Black women overwhelmingly work in low-wage, high-risk healthcare jobs

Healthcare entities employ more Black women than any other industry and have a crucial part to play in undoing racial and gender inequities, according to research from the University of Minnesota and the University of Massachusetts.

Historical gender norms and the legacy of slavery contribute to women, especially Black women, working a disproportionate share of caretaking jobs, the researchers wrote. White women are more likely to fill public-facing positions such as nursing, teaching or social work, while women of color are more likely to work behind the scenes in jobs such as aides, cleaners or cooks according to the study.

Using census data, the researchers found that Black women make up 6.9% of the labor force and 13.7% of the healthcare workforce, but they are heavily concentrated in lower-level positions and in long-term care facilities.

More than one in five Black women work in healthcare. Of those, 64.7% are licensed practical nurses or aides and 40% work in long-term care. Black women have a 1% chance of being a physician, a 2% chance of being an advanced practitioner and a 5% chance of being a community or behavioral health orofessional, according to the researchers' demographic model.

"This is a modern-day incarnation of the division of labor in private homes identified by scholars of slavery and domestic services and is built on the same interplay of structural exclusion and cultural association," the report says. "Black women faced exclusion from medical schools and nursing training as these occupations became professionalized, and white women activists carved out the niche of trained nursing by focusing rhetorically on the moral and spiritual caring aspects of the job."

The research goes beyond anecdotal evidence of racism in healthcare and zooms out to illustrate that Black women are condensed in the lowest-paid, highest-risk healthcare jobs compared to other ethnic and racial groups. The trend persists regardless of education, age, marital status or immigration status, according to the study.

"Healthcare organizations give a lot of lip service to talking about addressing racial disparities in patient care, which is important," said Janette Dill of the University of Minnesota, who co-authored the report. "If they really are serious about racial justice, they also need to look at their own workforce because there are these very strong racialized patterns."

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Higher reimbursement to long-term care facilities and home health providers would enable employers to raise wages, create career advancement opportunities and invest in early intervention programs to address the consequences of gender and racial norms in their workplaces, Dill said.

The mean hourly wage for home health workers and nursing aides in 2019 ranged from $12.12 to $13.90 per hour, leaving one in six of these workers below the federal poverty level, according to the study. Among Black and Hispanic female direct care workers, about half earned less than $15 per hour.

The system that certifies eligibility for positions such as nurse aides also is inflexible and a barrier to promotion, meaning workers get stuck in jobs with stagnant wages, Dill said. Employers could establish programs that help employees level up throughout their careers to combat this, she said.

"A lot of women who are in these aide jobs especially don't have great alternatives. They are largely retail and food services, and so there is not a lot of opportunity for social mobility," Dill said.