Will Increasing Wages Improve Worker Health?

Researchers Argue for Treating Low Wages as an Occupational Health Hazard

When thinking of the most common occupational hazards, risks associated with things such as moving machinery, toxic chemicals, and repetitive or strenuous movements generally come to mind. However, there is a growing body of literature examining so-called “psychosocial” hazards, which includes detrimental aspects of work like job insecurity and organizational injustice that generally prey on a worker’s mental or social well-being. In “Low Wages as Occupational Health Hazards,” published in the May 2016 issue of the Journal of Occupational and Environmental Medicine, authors J. Paul Leigh, Ph.D., and Roberto De Vogli, Ph.D., discuss the relationship between low wages and poor health, arguing that low wages should also be treated as this type of psychosocial occupational health hazard. The authors note that over 25% of the American workforce makes $11.45 or less per hour, making this issue especially topical in light of growing public debate over stagnant wages and income inequality.

In that particular essay, Dr. Leigh and Dr. De Vogli identify seven “hypotheses” or potential mechanisms that might explain an association between wages and health, noting that these are only hypotheses that would require further research to substantiate. The first five of these support a positive correlation between low wages and poor health:

1. Low Self-Esteem: Low wages have an adverse effect on self-esteem, which in turn can trigger negative health conditions, such as reduced neuroendocrine, inflammatory, and cardiovascular activity, especially in middle-aged workers.
2. Unhealthy Lifestyle: Low wages result in less money to spend on those things that support a healthy life, including less to spend on medical services or medicines, and can possibly force a choice when paying for essentials such as rent or healthy food.
3. Chronic Stress: Low wages result in low socioeconomic status, which, because we are a social species, results in chronic stress that can trigger adverse health conditions, including “tumor growth, neuroendocrine hormone levels, high-density lipoprotein (HDL) levels, and cellular immune responses.”
4. Bad Health Habits: Health is viewed as an investment and lower wages reduce the incentive for avoiding bad health habits; poor health in the future costs less because, earning a low wage, missed days from work result in less wages lost than they would with a higher wage.
5. Living in the Present: People with higher wages develop a greater ability to defer gratification and, conversely, people with lower wages develop less ability to defer gratification; therefore, low wage earners have less patience, are more concerned with the present, and are less likely to invest in current health as a way of stemming future problems.

The last two hypotheses suggest a more complex relationship between wages and health:

1. Poor health leads to low wages, rather than the other way around, as people in poor health cannot work as hard as people who are healthy.
2. Any direct correlation between low wages and poor health is coincidental and the true causes of any correlation are unmeasured third variables.

The authors note that while any combination of these hypotheses might be true, any evidence showing that increased wages can increase worker health would justify their call to listing low wages as an occupational health hazard. To this end, they briefly review some research literature that studies the topic and find evidence to support a correlation.

For example, one study that measured the impact of workers’ knowledge of computers and the state’s minimum wage found that low wages were a predictor for a higher prevalence of obesity. Another study found that wages were a predictor for participation in heavy physical activity, which could of course increase a worker’s risk of injury. Another study that focused on smoking and the effect of wages on the ability to quit the habit found that low wages predicted a low quit rate and high continuation rate. Another survey study looked at the effects on an increase in the British minimum wage, with workers directly impacted by the increase reporting “improvements in measures of mental health measuring anxiety and depression.” The authors also note, without discussion, that many studies have found that increasing wages can reduce absenteeism, increase productivity, improve customer service, and reduce worker disciplinary issues.

While not involving “wages” specifically, the authors also briefly note several studies that looked at the impact of changes in the Earned Income Tax Credit that resulted in an increase in income for mothers with more than two children, and while the results were not conclusive, most results suggested that the short-term effects benefitted health.

Amid their call to add low wages to the list of occupational health hazards, the authors also recognized other policy benefits for increasing low wages. An increase in the minimum wage, for example, has in the past resulted in increases for workers earning as much as 150% of the minimum wage. Similarly, an increase in wages for unionized workers generally results in an increase for non-unionized workers as well. Finally, many people believe that requirements for a “living wage” will improve the health of low-income populations.

While increases in minimum wages are being implemented in many states and localities, it remains to be seen whether this trend will continue and whether treating the issue as an occupational or public health issue will take hold in the public debate.

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