Employment & Income
Employment plays a key role in shaping health, with factors like job security, work environment, pay, and job demands all having an impact.
Socioeconomic factors such as income, wealth, and education are fundamental to a wide range of health outcomes. Health-related behaviors, like diet and exercise, are also strongly influenced by social factors, including income, education, and employment.[1]
Here’s what you’ll learn:
How Economic Stability Impacts Olivia
Meet Beth—an 18-year-old barista working part-time while dreaming of a better future. Formerly unhoused, she now lives with her aunt. Despite her aunt’s encouragement to save 30% of her income, Olivia can’t afford living on her own. She hopes a career in welding will bring a stable income and independence.
Get to Know OliviaHow Economic Stability Impacts The Jackson Family
Meet Marcus—a devoted husband and father who loves playing basketball and watching cooking shows. Injured on the job, he hasn’t been able to work for months. With one child heading to college and a baby on the way, he is deeply concerned about his family’s financial future.
Get to Know The Jackson FamilyHow Economic Stability Impacts The Garcia Family
Meet Elena—a young mom and veteran juggling work, child care, and debt after the death of her partner. Elena is working with a VA case manager to find resources, affordable housing, and child care in her rural community.
Get to Know The Garcia FamilyHow Economic Stability Impacts Chris
Meet Chris—an underemployed substitute teacher and choir coach who dreams of becoming a full-time tenured professor. To make ends meet, he offers private piano lessons and relies on food pantries, all while carefully managing the public benefits he receives due to his visual disability.
Get to Know Chris
Terms to Know
ALICE stands for Asset-Limited, Income-Constrained, Employed and is a way to describe the unique struggles of households that earn above the federal poverty level but not enough to meet all their needs. These households might have challenges affording housing, nutritious food, transportation, child care, health care, and necessary technology.[1]
[1] Virginia Department of Social Services: Alice Households
Economic mobility refers to changes in a person’s economic status during a person’s working life (intragenerational) or across different generations (intergenerational). Intragenerational mobility is when a person’s economic status changes during their working years. Intergenerational mobility compares a person’s economic status to their parents’ status at a similar age.[1]
[1] Institute for Research on Poverty – Quarterly Leadership Memo April 2020
The federal poverty level is a guideline calculated by the U.S. Census Bureau and issued yearly by the U.S. Department of Health and Human Services.[1] Factors in determining the federal poverty level include family income, family size, and state.[2]
Food security is always having enough food to live an active, healthy life. Nutrition security is a step further and means having access to affordable, healthy food. Food insecurity is when people can’t access or afford the food they need.[1]
Socioeconomic status is a combination of income, educational attainment, and occupational prestige. It affects someone’s quality of life and their opportunities.[1]
[1] American Psychological Association: Socioeconomic status
Supported employment is a program where a job coach helps someone find a job that fits their skills and interests. The coach helps the job-seeker prepare for interviews and later offers support with on-the-job training.[1] Some people need additional support in the workplace in areas like breaking down work tasks into smaller steps, strategies for working well with co-workers, assistance following directions, and how to advocate for accommodations.
[1] Indiana Disability Rights: Support Paths to Competitive Integrated Employment.
Disparities in pay between two groups of people, particularly based on demographic differences, are known as a wage gap. For instance, women often earn less income, have less wealth, and face greater economic stability than men. This is true for women across most racial and ethnic groups when compared to men of the same race or ethnicity.[1]
[1] National Community Reinvestment Coalition: Racial Wealth Snapshot: Women, Men, and the Racial Wealth Divide
People are considered unemployed if they do not have a job, have actively looked for work in the previous four weeks, and are available for work.[1]
[1] U.S. Bureau of Labor Statistics: Labor Force Statistics from the Current Population Survey
Underemployment is when people have involuntary part-time employment, poverty-wage employment, or insecure and intermittent employment.[1]
Key
Facts
- Indiana’s unemployment rate for July 2024 was 4%. Some rural counties report double that level.
- Black Hoosiers have an unemployment rate of nearly 6%, and Hispanic Hoosiers have an unemployment rate of nearly 5%, compared to the state average of 3.7% and the national average of 4%.
- The unemployment rate for Hoosiers with a disability is 8%.
- In Indiana, women who work full-time earn 71.6 cents on the dollar compared to men who work full-time, year-round.
- Hoosier women will not see equal pay until 2082 if current trends continue.
- 7% of the Indiana workforce consists of immigrants.
Employment
Education and Access to Jobs
Education helps people get stable jobs with higher pay and better benefits. This leads to better health and builds important skills like problem-solving and self-control, which help people make smarter health decisions and the ability to manage stress. People with more education tend to have healthier lifestyles, which keeps them in good health for longer.[1]
[1] Committee on Improving the Health, Safety, and Well-Being of Young Adults; Board on Children, Youth, and Families; Institute of Medicine; National Research Council
Working Conditions and Job Quality
Work affects people’s health by exposing them to a range of physical, environmental, and social factors. These work exposures can impact health in many ways, such as breathing in dust, contact with toxins, or changes in the body’s hormones due to stress, which can lead to other health problems and mental health issues.[2]
Work environments can expose workers to injuries, chemicals, infections, and stress, which can lead to illness or even death. A person’s job or industry also influences their risk of developing chronic illnesses, infectious diseases, and mental health conditions.[3] Exposure to these hazards can affect a person’s productivity, quality of life, income, leisure time, and access to health insurance.
[2] The American behavioral scientist
[3] International journal of environmental research and public health
Gender and Racial Disparities
Black, Latine, and female workers often face different challenges when it comes to job quality, including lower wages and fewer benefits such as health insurance, life insurance, and paid leave. Nearly one-third of Black women work in low-paying jobs, a higher rate than any other race or gender group.[4] These disparities are influenced by factors like limited access to reliable transportation and affordable housing and job structures that make it harder to find stable, good-paying work.
The COVID-19 pandemic exposed the fragile state of employment and caregiving in the U.S. From February to April 2020, mothers’ employment dropped by 16% due to economic disruptions, school closures, and limited caregiving options.[5]
Maternal employment has mostly recovered, now 2% higher than before the pandemic, partly due to the rise in telework. In 2023, about 24% of mothers worked from home at least once in the prior week.
However, telework is not a solution for everyone. Jobs in service, health care, and education rarely offer remote work options. Telework is less available for mothers with lower education levels. Only 4% of mothers without a high school diploma reported teleworking, compared to over 34% of those with college degrees.
[4] Urban.org: Job Quality and Race and Gender Equity
[5] U.S. Department of Labor: Mothers’ employment has surpassed pre-pandemic levels, but the child care crisis persists
Health Coverage
Employment-based health plans cover two-thirds of nonelderly Americans and pay most of the health care expenses for working families. This accounts for about one-quarter of all national health spending.
In a recent survey, 73% of workers said their employer-provided insurance was a “very important” reason for taking or keeping their job.[6] Health coverage can greatly influence where someone chooses to work, and not having access to a job with health benefits can be challenging for many families.
Unemployment and Underemployment
Low-income job seekers in the U.S. often face many factors that make it hard to achieve economic independence. These barriers include:[7]
- Mental and physical health challenges
- Limited education, fewer skills, and not enough training opportunities
- Lack of affordable child care
- Limited access to good jobs, often resulting in lower pay, less job stability, and fewer chances for promotion
- Gaps in personal balance or soft skills, like communication and time management
Being unemployed for long periods is linked to higher rates of psychological disorders, depression, and anxiety. People receiving unemployment benefits are twice as likely to experience anxiety and depression compared to those who are working.[8]
Mental health issues related to unemployment often come from feeling useless, lacking mental or physical activity, and losing social status and self-esteem.[9] There is also a stigma attached to unemployment and needing government assistance or help from others.
