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Undocumented Status as a Social Determinant of Occupational
Safety and Health: The Workers’ Perspective
Michael A. Flynn, MA1,*, Donald E. Eggerth, PhD1, and C. Jeffrey Jacobson Jr, PhD2,3
1National Institute for Occupational Safety and Health, Education and Information Division,
Cincinnati, Ohio
2Department of Anthropology, University of Cincinnati, Cincinnati, Ohio
3Department of Family and Community Medicine, University of Cincinnati, Cincinnati, Ohio
Abstract
Background—Undocumented immigration to the United States has grown dramatically over the
past 25 years. This study explores undocumented status as a social determinant of occupational
health by examining its perceived consequences on workplace safety of Latino immigrants.
Methods—Guided by the Theory of Work Adjustment, qualitative analysis was conducted on
transcripts from focus groups and individual interviews conducted with a convenience sample of
Latino immigrant workers.
Results—Participants reported that unauthorized status negatively impacted their safety at work
and resulted in a degree of alienation that exceeded the specific proscriptions of the law.
Participants overwhelming used a strategy of disengagement to cope with the challenges they face
as undocumented immigrants.
Conclusion—This study describes the complex web of consequences resulting from
undocumented status and its impact on occupational health. This study presents a framework
connecting the daily work experiences of immigrants, the coping strategy of disengagement, and
efforts to minimize the impact of structural violence.
Keywords
occupational safety and health; immigrant workers; social determinates of health; undocumented
status; structural violence; disengagement; latino health; theory of work adjustment; coping
strategies
INTRODUCTION
The World Health Organization [2014] defines the social determinants of health as “the
conditions in which people are born, grow, live, work, and age. . . These circumstances are
shaped by the distribution of money, power, and resources at global, national, and local
*Correspondence to: Michael A. Flynn, CDC/NIOSH, 4676 Columbia Pkwy, M/S C-10, Cincinnati, OH 45226. mflynn@cdc.gov.
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the
National Institute for Occupational Safety and Health or the University of Cincinnati.
HHS Public Access
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Published in final edited form as:
Am J Ind Med. 2015 November ; 58(11): 1127–1137. doi:10.1002/ajim.22531.
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levels, which are themselves influenced by policy choices. . .”. In short, how societies
arrange themselves affects who gets sick or injured, who receives treatment, who is healthy,
and who is not. When these social arrangements contribute to differences in health among
specific groups of people (gender, ethnic, racial, class) they are often referred to as health
inequities (Centers for Disease Control and Prevention [CDC], 2011). These inequities can
be seen as the physical manifestation or embodiment [Csordas, 1990] of social policies that
contribute to them. Galtung [1969] and later Farmer [2004] refer to these inequitable social
arrangements and their negative physical and psychological effects as structural violence.
As Farmer et al. [2006, p. e449] write, “the term ‘structural violence’ is one way of
describing social arrangements [economic, political, legal, religious, and cultural] that put
individuals and populations in harm's way. They are structural because they are embedded in
the political and economic organization of our social world; they are violent because they
cause injury to people . . .” The adverse impacts on health of social policies is often
unintended, and frequently indirect—but are no less real to those on the receiving end. This
paper examines the work experiences of a group whose social status leaves them especially
vulnerable to the impacts of structural violence—unauthorized Latino immigrants.1
Although undocumented immigrants are a particularly vulnerable population, there is little
research investigating the ways in which an “illegal” immigration status impacts their health
[Castãneda, 2010]. Surveillance reports on workplace fatalities and access to health care
provide a partial glimpse of the vulnerabilities and conditions of the undocumented
[Heyman et al., 2009; Orrenius and Zavodny, 2009]. Studies among Latino immigrant
agricultural workers and day-laborers (who likely include the undocumented) describe poor
living and working conditions [Arcury and Quant, 1998; Buchanan, 2004]. However,
researchers have rarely focused on the role and meaning of undocumented status as it relates
to occupational health. Given the relationship between work and unauthorized immigration
and the occupational health disparities suffered by immigrant workers, it seems reasonable
to explore undocumented status as a potential social determinant of occupational health.
Demographic Growth and Geographic Dispersion of Undocumented Immigrants
Despite increasingly aggressive approaches at the federal, state, and local levels to reduce
unauthorized immigration [Coleman 2007; Johnson 2001], the undocumented immigrant
population in the United States tripled from an estimated 3.5 million in 1990 to almost 12
million in 2012 [Hoefer et al., 2009; Passel et al., 2013]. De Genova [2002] points out
that “illegal” or undocumented immigration is primarily a labor migration. Indeed,
undocumented immigrants have historically had high rates of workforce participation and
currently four of every five undocumented immigrants of working age is employed
[Passel and Cohn, 2011]. Immigrants concentrate in difficult, low-paying, and dangerous
jobs [Hudson, 2007; Orrenius and Zavodny, 2009] and are often preferred by employers
to their U.S.-born counterparts because they are considered more productive [Waldinger,
1997; Saucedo, 2006].
