Nickel and Dimed: Public Health Review of Low-Wage Work

Overview of Nickel and Dimed

Barbara Ehrenreich's Nickel and Dimed: On (Not) Getting By in America has become a contemporary classic. Through a radical act of experiential journalism, Ehrenreich challenges the notion that the minimum wage is enough for a human being to live on in America today. By actually living the life of a low-wage worker across three different settings and recording her experiences, Ehrenreich demonstrates that the minimum wage is not a living wage. By approaching the life and work of an average worker in a hands-on fashion — rather than merely paying herself a salary while living at home — she also gains insight into the physical, psychological, and economic stresses of being poor.

Ehrenreich chooses three types of low-wage, low-skill jobs to experience. In Florida, she initially works as a waitress but is forced to take a second job cleaning motel rooms just to stay solvent. The fact that the waitressing job provides some food enables her to scrape by for a short period, but eventually the anger of the customers and the mistreatment of her colleagues — one of whom is fired unjustly for alleged stealing — drive her to leave. Ehrenreich then moves to Maine, which she characterizes as a region of white poverty. There she works as a housecleaner, supplementing her income by serving food at a nursing home. She paints a portrait of a community polarized between the haves and have-nots: women with barely enough to eat clean the marbled kitchen tiles of the wealthy.

Finally, Ehrenreich takes what she considers her worst job — at Wal-Mart, where she endlessly stocks shelves for little pay and almost no benefits. Efforts at unionization are cruelly thwarted by the world's largest retailer. Unlike her work as a waitress or even as a maid, working at Wal-Mart provides her with almost no solidarity among fellow employees.

Public Health Dimensions of Low-Wage Work

From the point of view of a public health provider, Ehrenreich's story might at first seem to have few features of direct interest — she never discusses going to the doctor, after all. But that is precisely what makes her account so relevant. None of her jobs offer healthcare benefits. Ehrenreich notes that, as an older woman, she was only able to keep up the pace of two-job shifts because of a lifetime of relatively good benefits, healthcare access, and the ability to exercise and eat properly. Many of her colleagues were far less fortunate.

In Maine, Ehrenreich describes women working as maids cleaning beautiful kitchens even though they are old, infirm, or so weakened by hunger they can barely stand. One woman, Holly, who is pregnant and has a sprained ankle, appears to have barely enough food to survive; the little money she has goes to feed other members of her family. Management is not only indifferent to the illness of maids laboring at physically demanding work — when the women complain, they are told to take an Excedrin and get on with it.

This dynamic highlights another critical public health concern: workers in low-wage jobs cannot easily take a sick day to recuperate, much less afford a doctor's visit when they carry no insurance or only meager coverage. Their bodies are treated as disposable commodities, to be worked hard until they can no longer function. Many of the waitresses in Key West barely last a single day, it is grimly noted, due to the strain the work places on their backs and feet.

Nutrition, Food Access, and Health Literacy

Another important finding in Ehrenreich's account is the low level of health literacy — and even basic literacy — among her colleagues. While hardly unintelligent, Holly has trouble reading directions and basic words. A low level of functional literacy is directly linked to a low level of health literacy. For example, someone who cannot read well will have difficulty understanding the nutritional labels on food packaging or medicine bottles. Ehrenreich observes how young women who spend hours cleaning houses often select a bag of Doritos over a sandwich for lunch — presumably because the chips are cheaper and palatable.

For workers at the lowest end of the pay scale, even that choice is a luxury. Lunch might instead be a store-brand hot dog or a bag of hamburger rolls. Public food assistance proves distinctly unhelpful: Ehrenreich dryly describes a bag of donated food containing candy and Hamburger Helper but no hamburger to help it along. Although health-conscious herself, Ehrenreich often finds herself eating fast food simply because of a lack of time, a lack of cooking space, and the fact that fast food is filling and cheap.

The poor are frequently criticized for eating fattening food, not cooking at home, and not exercising regularly. Ehrenreich's own struggle to stay healthy offers a potent illustration of why this is the case. She is forced to live in efficiency units with almost no access to cooking implements, located in unsafe areas with little opportunity for physical activity. Simply getting to work is a challenge. Her experience underscores the structural determinants of diet and health that are often ignored when poverty is framed as a matter of personal choice.

Conclusion: Education, Health Literacy, and Structural Change

Education is perhaps the most fundamental theme in Ehrenreich's manifesto. Without education, workers cannot make the connections needed to organize, unionize, and improve their circumstances. Educating the next generation about health literacy is equally critical: the link between health, safety, and the ability to better oneself is clearly delineated throughout Nickel and Dimed. Someone who is constantly struggling with bad teeth, a poor diet, an unsafe living environment, and the other compounding stressors of poverty has little energy left to pull themselves up by the bootstraps — as the working poor are so frequently counseled to do in America.

Reference

Ehrenreich, B. (2002). Nickel and dimed: On (not) getting by in America. Henry Holt and Company.