Work and community predictors of health
The social determinants of health (SDOH) model suggests that people’s health is impacted by personal factors, such as their genetics and health-related behaviors, but also factors external to the individual [
23,
24]. The medical care to which they have access and the quality of that care, the living conditions of their homes and broader communities, and economic factors, among others, all have the potential to impact people’s health and wellbeing collectively and synergistically. As some examples, the representation of Black primary care physicians in a county is associated with life expectancy among Black people in the US [
27]. In Taiwan, increased green space links with decreased risk of bipolar disorder and disability-adjusted life years [
28]. Further, air quality and water pollution negatively affect physical health, though these patterns can be offset when people have access to physical activity [
29].
Work is another social determinant that can affect people’s health [
30]. The Allostatic Load model helps explain the underlying mechanisms [
30,
31]. When encountering stressful situations at work, the body will have psychological (e.g., fear), physiological (e.g., cortisol), and psychosomatic (e.g., fatigue) responses. As the stress continues, people develop new setpoints, or what is known as the secondary Allostatic Load process. The new setpoint can affect people’s immune system (e.g., immunoglobulin levels), cardiovascular (e.g., resting blood pressure), and metabolic (e.g., cholesterol) responses. Over time, chronic stress can then negatively impact health outcomes, such as depression, diabetes, and all-cause mortality. These are considered tertiary Allostatic Load responses. Ganster and Rosen’s review of the literature pointed to strong support for primary outcomes, with some support for the effects of workplace stressors on secondary and tertiary outcomes, too [
30]. More recently, researchers have demonstrated the links among stress-inducing work experiences, such as incivility, discrimination, and mistreatment, and subsequent health outcomes, including poor physical and psychological wellbeing and unhealthy behaviors [
32‐
35].
Much of the work related to work- and community-related factors impacting people’s health has focused on the individual-level outcomes. However, when social determinants of health are pervasive and consistent within a given setting, it is possible that the factors would affect people in that setting similarly. In this case, the social determinants and the associated health outcomes take on a shared property. These possibilities are consistent with Hood et al.’s work focusing on county-level health in the US [
36]. They theorized and offered empirical support for the notion that economic and social factors could meaningfully contribute to the collective health among the county residents.
Consider the following examples that illustrate the link between work-related stressors and collective health outcomes. Incivility is commonly considered at the individual level and negatively affects people’s work and life outcomes [
37]. Smittick and colleagues, however, showed that these patterns can also take on a shared property among members of work groups, negatively affecting collective psychological outcomes [
38]. Beyond the organization focus, researchers have shown that county-level work-related indicators are predictive of county-level health outcomes. Goetz and colleagues, for example, showed that measures of social capital, education, and self-employment were linked with fewer poor mental health days among county residents in the US [
39]. Likewise, at the county-level of analysis in the US, a gender-wage gap is positively associated with domestic violence [
40]. This research suggests that, while work-related social determinants of health impact individuals, they can also take a shared property and impact the collective health of broader communities.
Current study
Building from this work, we examine the relationships among two work-related factors (sexual harassment and bias toward women at work) and women’s life expectancy at the state level. Consistent with the Allostatic Load model, these factors can negatively affect women’s physical, psychological, and social well-being and, thus, have the potential to reduce their life expectancy. We outline each of the relationships in the following space.
Sexual harassment represents “behavior that derogates, demeans, or humiliates an individual based on that individual’s sex” (Berdahl, 2007, p. 641). Researchers have commonly focused on three areas: unwanted sexual attention, sexual coercion, and gender harassment [
42,
43]. Though the former two are most evident to observers, gender harassment is more prevalent in practice, and paradoxically, organizational policies aimed at reducing sexual harassment are weakest in this area [
44]. Cortina and Areguin [
44] outlined several harmful effects of sexual harassment, including a decrease in job attitudes, increased work withdrawal, and poor job performance. Of particular relevance to the current study, the authors also showed how sexual harassment is related to poorer health, including lower levels of wellbeing, symptoms and posttraumatic stress, poor health behaviors, and increased stress.
