Balancing Work, Family and Health Disparities

Mar 14, 2013, 12:00 PM

Cassandra Okechukwu, MSN, ScD, is an assistant professor in the department of social and behavioral sciences at the Harvard School of Public Health, and an alumna of the Robert Wood Johnson Foundation Health & Society Scholars program.


With the arresting title of “Why women can’t have it all,” Anne-Marie Slaughter’s Atlantic magazine article generated many discussions on the issues women face in balancing competing work and family demands. However, these discussions have not addressed the vast disparities in the types of work-family issues women face and the limited resources available to many working women. Also painfully missing from the discussion are the health implications of these competing work and family demands.

One group for which these issues cannot be separated is nursing home workers. Data from the Bureau of Labor Statistics (BLS) show that the majority of nursing home workers are drawn from racial/ethnic minority groups and low-income communities; as such, many face significant health disparities. For example, racial/ethnic minority and low-income populations have a disproportionate burden of diagnosis of several cancers that are related to adiposity—including cancers of the lung, esophagus, endometrium, colon and rectum, kidney, pancreas, gallbladder and thyroid.

BLS data also show that women are disproportionately represented among nursing home workers. Generally, about 80 percent of the nursing home workforce is female and many of the positions are low-wage (see In addition, many workers are single mothers; 28 percent of nursing home aides are single mothers, while single mothers are 14 percent of all female workers. In my study of 416 nursing home workers from Massachusetts who answered a question on wage earner status, 193 female workers (46%) reported that they were primary wage earners in their households. Many reported financial strain and difficulty providing food for their family members. These family stressors are compounded by the presence of young children, which is associated with costs in terms of time and finances.

In many middle class families, both partners have to work in order to meet financial demands. While working serves as an important source for meeting financial need, it also creates its own unique stressors and constrains the time available for other activities. Apart from the emotional strain of caring for a sick and elderly population, nursing home workers face a hazardous work environment. The average rate of injury for nursing home workers, at 8.6 per 100 Full Time Equivalent (FTE), is almost five times greater than for private industry (1.8 per 100 FTE), and is also higher than that found in other high injury industries, such as coal mining (5.6) and construction (3.5). Nursing home work often requires nonstandard work hours that may conflict with standard hours for childcare service provision, and the interdependent nature of the job task means that workers have little choice in where or how their work is done.

What is a working woman (or man) to do? One strategy families use to conserve time and energy is fast food consumption, which requires very little advance planning and preparation time. Smoking has also been cited as a potential strategy employed by nursing home workers to cope with the stress of balancing competing work and family demands. This has further implication because studies, including studies I have conducted, show that family members are important to smoking initiation, maintenance and cessation.

Given these factors, what is the way forward for addressing health disparities that impact nursing home workers? The Centers for Disease Control and Prevention advocates a Total Worker Health© strategy that considers both work and non-work life exposures in the design of public health initiatives. For nursing home workers, this means that combating health disparities necessitates addressing the difficult work and home demands they face. Besides the impact on their health and the health of their family members, public health needs these workers. Government projections show that the current direct-care workforce is insufficient to meet the demands created by an aging U.S. population.

Photo credit: Suzanne Camarata

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.