Essential Workers are Essentially Unprotected
The authors of a new report on worker health data and surveillance during the pandemic reflect on what COVID-19 changed, and what it didn’t.
In their Data & Society report Essentially Unprotected: Health Data and Surveillance of Essential Workers During the COVID-19 Pandemic, Livia Garofalo, Amanda Lenhart, Ireti Akinrinade, and Joan Mukogosi draw on interviews with 50 workers in meat and food processing, grocery stores, warehouses and manufacturing to explore the tensions between health data privacy and worker safety. We spoke to the four authors about how they approached the project as a research team, their findings about how new health technologies impacted essential workplaces, and the assumptions their work confirmed or upended.
Read coverage of the report from STAT.
Workers already experienced a high level of precarity before the pandemic. What are some specific ways that situation enabled the challenges they faced in the workplace when COVID hit?
Joan Mukogosi: Black, Indigenous, Latinx and other people of color have been, and continue to be, overrepresented in essential work, a trend that reflects a systemic siloing of dangerous, low-wage labor in communities of color. Immigrants and migrants also make up a large part of the essential workforce and face weaker worker protections, limited access to healthcare, risk of wage theft, and the threat of deportation. Before COVID-19 hit, intersecting challenges like the physical effects of strenuous labor, poor or no health insurance, and lack of paid sick-leave all posed threats to essential workers’ health and safety. These pre-existing health disparities were exacerbated by the pandemic, resulting in disproportionately high infections and deaths among people of color and essential workers. Longstanding labor issues, like diminishing organizing power and the fight to raise the minimum wage, also complicated the integration of COVID health and safety measures. In workplaces where employees had strained relationships with managers or were prevented from or unable to organize, workers faced difficulties in getting accurate information about cases and protocols, and advocating for their safety.
COVID marked a moment when public health surveillance was introduced into the workplace. Apart from the specifics of how it played out during the pandemic, what are the implications of health surveillance, in particular, being a factor at work?
Livia Garofalo: The surveillance of worker health has long been part of the workplace in some industries, even before the pandemic — mandatory drug testing, for example. Even before COVID-19, meatpacking and poultry processing facilities had strict rules around contamination and control over workers’ bodies. In food industries, attention to health, safety, and hygiene was part and parcel of workers’ lives. What changed with COVID-19 is that the pathogen we were confronting was airborne and didn’t lend itself to a strict division between health at work and outside it. Workplaces and regulations were not really equipped to deal with that kind of scenario. But a lot of the dynamics of health surveillance (or lack thereof) during the pandemic just reflected and intensified broader kinds of surveillance that employers were enforcing before the outbreak.
At the heart of the report are some complicated tensions between health data privacy and worker safety. Regulations led companies to withhold information about the infection status of specific workers, which left colleagues without the information they needed to protect themselves. But they did so out of a desire to protect privacy. Are there ways employers can more effectively or responsibly walk that line?
Amanda Lenhart: One of the big takeaways from the report is that the most forthright employers were threading a needle between meeting their responsibilities to provide a safe and healthy workplace free from serious hazards, and meeting the ADA’s requirements to hold health data about employees strictly private. The result was that employers only gave workers the vaguest information about COVID-19’s presence at worksites. These major information voids left workers feeling deeply worried about their health and safety and the safety of their families. What helped? Workers at a handful of sites reported thorough and respectful contact tracing as key to making them feel like they were getting the information they needed, while also protecting their coworkers’ privacy. Other elements that helped create effective contact tracing practices were higher levels of trust and a more even balance of power between workers and employers. Workers felt better about the use of tech-based contact tracing tools when employers were transparent about what data they were collecting, and when they approached it with an attitude of data minimization — when they only collected data about the duration of contact between workers, but not location data, or data from outside the workplace, for example.
You talked to 50 workers across manufacturing, meatpacking, warehousing, and grocery stores. Were there overlaps or differences in their experiences that struck you?
