“Equitable Growth in Conversation” is a recurring series where we talk with economists and other academics to help us better understand whether and how economic inequality affects economic growth and stability.

In this installment, Director of Labor Market Policy and economist Kate Bahn talks with sociologist Adia Harvey Wingfield, Mary Tileston Hemenway Professor of Arts & Sciences and associate dean for faculty development at Washington University in St. Louis. Her research examines how and why racial and gender inequality persists in professional occupations. She is the author of several books, most recently Flatlining: Race, Work, and Health Care in the New Economy.

In an in-depth conversation about her research and its implications for public policymaking, Bahn and Wingfield explore:

Kate Bahn: Thank you very much for taking the time to talk today. I think your work really illuminates important features and dynamics of the modern U.S. labor market. I’m looking forward to digging into your work some more.

Adia Wingfield: Thank you.

Bahn: Let’s start with a really big overarching question. Economists know that racial and gender inequality are some of the most persistent determinants of U.S. labor market outcomes. But your sociological research really zeroes in on specific occupations to understand how these disparities are perpetuated. So, why look at occupations specifically as opposed to other factors that researchers believe influence labor market outcomes, such as educational attainment or other features of human capital?

Wingfield: That’s a great question. I’m interested in occupations for a couple of reasons. One, I wanted to understand the types of experiences that underrepresented minority professionals, usually black workers, have in the workplace. Racial and gender inequality certainly help shape what labor market outcomes look like, but it’s important to understand and have data about what’s actually going on day to day and in the regular experience that black professionals who are in these types of settings have. Because that gives researchers a lot more insights into how workplaces and organizations may, in many cases unwittingly, be structured in ways that are not necessarily conducive to the success of black employees. I think that that’s not information that we really get unless we are able to understand what actually is happening on the ground, on a regular, day-to-day, routine basis for many workers in certain occupations.

The other reason I like to look at occupations and professions has to do with my interest in understanding how occupations themselves are, as we would say in sociology, socially constructed in some ways. There’s a theory in sociology that many occupations are not necessarily these neutral spaces that we like to think of, but rather structured by ideas about gender and, perhaps somewhat more implicitly, ideas about race. So, for example, if you think about a nurse, often the immediate image that comes to mind is of a woman, maybe more frequently a white woman. This isn’t because white women are better at nursing or more skilled or capable at being nurses. But it does mean that with this idea so predominantly in place, in many cases people who don’t fit that criteria have certain challenges that come with the difficulty of meeting the unspoken expectations many people have about who should be in nursing.

When I look at occupations, it gives me a way to focus on the disjuncture between the expectations people have about the profession that I’m studying and who should be in that profession, and what that means when people who don’t fit that expectation are actually doing the work in that type of profession.

Bahn: Your research covers a lot of ground, but you mentioned that you look in particular at the healthcare industry, which is composed of typically higher-paid occupations, although not entirely, and also low-wage work such as the beauty industry. I’m curious what you’ve learned from your research about the intersections of race, gender, and occupational status. Are there commonalities in terms of how occupations are socially constructed between the experiences of workers in these different occupations? And what are the biggest differences, and what drives those differences?

Wingfield: That’s hard to answer quickly because I’ve learned so much and I feel like I learn something new from every project. The common factor across the board when it comes to race, gender, and class, I think, is that all of those things matter in shaping, again, both the expectations that go into a job and the outcomes for what comes out of it for different professions. So, I mentioned nurses, for example, in a previous answer. One of the reasons I wanted to focus on nurses in a previous research study was to get a look at how black men experience that profession, because it is so culturally feminized and implicitly racialized because society has the strong image of white women as being those who are most commonly nurses.

What I learned from that study was that intersections of race and gender create really unique outcomes for black men. They knew that they were in professions that were culturally feminized and predominantly white. What that meant was that, unlike many white men in the profession, they did not experience widespread support from many of their women colleagues. They didn’t experience the close relationships with white men in the profession that could lead to upward mobility. But, in contrast to white men in the profession as well, they didn’t really feel as uncomfortable with the femininity associated with nursing because instead they focused on the ways that working in the healthcare profession allowed them to offer strategies and initiatives that could help to improve conditions for minority communities.

