Occupational Segregation of Black Women Workers in Health Care

Addressing occupational segregation—and centering Black women workers in these efforts—is crucial to building a good-jobs economy where all workers have equal opportunities, living wages, robust benefits, and a voice in shaping the conditions of their work.¹

Occupational segregation reflects the systemic racism and sexism embedded in the U.S. labor market that systematically confines Black women workers to essential but undervalued, underpaid roles with poor working conditions.²

These disparities are particularly evident in the health care industry, where nearly a quarter of Black women workers in the U.S. are employed.³

The health care industry encompasses a wide range of services provided across diverse settings, including hospitals, clinics and doctor’s offices, nursing and residential care facilities, outpatient care centers, and private homes. Health care is the largest and fasting-growing employment sector in the U.S.,⁴ playing a critical role in the health of the overall economy while heavily relying on Black women’s labor to deliver essential services.

Although Black women have long been the backbone of this vital workforce, they have persistently been faced with unsustainably low wages, inadequate benefits, and unsafe working conditions. The industry’s reliance on Black women for undervalued work—particularly in home care—is rooted in the enduring legacy of slavery and white supremacy in the U.S. economy and discriminatory labor policies.⁵

As the health care industry expands and demand for home care rises with an aging population,⁶ improving job quality and desegregating opportunities in health care can play a pivotal part in combatting occupational segregation, improving Black women workers’ economic conditions, and supporting families and communities.

When Black women working in health care are well-paid, treated with dignity, and have safe working conditions and opportunities for career growth, everyone benefits.

This data brief presents findings from an analysis of recent American Community Survey data, continuing NELP’s examination of occupational segregation of Black women workers by focusing specifically on Black women workers in the health care industry. We also provide recommendations for comprehensive policy reforms and transformative solutions to desegregate opportunity and promote the collective economic mobility of Black women working in health care.

Methods

To understand the extent to which Black women are concentrated in certain health care occupations while being excluded from others,⁷ we classified occupations within the health care industry into one of four levels of representation based on the proportion of Black women in the health care occupation relative to their overall representation in the labor force (6.6 percent):

1. Underrepresented: Black women make up less than 5.3 percent of all workers in the occupation.
2. Proportionally represented: Black women make up 5.3-7.85 percent of all workers in the occupation.
3. Overrepresented: Black women make up 7.9-13.1 percent of all workers in the occupation.
4. Highly overrepresented: Black women make up 13.2 percent or more of all workers in the occupation.

Key Findings

• Black women workers are highly overrepresented in health care. Black women make up about 13% of the health care workforce, roughly double their representation in the overall workforce (6.6%).
• Among all industries, health care has one of the highest rates of occupational segregation of Black women workers. A staggering 92% of Black women working in health care work in jobs where they are highly overrepresented or overrepresented.
• Almost a third of Black women working in health care hold essential but undervalued home care jobs, which often come with low pay, inadequate benefits, unsafe working conditions, fewer protections, and frequent labor violations.
• Black women workers are concentrated in lower-paying health care jobs, significantly depressing their wages. Over 42% of Black women working in health care occupations where they are highly overrepresented earn low wages, and they make nearly $20 less per hour in these jobs than in occupations where they are underrepresented.
• Black women workers in health care experience severe wage gaps. On average, they make just 58.6 cents for every dollar paid to white men and 74 cents to the dollar paid to white women. These gaps are even wider in the South, and wage disparities persist across all levels of occupational representation and education.
• Occupational segregation affects Black women working in health care across all levels of educational attainment. Over 91% of Black women with a bachelor’s degree and more than 72% of Black women with a graduate degree work in health care occupations where they are overrepresented or highly overrepresented.