Intersectional Perspectives to Health and Work in Later Life

Abstract:

There are more older workers who are women and people of color in the American workforce than ever before. Advances in technology and medicine have allowed older workers to remain in the workforce longer, even as older workers continue to be challenged with chronic illness, mental distress (e.g., anxiety and depression), and fallout from COVID-19. In this article we discuss how understanding the various and interconnected ways in which our social identities enable or constrain our lives—also called using an intersectional lens—will help promote long, healthy, and productive lives for everyone.

Key Words:

intersectionality, employment, volunteerism, caregiving, care work, racial and ethnic disparities, inequity, health, retirement

A Day in the Life of Ms. Sarah

Today is Ms. Sarah’s 69th birthday. Her coworkers at the grocery store where she has worked as a cashier since she was 22 gave her a small party in the breakroom with a white cake that had “Happy Birthday Ms. Sarah!” written in big red letters. After her morning shift, she raced to her grandson’s high school to pick him up. Ms. Sarah has cared for her grandson since he was 6, and his mother was incarcerated for drug possession. Ms. Sarah has to pick him up because he has been banned from the afternoon school bus for fighting. She knows her grandson is being bullied because of his ADHD and psychological therapy sessions at school, so she doesn’t mind spending a bit of extra time with him on their ride home through the city.

On the way home, Ms. Sarah stops at the local pharmacy to pick up blood thinners for Margaret, her common-law spouse of 15 years, who 6 months ago had a stroke. The medicine costs $35.33; $4 more than it did last month. Ms. Sarah panics at first as she only could scrounge up exact change when she left the house this morning. Then she remembers her coworkers gave her a $25 gift card as a birthday gift. She uses it to pay for the medicine and grabs her grandson’s favorite candy bar as a treat for having passed his math exam today. As she heads to the exit, passing the COVID-19 home tests, she says a little prayer of thankfulness that she has recovered from COVID-19 twice and had enough money to pay for Margaret’s medicine. Ms. Sarah then rushes out the door. She wants to be on time to relieve the home health aide of her shift and start dinner and Margaret’s evening care routine.

Ms. Sarah identities as a grandmother, spouse, cashier, caretaker, Black woman, lesbian, and COVID-19 survivor. These seven characteristics could be those of seven different people or just one. Though a fictional character developed for the purposes of this article, she is not unlike many of the older workers we have heard from in our research on older workers and caregivers across the years.

Ms. Sarah’s life demonstrates the diversity and complexities of everyday people in America who are seeking a healthy and productive life full of family, financial security, and affordable healthcare. When it comes to addressing health disparities for working older adults, how do we as policymakers, practitioners, researchers, and society ensure that we consider all aspects that make older workers who they are, so we can design policies, programs, and institutions that support human flourishing?

In the United States, older Black women are more likely to work in low-wage essential jobs that increase their chances of exposure to COVID-19, because they work in close daily contact with the public (Centers for Disease Control and Prevention [CDC], 2020). According to the CDC (2022), Black Americans were hospitalized from COVID-19 at 2.1 times the rate of White Americans.

People in low-wage jobs who are racialized minorities also typically lack access to quality healthcare (Ray et al., 2021), and even those with good jobs often cannot claim same-sex dependents on their company insurance policies (Gonzales, 2014). Finally, even as Black Americans have more chronic illnesses such as diabetes, hypertension, and arthritis, Black grandmothers are more likely to have primary custody of their grandchildren (Smith-Ruiz & Jason, 2021) than their White counterparts, as they manage their declining health.

Ms. Sarah’s life, like everyone’s, is shaped by cultural norms intersecting with her sex, relationship status, health status, job, income, and geographic location, among other factors. To understand her life, the choices she makes, and the opportunities and barriers she navigates, we must use an intersectional perspective or what is more commonly known as “intersectionality.”

Why Intersectionality, Now?

Intersectionality was introduced in the late 1980s by legal scholar Kimberlé Crenshaw (1989). It describes the overlapping and intersecting social identities (e.g., race, gender, education, ability, sexuality, gender identity, socioeconomic status) that often affect and inform how we navigate society. Some identities garner privilege and power, while others assign us to lives of oppression and marginalization. Crenshaw argues that individuals’ identities are not mutually exclusive and that we must look at their intersections to understand where inequities lie and to better inform solutions. The question is: how does intersectionality help us make sense in 2024 of health and work options as people age into later lives?

Social inequalities over the life course have always shaped later-life opportunities and outcomes in important ways. Since the COVID-19 pandemic began in early 2020, we have seen major changes in whether and how older adults engage with and experience paid employment, as well as other forms of unpaid labor, such as care work (which can include caregiving for dependent children or adults, as well as other domestic tasks like housework, food preparation, and emotional labor provided to families or kin; Perry-Jenkins & Gerstel, 2020; Xue & McMunn, 2021) and formal and informal helping within communities.

