Jenny Hsin-Chun Tsai, PhD, University of Washington School of Nursing

Despite the improvement of occupational health and safety (OHS) protection in the United States (U.S.), there still remains profound segregation and differential risk for occupational and health disparities among the workforce based on socially constructed identities and positions, or social locations. Scholars have shown that classism, racism, and sexism, for instance, are systems of power that create, reinforce, and reproduce inequitable, or unfair and unjust, work and nonwork environments that lead to occupational health (OH) disparities. Notably, in OHS research, the paradigms used to examine disparate work-related health outcomes often prioritizes one oppressive structure over others (e.g., racism over sexism) or assumes social locations to be independent or constant (e.g., Asian or Female opposed to Asian and female). These approaches neglect to acknowledge the co-constituting nature of systems of power and how this interlocked power matrix manifests in individual worker and communal experiences. Additionally, class analysis is either excluded or operationalizes class as unidimensional (e.g., occupation-based socioeconomic measures), independent of social and power relations, and by individual attributes. The purpose of this presentation will be to introduce an intersectional relational class framework and discuss how such a framework can help OHS researchers and professionals better understand the relations between systems of power, the work and nonwork environments, and OH outcomes.

Womxn, Black, Indigenous, and People of Color (BIPoC), immigrants, and lower-classed workers are overrepresented in nonstandard employment arrangements where workers experience low employment quality and poor general and mental health and job insecurity. BIPoC workers and immigrants are consistently more likely to be exposed to hazardous and poor working conditions, resulting in poor work-related health and safety outcomes. Moreover, social disadvantages experienced by minoritized workers create preventable and yet unfair exposures outside of work, including inadequate neighborhood physical safety and healthy food availability in low-income communities. Therefore, analyzing systems of power and power dynamics need to be central to OH equity research. Traditional measures of class have narrow boundaries that neglect the power dynamics within and between class categories in and outside the work context whereas relational class centers on social relations to directly illuminate power dynamics within employment quality, working conditions, and on access to resources in the nonwork environment. Relational class also contributes patterns of inequity to various theorized mechanisms (e.g., exclusion, exploitation, domination). Further, relational class is conceptually expanded by intersectionality such that other systems of power, specifically racism and sexism, intersect and co-constitute classism, thereby racializing and gendering class. While the research literature finds relational class indicators to provide greater explanatory power and sensitivity of disparate health outcomes than non-relational indicators, such studies using these indicators are lacking in the OHS literature and the intersectional nature of class has not been readily included conceptually, theoretically, nor empirically.

Comprehensive reviews and syntheses of the literature on relational class and intersectionality were conducted.

An intersectional relational class framework was developed. It has four main components: systems of power, work environment, nonwork environment, and OH outcomes. Systems of power are invisible ideologies that visibly manifest in systems and structures of the work and nonwork environments to impact OH outcomes. The work environment includes employment quality (the quality of the contractual relationship between employer and employee and job-related benefits) and working conditions (the quality of the physical and psychosocial components of work). These are nested within, or influenced by, workplace policies, programs and procedures, which is further nested within local, state, and federal laws and regulations. Similarly, the nonwork environment locates physical and social resources within situational norms and values, which is nested within local, state, and federal laws and regulations. A case examining the mental health outcomes of nursing assistants will be used to illustrate the conceptual application of this framework and methodological approaches to be used.

This intersectional relational class framework pushes forward the science and disciplines of OHS to comprehensively examine systems of power and its relation to OH outcomes through the interplay of the work and nonwork environments. Most importantly, this framework guides investigation beyond the descriptive of what inequities exist and into the explanatory of how inequities continue to persist. The multi-level factors and mediation pathways of this framework capture the complexity and reality of conditions affecting minoritized workers? health outcomes; this new knowledge illuminates the mechanisms undergirding these relationships.

The prevalence and persistence of inequitable conditions and OH outcomes warrant research approaches that are conceptually and theoretically innovative. This intersectional relational class framework is one such approach that paves a different avenue for OHS researchers and practitioners to address OH inequities and to advance health and wellbeing of historically disenfranchised and marginalized workers.

Tags: Applicable to all occupations/industries, Diversity and Inclusion in a Changing Workforce, Minority and Immigrant Workers, Theoretical exposition or development, Workplace Diversity and Health Disparities