This post is based on a presentation given at AIHce EXP 2021 by Subena Colligan and Jennifer Hsu. It is the second in the “Essentials of Pandemic Response” series based on AIHA's recently published ebook.

While every worker in the United States has been affected by the pandemic, not all have been affected equally or equitably. According to CDC, evidence from provisional death data and recent studies “clearly illustrate[s] the disproportionate burden of COVID-19 deaths among racial and ethnic minority groups, particularly Hispanic or Latino, non-Hispanic Black, and non-Hispanic American Indian or Alaska Native people.” Members of the OEHS community have also recognized this reality and are mobilizing in response.

Early in the pandemic, while volunteering for AIHA’s Women in Industrial Hygiene Committee, Subena Colligan, CIH, CSP, and Jennifer Hsu, MPH, CSP, began to discuss the effects of COVID-19 on the communities they operated in and were related to. They wanted to assist minority communities affected by COVID-19, feeling that their platform within AIHA positioned them to support the expanding social justice movement within their area of expertise and make an impact on racial inequities.

Colligan said in an interview held Sept. 1, 2021, that the questions “If not us, then who?” and “If not now, when?” guided her and Hsu’s decision to take action. Colligan added that they felt they could use their knowledge in their areas of expertise not only “to share information on how to protect people but also have a voice for those that are being disproportionately impacted by systematic injustices.” With Ivory Iheanacho, MSPH, CIH, Colligan and Hsu collaborated on a guidance document, The Lens of Minority Populations in the Workplace During COVID-19 (PDF), and sought peer review from AIHA’s Minority Special Interest Group and Social Concerns Committee.

This document started a conversation within the OEHS field about the impacts of COVID-19 on minority communities and led to a webinar on the topic hosted by Colligan and one of the document’s peer reviewers in February 2021. At AIHce EXP 2021, Colligan and Hsu presented an educational session titled “OHS Strategies to Address COVID-19 Impacts in Minority Communities.” These strategies included acknowledging biases, seeking data for decision-making, and applying NIOSH’s Total Worker Health (TWH) framework, a holistic approach towards worker well-being.

Addressing Implicit Bias

In describing the first of these strategies, Colligan and Hsu called on OEHS professionals to identify and challenge their implicit biases that affect how they treat people belonging to various communities. Implicit bias underlies every aspect of daily life, including OEHS. During the September 2021 interview, Hsu cited the position of NIOSH’s Occupational Health Equity program, which is that “the systems that have created inequities throughout the United States for minorities and people of color are the same institutional inequities that are impacting health and safety programs.”

“The reason that we started off the baseline of acknowledging that we all have implicit biases,” Hsu continued, “is because the implicit biases that are institutionally conditioned are the same that have allowed for these disparities to happen during COVID-19.”

Particularly during the pandemic, OEHS professionals occupy influential roles in health and safety by taking part in drafting guidelines and public policy, creating health programs, and setting precedents for how people are protected. Therefore, it is incumbent on them to reflect on their beliefs and assumptions, question whether they are acting in a compassionate way, and change their behaviors if necessary. Moreover, Colligan and Hsu stress that self-reflection alone is not enough: you must also be willing to change your behavior.

“Awareness is not the same as practice,” said Hsu. “Our purpose for mentioning implicit bias was because as we go through our daily lives, we are each creating impact whether or not we realize it. Even small, nonverbal gestures can be considered microaggressions or passive aggression, and that can really affect how people respond.”

Collecting Data

After addressing implicit bias, the second strategy named by Colligan and Hsu in their presentation—seeking data—is one of the cornerstones of OEHS. With respect to protecting minority communities from COVID-19, “seeking data” means being open to the idea that some exposure groups are impacted differently than others. Additionally, there are ongoing organizational efforts that support research into occupational health inequities, such as NIOSH’s Occupational Health Equity program.

In their AIHce presentation, Colligan and Hsu cited CDC’s finding that 34 percent of deaths from COVID-19 occurred among non-Hispanic Black Americans, although this demographic makes up only 12 percent of the total U.S. population. CDC also states that residents of highly segregated neighborhoods in Chicago, which experience higher social vulnerability due to poverty and low levels of education, income, and employment, experience disproportionately high death rates from COVID-19.

