Low Wages as Occupational Health Hazards

Our plain-English summary of Low Wages as Occupational Health Hazards, by J.P. Leigh, R. De Vogli (Journal of Occupational and Environmental Medicine, 2016).

The study

• Authors: J.P. Leigh, R. De Vogli
• Journal: Journal of Occupational and Environmental Medicine
• Published: 2016;58(5):444-7
• Type of article: Editorial
• Cited by: 39 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The history of occupational medicine has been characterized by ever-widening recognition of hazards, from fires in 1911 to asbestos in the 1960s, to job strain in the 1990s. In this essay, we argue for broadening the recognition further to include low wages. We first review possible mechanisms explaining the effects of wages on health or health behaviors. Mechanisms involve self-esteem, job satisfaction, deprivation, social rank, the "full" price of bad health, patience, and the ability to purchase health-producing goods and services. Second, we discuss empirical studies that rely on large, typically national, data sets and statistical models that use either instrumental variables or natural experiments and also account for other family income. Finally, we draw implications for laws governing minimum wages and labor unions.

In plain English

This editorial essay did not report new research and is not a study of asbestos. Asbestos appears only as an example of a workplace hazard recognized in the 1960s. The authors argued that low wages should be added to the list of occupational health hazards. They cited a definition under which low-wage work in 2013 meant $11.45 per hour or less, earned by 27.5% of the American workforce. They described seven possible explanations for links between wages and health. In five, low wages lead to poor health. The two alternatives are that poor health lowers wages, or that some third factor causes both. They noted that none of these mechanisms had been directly and singly tested for wages. They then reviewed studies using large data sets, several co-written by Leigh. In US survey data, low wages predicted obesity, newly reported high blood pressure and continued smoking. In a UK study of 279 people, workers affected by a 1999 minimum wage increase showed improved anxiety and depression measures. The authors concluded that wages are job characteristics just as much as toxic exposures, with implications for minimum wages, labor unions and living wage ordinances.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Editorial essay with a narrative review of hypotheses and published studies; no new data
• Who was studied: No study population of its own. The authors discussed studies using large, mostly national data sets, mainly the US Panel Survey of Income Dynamics (PSID) and the British Household Panel Survey (BHPS).
• Exposure: Low wages. One cited definition set low-wage work in 2013 at $11.45 per hour or less, which 27.5% of the American workforce earned. Asbestos is not studied.
• Main results:
  • The authors described seven hypotheses linking wages and health. Five suggest low wages cause poor health. Two suggest alternatives: poor health causes low wages, or an unmeasured third variable causes both.
  • The authors stated that none of these mechanisms had been directly and singly applied to testing whether low wages harm health. They noted indirect evidence for each mechanism from other measures of socioeconomic status, including income.
  • In a reviewed study by Kim and Leigh of full-time employed heads of households aged 20 to 65 in the PSID, 2003 to 2007 (6312 person-years), low wages predicted higher obesity prevalence and higher BMI.
  • In a reviewed study by Chiteji of 525 adults from the PSID, wages were statistically significant positive predictors of participation in heavy physical activity.
  • In a reviewed study by Leigh and Du of full-time employed persons aged 25 to 65 in the PSID (17,295 person-years), low wages in earlier years predicted newly reported hypertension in later years.
  • In a reviewed study by Du and Leigh of current and past smokers employed full-time, aged 21 to 65 (PSID 1999 to 2009), low wages predicted high smoking continuation and low quit rates.
  • In a reviewed study by Reeves et al of 279 people in the BHPS after the UK's 1999 minimum wage increase, the 63 people directly affected (the intervention group) improved on anxiety and depression measures. Neither control group showed similar improvement.
• The authors' conclusion: The authors concluded that wages are job characteristics as integral as toxic physical, chemical, biological or psychosocial exposures, so low wages should be viewed as occupational hazards. They saw implications for minimum wages, labor unions and living wage ordinances.
• Limitations the authors state:
  • The authors stated that the direct evidence on wages and health cannot test any particular mechanism to the exclusion of others.
  • Kim and Leigh's study was restricted to heads of household (85% men) and did not account for other family income.
  • Leigh and Du's hypertension study used neither instrumental variables nor a natural experiment, and did not include job strain or other family income.
  • The Reeves et al study had small samples, and minimum wage increases have ripple effects on workers earning near the minimum.

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• Finnish Institute of Occupational Health Asbestos Program 1987-1992 — M.S. Huuskonen, K. Koskinen, et al. (1995)

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