Connecting the social and built environment to health and health inequalities

History

Since its inception in the early 1960s, the Social Environment and Health Program (SEH) has been a leader in the development of theory and research on the major role of psychosocial factors in the etiology and course of both mental and physical health and illness. Founded as a cross-disciplinary program, SEH was first led by psychologists John R. P. French, Jr., Robert Kahn, and Floyd Mann in the 1960s and 1970s, and joined by physician epidemiologist Sidney Cobb and several junior colleagues (especially Stanislav Kasl and Robert Caplan). One member of this founding group, Robert Kahn, remains an active and valued member of SEH, working on problems of productive activities and successful aging (Rowe and Kahn, 1998), as he continues to age successfully beyond his 90th birthday in 2008. We continue to expand this area of research, focusing on the importance of social context for health and well-being across the life course. Our work examines social disparities in health, including the role of racism, toxic and built environments, and the molecular pathways linking neighborhoods to health inequalities.

Despite the fact that racial inequities in poor birth outcomes have been well-documented, the underlying causes of these inequities is poorly understood, making efforts to close this gap challenging. Employment and the workplace context are likely key social determinants of perinatal health, as evidence suggests that when pregnant women involuntarily work part-time hours, physically demanding jobs, and nighttime shifts, they run a greater risk of experiencing preterm birth and low birth weight. However, many studies rely on small samples and focus on employment only while pregnant. As with broader population health efforts, understanding racial inequities in the social and economic context of women of childbearing age outside the perinatal period will likely clarify where we can direct effective, efficient intervention efforts. Indeed, the employment and workplace context are critically underexamined aspects of women’s lives when it comes to its impact and on birth outcomes. In particular, the racially unequal growth of the “gig economy” and precarious work have been shown to explain 10-38% of the life expectancy gap across racial groups, and may hold a key to understanding important policy levers to close the racial gap in poor birth outcomes. Precarious work is defined here as employment that is uncertain and unpredictable, marked by workers’ loss of control over the conditions of their work, including the pace, nature, and scheduling of work, and future pay and benefit improvements. Precarious working conditions have become increasingly common. Furthermore, compared to White women, non-White women are more likely to engage in precarious work. We propose to examine the link between racial inequalities in precarious work and poor birth outcomes using state- and county-level variation in these factors over time using innovative data on precarious work from the US Department of Labor. There is a dearth of empirical work on the role that county and state employment and workplace policies (e.g., minimum wage increases, elimination of “just in time” scheduling) could play in reducing inequities in birth outcomes. Measures of precarious working conditions can provide more detailed information about the labor market than commonly used measures such as the local unemployment rate. Measures of precarious work also provide information about the job conditions workers face when they do find work, the availability of “good jobs” that allow workers to provide for families’ financial and care needs, and the chances that workers will experience economic security in the near and distant futures — all factors both outside and within the perinatal period that may impact birth outcomes and the inequities in these outcomes.

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