In other words, they saw nursing as a stepping stone to reducing health disparities and giving back to black communities at large. And this is something that, again, comes from the intersections of race and gender in ways that play out in a rather unique fashion for black men in this profession.

That looks different from what I found for black workers in other professions. In my recent research on healthcare professions at large, I found that black women in medicine, who were working as doctors, had experiences where intersections of race and gender really created a sense of distance between them and many of their black male colleagues because they felt that gender mattered in such a way that they routinely weren’t seen as being doctors, which manifested in them being mistaken for nurses in ways that were a lot more common to what their white women counterparts experienced. So, for black women in medicine, there wasn’t the same sense of camaraderie with black men as there was for black women and men in other professions because of these intersections of race and gender.

I think that the common ground here is really that these intersecting factors matter across the board, regardless of what profession we are talking about. But how those intersections matter is going to vary depending on the profession and the circumstances and, in some cases, even the organizations to which we are referring.

Bahn: So, going back to how black men who are working as nurses saw their work as giving back to the community, a lot of your work focuses on service industries specifically, and you’ve thought about how diversity in these different service occupations impacts different marginalized communities. I’m curious how you think segregation or a lack of representation among those who are providing services affects the provision of those services? And what are the broader impacts of these phenomenon?

Wingfield: That’s one of the most interesting parts of some of my recent work. My most recent book is called Flatlining: Race, Work and Health Care in the New Economy. One of the things that I wanted to do with Flatlining was to look at how black workers experience professions that really are vocal about the importance of racial diversity but haven’t necessarily been able to translate that into specific gains. That is certainly is true for the physician world, where black doctors are only 5 percent of that population. And it’s true to a lesser extent with nursing, where black workers are only about 10 percent of registered nurses.

When you look at the gender breakdowns, those show even more stark disparities. Black men are 2 percent of doctors, a number that hasn’t really changed in almost 100 years. Black women are only 3 percent. When it comes to nursing, I believe black men are about 2 percent, and black women are about 8 percent of registered nurses. So, black men and women are underrepresented in both professions.

What that means for healthcare workers in both of those industries is that, to some degree, this creates the experiences that we might expect. There is a sense of isolation, a sense of not having the support of people in the profession who could kind of provide common ground or provide social support. But there are other ways that organizations can think about the implications of this lack of diversity for their bottom lines.

Bahn: Could you elaborate?

Wingfield: Sure. I’m thinking specifically of how I found that many black doctors and nurses were aware of how they were underrepresented and often were taking steps to try to both change not only that lack of diversity but also change organizations to make them more accessible for communities of color.

In my book, I talk about this process of doing equity work, and I argue that many black workers do this equity work of trying to make organizations more available to communities of color both as patients and as workers. And what this looks like varies depending upon the occupation they’re in. For doctors, they may do this by establishing informal mentoring networks. They may do this by establishing clinics and other outreaches that help to reduce racial health disparities. For nurses, this might look like working to be change agents for patients and trying to be a voice for patients if and when they see them being mistreated.

But what this means is that we have workers who are already underrepresented numerically who are doing these Herculean efforts of also trying to change organizations to make them more available and more accessible and more equitable for communities of color. But they are doing so as one or two individuals in a particular workplace setting. And when it comes to healthcare professionals, they are also doing so while they work bearing enormous loads. We know a lot about how doctors, routinely, can work way more than 40 hours a week. I think in many cases, 40 hours is the goal, or maybe not even the goal—it’s kind of a nice number, but it’s not really very realistic. So, workers who are already underrepresented in the profession are working enormously long hours, and by virtue of being underrepresented also are shouldering the burden of trying to change and improve the organizations where they work for communities of color.

