What Is Employment Quality? How Can We Study It for Occupational Health Equity?

Full-time, permanent employment that offers benefits and protection has been considered the standard work arrangement, but certain jobs are moving away from this standard.  Precarious employment, for example, is characterized by insecurity, short-term contracts, and limited access to workers’ rights and protection [NIOSH Strategic Plan, 2022]. These aspects of work represent employment quality (EQ). Employment Quality takes into account employment stability (e.g., the type and length of contract), material rewards (e.g., pay and benefits), working time arrangements (e.g., the length and predictability of work hours), training and employability opportunities (e.g., on-the-job training), workers’ rights and protections (e.g., access to unemployment insurance), empowerment and access to collective organizations (e.g., union representation), and interpersonal power relations (e.g., intimidation, discrimination). EQ research has a long history outside of the United States, but in the last few years it has gained increasing attention as a determinant of health among U.S. researchers. Now is an exciting time to explore EQ and its health consequences in the U.S. social context.

A recent paper published by a NIOSH researcher and her two colleagues from the University of Utah Center for Promotion of Work Equity Research (U-POWER)* and Emory University discusses a way to understand EQ as an imbalance of power between workers and employers. Proposing several concrete approaches to advance the research on EQ and worker health, the authors encourage EQ researchers to investigate the multi-level social contexts in which work is embedded. For example, research may focus on key indicators of power balance (e.g., union density, unemployment benefits) that vary across states and time periods.

The paper also discusses how EQ research could help explain how work contributes to racial, gender, and other types of health inequity. For example, if workers of color are overrepresented in jobs with poor EQ, then racial/ethnic health inequity could be explained in part by the poor EQ of these jobs.  Moreover, if good EQ promotes good health, improving EQ in jobs held by largely marginalized groups could reduce health inequity.

EQ offers an important way of understanding work as a structural determinant of health. If the EQ research specific to U.S. social contexts advances, what do we want to know about EQ so that we can equitably protect and promote worker safety, health, and well-being?  Please provide your feedback in the comment section below.

Kaori Fujishiro, PhD, is a Senior Research Epidemiologist in the Division of Field Studies and Engineering.

*U-POWER is one of NIOSH’s ten funded Total Worker Health® Centers of Excellence, each researching novel ways to expand the safety, health and well-being of workers.