COVID-19 and the Health and Wellbeing of Vulnerable Service Sector Workers across the Life Course

ABSTRACT The COVID-19 pandemic precipitated intermingled health and economic shocks, which were felt deeply in the service-sector. The service-sector workforce is large, with nearly 20% of the U.S. workforce employed in retail, grocery, food service and related sectors, and is predominantly low-income and disproportionately women and people of color. These underserved workers bore the brunt of the initial wave of mass unemployment, with potentially dire consequences for health disparities across the life course. However, the economic crisis was met by a safety net expansion that could have buffered the health consequences. For those who remained employed, many found themselves on the frontlines of the pandemic, staffing grocery stores, pharmacies, and fulfillment centers. These workers' adherence to coronavirus mitigation practices, including masking, staying home when sick, and getting vaccinated, shaped the further course of the pandemic. For vulnerable community-dwelling older adults and other vulnerable adults, visits to grocery stores and pharmacies remained essential throughout the pandemic and so were a regular source of risk. Community-dwelling older service workers' risks depended on both their own adherence to mitigation strategies and that of their younger co-workers. Yet, there is a gap in knowledge about how the economic crisis affected the health of these underserved workers and how adherence to coronavirus mitigation strategies played out in their workplaces, especially for older workers. To fill these gaps, we propose to draw on novel data we collected as PIs of The Shift Project from 161,619 hourly service-sector workers surveyed between 2017 and 2022, including 83,720 workers who were recently laid-off, or remained on the job and surveyed during the pandemic, as well as planned data collection through 2023. We propose to use this data to accomplish three key aims. First, we match the Shift Project micro-data with contextual data at multiple levels from novel sources to construct measures of workplace risk environment, company policies, local mandates, and COVID-19 rates. We will prepare a harmonized and integrated data file that meets FAIR standards to encourage discovery and use of the data. Second, we estimate the effects of economic disruption on the health of underserved workers, the role of the expanded safety net in buffering workers against harmful consequences of these shocks, and how these dynamics varied for older workers. Third, we examine the predictors of adherence to coronavirus mitigation practices. Uniquely, we incorporate firm and establishment- level predictors of risk environments and policies alongside individual-level and regulatory predictors and examine how effects vary by age. In sum, we propose to harmonize, link, and disseminate innovative and timely large-scale data for a population subgroup that is underserved and vulnerable to COVID-19 shocks and in a setting of considerable relevance for public health, and to generate rigorous evidence on job displacement and health and on multi-level predictors of adherence to mitigation practices in the workplace across the life course.