U.S. Food System Working Conditions as an Issue of Food Safety

Abstract

Food workers’ health and hygiene are common pathways to foodborne disease outbreaks. Improving food system jobs is important to food safety because working conditions impact workers’ health, hygiene, and safe food handling. Stakeholders from key industries have advanced working conditions as an issue of public safety in the United States. Yet, for the food industry, stakeholder engagement with this topic is seemingly limited. To understand this lack of action, we interviewed key informants from organizations recognized for their agenda-setting role on food-worker issues. Findings suggest that participants recognize the work standards/food safety connection, yet perceived barriers limit adoption of a food safety frame, including more pressing priorities (e.g., occupational safety); poor fit with organizational strategies and mission; and questionable utility, including potential negative consequences. Using these findings, we consider how public health advocates may connect food working conditions to food and public safety and elevate it to the public policy agenda.

Keywords

food workers working conditions food safety policy qualitative methods

Introduction

A connection between poor food industry working conditions and food safety (conditions and practices to prevent contamination of food/drink and foodborne illness) was first documented in Upton Sinclair’s 1906 novel The Jungle. Through detailed accounts of the lives of immigrant workers in Chicago stockyards and meatpacking companies, Sinclair wrote of an inseparable link between unsanitary food production and work characterized by wage theft, high-risk activity, low pay, and the absence of social benefits.¹ The novel was well received by the public, though to Sinclair’s dismay, the response primarily focused on descriptions of filthy and diseased meat rather than the experiences of workers.² According to social historian James Harvey Young, these events ended three decades of Congressional debate regarding regulation of the U.S. food supply as President Theodore Roosevelt, angered by the novel, signed the 1906 Pure Food and Drug Act and Meat Inspection Act into law.³ This legislation marked the beginning of federal regulation of food and drugs in the United States.⁴ Sinclair considered it a shortcoming of his work that these changes did not also address the hardships of food workers (“I aimed at the public’s heart, and by accident I hit it in the stomach”).²

Over one hundred years later, foodborne disease (illness resulting from consuming food or drink contaminated by various microbes and toxins) represents a significant public health problem in the United States.⁵ Though a variety of factors have been identified as causing foodborne disease outbreaks, one of the most common pathways by which food becomes contaminated is workers’ health and hygiene practices.^6,7 A number of food safety studies have focused on these issues (e.g., a sick worker, improper hand-washing practice) as a result of workers’ poor food safety knowledge, skills, and beliefs and recommend that food handlers across food sectors receive training to help prevent contamination.^8–10 Despite these efforts, recent data from the U.S. Centers for Disease Control and Prevention show limited progress in reducing foodborne infections.^11,12 To explore new prevention strategies, some research has looked beyond workers to consider food working conditions as factors that also impact workers’ health, hygiene, and ability to ensure safe food, including strenuous work environments in food production, processing, service, and retail; workplace policies, wages, and benefits in food service; and issues with resources (e.g., access to and quality of gloves, soap) in food production, processing, and service.^13–17

Food work, across five core sectors of the food system—food production (farm work and agriculture), processing (food, meat, poultry; plants, factories, and slaughterhouses), distribution (warehouses, trucking, and distribution centers), retail (supermarkets and grocery stores), and service (restaurants, dining halls, and cafeterias)—remains one of the least desirable jobs in the United States. Some food jobs afford a livable wage and the potential for upward mobility. There are also food industry sectors (e.g., food processing and retail) in which a percentage of the work force has union representation and can negotiate for improved wages, benefits, and working conditions. The vast majority of food jobs, however, are front-line positions—defined as nonmanagerial and nonsupervisory jobs with repetitive tasks, little decision making, and a lack of workplace power—which include low wages, little access to benefits, few opportunities for advancement, and significant risks to worker health and safety.^18,19 In a 2012 survey of workers across the food system, 79% reported that they lack, or do not know if they have, access to paid sick days, 83% reported a lack of health insurance from employers, and 58% lacked any health care coverage whatsoever.¹⁸ Beyond these conditions, many food workers note that inconsistent provision of wages and work hours challenges their ability to plan and achieve economic stability.¹⁸ Food workers and their families also experience high rates of food insecurity and, to support themselves, participate in public assistance programs at twice the rate of all workers.^18,20

In sum, existing data show that at some level, the working conditions of most concern to Upton Sinclair are still present. The separation of food labor from food production that followed The Jungle’s publication has continued today, and poor food working conditions as an issue of food safety still evades the public policy agenda. Thus, an important step to improve food safety and public health is to identify opportunities to reconnect these issues, including by returning them to the forefront of public and government attention.