In short, to put it very bluntly, it’s simply too much. And by not having more workers of color in these spaces and by not having organizations that can shoulder some of these burdens, what I ended up finding is that a lot of black employees experience burnout. They experience alienation, not just from other colleagues but also from the organizations where they work. They feel exploited, and it really does a disservice to the workers who are in these professions, but it also undermines the ability of organizations to meet their organizational goals of providing healthcare.

In my view, this is a different consequence and a different look at how this underrepresentation and this lack of diversity has real consequences. It’s not just about wanting to put these workers in an environment where they are not necessarily underrepresented or where they’re not necessarily one of the few. It’s also about the consequences of having them be in these spaces where they’re doing this added labor and they’re doing so in a way that’s actually detracting from the bigger organizational mission because there aren’t enough people to shoulder this work and because this work doesn’t get the institutional support that it deserves.

Bahn: That’s super interesting. So, the concept of equity work that you talk about, which you describe as a Herculean effort, makes me think about something you said earlier about these sorts of unwitting structures within workplaces. It may not be intentional of the employer or the workplace itself, but there are still these structures that they have to push against. Not to mix up my Greek references, but it’s sort of a Sisyphean task, that if you’re doing it as an individual or a small group of people within a workplace, you really can’t make a lot of headway without larger structural changes.

Wingfield: Exactly.

Bahn: So, my next question is sort of where are the solutions, then? Are there policies that the federal and state and local governments could take to improve working conditions for African Americans in different occupations, in different service industries? Are there broad employer-based policies that could be promoted?

Wingfield: Sure. I think that there are both. One of the things that I always tell people when I’m talking about this work is that the biggest thing that stood out for me in Flatlining is that what I found were a lot of individuals trying to solve structural problems. And as a social scientist and a sociologist, that’s enormously frustrating because that’s such a mismatch. There’s no way that that happens.

Structural problems are structural because they are built into how social structures work and how they operate. And they filter into how organizations operate as well. And what I found were a few people scattered in different places, because they’re underrepresented, who were taking on this enormous burden of trying to make these organizations different. I think your metaphor of it being Sisyphean is really apt.

So, when it comes to solutions, the biggest thing that strikes me, and that struck me in doing this work, is that the pathway for solutions are there, and ironically, they have been laid by many of the black workers that I see doing this equity work. But the things that they are doing have to be adapted and structured by organizations, and they have to be buttressed and supported by government policy. When I look at black doctors, for example, who were doing this work of setting up these mentoring networks and trying to establish clinics and outreach and nonprofit organizations and things like that where they could focus on reducing racial health disparities, it strikes me, why are these not things that hospitals are doing? Why aren’t these things that major professional associations in medicine can aid in and offer resources to and really develop on a national scale, so that it doesn’t have to be so piecemeal and so informal? Those are things that organizations can do. And those are things that, I think, with the resources that they have, organizations can do, relatively easily to some degree, if they rethink some of the priorities that they may have.

When it comes to the adverse experiences that black workers have in healthcare, particularly in jobs that are lower down the ladder, I think specifically of technicians who recounted often terrible cases of verbal racist abuse from patients. Organizations can have policies in place that patients are not allowed to verbally abuse workers and that they will not be allowed to receive healthcare there if they explicitly use racist slurs and harass the people who are there, for their jobs, to provide care for them. These are things that organizations can do on a policy level.

Policy, alas, can also move away from this direction, which many economists and sociologists find has been going on for the past several decades. This shift has been much more away from supporting workers and workers’ rights, and more so in terms of the gains from workers’ labor and their productivity going mostly toward those who are the top 1 percent, so to speak.

What would happen if policymakers supported the rights of workers to unionize, for example, and made it easier instead of more difficult? What would happen if policymakers put into place policies that funneled resources and support for various communities to move into the healthcare industry? And these are things that have been done before in the past. These aren’t things that we’re necessarily doing now because policy initiatives and goals are different. What would happen if policymakers focused on these areas of providing paid leave to workers, of making sure that federal policy demanded that worker’s basic rights were respected? Again, these are things that policymakers could do, and these are things that are not happening.

