Lorraine Conroy, ScD, CIH, UIC Center for Healthy Work
The primary objective of this research center is to explore the facilitators and barriers to healthy work for those engaged in precarious labor. The objective of the poster is to describe the research methodology and evidence used by the UIC Center for Healthy Work to promote community-oriented Total Worker Health initiatives.
The University of Illinois Chicago Center for Healthy Work (CHW) is a NIOSH-funded Center for Excellence for Total Worker Health (TWH). The CHW is a research and education center dedicated to advancing the health and well-being of workers. CHW addresses the determinants of worker health by identifying structural, societal, and workplace injustices affecting people in precarious jobs using participatory action research (PAR). Precarity at work is rapidly increasing and perpetuates occupational safety and health (OSH) disparities (Jeszeck, 2015; Kalleberg, 2009). Precarious work (PW) is insecure or unstable, has a greater risk for occupational injury or fatality, lacks opportunities to build power and take collective action in the workplace, leading to depersonalization, devaluation, and increased likelihood of bullying, harassment, and discrimination (Ahonen et.al., 2018; Vives et.al., 2010). The nature of precarious employment leaves workers vulnerable to direct effects of the work arrangement (stress related to unemployment or employment insecurity) and indirect effects (adverse physical and psychosocial working conditions); it also makes them susceptible to the social factors outside of working conditions that lead to poorer health (insufficient or uncertain income, lack of access to health care and other social benefits). Recent calls to action suggest a need to expand the paradigm of occupational safety and health (OSH) to explore social risk factors in worker well-being (Baron, Beard, & Davis, 2014). PW-focused OSH programs preclude the workplace as a point of intervention as workers with PW are unlikely to have a regular employer or workplace.
There is limited evidence on TWH in the context of PW. PAR is a promising and sustainable approach to TWH implementation for PW, wherein researchers and participants work together to address complex problems. The CHW uses PAR to embed action into the research itself, with inquiry initiatives that emphasize participation, power, knowledge democracy, and reflection to foster social change (Stringer, 2013; Wallerstein et.al., 2017). The CHW utilizes PAR through the Greater Lawndale Healthy Work project (GLHW) and Healthy Communities through Healthy Work (HCHW). GLHW uses community-based participatory research (CBPR) to engage in a mixed methods community health assessment focused on residents? experiences with PW in two Chicago neighborhoods with high social and economic hardship, Little Village and North Lawndale. GLHW engaged residents and community-based organizations (CBOs)s in CBPR to design, implement, and analyze concept mapping, focus groups, and community survey data; simultaneously building capacity of community residents and community-based resources. CBPR mixed methods informed GLHW directionality for TWH implementation. HCHW uses action research to understand facilitators and barriers to collaborative OSH initiatives between public health and labor. HCHW conducted a year-long mixed methods action research qualitative study that highlighted public health and healthcare organizations? limited knowledge and action surrounding precarious work, and a lack of collaboration between health and labor organizations despite recognition that work is a key social determinant of health.
GLHW analysis suggests that Greater Lawndale (GL) residents experience significant barriers to full-time jobs with decent wages and benefits in the community. Residents also experience job insecurity and instability. Increased job precarity for residents resulted in increased exposure to hazardous working conditions. Employment precarity was associated with poorer mental & physical health of residents. Through the PAR/CBPR process, GLHW built community capacity to recognize work as an important determinant of health by building a community-driven OSH Action Roadmap that has guided the development of the GLHW Community Council, a youth storytelling project, and an evidence-informed, culturally tailored, Lotería game to raise awareness on how PW impacts health.
HCHW developed the Healthy Work Collaborative to connect public health and healthcare with worker centers, labor unions, and other worker advocacy organizations to share resources and collaborate on policy and systems-level initiatives that address PW. Representatives from the labor sector provided technical assistance and facilitated trainings to help public and healthcare develop action plans for implementing policy, systems, and environmental change initiatives that address precarious work within their jurisdictions/communities. HCHW provided mini-grants for the implementation of collaborative OSH initiatives.
Participatory action research is an approach that embraces social justice and health equity as a research orientation that is better suited to addressing complex health issues, like PW and OSH disparities, through TWH (Newman & Glass, 2015). The CHW implements PAR by engaging communities to understand how PW impacts residents, building the skills of public health and labor to collaboratively identify pathways to healthy work, and working with local leaders to leverage resources to implement TWH.
CHW has demonstrated that the application of PAR in TWH can contribute to the development of strategic interventions to address the adverse health effects of PW and OSH disparities in communities.