The inverse hazard law: Blood pressure, sexual harassment, racial discrimination, workplace abuse and occupational exposures in US low-income black, white and Latino workers

• Published in: Social science & medicine (1982) 2008-12, Vol.67 (12), p.1970-1981
• Main Authors: Krieger, Nancy, Chen, Jarvis T., Waterman, Pamela D., Hartman, Cathy, Stoddard, Anne M., Quinn, Margaret M., Sorensen, Glorian, Barbeau, Elizabeth M.
• Format: Article
• Language: English
• Subjects: Abuse; Adult; African Americans; Biological and medical sciences; Blood pressure; Blood Pressure - physiology; Blood pressure Health inequities Occupational health Racial discrimination Sexual harassment Workplace abuse USA; Comparative studies; Discrimination; European Continental Ancestry Group; Female; Health; Health inequality; Health inequities; Hispanic Americans; Humans; Low income; Male; Medical sciences; Middle Aged; Miscellaneous; Occupational Exposure; Occupational hazards; Occupational health; Occupational medicine; Occupational Safety and Health; Poverty; Prejudice; Public health. Hygiene; Public health. Hygiene-occupational medicine; Race; Racial discrimination; Sexual harassment; Sexual Harassment - ethnology; Sexual Harassment - psychology; Social Factors; Socioeconomic status; U.S.A; United States; USA; White people; Work place; Workplace - psychology; Workplace abuse; Workplace violence; Workplaces
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2008.09.039

Research on societal determinants of health suggests the existence of an “inverse hazard law,” which we define as: “The accumulation of health hazards tends to vary inversely with the power and resources of the populations affected.” Yet, little empirical research has systematically investigated this topic, including in relation to workplace exposures. We accordingly designed the United for Health study (Greater Boston Area, Massachusetts, 2003–2004) to investigate the joint distribution and health implications of workplace occupational hazards (dust, fumes, chemical, noise, ergonomic strain) and social hazards (racial discrimination, sexual harassment, workplace abuse). Focusing on blood pressure as our health outcome, we found that among the 1202 low-income multi-racial/ethnic working class participants in our cohort – of whom 40% lived below the US poverty line – 79% reported exposure to at least one social hazard and 82% to at least one high-exposure occupational hazard. Only sexual harassment, the least common social hazard, was associated with elevated systolic blood pressure (SBP) among the women workers. By contrast, no statistically significant associations were detectable between the other additional highly prevalent social and occupational hazards and SBP; we did, however, find suggestive evidence of an association between SBP and response to unfair treatment, implying that in a context of high exposure, differential susceptibility to the exposure matters. These results interestingly contrast to our prior findings for this same cohort, in which we found associations between self-reported experiences of racial discrimination and two other health outcomes: psychological distress and cigarette smoking. Likely explanations for these contrasting findings include: (a) the differential etiologic periods and pathways involving somatic health, mental health, and health behaviors, and (b) the high prevalence of adverse exposures, limiting the ability to detect significant associations. As clarified by the “inverse hazard law,” to understand health inequities, research is needed that contrasts exposures and health status population-wide, not just among those most inequitably exposed.