The presenters also discussed how meatpacking workers, who are disproportionately Hispanic or Latino, have experienced high rates of COVID-19 due to crowded working conditions that allow for the virus to spread easily. Moreover, some plant managers have displayed carelessness toward worker health and safety, such as those cited in a wrongful death lawsuit involving meatpacking company Tyson Foods. Workers in certain occupations are more likely to be exposed to COVID-19, often because they are required to occupy indoor spaces that may be crowded, poorly ventilated, or inadequately cleaned and sanitized. They may also be frequently expected to speak or have face-to-face interactions with each other or members of the public. Many of those occupations disproportionately consist of workers from minority groups.

In addition to the immediate threat of contracting the virus, Colligan and Hsu were concerned that some minority communities have also experienced increased social stigma and discrimination. NBC reported that in 2020, hate crimes targeting Asian-Americans increased by 150 percent in the largest cities in the U.S., with the first spike occurring in March and April alongside rising COVID-19 cases across the country.

The evidence is clear that various demographic groups, including Black, Hispanic and Latino, Native American, and Asian American workers, are experiencing a variety of effects from the pandemic and that these effects may spill over into occupational health. If employers and OEHS professionals do not work to mitigate risks, take preventative actions, and protect the health of all employees equally and equitably, COVID-19 may remain a serious workplace hazard. Consequently, OEHS professionals will need to be aware of racial inequities and similar trends in order to completely protect the health of workers and their communities.

Total Worker Health

Colligan and Hsu’s third strategy was implementation of NIOSH’s Total Worker Health (TWH) framework, which the agency’s website describes as building on traditional OEHS practice by recognizing work as “a social determinant of health.” “Job-related factors such as wages, work hours, workload, interactions with coworkers and supervisors, and access to paid leave impact the well-being of workers, their families, and their communities,” says NIOSH. “The long-term vision of the TWH program is to protect the safety and health of workers and advance their well-being by creating safer and healthier work.”

In their presentation, Colligan and Hsu specified that social and economic structures, such as racism, xenophobia, sexism, and classism, contribute to occupational health outcomes as well. Temporary, seasonal, part-time, or gig work arrangements and job insecurity also affect worker health. Research suggests that workers from minority groups are at greater risk of injury and illness at work and may be excluded from efforts to correct them. A TWH approach would acknowledge all impacts on occupational health and safety in pursuit of safeguarding the health of every worker.

According to Colligan, the COVID-19 pandemic has made clear that health outside of the workplace affects health in the workplace. “A worker doesn’t get COVID-19 at home but not have it when they walk through the door to go to work,” she said during the September interview. “Between 2020 and 2021, it's been made clear that in order to continue progressing with this social construct [of work], we will definitely have to acknowledge the total worker and their entire social ecology.”

Hsu agreed that people do not stop being who they are—with their history, preexisting health conditions, and psychosocial stressors—as soon as they enter the workplace. Trying to motivate employers and organizations to move towards TWH makes sense “because, hopefully, that will show that they do care about the person that's coming in,” Hsu said. Furthermore, Hsu emphasized the need for workplace health programs to be made accessible to all workers regardless of position or skill level, as line workers are more likely to belong to racial or ethnic minority groups compared to office workers. Hsu said that employers need to look at each health and safety program and ask themselves, “Is it impacting, in a positive way, everybody across the board, equally or equitably? And if that's not the case,” she continued, “then there's still work to do.”

Conclusions and Further Reading

While the full effects of the COVID-19 pandemic will likely not be understood for years to come, what is clear is that different workers will be differently affected. In the meantime, conversations about race relations are difficult. Colligan and Hsu say this is OK—and that they’re not asking OEHS professionals to fix deep-rooted issues right away. Instead, they call for OEHS professionals to practice empathy and fairly assess health risks for minority communities.

As a basis for making decisions to protect the health and safety of workers from minority communities, the guidance document initiated by Colligan and Hsu includes a checklist of COVID-19 considerations for minority populations. Responding “yes” to more than 50 percent of the questions on the checklist may indicate that your workforce is disproportionately impacted by COVID-19. The Lens of Minority Populations in the Workplace During COVID-19 (PDF) includes other information and resources intended to help OEHS professionals protect minority communities during this pandemic.

Resources:

AIHA: “OHS Strategies to Address COVID-19 Impacts in Minority Communities,” AIHce EXP 2021 (virtual presentation by Subena Colligan and Jennifer Hsu, May 25, 2021).