Economic Hardship and Health Among U.S. Workers, by Occupation, 2022–2023

Economic hardship — being unable to afford basic needs such as food, clothing and health care — harms health, and it can leave workers less able to prevent or deal with illness. Occupations differ in pay and in benefits such as health insurance and paid time off, so where hardship falls among workers may help show where support is most needed.

A team from CDC’s National Institute for Occupational Safety and Health looked at that question in an exploratory analysis published in the Morbidity and Mortality Weekly Report.

The data

The analysis used the Behavioral Risk Factor Surveillance System (BRFSS), a yearly random-digit-dialed telephone survey of adults aged 18 and older. Two optional parts of the survey were needed: one asks what kind of work a person does, and one asks about social and economic circumstances. Thirty-six states and the U.S. Virgin Islands used both in 2022, 2023 or both years.

The study covered people employed for wages, self-employed, or out of work for less than a year — 165,060 respondents after exclusions. Each was checked for eight hardships over the previous 12 months:

1. losing a job or having hours cut;
2. food running out with no money for more;
3. being unable to pay the mortgage, rent or utility bills;
4. a utility company threatening to shut off service;
5. lacking reliable transportation to appointments, work or daily errands;
6. receiving food stamps (SNAP);
7. having no health insurance of any kind; and
8. needing to see a doctor but being unable to afford it.

Reporting four or more counted as a high level of economic hardship. Some measures overlap — food insecurity with SNAP, housing with utilities — so a cutoff of four means hardship in at least two different areas. Respondents also rated their own general health.

Overall

6.9% of current or recent workers had a high level of hardship, and 12.5% rated their health fair or poor. The commonest single hardship was losing work or hours (16.5%); the least common was lacking reliable transportation (6.7%). Food insecurity (12.1%), housing insecurity (12.2%) and being unable to afford care (11.8%) each passed 10%.

Who carried more of it

High hardship was significantly more common than among all workers for people who were out of work for under a year (26.8%), were aged 18–49, were female, were Hispanic or non-Hispanic Black, had a high school education or less, or had household income under $50,000.

Women reported more hardship than men in five categories — food insecurity (13.8% vs 10.7%), SNAP (12.0% vs 5.0%), housing (14.3% vs 10.5%), utility shut-off threats (9.0% vs 6.6%) and unaffordable care (13.0% vs 10.8%) — and more high hardship overall (7.9% vs 6.0%). Men, however, were more often uninsured (11.7% vs 6.9%).

Fair or poor health was significantly more common among workers who were recently out of work, Hispanic (19.7%), had a high school education or less, or had household incomes under $50,000.

By occupation

Six occupational groups had high hardship above 10%:

The lowest was in legal occupations, at 1.2%. Wages come from U.S. Department of Labor estimates, because the survey records household income rather than pay.

• Wages. Every high-hardship group had a mean wage under $50,000 and a median under $45,000 — except construction and extraction (mean $61,500, median $55,680).
• Health care costs. Being uninsured and being unable to afford care were both significantly elevated in each high-hardship group, except that health care support workers were insured at the all-worker rate.
• Health. Fair or poor health generally rose with a group’s level of hardship, and was significantly elevated in every high-hardship group except construction and extraction.

Construction and extraction stands out. Its mean income was only slightly below the average for all occupations, yet every hardship except SNAP was significantly more common than among all workers — the relationship between income and particular hardships, the authors note, is complex.

Who does these jobs

Several of the hardest-hit groups drew heavily on the demographic groups with the most hardship. In farming, fishing and forestry, 66.5% of workers were Hispanic (against 20.6% of all workers) and 54.8% had not finished high school (against 9.5%). In building and grounds cleaning and maintenance, the figures were 52.7% and 37.4%. Food preparation and serving had the youngest workforce, with 57.6% under 35 (against 32.6%). Health care support had the most women, 83.0% (against 46.6%), and the second-highest share of Black workers, 20.1% (against 10.5%).

What it means

Low-wage jobs are generally less likely to come with health insurance and paid sick leave. The finding that more workers in lower-paid groups could not afford needed care suggests, the authors say, that adequate wages may help keep workers healthy, and wider insurance coverage among lower-income adults has been linked to better management of chronic conditions. They suggest policymakers and public health practitioners could shape programs for the occupational groups carrying the most hardship, and use future surveys to track trends and test what works.

Limitations

The authors list nine:

• the survey is a snapshot, with the timing and length of hardships unknown, so it cannot show cause;
• 2022 data may still carry the pandemic’s uneven effects on employment;
• several hardship measures overlap;
• answers are self-reported, open to recall and social-desirability bias;
• missing or misclassified answers could skew results;
• major occupational groups are broad and mixed;
• a person’s job may not be their source of insurance or their household’s only income;
• the 36 states and the Virgin Islands are not nationally representative; and
• the analysis was exploratory, with no hypotheses set in advance.

Sources

Based on Silver SR, Li J, Shockey TM, "Economic Hardship and Health Within Sociodemographic and Occupational Groups — Behavioral Risk Factor Surveillance System, United States, 2022–2023," Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; a work of the United States government in the public domain. The imported copy was cut off in several places; the missing text and the occupational table were taken from the same report’s full text in PubMed Central (PMC12121729). Where the report says a group was elevated on every hardship but its own tables show otherwise, the claim is left out, and the group its text calls “transportation and materials manufacturing” is named as its table names it.