1For the purposes of this paper the terms undocumented, unauthorized and “illegal” will be used interchangeably to refer to immigrant
workers without work authorization. A detailed discussion of these terms is beyond the scope of this paper. For a detailed description
of these terms and their use please see [De Genova, 2002].
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In 2010, undocumented immigrant workers accounted for 5.2% of the total U.S. labor force,
up from 4.3% in 2003 [Passel and Cohn, 2009, 2011]. Latino immigrants are thought to
represent over 75% of the unauthorized worker population [Hoefer et al., 2009; Passel and
Cohn, 2009]. Traditionally concentrated in established settlement areas in the Southwest,
undocumented immigrants are increasing their national presence as their settlement patterns
become more dispersed. In 1990 over 85% of undocumented immigrants lived in just six
states with over 45% living in California alone. By 2004 these six states represented only
60% of the undocumented population with California accounting for less than 25% [Pew
Hispanic Center, 2005]. The saturation of low-wage workers in traditional settlement areas,
accompanied by job opportunities in the service, construction, and food processing
industries has resulted in the undocumented Latino immigrants settling in areas of the
country such as the Midwest and South that have not traditionally been immigrant
destinations [Striffler, 2007; Fry, 2008]. The Pew Hispanic Center [2005] has referred to the
cities of the Midwest and the Southeast experiencing explosive growth in their Latino
population as “new settlement” areas. Compared to immigrants in “old settlement” areas,
immigrants in the new settlement areas face additional challenges related to the lack of an
established Latino community. These challenges include the lack of a Spanish-speaking
infrastructure and community service agencies unprepared to cope with the sudden influx
and myriad needs of Latino immigrants.
Occupational Health and Immigrants
Research indicates that foreign-born Latinos (both documented and undocumented)
experience a disproportionate burden of fatal work-related injuries in the United States:
immigrant workers accounted for 67% of work-related deaths among Latinos from 2003 to
2006, up from 52% in 1992 [CDC, 2008]. In the construction industry, foreign-born Latinos
were fatally injured at 2–3 times the rate of U.S.-born workers doing the same jobs [Dong
and Platner, 2004]. While there are no data on the documentation status of workplace
fatalities, the simultaneous growth in the undocumented population and the workplace
fatalities for Latino immigrant workers has led many to suggest that undocumented status
contributes to this disparity [Pransky et al., 2002; Brunette, 2004; McCauley, 2005;
O'Connor et al., 2005; Ahonen et al., 2007; Orrenius and Zavodny, 2009; Schenker, 2010].
Any move beyond a simple cataloging of the hazards and poor conditions faced by Latino
immigrants would benefit from a theoretical framework. Unfortunately, as Blustein [2006]
has pointed out, most models of work behavior were developed for use with individuals
having a college education and for whom basic survival is more or less a given, thereby
allowing them to pursue the satisfaction of self-actualization needs through work. Blustein
challenged researchers to validate the applicability of such models when used with
populations having very limited options. One model that has successfully met this challenge
is the Theory of Work Adjustment [TWA; Dawis and Lofquist, 1984]. TWA views work as
an interactive and reciprocal process between the individual and the work environment. In
simplest terms, individuals may be viewed as fulfilling the labor requirements of the work
environment, in exchange for which the work environment provides reinforcers that satisfy a
wide range of financial, social, and psychological needs for the individual.
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The twenty work reinforcer dimensions identified by TWA are so central to its application
that it is of critical importance to do demonstrate their relevance when applying it to a new
worker population. In an exploratory study, Eggerth and Flynn [2012] demonstrated that the
18 of the 20 work reinforcer dimensions of TWA could be clearly be identified in transcripts
of Latino immigrants asked to discuss their jobs. It was suggested that the failure of two
reinforcer dimensions to emerge (doing work congruent with one's moral values and
exercising creative approaches to work) was more likely due to the very low skill and
responsibility levels of the jobs typically held by these workers. It should be noted that of
the 18 reinforcers dimensions that did clearly emerge, a number were discussed in terms of
their absence in these jobs.
TWA [Dawis and Lofquist, 1984] proposes that when workers are dissatisfied with
important aspects of their jobs, these workers have two broad approaches to reducing the
discorrespondence between what they want and what the job actually offers. One approach
is to reducing discorrespondence is for workers to attempt to get the work environment to
change to better meet their requirements. TWA terms this approach as being active. The
other approach is for the workers to attempt to changes themselves, in terms of performance
and/or expectations, to better match what the job offers. TWA terms this approach as being
reactive.
