Research Article Explores Black Women’s Employment in Healthcare

A Feb. 2022 research article from Health Affairs entitled, “Structural Racism And Black Women’s Employment In The US Health Care Sector” by Janette Dill and Mignon Duffy, describes how structural racism and sexism shape the employment trajectories of Black women in the U.S. healthcare system.

The authors write that “The COVID-19 pandemic has brought heightened attention to racial disparities in health outcomes as infections, hospitalizations, and deaths have had a disproportionate impact on Black populations, Indigenous populations, and populations of people of color. In this article we focus on an aspect of racism and health that has gotten somewhat less attention: the role of racism in the stratification of the healthcare workforce. Specifically, we build on the insights of interdisciplinary scholarship about the gendered and racialized division of care to examine the unique role of Black women in healthcare. We argue that structural racism in the labor market, linked to historical legacies of slavery and domestic service, has had a strong impact on shaping the healthcare workforce.”

The authors explain that they used the American Community Survey to analyze the probability of Black women working in occupations and sectors within the healthcare industry and it is an annual nationally representative survey conducted by the Census Bureau. The data is from 2019, which was the latest data available.

That said, “Black women make up 6.9 percent of the labor force in the U.S. and 13.7 percent of the healthcare workforce—a rate of overrepresentation that is about double. In comparison, white women are overrepresented in the healthcare sector at a rate of about 1.6 times their representation in the labor force. Black women are heavily concentrated in long-term care, making up 23.0 percent of the long-term care workforce compared with 12.1 percent of hospital and 9.6 percent of ambulatory care workers. White women are more evenly distributed among settings within healthcare, making up 40.8 percent of long-term care workers, 47.2 percent of hospital workers, and 48.6 percent of workers in ambulatory care.”

“Within healthcare, Black women make up 24.9 percent of licensed practical nurses and aides—a very high proportion that is consistent with their overrepresentation in long-term care settings,” the authors continue. “Note that this category of aides includes nursing assistants in hospitals and long-term care settings as well as home health aides and personal care attendants who work in private homes. They are also overrepresented at lower levels among community or behavioral health workers (11.8 percent), registered nurses (10.2 percent), technicians (9.4 percent), and therapists (8.1 percent). In comparison, white women are most heavily concentrated among registered nurses (61.3 percent) and therapists (56.1 percent) and are slightly underrepresented among licensed practical nurses and aides (39.8 percent) compared with their representation in the healthcare industry.”

The authors add that the overrepresentation of Black women means that healthcare is a key employer for Black women. More than one in five Black women in the labor force are employed in the healthcare sector—of these 64.7 percent are in license practical nurse or aide occupations and 40 percent work in long-term care.

The author suggest three strategies:

• Raising the floor for low-wage workers: The authors suggest raising wagers where workers are the most underpaid. They also suggest that federal minimum wage should be increased for all workers.
• Building career ladders within the healthcare sector: Since Black women are so overrepresented in healthcare having opportunities for job mobility within the sector is a key component to combat racism in the workplace and these “career ladders” can create pathways for workers’ advancement.
• Addressing racism in the pipeline: The authors argue that there are ideologies and stereotypes that push Black women into direct care jobs and the long-term care sector that are rooted in historical patterns, and it will take conscious effort to directly address these biases.

The authors conclude by saying that “Care work is a critical arena in which Black women are located at the intersection of racism and sexism. Black women are overrepresented in healthcare at higher rates than any other group and are heavily concentrated in low-wage jobs in the long-term care sector and in hospitals. Investing in Black women through targeted investment in care infrastructure can begin to undermine some of the ideological constructions and structural barriers that have devalued both.”