Advancing health justice with data
Emily Wright, PhD ’23, is shedding light on U.S. domestic workers’ health risks.
May 11, 2023—Emily Wright’s drive to use her research skills to advance health equity was sparked at a young age. Wright grew up in the beach town of Narragansett, Rhode Island, but briefly lived in Costa Rica with her family. There, she met a Nicaraguan woman whose husband was suffering from chronic kidney disease. Like many other men from his hometown, he was diagnosed at a very young age after years of work harvesting sugar cane by hand on an industrial farm.
Wright was inspired to seek answers about the population-level burden and determinants of this disease as a high school student and an undergraduate at Brown, including by volunteering with a Nicaraguan non-governmental organization focused on addressing chronic kidney disease and receiving a funded research fellowship to study how researchers were defining and investigating this emergent epidemic.
She planned to pursue her longstanding interest in chronic kidney disease and agricultural workers during her PhD program in Population Health Sciences at Harvard T.H. Chan School of Public Health; however, an early conversation with her advisor Nancy Krieger, professor of social epidemiology, persuaded her to consider additional options. “She encouraged me in my first year to look around and see what was out there in the world and learn new things without so much attachment to my dissertation,” Wright said. “And I now give that advice to everybody.”
Understanding domestic workers’ health
With this advice in mind, Wright learned more about another group of workers: domestic workers. People who are informally employed in these jobs, such as house cleaners, nannies, and home care aides, often lack workplace protections, leaving them vulnerable to abuse and health risks. Despite this, few studies have quantitatively analyzed the conditions domestic workers face on the job and how they impact workers’ health—a key step needed to further inform policy change. In fact, only one nationwide survey in the U.S., conducted in 2011-2012 by the National Domestic Workers Alliance (NDWA), the University of Illinois Chicago (UIC), and the DataCenter, has systematically assessed informally employed domestic workers’ working conditions. Wright saw these rich, innovative data as a key to addressing this knowledge gap.
As part of her dissertation, Wright used these survey data to investigate how informally employed domestic workers are exposed to patterns of physical, social, and wage-theft-related workplace hazards—rather than just singular hazards—and how these joint exposures may impact their health. She used a statistical model called “latent class analysis,” which identifies groups of individuals based on their patterns of responses to a set of questions.
Wright first-authored a paper published in June 2022 in the Annals of Work Exposures and Health that identified four latent classes or “types” of domestic work with particular patterns of workplace hazards. She named these types: low hazard domestic work, demanding care work, strenuous cleaning work, and hazardous domestic work. People in the demanding care work class, for example, had a moderate probability of exposure to pay violations, heavy lifting, working long hours with no breaks, and caring for someone with a contagious illness. A second paper published in October in the American Journal of Industrial Medicine looked at ways that workers’ patterns of exposure potentially lead to patterns in their health. This study found that, compared to domestic workers identified as doing low hazard domestic work, domestic workers doing demanding care work, strenuous cleaning work, and hazardous domestic work were at greater risk of experiencing work-related back injury and work-related illness, with domestic workers doing hazardous domestic work reporting the worst health.
Making science useful
From the beginning, Wright wanted her work to be useful to people involved with promoting domestic workers’ health. Using the survey data collected by NDWA, UIC, and the DataCenter was one step towards accomplishing this. Wright also collaborated and co-authored her 2022 papers with Paulina López González, economist-in-residence at NDWA Labs (the NDWA’s innovation arm), and Nik Theodore, professor of urban planning and policy at UIC.
Among many contributions, Wright said these collaborators helped her interpret her results and communicate them in ways that would be accessible and compelling to others. She initially packed the narrative sections of her papers with as much technical, methodological detail as possible and labeled her domestic worker classes with precise, yet “boring” descriptive names. Comments from co-authors and dissertation committee members encouraged her to provide a more accessible account of the rationale for her latent class analysis and to give her classes names that told a compelling, evidence-based story.
After presenting findings from her research to NDWA and NDWA Labs in the summer of 2022, their leaders have expressed interest in using Wright’s findings in a policy memo—an exciting development, she said. She added, “I have no illusions that the contributions I have made are anything more than a drop in the bucket relative to the work that they’ve been doing for decades.” But she said that she hopes her findings can help advance thinking around solutions.
Wright’s advisor Krieger praised her “rigorous, pathbreaking research,” in addition to her work as a teaching and research assistant, and “her commitment to ‘walking-the-talk’ for equity as evidenced by her leadership and teamwork helping to build and run the union for Harvard Chan School graduate students (Harvard Graduate Students Union-UAW).” She said, “In the midst of all the public health and political turmoil of these past few years, serving as Emily Wright’s advisor has been a vivid bright spot for me, buoying my spirits as I saw her grow in her skills and work to advance health justice.”
In September, Wright will begin a two-year postdoctoral fellowship at Harvard Chan School with Visiting Scientist Rita Hamad and the Social Policies for Health Equity Research (SPHERE) program. In this role, she will build on the expertise and methodological skills she gained in her PhD program and investigate the impacts of COVID-19-related county-level social and economic policies on health inequities. Wright also plans to pursue additional projects related to domestic workers’ health. She said that she’ll be leaving her PhD program with a trove of questions, ideas, and potential research projects to inform policy change and improve health equity in the workplace and beyond.
Photo: Kent Dayton