Although not directly addressed by the studies, the findings of two investigations of the
work experiences of Latino immigrant workers [Eggerth et al., 2012; Eggerth and Flynn,
2012] suggest that overall Latino immigrants are more reactive than active in their work
adjustment styles and that regardless of the locus of initiation, these workers were the locus
of change.
Study Aims
In an effort to more directly explore the topics discussed above, the following hypotheses
were proposed:
Hypothesis 1—Documentation status would emerge as a major factor impacting the
occupational safety and health of Latino immigrant workers.
Hypothesis 2—Latino immigrant workers attempting to reduce discorrespondence with
their work environments will tend to use reactive coping strategies far more than active
strategies.
MATERIALS AND METHODS
We employed a combination of focus group and individual key-informant interviews with
Latino/a immigrant workers to explore their experiences and conceptions of occupational
risk, injury, and safety as workers both in the United States and in their countries of origin.
By combining group and individual interviews we intended to exploit the advantages
associated with both data collection methods: breadth and variation of perspectives in group
settings; and experiential focus, depth, and detail in individual interviews. By dividing
participant recruitment and data collection activities between Santa Fe, NM, and Cincinnati,
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OH we intended to capture variation based on the possibility that immigrants to
nontraditional or “new” settlement areas such as Cincinnati experience greater risk, injury,
or safety challenges than those moving to traditional settlement areas such as Santa Fe.
Participants and Procedure
Participants for sixteen focus groups (n=103), 8 each in Santa Fe (n=53) and Cincinnati
(n=50) and 10 individual interviews were recruited from the local Latino community using a
snowball sampling technique with the help of local, non-profit, immigrant organizations
well known to immigrants in their respective communities and thus capable of recruiting
respondents based on inclusion criteria (employed, 18 years or older) and other demographic
criteria we provided: gender, formal education, and time in the U.S. All interviews were
conducted in Spanish by experienced bilingual researchers. Focus groups were stratified by
gender and education level (6th grade and below; 7th–12th grade) to encourage maximum
participation and to capture possible differences in experiences and perceptions between
men and women and those with different levels of formal education. An equal number of
groups were conducted for each demographic category. The study was reviewed and
approved by the CDC Institutional Review Board.
Focus Groups
Participants completed a brief general demographic information form at the start of the focus
groups. No personally identifiable information such as name, birth date, employer, nor
immigration or documentation status was collected. To further ensure anonymity, focus
group participants were assigned pseudonyms and asked to avoid use of personal identifiers
during the group interviews. Any inadvertent use of personal identifiers was subsequently
removed during transcription or during initial review of transcripts. Two bilingual,
experienced focus group facilitators, one male (third author), and one female, conducted the
group interviews of men and women, respectively.
The focus groups lasted approximately 1 1/2 hr and focused on participants’ work
experiences in the United States as well as in their countries of origin. Within a wider
methodological framework aimed at capturing a worker-centered understanding of
occupational risks, particular attention was paid to safety concerns at work, injury events,
barriers to safety, and preferred coping or adjustment strategies. In order to avoid leading
respondents, potential barriers to occupational safety and health (OSH: such as language and
documentation status) were not suggested by the facilitators. Rather, participants were asked
to discuss their experience with OSH and identify the barriers they felt were pertinent. When
barriers such as documentation status were mentioned by participants, interviewers
conducted follow-up probes.
Following each group or individual interview, participants were paid $50 and given a list of
local occupational safety and health resources. Audio recordings were transcribed verbatim
and were prepared for analysis. Upon completion of transcription and translation into
English, the recordings were destroyed to insure the confidentiality of the research
participants.
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Individual Interviews
Key informant interview participants (n=10) were recruited from a roster of individuals who
had signed up to participate in the focus groups. Prior to convening the focus group for
which the participant was originally recruited, and if numbers allowed for a viable focus
group, one participant was selected at random and asked to instead take part in an individual
interview which addressed—in greater depth—many of the same topics covered in the focus
groups. Similar in duration to the focus groups, these interviews typically took place
simultaneously in a private space adjacent to the focus group setting. Participants were paid
the same compensation for their time and given the same list of local occupational safety
and health resources provided in focus groups. No participant refused the offer to be
interviewed separately. Individual interviews were conducted in Spanish by the same
bilingual individual (first author) and were audio recorded for later transcription. Upon
completion of transcription and translation into English, the recordings were destroyed.
