Excerpted From: Pilar C. Whitaker, Occupational Segregation as a Driver of Racial Health Disparities among Black Women, 67 Saint Louis University Law Journal 95 (Fall, 2022) (140 Footnotes) (Full Document)


PilarCWhitakerRacial health disparities--defined by the federal government as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage” been inexorably linked with discriminatory labor systems since the slave trade. This is especially true for people of color, and Black Americans in particular, who have endured worse health outcomes relative to white people since slavery. For example, in 1860, the death rate was 1.8 percent for enslaved people and 1.2 percent for white people. As described in Caring for Equality:

Overall, the enslaved person's health was under constant peril. Harmful physical and physiological conditions such as poor diets, inadequate shelter, violence, and psychological stress were endemic to slave life. Some of these conditions triggered biological processes of specific diseases. Moreover, slaves were subject to the frequent misdiagnoses or prejudiced callousness of physicians and other health practitioners in charge of tending ill slaves.

And so, biological differences between races do not account for racial health disparities. Throughout history, racial health disparities have been caused by occupational segregation--the systemic, and often violent, relegation of Black, Indigenous, and other people of color to harsher, more dangerous labor conditions that maintain the economy at the expense of individual health. This paper argues that occupational segregation--the overrepresentation or underrepresentation of different demographic groups in certain kinds of work based on race, ethnicity, and sex--is a primary cause of racial health disparities in the United States, especially among women of color. Part I demonstrates how various legal authorities create and reinforce a segregated workforce driven by race and sex discrimination. Part II identifies occupational segregation as a targeted effort to relegate Black people and women to lower paying jobs through rigid legal policy and social structures. Part III discusses the vast and harmful economic and health impacts of occupational segregation, especially on women of color. Part IV demonstrates that occupational segregation underlies each of the Social Determinants of Health (“SDOH”), by: (1) creating economic instability for workers; (2) acting as a barrier to health care of all forms; (3) erecting near insurmountable barriers to quality education and housing; and (4) subjecting people to stressful or even hostile work environments.

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Though not considered a SDOH, occupational segregation is a clear driver of racial health disparities in the United States. Addressing occupational segregation, and its impacts on the health of workers, requires a multi-pronged approach from both government and industry. First, as noted by Rebecca Dixon, because occupational segregation is a direct outgrowth of race and gender discrimination, the federal government must invest in the EEOC to allow more robust enforcement of civil rights protections in the workforce. Moreover, state and local governments must raise and maintain a livable minimum wage and vigorously enforce equal pay laws to ensure people who are working full time are not living below the poverty line. Laws requiring paid sick leave are also crucial to ensuring women can access vital health care services, including preventative care and treatment of chronic disease.

Absent governmental intervention, employers must implement policies that support the health of workers. There are no laws prohibiting firms from raising wages, providing sick leave, or providing employer-sponsored health insurance. Employers must also establish pathways to career growth and development for women of color, especially. Without intentional and targeted investment in opportunities for those most often overlooked for higher status positions, the workforce will remain deeply inequitable, and the health of workers comprised.

Pilar C. Whitaker is Special Economic Justice Counsel at the NAACP Legal Defense Fund.