Economic Inequality’s Toll on America’s Workforce

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A new analysis of data from the 2022-2023 Behavioral Risk Factor Surveillance System (BRFSS) reveals that economic hardship is more than just a financial stressor — it’s a significant public health issue.

The study, published in the CDC’s Morbidity and Mortality Weekly Report, found that 6.9% of adults living in the U.S. who are currently or recently employed reported experiencing four or more serious economic challenges, such as food insecurity, unstable housing, lack of transportation or inability to afford health care. Economic hardship, including being unable to afford health care, food and clothing, has been shown to adversely affect health.

“Given associations between economic hardship and physical and mental health, the distribution of categories of economic hardship across sociodemographic groups and occupations can help identify where resources are most needed to support the health of workers,” the team of investigators wrote.

The BRFSS core survey gathers data on demographics, health status, behaviors and use of health services. Additional insights are available through optional modules, such as the Industry and Occupation module and the 2022-2023 Social Determinants of Health/Health Equity module. A total of 457,586 people surveyed were current or recent workers.

Affected individuals were also far more likely to rate their health as fair or poor (12.5%), suggesting a direct link between economic strain and well-being.

Key hardships measured included the following:

• Job loss or reduced hours
• Food, housing and utility insecurity
• Lack of reliable transportation
• Use of Supplemental Nutrition Assistance Program (SNAP) benefits
• Lack of health insurance
• Inability to afford needed medical care

The burden of economic hardship and its health consequences wasn’t evenly distributed. Young adults (ages 18 to 49), women, Hispanic and Black workers, and those with lower income or education levels were significantly more affected. The most frequently reported economic hardship was job loss or work hour reduction (16.5%), followed by food insecurity (12.1%), housing insecurity (12.2%) and cost that prevented necessary medical visits (11.8%).

Certain jobs showed a higher concentration of hardship, with the highest rates found in the following:

• Farming, fishing and forestry (18.5%)
• Building and grounds maintenance (18.2%)
• Food preparation and serving (16.0%)

Workers in these fields not only experienced more economic strain but also had higher rates of poor self-reported health — a strong signal that economic insecurity harms physical and mental health alike.

Importantly, access to health care played a critical role. Lack of health insurance and the high cost of care were common barriers in nearly all occupations experiencing hardship. For many, skipping or delaying care due to cost worsens existing conditions and increases long-term health risks.

While the study had some limitations — such as self-reported data and limited geographic representation — the findings support a growing call for targeted public health interventions. Expanding insurance coverage, improving wages and tailoring occupational health support could help reduce health disparities linked to economic strain.

“The findings that some sociodemographic and occupational groups disproportionately bear the cost of economic hardship, including high costs preventing health care, lack of health insurance and fair or poor health, highlight gaps that affect worker health and the sustainability of employment,” concluded investigators.