The U.S. has seen a rise in suicide rates, substance abuse, and poorer physical and mental health, partly due to unemployment, underemployment, and poor job quality. These “deaths of despair” are linked to a lack of good jobs, skills, and opportunities, leading to increased hopelessness and health issues across groups like middle-aged white Americans, young adults, and African Americans.
While often seen as economic problems, unemployment and underemployment are also complex public health issues tied to various social factors that contribute to health inequities.[10]
Jobs with irregular or nonstandard hours are often linked to mental health struggles. About 20% of men and 12% of women work more than one job at the same time each year.[11] People with multiple jobs usually work more hours, which increases stress. This aligns with role strain theory, which suggests that juggling multiple roles daily causes fatigue and makes it harder to meet the demands of each role.
People with multiple jobs make up 10% of the U.S. workforce and are more likely to work over 50 hours per week.[12] This can negatively affect their sleep, both in quality and quantity. Working multiple jobs also means longer commute times, lower work performance, and a higher chance of workplace injuries.
[7] Social Development Issues: Centering on Structural and Individual Employment Barriers for Human-Social Development
[8] Milbank: Unemployment and Mental Health: An Important Opportunity for Cross-Sector Action
[9] American journal of public health
[10] International journal of environmental research and public health
Key
Facts
- A household income of $31,200 or below is the federal poverty level (FPL) for a family of four
- 13% of Indiana households earn below the federal poverty level
- 16% of children in Indiana live in poverty, with 8% in extreme poverty
- 27% of all Indiana households are considered ALICE households
- 32% of Americans reported being unable to afford a $400 unexpected expense
- One-third of children who grow up poor in the U.S. will also experience poverty as adults
Income
Financial Well-Being vs. Stability
Financial well-being means meeting immediate needs and feeling secure about one’s economic situation.[1] Financial stability is key to achieving this, requiring a plan for economic ups and downs and having savings for emergencies.[2] People who are financially stable tend to be healthier and happier, while financial stress can lead to anxiety and prevent access to healthy foods, medicines, and essentials.[3]
Changes in household dynamics and resources can negatively affect children’s well-being, leading to behavioral problems and poorer educational outcomes.[4] Unpredictable income, like job loss, makes it hard for families to plan for future needs when they are struggling to meet immediate ones.[5]
[1] NEFE: Core Concept – Financial well-being
[2] U.S. Federal Reserve: What is Financial Stability
[3] NYC.gov: Economic stability creates health
[4] Children and Youth Services Review
[5] Children and Youth Services Review
Poverty
Poverty is measured by a family or individual’s income and the poverty threshold. If a family’s total income is below this threshold, all members are living in poverty. Living in poverty makes it harder for families to get health insurance and access health care. People in poverty are at a higher risk for mental illness and chronic diseases and have shorter lifespans.
Children may face developmental delays, toxic stress, and poor nutrition, which can contribute to additional health problems as adults. People in the top 1% of income can expect to live 10 to 14 years longer than those in the bottom 1%.[6]
Intergenerational poverty happens when children who grow up in families below the poverty line remain poor as adults. Among U.S. children born around 1980, 34% who grew up in low-income households were still in low-income situations in their 30s.[7] This rate is even higher for Black children (37%) and Native American children (46%). Ongoing and past disparities, discrimination, and structural racism make it harder for Black and Native American families to achieve economic security for their children.
[6] Healthy People 2030: Poverty
[7] National Academies – New Report Identifies Policies to Reduce Intergenerational Poverty in the U.S
Unmet Needs
The biggest barrier to self-sufficiency for low-income individuals is often the “cliff effect.”[8] The cliff effect refers to the sudden and often unexpected decrease in public benefits that can occur with a small increase in earnings. Eligibility for work support programs like the Supplemental Nutrition Assistance Program (SNAP) and Child Care Development Fund (CCDF) are based on income, usually for those earning less than 200% of the federal poverty guidelines. As earnings increase, these benefits start to phase out. This can mean that even a small increase in income can make it harder for families to reach financial independence.
