The most important healthcare workers in this country—entry-level workers who do the caregiving and provide preventive services—are often paid poverty-level wages and provided insufficient benefits and supports, said panelists at a Fresno event in the statewide Zócalo Public Square series, “What Is a Good Job Now?”

As a result, the panelists said, there aren’t enough such workers. So, improving health care should start with improving caregiving and other entry-level health care jobs—with higher wages, better benefits like paid leave and health insurance, and career pathways that allow nurse assistants, for example, to become registered nurses.

“A lot of jobs are invisible in our health care system, even though they are very important,” said University of Minnesota health policy and management scholar Janette Dill, who studies the public health workforce. What undervalued jobs like home health care aides or nursing assistants have in common is that most of the workers are women of color, or immigrant women, she added.

“It really speaks to the fact that women’s labor is undervalued in our society,” Dill said.

The event, presented in partnership with the James Irvine Foundation and focused on healthcare, was moderated by Cresencio Rodriguez-Delgado, news director of KVPR (Valley Public Radio). It took place at the Fresno Center, a multi-faceted community service space on the south side of Fresno.

He began by asking panelist Helda Pinzón-Perez, a Fresno State public health professor with expertise in the health issues of rural areas and vulnerable populations, to define the problem with health care jobs.

Pinzón-Perez answered that California and the country badly need more health workers for three reasons. Our aging population needs more care. Rural and underserved communities lack providers. And we all need more preventive care, and caregiving and health education.

But we can’t get more health workers if we’re not willing to make those jobs more appealing to workers.

Asked by Rodriguez-Delgado about what her Fresno State students who are going to health want from their jobs, Pinzón-Perez emphasized that they have many desires and expectations. Among them are competitive salaries, the chance to grow in their careers, and enough free time to attend to their families and their own health.

And most of all, she added, “they are also looking for opportunities to apply what they learn to serve the community.”

A frontline caregiver on the panel, Martha Valladarez, noted that she hadn’t pursued the job. Instead, after years as one of Fresno’s first female letter carriers, she became an in-home supportive services provider to care for her youngest daughter, who has Down Syndrome.

She said she had received no training in caregiving upon taking the job. And she expressed frustrations with its pay—getting a raise required nine years of lobbying Fresno County. And it has been a struggle to secure vital benefits, around leave and retirement. To advocate for herself and other caregivers, Valladarez joined the union, SEIU, that represents in-home supportive service workers.

“We deserve a lot more and we’re going to fight,” she said.

She strongly backed state legislation to raise the minimum wage of healthcare workers to $25 per hour. But she also said that a big issue is that caregivers aren’t paid for all the hours they work—because it’s hard to say no to the people you care for. “This is a job where everyone knows you’re not going to leave,” she said.

Dill, the University of Minnesota scholar of health policy and workforce, emphasized the high stakes of improving health care jobs. The health sector is now the largest employer in the country; health care has transformed distressed manufacturing economies in the Rust Belt and other American places.

But those workers often have to work more than one job because they don’t get full-time hours, or health insurance of their own. They don’t have schedules that allow for respites or breaks that are vital for their mental health, she said. And health care jobs have physical demands that can make them quite dangerous; nursing assistants, she said, have relatively high rates of occupational injuries and infections.

Illustration by Soobin Kim.

Near the end of the conversation, panelists took questions from the audience attending in-person at the Fresno Center.

Rodriguez-Delgado, the moderator, talked about the closure late last year of Madera Community Hospital, in the community to the north of Fresno. “That probably sent signals to people who want to go into health care that it seems unstable,” he said.

In response, Dill noted that hospital closures and the failures to invest in health care personnel are often a function of choices made by “payers”—insurance companies, that tend to value fancy care more than daily hands-on care.

Pinzón-Perez said that mental health care for everyone, including front-line health workers, is important, and more might be done with the evolution of telehealth. Healthcare workers also need to do more work and tasks that are rewarding and seem meaningful, she said.

Pinzón-Perez and Dill both said that there had been an exodus of entry-level health care workers since the pandemic, with higher salaries being offered in other sectors. Those departures have made workloads even more intense in healthcare, Dill said.

Pinzon-Perez, an immigrant from Colombia, said that one way to produce more health workers is to utilize more immigrants who arrive in the U.S. with medical training.

Dill said that extensive data research shows that union membership can also improve the pay of health workers. She added that public policies—including minimum wages, paid leave, and health insurance—can “create better jobs in the lowest levels of the health care sectors.”

And she said there need to be pathways for greater mobility for workers, so they can rise to better-paying job categories.

“A nursing assistant is poverty wages and an RN is middle class in the U.S.,” she said. “Helping people make that transition through the health care sector is one powerful way we can promote social justice.”