I really believe that this bigger shift in moving toward a national policy agenda where workers of all ideologies and backgrounds—and in all sectors of the economy—receive more support, rather than the direction we’re going in now, where it’s much more likely to see workers who have the ability to be fired with or without cause, where workers can be required to work without having access to their hours or having set schedules in advance, which we know makes it more difficult for workers. All of these things are compounding the issues that I’ve been talking about in this book and in my research. I think shifting away from those would really make a major difference in creating more equitable grounds for the black workers that I talk about in my book.

Bahn: You’ve mentioned individuals trying to solve structural problems as very frustrating to sociologists, and then you talk about very concrete policy ideas that your work leads you to concluding. So, I want to get into that a little bit more, about the ways in which sociologists bring a different set of tools to study economic phenomena, and how this may impact the policy conclusions that one draws. Can you describe how you conduct research and the additional insight that this brings to understanding the role of racial and gender inequality in the U.S. labor market? I’m really curious about this as an economist. What is one insight from your research as a sociologist that you wish economists doing policy work would consider when they’re researching similar topics?

Wingfield: Well, not to shame my economist friends in any way, shape, or form, but I do think that one insight that we do have as sociologists is that we are, in my view and in my reading, more likely to likely to question and think about how structures and institutions that economists may take for granted are perhaps more socially constructed than many economists think.

Bahn: I think there should be a constructive critique of what economists are doing, and I think we should think a little bit more about how to do interdisciplinary work between economists and sociologists and other social researchers, so I’m happy for this because this is exactly what I want you to be doing.

Wingfield: Good. Good. Good. I think as sociologists, our training is such that our thinking is about how everything is constructed by shared social ideas to some degree. So, markets are there, and they certainly exist, but they don’t exist as infallible structures. They exist as things that are socially constructed by human beings. And if they are socially constructed by human beings, then there are ways that social construction can create outcomes and disparities along racial lines, along gender lines, among other lines that, I think, seem very evident and clear to many sociologists in ways that may be less so to some economists. And I think that some of that has to do with training and the acceptance of these questions about markets and economic outcomes as kind of self-evident phenomena.

In sociology, our thinking is always around how the things that we think are self-evident are perhaps less so. It’s important always to take a step back from things that we think we know, to try to consider empirically how those things came to be and what outcomes are present from those things being in place. And then to think about how those outcomes could potentially be changed or be different.

What are the consequences of this focus on markets, for example? What are the consequences of a focus on markets that prioritizes maximizing profits? And, to go back to some of the findings from my book, one of the things that I try to argue there is the shift that we’ve seen over the past several decades—this policy-oriented focus on markets and on profits and on shareholder value and on organizations being able to maximize their economic returns—has had sociological consequences, particularly for workers who are underrepresented and who are now starting to have more of a foothold in professional jobs, even as they’ve become more uncertain and a little bit more unstable.

So, I would just like to see economists and sociologists and more social scientists who study these outcomes engaged in more dialogue with each other. I think we get much more powerful data and much more comprehensive understanding working together. I know that there are things that sociologists can certainly learn from economists, but I’d also like to see economists be a little more open, in some cases, to our views about how studying society and studying social outcomes doesn’t only mean focusing on the economics of matters and market-based outcomes and solutions, but also how those market-based outcomes and solutions have consequences for various social groups and social institutions. Because those things are socially constructed in ways that lead to different outcomes for different groups. Maybe we could think about what those consequences are a little more critically, instead of just accepting them as outcomes.

Bahn: I agree.

Bahn: You note the ways in which communities of researchers and those who are doing research influence the outcomes or whatever our conclusions are. Historically, African Americans in particular have been underrepresented in research spaces. I know this has been a big problem in economics, which is finally drawing a little bit more attention recently. Can you talk about the importance of having research conducted by a diverse group of people, and what the implications would be if that was the case?