Agenda-Setting in Health Care and Transportation Industries

To explore opportunities to connect food work to food safety, we consider U.S. industries where the role of working conditions in public safety is better established. For example, health professionals’ working conditions are increasingly recognized to influence the likelihood of errors and the quality of patient care, including factors such as staffing levels, work hours, the physical environment, and organizational culture.^21–25 Recognition of the link between conditions of work and public safety is exemplified by state and national policies such as California’s minimum nursing staffing legislation and resident physician hour and shift requirements under the Accreditation Council for Graduate Medical Education.^26,27

While these gains in the health care industry have been slow and remain a work in progress, policy research cites support in models set by the U.S. transportation sector, where hours of service regulations, for the purpose of trucker and public safety, have existed since the 1930s.^28,29 Historical accounts of these regulations draw parallels between the two industries and highlight a central role for advocacy groups focused on consumer protection and public health, worker advocates, and labor organizations in building momentum for and shaping policy change.²⁹ These assessments are supported by research on stakeholder analysis and the policy process, which identifies interest groups as key actors whose interests and power may impact policy.^30–35

Key Stakeholders on Poor Food Working Conditions and Food Safety

Identifying key stakeholders for the issue of food work and food safety requires consideration of the interest group landscape in the food industry. In recent years, food worker centers,^a labor unions, and related groups have increasingly come together to change food working conditions at the local, state, and national levels.^37–40 Despite variation in specific goals and activities, these organizations share a purpose of improving food working conditions in the United States.³⁶ Through collaboration, these stakeholders may increase power and influence by connecting work strategies, experience, members, and campaign work to represent and support workers across the food production, processing, distribution, retail, and service sectors.^41–43

Worker centers and their networks have been credited with putting labor standard enforcement in low-wage, immigrant-heavy industries back on state and national public policy agendas.³⁷ Strategies to accomplish this work are varied and include engaging in campaigns, drafting reports, writing legislation and contracts, engaging with elected officials, organizing strikes and marches, and performing wide dissemination of workers’ stories among policymakers and the public.^36,44 While not all of these initiatives have been met with success, collaborations among worker centers and unions have contributed to the development of new state and local ordinances as well as the drafting of stronger federal labor standards, such as the Wage Theft Prevention Act.^37,45

Though much work to improve food working conditions remains, some researchers anticipate that these food-related stakeholder groups and alliances, through their continued growth and partnership, may represent an important opportunity for renewed visibility and policy change for better labor conditions among low-wage U.S. workers.^37,43,44 According to agenda-setting research and the historical development of these issues in health care and transportation sectors, these groups (in addition to public health advocates) may also represent key actors for mobilizing policy around poor food working conditions as an issue of food and public safety in the food industry. A food safety frame may help these stakeholders to draw broader public attention to the importance of improved food working conditions while also developing a food work/food safety message that attends to and helps protect a socially and structurally vulnerable work force. Despite this advocacy potential, however, and the appearance of relevance and opportunity in a food safety frame, these stakeholders’ engagement with this issue is seemingly limited and has yet to be explored.

To shed light on stakeholders’ interpretations of poor food working conditions as an issue of food safety, and to consider strategies for advancing the issue within public policy, this study aims to (1) describe key stakeholders’ current engagement with food safety, (2) investigate participant perceptions of barriers to adopting a food safety frame, and (3) identify recommendations to connect food labor issues to food safety for the public and policymakers. The findings from this research may help public health advocates and researchers to understand their role in, and opportunistic starting points for, advancing these issues within the food industry and on the public policy agenda.

Methods

To explore key stakeholder interpretations of poor food working conditions as an issue of food safety and to identify recommendations for elevating the issue to the public policy agenda, we conducted in-depth interviews with key informants from 10 critical stakeholder organizations.

