The Key Role of Work in Population Health Inequities

[...]because the nature of work has changed in the United States, with less union density and workers' power to protect working and employment conditions, what was formerly seen as a problem faced by poorer workers is increasingly recognized as an important structural factor for many. Many population health researchers have used standard socioeconomic status measures, such as education and income; however, we also recommend the use of social class concepts that describe relationships in the production process (e.g., manager, supervisor, and employee, workplace decisionmaking).3 Acknowledging these relationships can contribute to solutions that go beyond improving educational opportunities or reducing income inequalities, such as the promotion ofgreater workplace democracy and social protection. Intersectionality theory was developed to better understand the interlocking and potentially additive or synergistic nature of social identity, social position, and systems ofoppression or privilege, including gender, race/ethnicity, social class, disability status, and sexual orientation.4 Krieger et al.5 and several of us have incorporated intersectional approaches to study work and health in racially/ethnically diverse, low-wage work forces; for example, Choi et al.6 assessed the impact of poor working and living conditions on obesity and obesity disparities among racially diverse urban transit workers. Labor unions, worker centers, public health advocates, regulators and others are collaborating on legislation and regulations (e.g., paid sick leave or family leave, advance scheduling, safe staffing), collective bargaining, community-based research, edu-cation, and legal action.