Ireti Akinrinade: The greatest differences were the themes workers wanted to talk about. Grocery workers were the only workers who were expected to come into work and interact with an unspecified public. The highly transmissible virus, and its politicization, added a unique degree of distress and anxiety for workers: it meant they feared both contracting COVID-19, and physical violence from customers for enforcing health measures. In many conversations with workers from rural areas, as well as from Florida, Texas, and parts of Virginia, workers told us that store mask mandates were virtually nonexistent due to fears of ostracizing customers or prompting a hostile interaction. The need to appease both employees and customers was a challenge for employers, and many workers felt their company prioritized customer satisfaction over worker safety. Unlike grocery workers — many of whom did not wear masks, gloves, or hairnets prior to the pandemic — meatpacking and food processing workers were largely accustomed to personal protective equipment, so we rarely discussed opposition to new PPE or other occupational hazard reduction tools. But they explained that many of their work stations and work spaces were in extremely close proximity, and PPE did very little to mitigate personal risk. In these food-focused workplaces and others, there was virtually no monitoring of symptoms or infections, and when there was, it was often flawed, leaving workers feeling worried and unsafe.
Manufacturing workers, many of whom were male, white, and the highest paid participants in our study, — and who often had the most power to push back against their employer — were also the most informed about the technologies introduced into their workplace. Of the essential workers we talked to, only those in manufacturing facilities were armed with contract tracing badges. Their secure employment meant that employees could be transparent about their infection status without fearing a life-threatening loss of income or employment, and managers would alert workers who had prolonged exposure to a colleague with COVID-19. Some workers told us they felt positively about the technology’s ability to arm themselves with actionable information, though others recalled times where their contact tracing technologies were annoying or too sensitive, detecting proximity through walls, etc. And warehouse workers were the most likely to talk to us about intensive, data-focused surveillance of all kinds — a symptom of the prevalence of Amazon workers in our sample of warehouse workers.
In the face of major information gaps, you found that workers got creative and built their own solutions, often informal, ad-hoc, and or community-based. Tell us about how those emerged, and what some of them looked like.
Akinrinade: In workplaces where coworkers had close relationships, they gathered their own information about COVID-19 infections and identified ways to reduce their risk and build community trust. When feasible, they would pay attention to who was missing at work and talk with colleagues to share information and assess their own risk. Some worked to enforce group norms when leadership failed to enforce or support a culture of masking, and others found creative ways to reduce the anxiety and stress of their colleagues. In some workplaces, social distancing policies, along with monitoring and scheduling practices that predated COVID-19, limited people’s ability to feel connected with their coworkers. While informal, grassroots initiatives persist in the face of risk and vulnerability, some workplaces were better structured to allow familiarity and meaningful connection.
The period of time you examine was characterized by a very public collision of health and work issues. What did you observe in your research, and what can we all learn, about the connection between the two?
Garofalo: If we look at labor history, work and health have always been deeply intertwined. The fight for the 8 hour work day was intimately tied to the fight for other basic labor rights, like paid sick leave, worker compensation, and the demand for safe working conditions, especially in hazardous industries.
Occupational health is really a fundamental part of public health, because work is a very big part of how we’ve organized society. In the US, we have tied the ability to get healthcare to employment (which is quite unusual if we look at it from a global comparative lens). From a public health perspective, COVID has brought to the fore the importance of considering work as a site of health risks — infection, hazards, and injury — but has also highlighted the need and potential for making workplaces one of the primary sites to implement structural change. As the workers we interviewed told us, it was the lack of broad supportive policies like paid sick leave that made the experience of the pandemic more taxing to their health. It’s important to think about health not as just the absence of illness, but as a more comprehensive sense of physical and mental wellbeing.
At D&S many projects and researchers are reflecting on the ties between health and labor and how this relationship is shifting, in different kinds of workplaces and for different kinds of workers.
The report is centered on experiences during COVID, but there are much broader implications here when it comes to health and the workplace. What are the lessons we can carry forward?