Data Analysis
Qualitative analysis for this study involved a combination and sequence of document
formatting and indexing, question and theory driven coding, and grounded, worker-category
based coding activities. In a preliminary formatting step, we labeled and coded all focus
group and individual interview transcript content broadly and comprehensively in terms of
the distinct sections and transitions reflected in the interview format. To facilitate this and
later steps, we used a qualitative data management software program (QSR NVIVO 8)
which allowed us to code, search and have easy access to the full transcript database. These
activities formed an initial database and basis on which more focused and in-depth content
and thematic coding activities were conducted.
Subsequent analytic steps for this report (and others) were shaped and guided primarily by
our initial research questions on immigrant worker safety and addressed through iterative
individual- and group-coding activities and meetings. They were also guided by emergent,
or worker based categories findings that surfaced during descriptive coding. Worker
immigration or documentation status emerged as a significant theme in each of 16 focus
groups and 10 individual interviews, despite unplanned and unsolicited as a topic of
discussion. Given its significance and pervasiveness in response to queries about immigrant
safety and health on the job, the perceived role played by documentation status became a
central analytic focus.
Thus we undertook a more focused examination of the transcript database to identify the
language of, and whether and how documentation status was captured or coded alongside
other topics (e.g., injury reports, access to medical care, fear of being fired). This led to
additional coding or re-coding of some content, after which we created a set of
comprehensive “documentation status” coding reports. During the analysis and discussion of
this material, we referenced the theory of work adjustment (TWA)—particularly the work
adjustment strategies—as a template or framework for presenting and understanding the
findings.
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RESULTS
Participant Demographics
Of the 113 respondents, the majority (54%) were Mexican, followed by Guatemalans (36%),
Peruvians (9%), and Nicaraguans (1%). Roughly half were male (n=53) and half female
(n=50). The ages of the participants ranged from 18 to 69 years with a mean of 31. The
mean salary was $9.48 per hour and 89% of all respondents reported speaking little to no
English. Roughly half the participants (52%) emigrated from an urban area and the other
half (48%) from a rural area. The mean education level for those completing 6th grade or
less was 4.7 years, 5 respondents never attended school. The mean educational level for
those completing more than a 6th grade education was 11.8 with a range of 8–18 years of
formal education. Participants worked in the service (65%), manufacturing/packing (25%),
or construction (9%, men only) industries. The only demographic difference that emerged
between the two data collection sites reflected differences in local economies. In Cincinnati,
only 13 participants were employed in the service sector, while in Santa Fe, an area heavily
dependent upon tourism, 30 participants were employed in the service sector.
Thematic Findings
Our application of the Theory of Work Adjustment (TWA) as a conceptual template for
analyzing the meaning and perceived consequences of documentation status emphasizes the
sub-domain of work adjustment strategies over work environments. For immigrant Latino
workers, the latter have been and continue to be well characterized in terms of conditions
and status as “3D jobs”: demeaning, dirty, and dangerous [Connell, 1993].
Work adjustment strategies—The work adjustment strategies we identified correspond
to four cognitive-behavioral themes. The first, killing yourself to make a living, represents
the coping strategy initially adopted by most immigrants. The second theme, fear of
deportation and undocumented status, concerns how fear of detention and deportation
impacts a worker's behavior. The third theme, economic vulnerability, focuses on the
erosion of economic security resulting from a lack of documented status; and the final
theme, limited access to institutional resources concerns the barriers to taking advantage of
existing resources and protections.
Killing yourself to make a living—Newly arrived immigrants reported feeling
significant pressure to find a job in order to pay off debt to smugglers, maintain themselves,
and contribute to the economic well-being of family members left behind. Many relied on
relatives or friends to help them find work, but mentioned that finding steady employment is
often difficult. The elusiveness of the first job, combined with the pressures to start earning
money, can influence the work experience from the beginning. As one participant put it,
“When I got my first job, I really needed it. I was tired of knocking on doors. When
someone gave me the opportunity I said, ‘I'm not going to let this go.’ I did the best
I could to make a good impression on my boss. That's where the abuse originates.”
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The tendency of recent undocumented immigrants to over-perform was perceived as
contributing to an unsustainable pace at work resulting in fatigue and injury. Another
participant reflected on her experience:
“I used to think that they [managers] were wringing everything out of me, but it
was my fault. As time goes on you just can't keep up that kind of a pace. But it is
because you have let them get used to you doing the work of 3 or 4 people.”
Over time workers reported feeling trapped by their accelerated productivity. One
participant discussed his experience as one of the first immigrant employees at a factory in
Cincinnati:
“When I started working there I was the only Latino out of 15 on the line. I would
work very hard and the [U.S.-born workers] would come to me and tell me to slow
down and not kill myself. But we are used to hard work and are not lazy like they
are. So I didn't listen and kept working as I know how. Little by little the boss
began replacing the [U.S.-born workers] with immigrants. Now there are only 10
on the line, all immigrants, but we have to produce more than before. It has been
several years now and I get tired and sore at work. It is harder to keep up but I
know that if I don't, the boss will replace me with some other immigrant. Now that
I think about it, maybe the [U.S.-born workers] had it right all along.”
