Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, R21-OH-009081, 2010 Nov; :1-22
The San Francisco Chinatown Restaurant Worker Health and Safety Project was a community based participatory research (CBPR) effort that used an ecological framework to better explore and address working conditions in Chinatown restaurants. The restaurant industry employs almost one-third of all adult workers in Chinatown and the work is characterized by many physical and psychosocial stressors which may be exacerbated for low-wage Chinese immigrant restaurant workers due to language barriers, low educational levels, and lack of health care coverage. The project brought together a diverse set of community members, researchers, and government officials from the Chinese Progressive Association (CPA), the San Francisco Department of Public Health (DPH), UC Berkeley's School of Public Health and Labor Occupational Health Program, and UC San Francisco's School of Medicine. In accordance with CBPR principles, the project used a collaborative approach that built upon diverse areas of expertise and involved all partners throughout the research and action stages. In addition to partnership development, project aims included conducting a detailed occupational health and safety survey of 400 restaurant workers and developing and piloting an observational restaurant worker safety checklist in all Chinatown restaurants, as well as widely disseminating and applying research findings for education and action to the improve working conditions and lay the groundwork for pilot testing future interventions. A final aim of the project was to conduct a participatory evaluation to assess the partnership's effectiveness in working together as it undertook research and action. The partnership completed the pilot test and data collection of the observational checklist in all but two of Chinatown's 108 restaurants and collected 433 detailed (103 item) surveys of current and recent Chinatown restaurant workers. A core group of 9 such workers was hired and trained, and worked closely with other partners to develop the research instruments and to design and implement recruitment strategies for the survey. Seventeen additional workers were hired and trained as survey recruiters. Worker participation was critical to the project's accomplishments including making the research tools more relevant to the population, and achieving a high response rate and improved interpretation, dissemination and use of study findings. Key findings from the survey were sobering: 50% of workers reported minimum wage violations, with other forms of "wage theft" reported including withholding of wages, and employers' taking a portion of workers' tips. Forty two percent of workers reported working over 40 hours a week, with half of those working 60+ hours; 40% reported getting no rest or meal breaks; and 76% not receiving overtime pay. Close to two-thirds (64%) reported receiving no on the job training, and high proportions reported having sustained burns (48%) cuts (40%) and slips or falls (17%) in the past year. High levels of psychosocial stress also were reported, including increasingly demanding workloads (72%), feelings of job insecurity (68%) and being yelled at by their supervisors and others in the work place (40%). Only 3% of workers reported having employee paid health care, with the majority (54%) paying for their care out of pocket. Findings from the observational check list were equally disturbing. Of the 106 restaurants observed, 65% did not have any of the required labor law postings displayed, 62% had wet and greasy floors, under half (48%) had non-slip mats, and 82% did not have fully stocked first aid kits. Study findings were presented in a detailed report, academic publications, presentations at local and national meetings, and through the mainstream and ethnic media press. A colorful 27-page report for workers and policy makers, presenting key study findings and recommended actions, was released at a press and public education event that attracted 170 people, including 4 of the 7 City Supervisors, three of whom spoke to express their support. A Low Wage Worker Bill of Rights also was presented at this event, and included in the Booklet as were additional recommendations including the convening of stakeholder roundtables on healthy jobs, healthy communities; the strengthening of local government enforcement of labor and health and safety laws; and significantly increased investment in healthy economic development and responsible employment practices in communities like Chinatown. Follow up actions to date have included letters from the DPH to OSHA, the California Division of Labor Standards Enforcement and the Division of Workers' Compensation citing study findings and urging improved compliance. Two local supervisors also recently introduced a wage theft ordinance based on our study findings. An article in the American Journal of Industrial Medicine, (2010) and the sharing of a report and the project's observational check list tool through a DOH web link (<a href="http://www.sfhealthequity.org/component/jdownloads/finish/34-chinatown-restaurant-workers/65-restaurant-health-and-safety-checklist/0?Itemid=0"target="_blank">http://www.sfhealthequity.org/component/jdownloads/finish/34-chinatown-restaurant-workers/65-restaurant-health-and-safety-checklist/0?Itemid=0</a>) were additional important steps for dissemination and subsequent action. Additionally, a paper on the check list was submitted to Public Health Reports and is under final review; if accepted, this will further help disseminate this new instrument and information about its utility and testing to public health and occupational health agencies and departments around the country and beyond. Worker friendly educational materials, (e.g., Frequently Asked Questions) also were developed and disseminated in Chinese and English and information further provided through educational "afternoon teas" and community meetings. A final anticipated action outcome-laying the groundwork for a DOH program to incentivize restaurants that were "good employers" proved unfeasible at this time, in part given the poor economic climate, but may be revisited if appropriate at a later date. As the population of low-wage immigrant workers in the restaurant sector continues to climb, and as restaurants remain among their largest employers, the utility of an approach to research that can combine the insights of workers with those of occupational health specialists and other professionals deserves much more careful attention. We hope that this study will provide the foundation for a continuing collaborative effort between community, health department and university partners to study and work to improve working conditions and health and safety for this growing immigrant worker population.
Meredith Minkler, DrPH, MPH, Professor and Director, Health and Social Behavior School of Public Health, 50 University Hall #7360, University of California Berkeley, Berkeley, CA 94720-7360