Health care workforce challenges require transformative thinking on equity, pay

Every day, the COVID-19 pandemic shows — in stark, heartbreaking detail — how health care workforce and equipment shortages create impossible life or death choices in health care settings across the country. The crisis demands a seismic shift in health care workforce development in the United States, coupled with a bold re-envisioning of workforce development policy, to improve job quality and equity. 

While health care employment is the largest source of jobs in the U.S., the quality of these jobs depends on the occupation. For example, nursing assistants make about $29,000 a year — or about $14.25 per hour — and often lack access to benefits, including health care and paid leave.  These jobs are physically and emotionally demanding, with often unpredictable work schedules. 

Black and Latinx workers are overrepresented in lower-wage, entry-level occupations and underrepresented in higher-wage occupations. Black health care workers bear a disproportionate share of COVID-19’s devastating impact. One-third of nearly 5 million direct care workers are Black and over a million are immigrants, largely from the Caribbean, Central America and Southeast Asia. Brookings found that Black and Latinx women are more likely than white men (45 and 54 percent, respectively) to be low wage workers and that low-wage workers of color are more likely to be trapped in these jobs.  

Investment to increase diversity in the health care workforce must address long term occupational segregation, and the highly racialized and gendered nature of care work. Yet some calls for shorter training for frontline health care workers correlate increased access to shorter training programs and diversification of the health care workforce in higher-wage occupations, failing to account for the structural conditions many people of color encounter.

Research shows that while some credentials do provide increased earnings overall, the majority do not provide significant wage increases, especially compared to programs that lead to a degree. And while many admit that skill training is not a panacea, false promises of worker retraining and job placement remain rampant in the education and training industry. Instead, we should invest in retraining tied to better job quality and equity-driven advancement.

Labor-management partnerships bring together worker organizations and multiple employers in a proven workforce development model that increases individual skill development and improves the quality of employment within an industry. These partnerships create economies of scale by ensuring employers don’t have to worry about competitors poaching well-trained workers.  For workers, quality training is free. In addition to skill development, workers expand career networks and build up work experience, supported with access to childcare, health care, paid leave, a safe workplace, and a voice on the job to raise concerns.

Now more than ever, this public health and economic crisis demand aggressive action.  We must re-envision workforce development to ensure a good job to any individual seeking employment and training. We must acknowledge the unequal burden women, people of color, and immigrants face in the labor market. Policy decisions must address occupational exclusions and persistent disparities limiting job quality and employment trajectories. We must:

• Affirm partnership strategies that explicitly improve job quality, including labor-management training and rewarding coordination with partner entities to develop innovative strategies such as portable benefit and wage board structures, targeted hiring and fair-chance policies;

• Rebalance power structures by requiring equal decision-making authority between workers, businesses and communities;

• Increase employment and training responsibilities so employers bear as much of an industry’s risk in hiring as the burden a worker takes on when participating in training and seeking subsequent employment; and

• Incentivize the use of data analytics to capture quality employment conditions and establish a dashboard of multiple indicators to measure job quality.

Collectively adopting these actionable goals to improve job quality will ensure the employment and training delivery system matches all workers to good jobs, increases equity, and helps build a cohesive understanding of how workforce development policy can fortify worker power.

All workers deserve to go back to jobs that were better than before the outbreak.  But without accounting for the legacy of structural bias that the recession has laid bare, scaling workforce dollars up wholesale to shorter-training programs will have profound unintended consequences on women, people of color and immigrants.

The pandemic has rendered clear the critical need for a well-trained health care workforce. Our lives depend on these essential workers. Millions of lives, our economy, and our future are in their hands.  In a moment where transformational policies are increasingly sought, and critically needed, we have an unprecedented opportunity to pursue a bolder policy vision to build a more moral and equitable society.

Daniel Bustillo is the executive director of the health care Career Advancement Program (H-CAP), a national organization of SEIU unions and health care employers partnering to develop quality health care career education models for high road jobs that increase equity in the health care workforce.

Livia Lam is a senior fellow and Director of Workforce Development Policy at the Center for American Progress, an independent nonpartisan policy institute in Washington, D.C.