Mukogosi: When we started this project, we thought we would see new health technologies impacting essential workplaces in a more disruptive way. Instead, we found that long-standing labor problems are still the most pressing problems for workers. Workers told us that beyond the need for more transparency about COVID-19 cases in the workplace, basic protections like paid sick leave, salary increases, and improved health benefits would make an impact in their lives. Although public attention and government protections for COVID-19 are coming to an end, the brief focus on occupational health and safety during the pandemic has contributed to a growing momentum for unionization and put pressure on lawmakers to do more than laud essential workers for their sacrifices. Regulatory changes geared towards providing workers with more power over their health information, and legislative changes to provide workers with greater safety, compensation, and respect, are key to ensuring that the lessons we learned during the pandemic will have a lasting impact.
This report was a collaboration between all members of the Health + Data team. How did you approach the project as a group?
Lenhart: This project was a massive undertaking, especially as we were and are still navigating what an exit from the COVID-19 pandemic looks like. All four authors, plus two additional interviewers were needed to conduct the 59 interviews. While we did divide up some of the work — logistics management, Spanish language interviewing and translating, literature review — it was truly a group effort to analyze the huge amount of data generated by all the interviews, the literature review and the background conversations we had that informed the design of the interviews, and write this report. Each of us brought our unique academic and personal backgrounds to the interpretation of the data, and that flowed into a division of different sections for the initial drafting of the report. One of the beauties of Data & Society is the way it brings together cross-disciplinary perspectives in its work, and this project was no exception.
What surprised you in this research?
Lenhart: We went into this project thinking we were going to see a tech-mediated expansion of the already relatively robust surveillance of essential workers around their health, and a further entrenching of imbalances between workers and employers. And while there certainly was data collected about the health workers, it was mostly pretty haphazard, and (with one major exception: Amazon) infrequently leveraged for other purposes. What we really found was a story of regulatory failures that left workers without access to information they needed, and ultimately also a story of worker resilience and creativity.
Garofalo: While I was aware of some of the challenges that essential workers were facing, I was struck by the true lack of protective policies in some sectors and the vulnerability of migrant workers, especially in meatpacking. Conducting the interviews with the Spanish-speaking workers really illuminated for me how immigration policies and practices are so deeply tied to how the United States has structured its labor market, who is benefitting from it, and who is losing out. Speaking to experts in federal agencies was also interesting in understanding how policy change happens, and how much of it relies on deep, patient and consistent work on the part of staff who are fighting often unseen bureaucratic battles. I appreciated that we were able to have such a range of perspectives at different scales in this project, to help us make sense of a very challenging time.
Akinrinade: This work was conducted remotely, by a distributed team of researchers: myself in Chicago, and my colleagues in Philadelphia, Washington, DC, and New York City. From the relative comfort of my own home, my experience of the pandemic was largely shaped by news and media coverage, numbers and graphs that depicted the danger outside. For the people we spoke to, whose exposure to the public was enduring, their assessment of risk or safety was immediately tied to their surroundings, based on the policies introduced and repealed in their workplace, the presence or absence of familiar faces at work, and other indications of just how bad it was at any moment. From the house it was easy to think back on COVID as starting in March 2020, when my school and workplace made a single concrete adjustment: going remote. But some workers identified a different moment when COVID hit in their immediate environment: late 2020, early 2021. In 2022, still working remotely, when we asked people about the pandemic, they referred to a period of time that had long passed, as masking mandates had been repealed and the signs or COVID-19 had either faded into the background or disappeared entirely. While I wouldn’t say that these differences in lived experience surprised me, I found it interesting how the temporality of the pandemic could be so different from person to person, from region to region, state to state, town to town, yet similar among the people closest in my network.
Mukogosi: In the early months of the outbreak, people who worked from home or entered strict quarantine struggled with social isolation. While essential workers were interacting with coworkers and customers in person, I was surprised to see that many of them had not had the opportunity to talk in detail about the specific challenges they were facing at work. Since the pandemic began, essential workers haven’t had a break or a moment to reflect on what they are experiencing. I feel very grateful to have been able to offer a space for them to unload, and in each interview, I was in awe of the breadth of expertise that each and every worker possesses. To me, this quasi-therapeutic aspect to interviews is a sign that providing more emotional support for workers should accompany the provision of greater worker protections and compensation.