Simultaneously, we have seen shifts in our collective understanding of how structural factors and multiple sources of oppression (e.g., ageism, ableism, racism, and other “isms” based on marginalized social identities) intersect to constrain choice and opportunity over the life course to produce health and economic inequities. Research and discourse on paid and unpaid work in later life have not always captured (and have sometimes mischaracterized) the variety and complexity of lived experiences in later life—especially for low-income workers, workers of color, women, and others marginalized due to their social position (Matz & Brown, 2021).

Statistics often obscure how the most marginalized older workers are faring. Dominant narratives emphasize individual agency and choice, depicting “successful” or “productive” agers as those who make good choices to secure their health and well-being, employment security, and pension and welfare provision in later life. However, such approaches ignore the variety of socioeconomic, structural, historical, and cultural factors contributing to unfair workplace practices, lack of care structures, poor health, heightened stress, early retirement, and employment/retirement insecurity.

More research is necessary to gain a better understanding of the social contexts and environments that support choice and opportunity in later life when it comes to work, retirement, care work, and community engagement, especially in a post-COVID world. Here we challenge readers to apply an intersectional lens to better understand how multiple marginalized identities come together to cumulatively shape later life choices and opportunities and, ultimately shorten health- and life-spans.

The Evolution and Application of Intersectionality

When Crenshaw (1989) coined the term intersectionality, she did so to highlight the dual marginality of Black women and their lived experiences; thus, intersectionality is a Black feminist framework that centers Black women and explores racialized inequalities and their consequences of oppression as a result of race and gender. Although it was introduced in response to the exclusion of Black thought in social science and to center the experiences of Black women, it has since evolved into a generalized framework to understand the multiplicative, complex, compounding, and intersecting identities (e.g., race, class, gender) and discriminatory social structures (e.g., racism, classism, sexism) that shape the lives of all individuals, and has been used to explain the experiences and life outcomes of all populations (Crenshaw, 1991).

Intersectionality provides background and a framework for comprehending power and privilege and the linkages of numerous systems of exploitation and domination operating at the structural level, and acknowledges how oppressive systems are mutually dependent in their reinforcement of inequality (Collins & Bilge, 2020). Since its introduction nearly 40 years ago, intersectionality has gone from the obscure—being used exclusively by academics—to being a common term in pop culture. For instance, Ashton Applewhite, an anti-ageism activist and influencer and TED Talk speaker, uses her platform to include age and ageism in the conversation about intersectionality.

Unpacking Intersectionality in Health and Work in Later Life

The rapid growth of the older adult population has increasingly highlighted the importance of social and productive engagement in promoting the health and well-being of older adults. The productive aging paradigm considers both paid and unpaid forms of work, as it is important to acknowledge and understand other forms of labor in which older adults are often engaged, but that tend to come without a paycheck and to be undervalued. For instance, caregiving—whether for grandchildren or for an ill or disabled spouse or parent—as well as volunteerism and other forms of helping within communities. Learning and education in later life is also part of this picture, as education in many countries has tended to be designed and structured for younger adults, restricting pathways for midlife and older adults in important ways.

The global pandemic has only highlighted how vital or how harmful such engagement can be for health and well-being, depending upon the quality of the environments in these roles and how they complement or compete with one another. Further, socioeconomic, structural, historical, and cultural factors can affect access to and participation in such activities as well as the extent to which positive (or negative) outcomes are derived.

According to Wrigley-Field’s estimates in 2020, if we look at life expectancy by race, we see that the highest-ever Black life expectancy (in 2014) equaled White life expectancy levels from 1989. While this author’s figures show that Black life expectancy was also increasing during that time, there are some significant race-based gaps here. If we consider the intersection of race, gender, and social class, we see even more evidence that social inequalities over the life course shape later-life opportunities and outcomes in important ways. Olshansky and colleagues (2012) estimated that Black men with less than a high school education have a life expectancy that is about 20 years lower than the life expectancy of highly educated White women.

Crenshaw offers a simple analogy of an intersection as a frame. Let’s take Ms. Sarah. The roads to the intersection in this case would be the way that the workforce is structured by age and by race. Then the traffic on those roads would be the hiring policies and the other practices that travel on those roads. So, Ms. Sarah is positioned precisely where the age and race roads overlap, experiencing the simultaneous impact of the company’s age and race traffic.