Respondents typically considered themselves better workers than their U.S.-born co-
workers. Over time some respondents, like the one above, reported realizing that their initial
negative appraisal was inaccurate and indeed, the advice of their co-workers represented a
necessary survival strategy given the physical demands of the job. This insight usually
occurred after they had been on the job long enough to realize that the pace of work was
unsustainable. Unfortunately, by this time, the American-born workers had all been replaced
with immigrants and there was little chance of returning to the earlier, more sustainable
pace.
Fear of deportation and undocumented status—Some participants suggested that
they do not complain about unsafe situations or injuries at work out of fear that the employer
will report them to the authorities resulting in deportation. As one respondent recounted,
“I did what the boss told me to do and did not complain because I was afraid that
he would call the police, afraid that I might get deported, that's why I didn't speak
up.”
Fear of problems with authorities can also impact a supervisor's decisions regarding
workplace safety. According to one respondent,
“A coworker of mine was pregnant and injured herself lifting a heavy bag. She
began bleeding but kept working. She bled a lot but the supervisor did not call the
ambulance because he was afraid that ICE [Immigration and Customs
Enforcement] would come. She lost the baby.”
Many participants reported that fear of deportation is a constant concern that permeates their
lives. However, only a few reported being afraid that complaining at work would directly
result in deportation. It was far more common for participants to report that they accept
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dangerous situations and incur workplace injuries for other reasons related to their
undocumented status, rather than just deportation.
Economic vulnerability—The fear of losing one's job forces many workers, both
immigrants and native born alike, to accept unsatisfactory and unsafe working conditions.
One respondent recounted being cautioned by a coworker when she told him she was going
to confront their boss for continually yelling at her:
“You have to put up with it, that's just the way it is, there's nothing you can do.’
But I would say, I don't have to put up with it; but in the end I did because I had to
keep my job.”
Respondents perceived that the consequences of losing one's job are accentuated by a lack of
legal status. They reported that recent increased enforcement of immigration law has
prompted many employers to verify an applicant's immigration status before they are hired,
making it more and more difficult for undocumented workers to find employment. One
participant described these changes:
“With the immigration problems that are going on now, you can't find a job just
anywhere. Before, they wanted to fill the position and get the work done. They
didn't care if they [the papers] were good or not. But not now, they have someone
checking the papers.”
As it becomes harder to find a job without working papers and government-issued IDs,
participants reported they were becoming less likely to complain about dangerous conditions
at work for fear of being fired. According to the respondents, one of the most common ways
they protect themselves from dangerous working conditions is to get another job. However,
many respondents felt that this coping strategy is no longer available to them because of
increased scrutiny by employers, mandated by federal and local laws.
The lack of a safety net is keenly felt by participants. Without legal status in the United
States, workers knew that they were not entitled to unemployment insurance or other
benefits from the government despite the fact that they pay taxes, including social security.
Respondents commonly perceive themselves as having fewer rights and protections than
their U.S. born counterparts, as suggested in this comment:
“I think Americans don't . . . feel the pressure; that is, if they get fired they can get
the same job back the next day because their status allows them. (Other respondent:
Yes, there are laws. They can just go for their [unemployment] check).”
Participants perceived that their undocumented status not only makes it more difficult to find
a job, but it excludes them from resources meant to protect workers who are between jobs or
looking to advance. This contributed to many participants feeling an even greater pressure to
over-perform and not complain.
Limited access to institutional resources—Undocumented status can limit
individuals from accessing institutional resources in several ways. Undocumented status
disqualifies individuals from an increasing number of governmental and non-governmental
resources, services and protections. In addition, participant's responses suggested that
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ineligibility for some resources is often mistaken as ineligibility for all rights and privileges
or leads to confusion as to what they are and are not entitled to. As one respondent put it,
“I haven't complained [about safety concerns at work]. We are scared of talking
and we don't know what our rights are here. Maybe if I say something, they might
send me back to México or I could lose my job. It's very problematic, and we don't
want any more problems.”
Even when undocumented workers are legally entitled to specific resources and willing to
access them, their undocumented status can create complications. One participant recounted
the difficulties undocumented workers can face when reporting an injury sustained at work:
“[Getting medical care after being injured at work] is also a problem because we
work with a different name [fake social security number] and when we come to the
hospital we use an identification card which has our real name on it. This name
doesn't match the name we use at work. So the [name on the] papers from the
hospital or worker's comp claim will not match with the [name on the] work papers
and it's a problem [because now the boss knows you are using a fake name] and so
it's often better to say I'll stay here [and not go for medical treatment].”
