As we re-open, how do we create a healthier future of work?

In the last few weeks, we have launched into a national debate about how to “re-open America” centered around questions of how to preserve the health of our population, ensure our children’s care and education, support parents’ productivity (and sanity), and maintain our economy. Too often, these decisions are framed as trade-offs when in reality they are so deeply interconnected.

Over the last two years, Blue Shield of California Foundation, in partnership with the FORESIGHT initiative and the Institute for the Future, has supported dozens of conversations with low-income Californians focused on the future of health and family life. People told us plainly that what will make them healthy in the future is deeply connected to escaping their day-to-day struggle for survival and achieving a sense of belonging in their communities, both socially and economically. Hope for the future involves being able to provide for their families and spend time with their children.

These stories illuminated that where we work, how we work, and how our work is compensated and valued are such essential aspects of health and well-being. The future of work will be inextricably linked to the future of health.

Unfortunately, before the COVID-19 crisis, conversations about the future of work were focused largely on the impact that automation would have on certain occupations or sectors of the economy. It tended to be very fear-based (the robots are coming for the jobs).

But there were other important signals that were less talked about like too many people were working too much and still not making enough to support their families, and the relationships between businesses and workers were shifting and affecting working conditions and access to important benefits like consistent work hours and paid family and sick leave. Workers in sectors like childcare, home care, and other kinds of domestic work were undervalued or simply ignored. If these trends continued, the future of work would have profound effects on health and family life — more profound than the automation of jobs.

These issues are now in the spotlight during the COVID-19 pandemic. Never has a crisis so deeply revealed the dynamic relationship between work, health, and family life in our homes and communities, and the connection between racial, economic, and health inequities in our country. Data from the California Budget & Policy Center shows that nearly two out of three jobs lost during the pandemic were in low-income industries. Black and Latinx women have seen three times the job losses as white men; Asian and Pacific Islander and Latinx men have lost jobs at one-and-one-half the rate of white men.

Many essential workers — home care workers, childcare workers, farmworkers, or those in the food service industry — are low-income women, people of color, and undocumented immigrants who entered the crisis marginalized by health and economic burdens brought on by centuries of racial and gender inequality. Now they risk their own health and their families’ health to keep us all safe, often without adequate benefits like paid sick leave or protections on the job.

Re-opening our economy as it existed before will only get workers back to the struggle for survival — not to thriving or believing they can achieve the hopes and dreams they have for themselves and their families in the future. Creating a new economy that works for our health will require making good on a new set of values that are emerging for us in the pandemic. That means supporting our families, thinking more boldly about what all workers deserve, and shaping some of these trends in the future we were seeing go in the wrong direction.

Through research generated through partnerships with FORESIGHT and the Institute for the Future, coupled with our support of the California Commission on the Future of Work, our Foundation has been tracking several of the emerging trends and issues that will require us to take bold action on to secure the future of health and family life. These include:

• Unstable and unpredictable work schedules compromise economic security and health for workers and their children. Research shows that workers of color, specifically women of color are disproportionately affected by unfair scheduling practices. They continue to face a nearly impossible struggle to support their families not knowing how much income they will earn on a weekly or monthly basis, and how to meet basic family needs such as food, housing, and childcare.
• Shifting arrangements between businesses and workers — in the absence of new social and economic benefit structures — threaten long-term wealth and health for workers and their families. Research suggests that independent contracting could grow in the future, yet many benefits are provided through traditional employment and supported by complex shared responsibility and cost-sharing arrangements between government and business. Looking ahead, a re-imagining of the relationship between work and social and economic benefit structures is critical. We see this already in debates about how to guarantee paid sick and paid family leave during COVID-19. The California Commission on the Future of Work has called for the creation of a 21st century benefits model — an exciting design challenge.
• The systematic undervaluing of care workers threatens our overall economy and the health and well-being of families. With the aging of the population, it is projected that demand for home care workers will grow in the coming years. Child care workers will also remain critical to children’s healthy development and parents’ ability to work. While now viewed as essential workers in the pandemic, these workers are deeply underpaid and do not receive access to health insurance benefits, retirement, sick leave, and parental leave. Three-fourths of personal care and service workers, including child care workers, lack paid sick days. Women of color and immigrant women occupying these critical roles are also the breadwinners and caregivers for their own families. Investing in these workers — through practice and policy innovations as well as increasing wages, benefits, and job quality — is an investment in the health of future generations and a healthy economy.

The COVID-19 crisis has added complexity and urgency to these issues but also made one thing abundantly clear: the way forward is to place health and family life as central to the needs of workers and families in a changing world of work. For our Foundation, this has meant investing in three important strategies that can improve the economic security and mobility of low-income Californians as a pathway to improving their health:

• Increasing workers’ wages, benefits, and job quality in the changing world of work through a focus on care workers, who are essential now and in the future for the healthy development of children, and the health and quality of life for people with disabilities and older adults. Care workers’ health, safety, and economic security needs must now be viewed as essential to their support of countless families and our economy. Achieving these goals will require a major public investment in care, including bold policy solutions like universal family care.
• Putting more time and money into the hands of low-income, working Californians through supporting policies like paid family leave and paid sick leave that allow workers to care for their health and their families’ health and protect the health of the broader community. Fair tax policies such as earned income tax credits and child tax credits that make work pay for low-income workers and parents are critical. In California, there are advocacy efforts to extend these benefits to undocumented workers who file taxes as non-residents, including many essential workers in the pandemic.
• Investing in innovations that support the economic mobility of families through partnering with groups like Family Independence Initiative, LIFT, and FreeFrom that are experimenting with building financial and social capital together, focusing on the aspirations of families, and creating systems of mutual support to achieve their goals. These organizations have been a lifeline to many people who were excluded from COVID-related federal support or struggle to access available benefits. They are also gaining insight into what families truly need not just to survive, but to save money and to thrive — insights that will be critical in an economic recovery.

Through the pandemic, we see clearly how the systems and policies of our past and a lack of attention to emerging signals of our future are forcing families to make impossible choices between their economic security and their health. In California, we have the power now to create a future of work that values health and family life and the contributions of all workers. That is the future Californians want and deserve.