Importantly, sexual harassment can also take on a shared property at the community and state levels, though research in this area is scarce [
45]. For example, King and colleagues examined sexual harassment in one state in the US (Idaho). They observed that 20% of people working in the state experienced some form of sexual or gender harassment, and the patterns remained stable over time [
46]. Further, Cortina and Wasti [
47] conducted a cross-cultural study and found that strategies for coping with sexual harassment varied among White Americans and people from Turkey. Their research suggests that ways people think about and respond to sexual harassment could be commonly understood among people in a given environment. Finally, O’Neal and colleagues [
45] commented on the potential public health benefits of addressing sexual harassment within a cultural context. They noted, “challenging complex issues such as male entitlement, rigid gender norms, and the subjugation and objectification of women that arise from patriarchal power structures is likely to benefit women’s health“ (p. 2588).
The theoretical and limited empirical work related to sexual harassment is consistent with related scholarship at the state level of analysis showing that harassment and mistreatment can negatively impact people’s health. For example, gender inequality in a state, as reflective in reproductive health rights, work participation, and empowerment among women, is related to both psychological and physical intimate partner violence in the state [
48]. Hatzenbuehler and colleagues found that immigrants living in states with restrictive policies, which potentially resulted in harassment and mistreatment, experienced poor health outcomes [
49].
Collectively, this scholarship suggests that sexual harassment is related negatively to physical, psychological, and social health outcomes, and that the patterns of sexual harassment can vary based on context. Given that poor psychological health and health behaviors are linked with premature death [
21,
22], we hypothesized the following:
Next, we consider state-level implicit biases related to women at work. Unlike explicit forms of bias, which are deliberate and consciously maintained [
50], implicit bias represents the automatic, unintentional associations people make with different targets [
51]. They are likely to manifest when there is congruence between a target (e.g., women in the workforce) and subsequent evaluations people have toward that target (e.g., good or bad) [
52]. People’s implicit biases activate automatically, though there is some evidence that people can predict their own biases with some accuracy [
53,
54].
Though scholars have historically considered implicit bias at the individual level, recent evidence points to the value of considering aggregate-level bias and its association with subsequent outcomes [
18]. From this perspective, although individuals will hold their own biases, people within a given social environment are also exposed to similar sets of cues, activities, and experiences. As such, biases have the potential to take on a shared property, and the collective biases in one community might vary from those in another. Further, relative to the experiences of an individual, environmental factors are stable, and thus, are likely to be better predictors of subsequent outcomes. Consistent with this view, researchers have shown that community-, state-, and country-level bias is predictive of a host of outcomes, including COVID-19 cases and deaths [
55], racial disparities in the use of police force [
56], patterns of school discipline [
57], girls’ science and math achievement [
58], and organization’s inclusion strategies [
59].
In the current study, we focused on implicit gender-career biases. These biases reflect a stronger connection between women and family than between women and careers outside the home. People across a host of contexts hold such biases, including college students in Korea [
60], surgeons around the world [
61], and parents in the Netherlands [
62], among others. This previous research has shown how gender-career implicit attitudes relate to women’s guilt associated with working outside the home [
62] and career decisions [
60]. Furthermore, a study of Indian journalists revealed that awareness of implicit biases reduced the incidence of gender-biased content [
63]. Relatedly, Teelken and colleagues showed how implicit gender biases helped perpetuate the social mobility and career outcomes that limit women professors [
64].
Collectively, this scholarship suggests that implicit gender-career biases relate to how women and men engage with their work and work outcomes for women. Further, implicit biases can take on a shared property at the community, state, or national levels. These associations give rise to the possibility that people in a given state might hold shared implicit gender-career biases, and that these biases might negatively impact women’s health and wellbeing. Thus, we hypothesized: