., related to family support or immigration status). Welfare state differences were reflected in the level of workers’ exclusion from social protections, the time scale of their insecurity (threatening daily survival or longer-term life planning), and their ability to derive a sense of control from NSE. Workers in Belgium, Sweden, and Spain, countries with more generous welfare states, navigated these insecurities with greater success and with less influence on health and well-being. Findings contribute to our understanding of the health and well-being influences of NSE across different welfare regimes and suggest the need in all six countries for stronger state responses to NSE. Increased investment in universal and more equal rights and benefits in NSE could reduce the widening gap between standard and NSE.