Critical stakeholder organizations were identified from a purposive sample of organizations (worker centers, labor unions, and related groups such as a legal center and training academy) focused on issues related to food workers, food working conditions, and/or food safety. Eligible groups were identified on the basis of geographic diversity (representing the four U.S. census regions—Northeast, Midwest, South, and West), level of engagement in collaborative work (local, regional, and national), and representation of the five core sectors of food system (food production, processing, distribution, retail, and service). To help develop the study sample, leadership from a national food labor alliance network (coalition of worker-based organizations focused on developing a sustainable food system while also promoting workers’ rights) provided feedback on a list of pre-identified groups and made recommendations to assure that the sample would best inform study aims and meet inclusion criteria.

Within stakeholder organizations, participants were English-speaking adults who had been active in their organizations for at least a year and who self-identified or were recognized by colleagues as informed about their organization’s mission, work strategies, and the challenges faced by the worker population served. The purpose of these criteria was to increase the likelihood that participants could provide rich information about stakeholder engagement on food work and food safety and about advancing these issues on the public policy agenda.⁴⁶

Recruitment and Data Collection

After gathering participant contact information from personal contacts, public websites, organizational reports, and key informants, representatives from select stakeholder groups were contacted by email. Representatives were sent a recruitment letter with a brief overview of the study and participant eligibility criteria. Altogether, 14 stakeholder organizations were contacted, and individuals from 10 organizations expressed interest in participation (two stakeholder groups did not respond and two responded with interest but indicated a lack of time and personnel to participate).

This small sample size is adequate for our study aims given the limited number of groups (the organizational population) that currently occupy positions of high visibility and engage in multi-stakeholder partnerships to impact change in the food system.

We conducted in-depth semi-structured interviews that lasted approximately 40 minutes. The interviews were conducted between December 2013 and April 2014 and occurred by phone at participants’ convenience. The interview guide included general questions about stakeholders’ history, mission, and activities (including strategies for advancing organizational priorities), the type of food workers and food system sectors that the organization supports, whether and why stakeholders may engage issues of poor food working conditions in relation to food safety, and perceptions about opportunities and barriers for adopting and advancing this issue as a part of their efforts to change food working conditions at local, state, and national levels (Appendix).

Interviews were recorded, transcribed, and validated. All participants provided oral informed consent as part of the study protocol approved by the Johns Hopkins Bloomberg School of Public Health institutional review board.

Coding and Analysis

Each transcript was read in its entirety to gain familiarity with the body of data as a whole. Transcripts were then reread and brief summaries were created to capture initial reactions and any emergent analytic categories or topics. To gain new perspectives on assumptions about the data and to help examine and test emerging hypotheses, study transcripts, initial coding frameworks, and summaries were shared and further developed with input from study coauthors. Following seven interviews, repetition among stakeholder responses was recognized, which signaled that little new information regarding the research objectives was emerging from transcripts. The three additional interviews conducted as a part of the sample further supported this assessment. The broad categories identified during this analysis process were consolidated into major themes and developed into an initial coding framework organized by study aims, including themes related to food safety engagement, challenges or barriers to action, and opportunities to advance the issue on the public policy agenda.

Before applying the framework to all transcripts, the study team again engaged in peer-debriefing, including questioning assumptions and further developing observations associated with identified themes and coding categories.⁴⁷ The framework was adjusted based on input and applied to all transcripts using ATLAS.ti 7.1.8 qualitative data analysis and research software.⁴⁸

To further ensure trustworthiness in this study, exemplary quotes were identified to ground results in examples provided by stakeholders and to clarify the study team’s interpretation and understanding of data. To protect the confidentiality of participants, data are deidentified in results and reported across the entire stakeholder sample.