This example demonstrates how undocumented status adds a level of complication to
accessing systemic protections to which the individual is entitled. Respondents reported that
their lack of knowledge of the system led to uncertainty about how to behave in many
situations.
Legislative efforts targeting undocumented immigration at the local and state levels and
their uneven enforcement create increased variability in entitlements and consequences for
undocumented immigrants that can vary significantly from one jurisdiction to the next. For
example, in all but a handful of states, proof of legal residence is required to obtain a driver's
license and, by default, insurance. Many respondents felt that police, in certain local
jurisdictions, targeted Latinos for traffic violations because they assume they do not have a
driver's license or insurance. According to participants, these enforcement efforts varied
widely from one jurisdiction to another and a traffic stop that resulted in a warning in one
jurisdiction could result in the impounding of your car or even deportation in another.
Respondents reported that the different laws and level of enforcement from one jurisdiction
to another often complicated their efforts to understand and engage the system such as
Workers’ Compensation or the Occupational Safety and Health Administration protections.
A respondent who had spent 8 years in the United States explained that over time, and with
help, she was able better to manage the system:
“If I had known then what I know now, I would have come to [local non-profit
agency] and they would have helped me, because I was being treated badly and
didn't know how to defend myself. Many bad things happened to me, but over time
you learn to defend yourself, and now I don't let them treat me that way.”
While some undocumented respondents recounted instances of successfully accessing and
benefiting from systemic protections and resources, many others reported that the potential
for complications resulting from lack of legal status often led them to avoid institutions for
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fear it would create more problems than solutions. Reluctance to engage institutions
develops as a survival strategy which is reinforced by the economic vulnerability and fear of
deportation resulting from an undocumented status. This survival strategy, which we refer to
as “disengagement,” protects undocumented workers in some circumstances (i.e., not losing
a job for filing a worker's compensation claim) but can be detrimental in others. As a result
workers often reported adopting a submissive attitude toward authority figures at work as
described in the Killing yourself to make a living section above. “Disengagement” as a
response to structural exclusion and vulnerability caused by an undocumented status, is
discussed below.
DISCUSSION
As was previously mentioned, although discussion of documentation status was not solicited
by the facilitators, it was expected to emerge on its own as a major theme. Indeed,
participants volunteered so many comments related to the adverse impact of being
undocumented, that documentation status might be viewed as the context within which all
other study findings must be conceptualized. Therefore, Hypothesis 1 may be considered
confirmed.
One indicator of the pervasiveness of the impact of documentation status may be found in
the types of work adjustment strategies identified in this paper. The TWA [Dawis and
Lofquist, 1984] proposes that an individual may address problems at work by either
attempting to change the work environment (active mode) or by attempting to change
themselves (reactive mode). All of the coping strategies shared by the participants were
reactive. Therefore, Hypothesis 2 may be considered confirmed.
Hesketh [1985] argued that understanding of the work adjustment process could be enriched
through considering two related constructs. In work environments, it is important to
recognize the source of the initiative for change—the worker or the employer. Hesketh
termed this the locus of initiation. The second related construct is who is being asked to
change—the worker or the employer. Hesketh termed this the locus of change. Whether it be
the overexertion of “killing yourself to make a living” or the various efforts to “fly under the
radar” involved with disengagement, the participants believed that it was incumbent upon
themselves to maximize the rewards and to minimize the punishments related to working in
the United States. Attempts to change the structure of the workplace were reported
infrequently and were initiated only by participants who had received considerable support
from a community-based advocacy group. Stated in Hesketh's terms, regardless of the locus
of initiation, the locus of change will almost always be the Latino immigrant workers. This
has significant impact on understanding the emergence of disengagement as a major coping
strategy. Lewin [1977] famously conceptualized behavior (B) as arising from an interaction
between the person (P) interacting with the environment (E), sometimes expressed quasi-
mathematically as B=f (P×E). Given that the onus of adjusting to circumstances is almost
inevitably placed upon the immigrant workers, an obvious way to reduce the level of
behavioral demands is to reduce the number of interactions with the environment. Therefore,
in addition to referencing the adverse affective impact the disenfranchisement and
disillusion of the immigrants experience living in the United States, in simple mathematical
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terms, disengagement represents a way to minimize the impact of structural violence by
minimizing the number of interactions with societal structures.
Clearly, the ability to stay and work in the United States is fundamental to the livelihood of
undocumented workers, and detention and deportation are pervasive concerns. However, the
data suggest that political and legislative efforts to restrict undocumented immigration can
create a complex network of legal and social consequences (e.g., reduced mobility,
increased economic insecurity, etc.), beyond deportation, that leaves respondents feeling
trapped in their current jobs. For example, we heard reports of how intensified enforcement
has led to increased scrutiny of employment eligibility by employers which, in turn, has
made it more difficult for undocumented workers to find another job if they are fired or quit.
