Closing The Racial Gap In Hypertension: The Role Of Work Inequity And Occupational Segregation

Abstract

Health inequities between Black and White workers are persistent problems in the United States. To address these problems, scholars and policymakers have put their effort into minimizing workers’ exposure to occupational health risks and providing high-quality healthcare when workers get sick. However, while these initiatives help improve workers’ health overall, limited progress toward racial health equities has resulted from these initiatives. Grounded on the social production of workers’ health inequities framework, this dissertation critically examined the role of work as a social determinant of health and the extent to which work inequity and occupational segregation create and sustain workers’ health inequities. Black workers are more likely to work in occupations with high occupational health risk exposure and a high likelihood of unemployment compared to White workers. Hence, Black workers are systematically more vulnerable to getting sick yet can lose access to health-promoting resources like healthcare coverage more easily than their White peers. We argue that policymakers should prioritize eliminating work inequity and occupational segregation – what we referred to in this dissertation as “desegregation policies” - rather than those that correct the “symptoms” of racial health inequities. Using hypertension inequity between Black and White healthcare workforces as a case study, we predicted changes in racial gaps in hypertension under various desegregation scenarios. This dissertation has four chapters. Chapter one introduces the social production of workers’ health inequities framework. Chapter two describes our efforts to derive a hypertension risk equation incorporating work-related factors, a key ingredient for a microsimulation to predict hypertension trends. Chapter three describes our microsimulation model and results from a counterfactual analysis. We predicted changes in the racial gap in hypertension under four desegregation scenarios relative to in the current occupationally segregated workforces. Lastly, chapter four discusses our early effort to validate our model prediction with real-world data. Overall, this dissertation provides a novel framework and a methodology that scholars and policymakers may leverage for future efforts to eliminate workers’ health inequities targeting upstream factors.