January 21, 2019 Celeste Monforton, DrPH, MPH 0Comment

The healthcare industry promotes wellness and health yet income is a fundamental social determinant of health and many healthcare workers earn poverty level wages.

The February edition of the American Journal of Public Health (AJPH) features a paper that examines the prevalence of low wage jobs in the U.S. healthcare sector. Using BLS and Census Bureau data from 2017, researchers with the University of Pennsylvania found that nearly 35 percent of all women working in the industry earn less than $15 per hour. For Black and Latina workers, nearly 50 percent earn less than $15 per hour.

The authors, Kathryn Himmelstein and Atheendar Venkataramani, note that five percent of the healthcare workforce live below the federal poverty line. When they examined the wage situation for Latino and Black women in the industry, the portion living below the poverty line was even more pronounced: 8.8 percent and 10.6 percent, respectively. The impact on communities is significant. It represents 1.7 million workers and their children. Himmelstein and Venkataramani’s paper illustrates how gender and racial inequality permeate the healthcare industry.

Alfredo Morabia, the editor-in-chief of AJPH, discussed the paper with Kathryn Himmelstein in his monthly podcast. Himmelstein is a resident at Massachusetts General Hospital and was a medical student when she co-authored the research. She told Morabia:

“We have colleagues who work in food service, janitors, nurses aides, medical assistants who we interact with every day in the hospital and the clinic. … We know many of them are struggling with poverty and access to basic services.”

She added:

“We would like to be feeling that we provide excellent care—that we’re a community of healthcare workers that care for each other. That’s not possible when many of our colleagues, just can’t get the care they need, can’t live happy, healthy lives because they don’t have adequate income to do so.”

The economic analysis she conducted with Venkataramani estimates that 900,000 women healthcare workers and their children would be lifted from poverty if they earned $15 per hour. Doing so would increase expenditures in the industry by only 1.3 percent — a sector with annual spending of $3.5 trillion.

AJPH complements the paper by Kathryn Himmelstein and Atheendar Venkataramani with three commentaries. UC Davis health economist J.Paul Leigh briefly examines the arguments for and against a $15 minimum wage for healthcare workers. Despite the common assertion that raising the minimum wage will result in job losses, Leigh notes that a 5 to 10 percent (perhaps even 20 percent) increase in hourly wages has minimal impact on employment. He notes concomitant benefits of minimum wage increases. For employers the benefits include increased productivity and morale, and for taxpayers, less demand/need for anti-poverty programs such as Medicaid, food stamps and housing assistance.

A commentary by Henrie M. Treadwell with Morehouse School of Medicine urges the healthcare industry to look in the mirror. Treadwell writes of the industry’s own role in health disparities:

“The health care system need not look upstream at external forces for social determinants of health in the ecological context that affects their own employees. …the health care system must focus within and initiate protocols and the use of metrics that eliminate race as an explicit or implicit variable that continues to disparately impose poverty on female employees of color, their children, and their families.”

The final commentary “In demand and undervalued,” comes from Mandy Rae Hartz and Michael J. Wright with the United Steelworkers. In the podcast with AJPH’s editor-in-chief, Hartz explains:

“the fastest growing sector of our economy is employing millions of women in work that is low paid, emotionally and physically taxing. This is dangerous for our economy, it’s dangerous for healthcare workers, and it’s dangerous for us as patients.”


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