Association for Public Policy Analysis & Management

Occupational status of workers influences levels of exposure to risk factors of hypertension. Past research has shown that exposure to job strain, characterized as high psychosocial job demand and low control over work activities, increases the risk of hypertension among workers. Job strain is more prevalent in low-status occupations (i.e., low earning and education requirements) than in high-status occupations. Low-status workers also face a higher threat of unemployment than high-status workers, putting them at a greater risk of
loss of income and insurance coverage. In the US labor market, a disproportionate number of low-status occupations are held by Black workers. This may contribute to the persistent racial disparity in hypertension. We assess the extent to which diversity policies (e.g., affirmative actions), which improve access to high-status occupations for Black workers, affect racial trends in hypertension using healthcare workers as a case study.

We develop a microsimulation that tracks employment dynamics and hypertension risk factors (e.g., smoking, physical activity, levels of job strain) among a cohort of Black and White workers and use these factors to predict their hypertension status over an 8-year period. Hypertension trends observed in the status-quo scenario where the Black and White workers’ occupational classes are determined by race-specific probabilities from the American Community Survey are compared to those observed in the scenario where all workers are selected into occupational classes based on non-discriminatory probabilities. The results of this study will inform policymakers about the impacts of diversity policies on health outcomes.