Many public assistance programs require recipients to work a certain number of hours to receive benefits but limit how much they can earn. A small increase in income can quickly make them ineligible, resulting in a big drop in total income and benefits.[9]
ALICE stands for Asset-Limited, Income-Constrained, Employed individuals. These are people who earn above the federal poverty line but still struggle to achieve financial stability and meet their basic needs. ALICE households make up 29% of all U.S. households and are disproportionately BIPOC.[10] The pandemic highlighted the importance of ALICE workers, who are essential to the economy. However, many ALICE households are not eligible for government benefits or are at risk of losing them due to the benefits cliff.
[8] Indiana Institute for Working Families: The Cliff Effect: One Step Forward, Two Steps Back
[9] NCSL: Introduction to Benefits Cliffs and Public Assistance Programs
Gender and Racial Disparities
Women often start their careers earning closer to what men earn, but they fall behind as they age and progress through their careers. This pay gap remains even though women are now more likely than men to have a college degree.[11]
Family responsibilities can also affect the types of jobs women and men choose, leading to gender differences in various occupations. Gender stereotypes, discrimination, and differences in pay are even greater when considering race and ethnicity.
[11] Pew Research Center: The Enduring Grip of the Gender Pay Gap
Key
Facts
- 12% of Hoosiers are food insecure
- 1 in 5 Hoosier children are at risk of hunger
- 30% of food-insecure children in Indiana are likely ineligible for federal nutrition programs
- 20% of adults aged 60+ report at least a minor problem in having enough to eat
Food Insecurity
In 2020, 29% of low-income households were food insecure, compared to the national average of 11%.[1] Black non-Hispanic households were over twice as likely to be food insecure compared to the national average.
Food insecurity can be either long-term or temporary and is influenced by factors like income, employment, race/ethnicity, and disability.[2] Unemployment can make it harder for households to buy enough food, and children with unemployed parents are more likely to face food insecurity. Adults with disabilities may also be at higher risk due to limited job opportunities and health care expenses that reduce the money available for food.
Food insecurity is a major stressor for families and has serious negative effects on children’s health and development. It can harm a child’s physical, social, cognitive, and behavioral growth.[3] Children facing food insecurity often have lower reading and math scores, struggle with working memory, and have more behavioral issues, like difficulty with self-control.
Food insecurity and lack of access to affordable, nutritious food are linked to higher risks of chronic conditions like diabetes, obesity, heart disease, and mental health disorders. Hunger is nationwide but is more common in rural areas. Nine out of 10 counties with the highest rates of food insecurity are rural.[4]
Many rural residents eligible for SNAP benefits do not receive them due to a lack of information or limited access to apply. People who are severely food insecure may run out of food and go without eating for a day or more.[5] When they do eat, it’s often the cheapest or most accessible options, which tend to be highly processed and lacking in nutrition. Low-income individuals are more likely to have poor-quality diets, while higher-income individuals tend to consume more fruits and vegetables.[6]
[1] Healthy People 2030: Food Insecurity
[2] Healthy People 2030: Food Insecurity
[3] International Journal of Environmental Research and Public Health
[5] International Journal of Environmental Research and Public Health
[6] Nutrition quality of food purchases varies by household income: the SHoPPER study
Key
Takeaways
- Access to education improves job stability, pay, and benefits, leading to better health and lower stress levels. However, disparities in job quality, wages, and benefits still affect many Black, Latine, and female workers.
- Many people who earn above the federal poverty line, such as ALICE households, still struggle with financial stability and may lose government benefits with even a small increase in income, making it difficult to achieve economic independence.
- Food insecurity affects 12% of Hoosiers and is more common in rural areas and among low-income, Black, and disabled populations. Food insecurity contributes to higher rates of chronic health conditions and negative impacts on children’s development.