As a result they reported being more hesitant to complain about unsafe working conditions.
These findings expand on Nuñez and Heymans's [2007] concept of “multiple whammies”
which suggests that undocumented status adds additional and unique obstacles to traditional
barriers to safety and health (e.g., no right to work and not having financial resources). The
data presented here suggest that undocumented status not only adds additional barriers to
safety and health but that it also interacts with and exacerbates traditional barriers to
workplace safety (e.g., increased financial insecurity because undocumented status
eliminates eligibility for unemployment insurance) that are common to all workers. In
another example, reports of adopting an accelerated pace at work echo Gomberg-Muñoz's
[2010] concept of “willingness to work” as a cultural adaptation which allows
undocumented immigrants to gain a competitive advantage in the labor market.
Outcompeting local workers to the extent that entire workplaces are staffed solely by Latino
immigrants not only increases the physical danger of the job but leaves them even more
socially and politically isolated.
The confusing patchwork of local legislation and enforcement were mentioned as
contributing to the perception that basic labor protections were either legally or practically
beyond the participants’ reach. Respondents routinely reported not seeking services they
were legally entitled to, such as workers’ compensation or emergency medical care. These
findings suggest that an undocumented status can not only present a direct threat to an
individual's physical and psychological health but also conditions participants to perceive
additional barriers and accept a position of vulnerability, resulting in a degree of alienation
and marginalization that exceeds the specific proscriptions of the law. It is not difficult to
imagine how this tacit social positioning and vulnerability might be collectivized as a central
cultural orientation toward institutions and authorities. Perceived vulnerability translates into
a general distrust of all institutions and a de facto coping strategy we are calling
disengagement. This strategy of disengagement is not dissimilar to the mistrust and
underutilization of institutions that has developed in other marginalized communities, for
example African Americans and the health care system [Jupka et al., 2008; Hammond,
2010].
While strategic disengagement can be an effective tactic for avoiding problems related to
undocumented status under some circumstances, indiscriminate use of this strategy prevents
undocumented workers from accessing resources to which they are entitled and may
contribute to the disparities in occupational health outcomes for immigrant workers.
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This study is limited by the fact that while the investigators were able to follow-up with
probes once the respondent mentioned immigration status they did not initiate conversation
on the topic. This limited the consistency of the data and also the ability to determine
whether or not theoretical saturation was reached. However, since documentation status was
mentioned in all of the interviews at one time or another, without interviewer suggestion,
this extensive data revalidates the importance of immigration status. Another limitation of
this study is that it was only conducted in two cities. Although a high degree of
correspondence was found between the responses of participants in the two sites used by this
study, it remains to be determined whether the same findings would have been found in
other urban settings or with immigrants living in smaller communities or rural settings.
Despite these limitations, it is clear that the participants perceived undocumented status to
play a significant role in determining the risks they face at work and limited their ability to
respond to those risks. This perceived relationship between undocumented status and the
pressure to accept dangerous working conditions shows how abstract structural
vulnerabilities materialize in the workplace. As such the findings in this study suggest that
occupational health inequity for undocumented workers can be understood as an example of
structural violence and that further investigation of undocumented status as a social
determinant of occupational health is warranted [Farmer, 2004]. These investigations would
not only inform our understanding of the current vulnerability that undocumented works
face, but could also inform policy so the current political efforts at immigration reform do
not perpetuate unintended but real vulnerabilities for immigrant workers; for example,
threatening their right to a safe workplace and contributing to the lowering of working
standards for citizen workers as well.
A fuller understanding of the impact of undocumented status on occupational health
disparities could be gained if data on immigration status were routinely collected by current
epidemiological surveillance efforts or as the result of new initiatives [Schenker, 2010]. The
impact of local legislation on OSH could also be explored by comparing industry specific
injury rates or worker's compensation claims across jurisdictions, including those actively
targeting undocumented immigrants and those with more lenient policies. Research could
also operationalize the various cultural, linguistic, and structural barriers to OSH and
examine the relative importance of each on the decision-making process and health status of
undocumented workers.
Gaining a better understanding of the psychological stress associated with undocumented
status and how to cope with it is an often overlooked but essential task in documenting and
improving the occupational health of this population. Operationalizing the psychological
stressors identified in this paper (e.g., fear of deportation, increased economic insecurity,
limited mobility), and examining their impact on the behavior and attitudes of individuals
would be an important next step. Exploring how undocumented status impacts work-life
issues (e.g., sustained separation from family or working in politically hostile environments)
would also be beneficial for understanding the psychological costs of adopting an “illegal”
status in order to work. In short, including immigration status as a key demographic variable
would provide a more complete understanding of workplace stress and the role immigration
status plays relative to other factors such as race and gender.