Results

The study sample consisted of representatives from 10 stakeholder organizations, which included worker centers (n = 4), labor unions (n = 3), and other groups (n = 3) including a legal center, worker training academy, and business/organization partnership (Table 1). Participating organizations represented food workers across the five main sectors of the food system, including production (n = 3), processing (n = 4), distribution (n = 1), retail (n = 2), and service (n = 3) and organized or targeted their work at the national (n = 2), regional (n = 2), and local (n = 6) levels. Stakeholder groups were also geographically diverse and were located in the West (n = 2), Northeast (n = 3), Midwest (n = 1), and South (n = 2) U.S. regions; the two remaining organizations identified their location as national (Table 1).

Table 1.

Characteristics of Stakeholder Participants.

Characteristic	Number
Organization type
Worker Center	4
Union	3
Other (e.g., legal group)	3
Level organized
National	2
Regional	2
Local	6
Food sector represented*
Production	3
Processing	4
Distribution	1
Retail	2
Service	3
Geographic distribution
West	2
Northeast	3
Midwest	1
South	2
National	2

Numbers do not equal 10 because characteristics are not mutually exclusive

Stakeholder Missions and Strategies

The majority of participants identified their organizations’ main missions as improving wages and working conditions for food workers. Organizational missions for the remaining participants also included reducing poverty, addressing environmental issues, and improving food safety, and they extended to other worker groups (e.g., manufacturing and health care workers, immigrants, various minority groups, and food industry employers).

Almost all participants accomplished their mission by organizing workers, including through negotiating bargaining agreements, strikes and marches, and popular education, media, and social activities (e.g., theater, community radio, and movie nights). A few participants also accomplished their missions by recruiting and connecting exemplar employers, as Respondent 1 explained,

There are employers that are offering paid sick days to everybody on their staff—front of the house, back of the house, full-time, part-time—there are employers that are doing good by their workers and so [this prong of our work] is how we try to find those employers and, the same way we organize workers, we try to organize employers.

To enhance workers’ power in the workplace, most groups provided workforce development programs (e.g., building skills for higher wage positions and career preparation, including how to apply, dress, and interview for jobs), services (e.g., assistance “dealing with contracts” and confidential complaint hotlines), and education (e.g., English as a Second Language and nutrition classes, and worker rights training). Beyond these strategies, participants also engaged in member-led participatory research, policy-based advocacy, and litigation. These strategies included testifying in front of local councils and campaigning for wage and benefit requirements. In a few instances, stakeholders created food businesses and workplace monitoring programs for setting new and enforcing current labor standards.

Across stakeholder groups, participants emphasized that their strategies were worker-led or developed through significant engagement with workers and worker communities. Almost all participants conducted their work in partnership, including collaboration with academics and universities, businesses or employers, and other related organizations. As Respondent 2 from a worker training center explained, “We partner with a lot of our local—not only unions; different unions—but we also partner with a lot of different labor organizations and civil groups as well.”

Limited Food Safety Engagement and Barriers to Action

All participants indicated that they recognized a connection between poor food working conditions and food safety. Only a few stakeholders, however, identified purposeful adoption of a food safety lens in their work. These participants explained that the issue was “mutually reinforcing” with other core components of organizational work.

Most participants explained that they were interested in this perspective but did not engage with the issue (“we do not frame our cause around food safety”). Across all participants—engaged and not engaged on the issue—perceived barriers to action were identified. These perceptions are organized according to three main themes: (1) more pressing needs and issues for food workers and work, (2) a lack of fit with organizational strategies and mission, and (3) questionable utility of a food safety frame (including the potential for negative consequences).

More Pressing Needs and Issues for Food Workers & Work

In some cases, stakeholders suggested a lack of food safety engagement resulted from a need to manage more pressing issues faced by food worker populations. For example, one participant suggested that due to changes in the food industry, such as increased consumer demand for fresh foods, many workers in the processing and canning industries were struggling to maintain employment. Building a food safety frame to support their mission, therefore, had to be secondary to ensuring that these workers remained employed. Respondent 3, who represented a union focused on slaughterhouse workers, echoed this sentiment in relation to the dangers of food work and the need to first protect workers’ health and safety: “The food safety issue is a good one, but we’re just keeping workers from being killed.”