Wingfield: That’s a great question. One of the things that is interesting about sociology is that it does strike me as one of the more racial- and gender-diverse social sciences in many ways. The consequence of that is a wide array of people studying an enormous variety of different things. And a big part of how that comes to be is that people across the board in sociology bring aspects of their own experiences into the questions that they ask and the research that they study and the orientations that they have about a number of things.

So, by way of example, this semester I’m teaching a social theory class at Washington University in which we talk about the people who are considered the founding fathers of sociology, Karl Marx, Émile Durkheim, and Max Weber, when it comes to social theory in particular. But we also talk about how, even for theorists such as these, it’s important to think about how their viewpoints shape the things that they thought were important and necessary.

Marx was writing during the industrial revolution. It’s not an accident that he becomes so singularly focused on class and class dynamics. Durkheim came into his own during a time of enormous social upheaval and social change. It’s not coincidental, in my view, that he ends up focusing on how societies maintain social order when there’s enormous social change happening at the same time. And when we look at other social theorists who have been kind of understudied, say the great W.E.B. Du Bois, a black man born right after the Civil War who died on the eve of the civil rights movement, he experienced a time period of enormous racial difference, which had a lot to do with the things that mattered to him and which he wrote about.

I think you see that reflected in sociology very broadly because it is among the more race- and gender-diverse of the social sciences. I think there are other disciplines, including but not limited to economics, that need to have more breadth of diversity when it comes to the researchers who are asking these types of questions and asking what sorts of things bear study and bear focus. I really think that would only be good for a variety of research and studies and disciplines because you do get different perspectives and different views with a broad array of different viewpoints.

So, you mentioned economics and the lack of gender diversity in that profession. I thought about that, reading recently The New York Times story about how for a long time at economic conferences, interviews for jobs were conducted in hotel rooms. It seems to me that if there were a great deal of women in positions throughout economics, then it might have been obvious earlier why that could potentially be a misstep. And how that practice could potentially be a challenging situation for women interviewing for jobs.

That’s why a diversity of people in a various array of leadership roles but also throughout organizations and throughout standpoints are needed to be able to bring those diverse views to bear about why certain issues matter and what types of different questions might be useful to ask about various phenomena. And I think that when we have that in research, we get a much more comprehensive view of the broad variety of human experience and how we can better understand what that means in different settings.

Bahn: That was great. I think there’s still a lot of work to be done, but I’m happy that people are having the conversation more than I’ve seen.

Bahn: Thank you so much for the time. Are there any final points you want to make, before we close out, that we should keep in mind?

Wingfield: Yes. We are at a point where our society itself is becoming more diverse every day. It’s becoming more racially diverse. It’s becoming more diverse in terms of gender identity and they way that we think about and understand that concept. It’s becoming more diverse in terms of citizenship and nationality. We really do ourselves a disservice as a society if we are not prepared to move forward in a way that speaks to the broad experience and backgrounds that many people bring to a more multiracial and more multicultural U.S. society. I think we have not done successfully in the past and, to be quite frank, I don’t think any other modern developed nation has been able to do successfully.

So, it strikes me that in the United States, we have an opportunity here. We are on the cusp of change, so it is important to be able to think about what these changes mean for our society in a way that could allow us to maximize our human capital and our potential going forward. It’s really necessary that these types of questions are brought to bear and that we think more widely about what it means to be a society that isn’t going to be predominantly white indefinitely. And to think about what that means for our institutions, for our organizations, for our workplaces, for our healthcare facilities, for all of the institutions that are part of the United States.

It strikes me that the only way we move forward as a nation in a productive fashion is by making sure that all citizens are fully included in our society and our economy rather than remaining on this pathway that excludes large segments of the population. That doesn’t work when large segments of the population get even larger and become the majority of the population. It hasn’t worked to this point, and it certainly won’t work going forward.

Bahn: Great. Thank you so much, Adia.

Wingfield: You’re welcome. Thank you.