Many of our institutions, polices, and practices are set up to address harms Ms. Sarah might experience on the age road or the race road, but what happens when you are experiencing both? What if there were a third road at play? A fourth? Often in these situations, what you find is that folks are being impacted by multiple forces and then abandoned to fend for themselves. Using an intersectional lens allows us to see and address such issues and sheds light on the structural factors that are responsible. Structural and institutional racism, ageism, poverty, and other forms of oppression deeply ingrained in institutions trickle down to affect individual outcomes.

Part of what applying an intersectional lens looks like in practice is not only identifying where inequities lie, but also giving voice to/centering those, much like Ms. Sarah, who are the most proximal to the inequity when proposing and implementing solutions. We want to elevate the experiences and lives of those who exist outside of socially constructed dominate spaces. For instance, women and people who identify as trans often are marginalized in male-dominated spaces. People of color often are marginalized in White-dominated spaces. People who have disabilities and sexual minorities often are marginalized in able-bodied and heterosexual spaces. In many mixed group settings, such as workplaces, people with dominate identity statuses often overlook the needs and perspectives of others. This is what makes intersectionality useful.

Call to Action for New Solutions and Approaches

All people should have the right to choice and opportunity when it comes to work/retirement, care work, community engagement, and learning across the life course, particularly later in life. It is through such roles and aspects of our identity that we derive a sense of meaning and purpose, which is critical to quality of life. We also know, however, that race, birthplace, social and economic class, and additional layers of being “othered” impact the choices and opportunities available. When multiple marginalized identities (e.g., being gay and Black, being working-class, etc.) intersect with ageism, untold numbers of constrained choices accumulate over a lifetime, driving increasing distance between the privileged and the marginalized on a variety of life outcomes—including health and life expectancy.

Now is the time to act on this front. Portraying the experiences of older adults holistically is important to advancing this area of scholarship and changing institutions, infrastructure, policies, and programs to support our aging population. What is most critical, though, is ensuring we approach this work with intentionality and purpose. We need to have representation on research teams, in workplaces (e.g., boards of directors, human resources, etc.), community settings (e.g., advisory boards), and in policy discussions of older workers across various identities. We need to ask, before we do a study, develop a program, or write a policy: which workers would benefit, who is represented, and who is left out? (See Morrow-Howell, Halvorsen, and Lee in this issue for more on work and older adults.)

We cannot address age inequities without looking deeply at other isms—such as racism, classism, and ableism. This has to be central to our work. One way to do this is to give voice to those who are nearest to inequity—and to listen to these voices when proposing and implementing solutions. This is our call to action.

In offering this call to action, we propose that readers consider new solutions and approaches in each of four action domains: work environments and employment policies, caregiving and other forms of care work, diverse opportunities to give back to others and to engage socially, and age-friendly educational institutions (Gonzales, et al., 2022; Morrow-Howell et al., 2018). These four domains represent several pathways to action that may serve to advance long, healthy, and productive lives for everyone. This, of course, is not a comprehensive road map of action domains that we might move toward, but instead serves to provide broad guideposts for action. It can compel us to first ask, what is the vision/goal here? Perhaps it is a world where:

• Work environments and employment policies enable all people (regardless of race, gender, socioeconomic status, disability, sexual orientation, gender identity, immigration status, etc.) to obtain and maintain good, quality work across the lifespan, to work longer if needed or desired, and to enjoy a comfortable retirement.
• Caregiving and other forms of care work are properly supported across the lifespan and in later life particularly, so that individuals and families have increased control and choice and reduced stress.
• Diverse opportunities exist across the lifespan for individuals to give back to others, to their communities, and to engage socially.
• Educational institutions are restructured to be accessible and inclusive so that individuals can develop new knowledge and skills across the life course (Gonzales et al., 2022; Morrow-Howell et al., 2018).

None of this is possible without first dismantling structural racism and other ingrained systems of inequity and interrogating the assumptions that shape access to choice and opportunity across the life course and in later life.

This call to action compels us to ask questions about inequities that exist, where they exist, and what is their root cause. It asks us to seek understanding from those who are closest to inequity, those who are at the intersection of multiple marginalized identities to inform solutions. It is only through such an intersectional lens that we will be able to identify where our institutions, infrastructures, policies and programs are inequitable and to elevate the experiences and lives of those who exist outside of socially constructed dominate spaces to advance long, healthy, and productive lives for everyone. Because if we can unearth the inequities and redesign institutions and systems to work for the most marginalized among us—those like Sarah, who live at the intersection of many marginalized identities—all of us will be better served.

Kendra Jason, PhD, is an associate professor in the Department of Sociology at the University of North Carolina at Charlotte. Christina Matz, PhD, is an associate professor at the Boston College School of Social Work, chairs the Older Adults & Families Department and directs the Spier Fellows in Aging program.

Photo credit: Shutterstock/Mangkorn Danggura

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