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The study findings have practical applications for those working to improve the
occupational safety of these workers. While the structural vulnerability resulting from
undocumented status is almost universally recognized as a barrier to safety, interventions
usually focus on addressing factors such as culturally tailoring interventions to more
effectively communicating safety knowledge or motivate workers to implement safety
procedures. An underlying assumption of these approaches is that the worker controls his or
her work environment and either does not know how or is not motivated to work in a safe
manner. While making OSH information materials accessible to immigrant workers and
finding ways to encourage safe behavior are essential to improving workplace safety, the
lack of structural analysis often transforms well-intentioned efforts to include cultural
understandings into an over-exaggeration of the worker's agency in perpetuating OSH
inequities [Farmer, 2004]. Research should not only include what workers “bring” in terms
of culture and safety dispositions but should also explore the additional, often pervasive
structural barriers associated with immigration status, poverty, race, and gender and how
they may be overcome or at least mitigated.
While structuralist approaches ultimately suggest the need for longer-term social, political,
and legal changes, they are not incompatible with more short term, applied efforts targeting
workers. Structural change is slow. Workers need the tools to recognize and minimize, if not
overcome, barriers while simultaneously empowering them to advocate for removal of these
barriers [Weinstock and Slatin, 2012]. Identifying structural barriers, understanding the daily
consequences for and coping strategies of workers, and developing interventions to increase
the ability of workers to minimize, if not eliminate, these barriers would be a direction for
future training intervention research. Investigations on increased message relevance by
acknowledging structural barriers or the effectiveness of providing workers with basic
interpersonal tools (e.g., negotiating skills or strategies for collective action) could be an
important step in addressing these barriers [O'Connor et al., 2014]. Likewise, interventions
that directly address the dynamic of disengagement, inform workers of their rights and
exclusions associated with undocumented status and provide them institutional support such
as legal counsel might better enable them to selectively engage the legal and healthcare
systems [Flynn et al., 2013]. Finally, developing an understanding of the complications and
unintended consequences that may arise as a result of complying with recommendations in
the intervention is essential. This is a particular challenge for national institutions as the
patchwork of local and state legislation makes it increasingly difficult to provide advice that
is applicable throughout the country.
CONCLUSION
The experiences recounted in this article provide poignant insight into the lived experience
of immigrant workers who adopt the status of “undocumented” or “illegal” as a condition of
their livelihood. They highlight how legislative and enforcement efforts to address
unauthorized immigration are perceived by these workers as placing them at increased risk
for workplace injury and illness. Furthering our understanding of the complex web of
consequences resulting from undocumented status and developing and testing strategies for
how workers can minimize or overcome the subsequent barriers is essential to addressing
the occupational health disparities for immigrant workers.
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Through using concepts from the Theory of Work Adjustment [Dawis and Lofquist, 1984;
Hesketh, 1985] this study has presented a framework that connects the daily work
experiences of Latino immigrants that lead to a strategy of disengagement from their host
society in an effort to minimize their experiences of structural violence [Farmer, 2004]. By
doing so, it is hoped that a foundation has been laid that will encourage others to see the
interconnectedness of macro-level social policies and understand how they are connect to
the micro-level lived experiences of immigrant workers. Such integration may eventually
lead to more effective, coordinated, multilevel interventions to alleviate the occupational and
health disparities suffered by undocumented immigrant workers.
Global and regional economic forces will continue to shape the ebb and flow of immigrants
to the United States. Regardless, for the millions who are among us, the data suggest that our
current legislative and enforcement approaches to undocumented immigration have resulted
in social arrangements that workers perceived as increasing their risk of occupational illness
and injury. If these perceptions are accurate, the analytical lens of structural violence
suggests that the resulting occupational health inequities are best understood as a physical
manifestation of these policies. Clearly, finding a way to meet labor demands of the global
economy while ensuring a worker's right to a safe workplace would go a long way in
addressing many of the barriers to occupational safety and health identified in this study.
Until this happens, we need to improve our understanding of these barriers and how their
impact can be mitigated.
ACKNOWLEDGMENTS
The authors would like to thank Emily Ahonen, Heide Castañeda, Pietra Check, Deogracia Cornelio, Ruben
Martinez, Martha Rees, Angela Stuesse and Antoinette Johnson for reviewing previous drafts of this paper. The
authors would also like to thank the community based organizations, Somos un Pueblo Unido in Santa Fe, NM and
the Coalition for the Dignity and Rights of Immigrants (CODEDI) in Cincinnati, OH who were central to the
success of this project.
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