Dissertations and Theses

Date of Degree


Document Type


Degree Name

Doctor of Philosophy (Ph.D.)


Community Health and Social Sciences


Nicholas Freudenberg

Committee Members

Sherry Baron

Emma Tsui

Subject Categories

Community Health and Preventive Medicine | Mental and Social Health | Occupational Health and Industrial Hygiene | Public Health | Work, Economy and Organizations


social determinants of health, worker well-being, food labor, precarious employment, health disparities, qualitative methods


Much of the United States (US) food chain – from production to processing, wholesale, retail, and services – is characterized by precarious employment, defined as work with little employment security, inadequate income, and limited rights and protections. Studies show that precarious employment is associated with adverse mental and physical health and well-being outcomes. Separate research indicates numerous health issues in certain segments of the food workforce; little scholarly work has explored the contribution of precarious employment as an upstream driver of these health issues. Gaps remain in our understanding of 1) the health needs and status of workers across the entire food chain; 2) the mechanisms through which precarious employment influences food chain workers’ health and well-being, and how they navigate these processes, in a US context; and 3) which policies and employer practices, particularly from workers’ perspectives, might mitigate the harms of precarious employment. The global health and economic crisis caused by COVID-19 provided an opportunity to explore these topics when they were profoundly magnified.This multi-methods project aimed to address the three research gaps described above.

In collaboration with National Institute for Occupational Safety and Health researchers, we conducted binomial logistic regression of 2018-2019 data from the Behavioral Risk Factor Surveillance System (BRFSS) to quantify the association between food-related work and health outcomes, adjusting for relevant covariates (Aim 1). Food chain workers had higher odds of barriers to healthcare access (most notably in lack of health insurance, Odds Ratio (OR)=2.14), smoking (OR=1.5), poor self-reported health (OR=1.59), depressive disorder (OR=1.22), and several chronic health conditions than all other workers. Compared to non-food chain workers in the same sector, food workers in manufacturing, commercial services, and institutional services all had higher odds of barriers to healthcare access, smoking, lack of exercise, and poor self-reported health; institutional services workers had an added burden of higher odds of poor mental health (OR=1.57), obesity (OR=1.78), and hypertension (OR=2.15).

The qualitative arm of the project drew on in-depth interviews among 19 precariously employed, English- and Spanish-speaking food chain workers in New York City. I explored how workers experienced and navigated their precarious employment, the ways it influenced their well-being, and how this intersected with their perceptions of the social value of their labor, in light of the “essential worker” concept introduced during COVID-19 stay-at-home-orders (Aim 2). Precariously employed food workers coped with different manifestations of constrained power in their employment relationships, which had a range of negative influences on their well-being, including their quality of life, emotional states, mental well-being, and relationships. Workers had nuanced attitudes towards the value of their labor in society, but many expressed the idea that they felt their labor and they were invisible, marginal, or undervalued.

I also sought workers’ perspectives on what kinds of existing supports were most useful to them in mitigating the effects of precarious employment, and what changes they would like to see (Aim 3). Workers cited a mix of employer practices, features of “non-standard employment” (e.g., schedule flexibility), collective representation, and public supports (paid sick leave, public health insurance, and free or low-cost culinary training) as supportive of their well-being. Workers’ needs and desires included higher wages, better benefits (especially paid sick leave and health insurance) that do not rely on employment arrangement and immigration status, and better access to information on labor laws and social services. They also cited a demand for more voice as workers and more recognition of their humanity.

Taken together, the results strengthen the case for public health and food justice researchers to turn our attention to the well-being of food chain workers. People of color, women, and immigrants are overrepresented both in precarious employment and in food jobs, making this a health equity concern. On a theoretical level, focusing on work itself when studying and advocating around the health implications of precarious employment can provide an opening to more concrete critiques of labor market hierarchies and power structures that contribute to health inequities. To promote the health and well-being of precariously employed food workers, we should address immediate gaps both in wages and social benefits, i.e., by raising the minimum wage and adjusting it for inflation, increasing eligibility for and awareness of paid sick leave, and increasing enforceability of labor rights – holding employers accountable for these protections where feasible. However, there is a simultaneous need for policy approaches that decouple vital resources such as health insurance from employment to ensure social protection for all, and for transformative strategies that help shift the massive imbalance of power between workers and employers in the US.

Available for download on Thursday, April 24, 2025