Are low wages an occupational health hazard? Two public health researchers say 'yes'

Low wages certainly impact a person’s health, from where people live to what they eat to how often they can visit a doctor. And low and stagnant wages certainly contribute to poverty, which is a known risk factor for poor health and premature mortality. But should low wages be considered an occupational health hazard?

Health economist J. Paul Leigh thinks that they should. In an article published in May in the Journal of Occupational and Environmental Medicine (JOEM), Leigh, a professor of health economics at the University of California-Davis, and Roberto De Vogli, a global health professor at the university, put forth a compelling argument that our current understanding of occupational hazards should expand to include low wages. In particular, Leigh says such recognition would fall under the psychosocial aspects of work that can affect a person’s physical and mental well-being.

“Wages are intimately associated with work,” Leigh told me. “Above and beyond the fact that you can buy things you need with wages, it’s an identity marker for a job and for status in the community and in society. In our minds, it’s a natural extension of the burgeoning field of the psychosocial aspects of work. …If you want to talk about the psychosocial aspects of a job, I’d argue that wages are way up there, if not at the top.”

The study of the psychosocial aspects of work is a fairly new field compared to the study of more traditional occupational health and safety issues, such as preventing falls on a construction site or reducing harmful chemical exposures on an oil rig or safeguarding manufacturing workers against amputation risks. Psychosocial job risks, on the other hand, can include job stress and strain, interpersonal relationships at work, job insecurity, irregular scheduling practices, long work hours, unfair treatment in the workplace or outright discrimination.

Fortunately, many of these psychosocial issues are already the focus of health-related study. For example, research has found an association between job strain and long working hours and an elevated risk of heart disease and stroke; other research has found a link between high-demand jobs in which employees have little control over their tasks and negative mental health outcomes; and other studies have revealed links between particular scheduling practices, like shift work, and elevated risks of heart disease, depression and even cancer. In a 2008 report from the National Institute for Occupational Safety and Health (NIOSH), the authors wrote: “The economic costs of job strain and job stress in general are related to absenteeism, turnover and lost productivity, and, although difficult to estimate, could be as high as several hundred billion dollars per year.”

In arguing that low wages should be added to the list of psychosocial work hazards, Leigh and De Vogli write:

Just as psychologists and sociologists have attempted to widen occupational hazards to include psychosocial characteristics, this essay has cited economic and other social science research in an effort to include an economic variable: low wages. Wages are integral characteristics of jobs just as much as toxic physical, chemical, biological, or psychosocial exposures. Low wages are experienced by over 25 percent of the American workforce and that percentage has been increasing since 2001. Numerous hypotheses suggest that at least part of the correlations between wages and health can be attributed to low wages resulting in poor health or health behaviors rather than vice versa.

Leigh and De Vogli lay out their argument in three parts: hypotheses for the associations between wages and health; direct evidence regarding the impact of wages on health and health behavior; and the implications for policy and public health. But before diving in any further, we should probably make one thing clear — their argument focuses on wages, not income. Income, Leigh reminded me, can come from a variety of sources, such as Social Security, pensions, stock dividends, public assistance programs or rent from a tenant. Wages — while a subset of income — are directly linked to a person’s job.

In addition, Leigh said he wanted to focus on wages, as opposed to income, because there are very specific policy actions that can impact wages, such as state lawmakers voting to boost the minimum wage.

Among the hypotheses that Leigh and De Vogli offer in the JOEM article are ones that consider wages as contributors to low self-esteem; link wages to one’s ability and desire to invest in his or her health; and the more tangible deprivation that comes with low wages, such as a person’s ability to pay rent, see a doctor or live in a safe neighborhood. For example, the article cites a theory from Nobel Prize-winning economist Gary Becker, who argued that increasing wages may give more people a greater opportunity to be more future-oriented. And people who are more future-oriented may be more likely to invest in their health.

“Having a higher wage encourages your imagination to think about the future,” Leigh told me. “And if you’re thinking about the future, you may invest in being healthy five or 10 years from now. …It enables you to imagine the future more vividly.”

The paper also notes hypotheses on the other side of the argument, such as one that posits that being in poor health leads a person to earn low wages, instead of low wages leading to poor health. There’s also the hypothesis that any association between low wages and poor health is simply a coincidence. However, as none of the paper’s hypotheses automatically cancel each other out, Leigh and De Vogli write: “For our purposes, the most important question is whether there is evidence for increasing wages causing improvements in health and/or health behaviors regardless of the hypothesized mechanisms…”

In the “Evidence” portion of the paper, Leigh and De Vogli cite a number of studies, such as one that found low wages may be connected to a low risk of quitting smoking or that low wages may be a predictor of future hypertension. And in the article’s section on “Implications for Policy and Health,” the authors write that while there’s some debate about the impact of higher minimum wages on employment, there’s little question about the effect of a higher minimum wage on low-wage workers, adding that a hike in the federal minimum wage could benefit 35 million people.

“Viewing low wages as occupational hazards is consistent with opinions that living wage ordinances will enhance the population health of low-income communities,” Leigh and De Vogli argue.

At the end of the day, Leigh told me that while he’d like to see agencies such as NIOSH expand their understanding of psychosocial hazards to include low wages, he also hopes to elevate the connections between better wages and broader public health goals.

“I want people in public health to try to imagine or think about the minimum wage as a public health policy lever,” he said.

To request a full copy of “Low Wages as Occupational Health Hazards,” visit the Journal of Occupational and Environmental Medicine.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for nearly 15 years.