How the Covid 19 Pandemic has Adversely Affected Low Income Workers

A Review of a Study of Health Disparities in the United States

Article Abstract

Study objective:

Background: This study analyzed the disproportionate impact that the Covid-19 pandemic had on economically disadvantaged populations in the U.S. who were essential workers but unable to remain at home due to income needs [1].

Main ideas explored: This main focus of this study was the relationship between income and employment conditions with respect to the use of protective behaviors during the initial stage of the Covid-19 pandemic.

Study design and method: A self-administered survey advertised through a social media campaign collected data from 2,845 employed American adults in April 2020. The authors used a hierarchical generalized linear model approach to identify differences in the use of recommended protective practices based on income and employment status, controlling for the perceived threat of Covid-19 and worker knowledge.

Principal conclusions/results: Significantly higher percentages of essential workers experienced income loss and challenges using protective gear and behaviors in their workplace. Essential workers were less likely compared to non-essential workers to use conventional hygiene precautions such as wearing a mask and regularly washing their hands while at work.

Keywords: Pandemic, Covid-19, health disparities, hand hygiene

Introduction

Statement of the Problem: The impact of the Covid-19 pandemic has adversely affected American workers who occupy essential occupations but are paid disproportionately less than most non-essential workers. In addition, the working conditions of essential workers limits their ability to engage in protective behaviors and the use of protective gear.

Purpose of the Study; The overarching purpose of this study was to analyze the relationship between worker economic status and employment conditions with the use of protective behaviors during the beginning stage of the Covid-19 pandemic in order to confirm or refute the hypotheses below.

Hypotheses

The study was guided by two hypotheses as follows:

1. Hypothesis 1: Knowledge of recommended Covid-19 protective behaviors and Covid-19 threat perception are positively associated with engagement in such protective behaviors, such as frequent handwashing.

2. Hypothesis 2: Adoption of protective behaviors related to social distancing, such as staying at home, is determined by employment conditions. Specifically, from the perspective of the Health Belief Model (HBM), employment conditions impede self-efficacy to engaging in certain Covid-19 protective behaviors but not others.

Methodology

Methods: This was a quantitative study that used a social media platform for recruitment purposes.

Participants: A total of 2,845 working American adults completed the self-administered, online survey.

Data Collection Procedures: Participants completed the online survey in April 2020.

Data Analysis Procedures: The authors employed hierarchical generalized linear models to analyze the differences in the use of recommended protective gear and behaviors and workers’ employment status and working conditions, controlling for the perceived threat of the Covid-19 virus and worker knowledge as predicted by the HBM.

Quality of the Literature Review

Was literature review present? The study included an introductory literature review (p. 2).

Was it useful? Rigorous? Although the review of the literature was useful, it was brief. The literature review, however, also included a useful graphic depicting how certain employment conditions can become barriers to Covid-19 preventive behaviors.

What did you learn? While the Covid-19 pandemic had not been active that long when this study was conducted, it provided valuable benchmarks for future studies in this area.

Were there surprises? The issues of interest in this study have been featured prominently in the national news and there were no surprises.

Results

Both of the above-stated hypotheses were confirmed. The lower-income essential workers (42%) who participated in the study were at greater risk of suffering lost income due to Covid-19 compared to non-essential workers with paid sick leave, and 15% were food insecure as a result. In sum, essential workers suffered from multiple challenges in their workplace as well as experiencing an inability to remain at home due to their need for income. In addition, non-essential workers were also more likely to engage in protective behaviors (i.e., hand-washing and wearing a mask) compared to essential workers (70% less likely) due to the nature of their employment.

The results of this study were congruent with a growing body of evidence concerning the plight of essential workers during pandemic conditions. Not only do essential workers encounter more constraints to their use of protective gear, they are at far greater risk of experiencing income loss and food insecurity compared to non-essential workers. Based on these findings, the authors conclude that more informed policy responses are needed today and in the future in order to help reduce these health disparities among a large percentage of the American population.

Conclusions and Recommendations

The results of this study confirm the health disparities that exist in American workplaces for essential workers who are forced to report to work each day out of economic necessity as well as the nature of their occupations which preclude virtual work. The authors recommend that lawmakers formulate national policies that provide some level of safety net for essential workers such as mandatory paid sick leave and universal health care coverage.

Discussion

Although the study achieved a robust sample of participants, the authors point out that they were all anonymous and it was entirely possible that one individual completed more than one online survey using different computers. In addition, it was likely that comparatively larger numbers of essential workers with lower income levels did not have the same level of access to the social media platform that was used to recruit participants for the study. These limitations likely increased the number of non-essential worker participants in the study, but this constraint was not reported by the authors.

Notwithstanding these limitations, though, the findings that emerged from this study underscored the multiple sources of health disparities that may go overlooked by policymakers who are more concerned with economic performance and stability than they are about the welfare of disadvantaged and undervalued Americans who do not enjoy the luxury of working from home or taking paid sick leave [2]. The methods used by the authors were described in sufficient detail to ensure their validity and reliability, and the findings that resulted during the initial phase of the Covid-19 pandemic provide valuable insights for policymakers and employers alike. In addition, given the nationwide lock-down status that was in effect when this study was conducted, its design was optimal with a high degree of applicability for community health practitioners.