Other
Economic Stability
Topics
Childcare
High-quality child care nurtures development, reduces stress, and fosters growth, providing a stable, supportive environment when parents are at work.
Housing Stability
Safe, affordable housing is a foundation for health. Stability in housing impacts well-being, especially for those facing trauma, poverty, or chronic challenges.
Child care: Without affordable, accessible child care, it’s difficult for parents to work full-time during typical work hours. Low-income mothers have a significant increase in participation in the workforce when they have greater child care subsidies.[1]
Housing: Increasing access to affordable housing is the most cost-effective way to reduce childhood poverty. It increases economic mobility, and children who moved to less-impoverished neighborhoods had a reduced likelihood of becoming single parents and saw their earnings increase by about 31% as adults.[2]
Poverty and disability: Households with an adult who has a disability that limits their ability to work need 28% more income to maintain the same standard of living as those without disabilities. These costs are even higher in low-income areas where basic needs like food and financial services are more expensive.[3]
[1] ASPE: The Effects of Child Care Subsidies on Maternal Labor Force Participation in the United States
[2] National Low Income Housing Coalition: Why do affordable homes matter?
[3] Enabling America: Assessing the Role of Rehabilitation Science and Engineering. Magnitude and Cost of Disability in America
Educational attainment: Earnings increase and unemployment decreases as educational attainment rises. Those with more education have higher earnings and lower rates of unemployment.[1]
Literacy: About 24% of unemployed people in the U.S. have low literacy, making it hard to find jobs that require reading skills. Low literacy reduces job opportunities and increases poverty rates. Many low-skill jobs are outsourced or replaced by technology, leaving many adults without work.[2]
[1] U.S. Bureau of Labor Statistics: Education matters
[2] Ballard brief: Illiteracy among adults in the United States
Overall health: Acute and chronic illness can lead to job loss and prevent wage gain.[1]
Health coverage: During the COVID-19 pandemic in the spring and summer of 2020, nearly 2.7 million people in the U.S. lost their health insurance due to losing employer-sponsored coverage.[2]
[1] United Healthcare: The Link Between Employment & Health
[2] Duke: New Study: Health Insurance Coverage Declined During the Pandemic
Neighborhood: A person’s neighborhood strongly affects their chances for upward mobility. Factors like parental income, education, school quality, and job opportunities all contribute to outcomes. People who live in high-opportunity neighborhoods have more economic resources and benefits, such as less time commuting and working multiple jobs and more time for parenting.[1]
Transportation: Not having a car can make it hard to find and keep a job, especially for low-income individuals. Low-income people are less likely to have a vehicle and must rely on public transit, ride services, biking, or walking Financial challenges and legal issues can make it hard for some to buy and drive a car with a valid license.[2]
[1] National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. Community Health and Economic Prosperity: Engaging Businesses as Stewards and Stakeholders—A Report of the Surgeon General [Internet]
[2] Federal Reserve Bank of Richmond: Transportation Access as a Barrier to Work
Race and gender: Minority status, being a single mother, and having low education levels increase the risk of food insecurity. Some people skip medical care to afford food, while others go without food to get necessary medical attention.
Disability: People with disabilities are less likely to have full-time jobs. They are over three times more likely to live below the federal poverty level and receive SNAP benefits and rental assistance.[1]
Criminal justice involvement: Employment is crucial for successful reentry into society after incarceration and reduces the chances of recidivism. However, formerly incarcerated people earn 11% less and work 12% fewer hours than those without a criminal record.[2]
LGBTQ+: LGBTQ+ adults face higher rates of food and economic insecurity. About 13% live in food-insecure households, and 37% had difficulty paying for household expenses in the past seven days, according to a survey.[3]
[1] Disability-Based Disparities among Noninstitutionalized Working-Age Adults in the US: Evidence from the 2018 National Health Interview Surveys
[2] New York State Department of Labor: Individuals Who Are Justice-Involved
[3] U.S. Census Bureau: LGBT Community Harder Hit by Economic Impact of Pandemic