In addition to challenges associated with worker safety and employment, the majority of participants suggested that talking about food safety is thwarted by the fact that food workers are a vulnerable and disempowered population. For example, in addition to poor working conditions across sectors, participants discussed challenges associated with immigration status (e.g., “95% of the workers that we engage with are undocumented”), poor economic conditions, and unemployment, and that “low-wage workers, across the board, regardless of race or ethnicity, tend to not be very highly valued, and are thought to be quite replaceable.” Because of these vulnerabilities, and “respect and treatment issues,” many participants suggested that food workers are taken advantage of and feel unable to speak up about poor food working conditions, let alone the impact on food safety. Respondent 4 characterized the issue as “a climate of fear,” and explained these issues as experienced by processing workers in the rural South:

A lot of people are in jobs where, if they lose that job, they don’t have alternative employment, so people feel like they can’t leave their job, and employers take advantage of that and make very implicit and explicit threats that any effort to improve conditions or enforce legal rights will be met with retaliation; people will lose their jobs.

Some participants added that many food workers lack the legal protection necessary to advance a food safety perspective. Respondent 5 from a worker advocate center explained:

Under labor law, workers can speak publicly, generally speaking, about their working conditions, and that's considered a protected speech. But workers are not protected in terms of their jobs to criticize the employers, their employer's products …

These challenges were especially salient given that most stakeholders accomplished much of their work through worker-led initiatives. For these participants, advancing any issue in the food industry required “building [workers] up to feel worthy,” a process that was described to take years.

Lack of Fit With Organizational Strategies and Mission

For a few stakeholders, organizational strategies were not considered conducive for addressing poor working conditions as an issue of food safety. This perspective was conveyed well by Respondent 4, who represented a legal advocacy organization,

For a lot of these issues, we try to use litigation, but that’s most effective for things like discrimination, sexual harassment, or minimum wage violations. Litigation, for better or worse, is harder to use as a tool to improve health and safety issues.

For a number of other participants, who conducted the majority of their organizational work through campaigns and public education, the food safety message was described as too complex. Using an example of recent work to develop this perspective, Respondent 1, who represented a worker center, explained the difficulty of succinctly and clearly communicating these issues while also supporting food workers:

… the biggest trouble that we had was what is the quick way of saying that workers are coming into work sick, they can very easily spread diseases when they are showing up to work sick, but at the same time not demonizing workers for showing up sick and passing on diseases? It’s like this weird tightrope that you have to walk and then you continue that sentence by saying tipped workers are making $2.77 an hour, they rely on tips to pay rent, child care, to live, they have to show up for work even when they’re sick because they cannot afford to take a day off. But in so many campaigns you want that short and sweet slogan, and it’s a two-sentence issue at least.

In addition to a lack of fit with organizational strategies, a few stakeholders suggested that a food safety perspective detracted from a mission centered on workers (“… it basically takes away the human element in the labor force”), labor and human rights, and the development of a “consciousness about [poor working conditions]” in the food industry. As Respondent 6 from a worker organization in the South explained,

We haven’t really addressed it purely as a food safety issue, I think, because we don’t want to necessarily give up on regulators and petition makers and the public caring about what happens to workers …

For these participants, food safety was identified as important and for some “connected” to their work; however, it could not be “the center of conversation” in their organizational efforts.

Questionable Utility and Negative Consequences

Some participants were divided on the utility of using a food safety frame. For a few groups, food safety was described as a less powerful angle for change than discussing poor working conditions in terms of human rights or social justice. Respondent 7, however, who represented an organization that already used a food safety perspective, contested this idea and suggested that food safety was a key priority for the food industry. As such, a food safety frame may be a critical opportunity for incentivizing employers to “move resources back through the value chain to improve wages and working conditions.”

Other participants echoed concerns about engaging with food safety, and suggested that without extensive thought and care in messaging, stakeholders may create “the worst outcome” where “workers become the target, or the idea that it is somehow the workers’ fault.” For participants who shared this concern, many did assert that the pushback from employers should not create concern that differs from “the pushback that you already get when you are talking around raising wages” and other issues to improve working conditions in the food services industry.

Opportunities for Future Food Work/Food Safety Engagement

Despite an overall lack of engagement with food safety, participants considered how barriers to action may be overcome in future organizational initiatives. Informants’ recommendations clustered around three main opportunities: (1) building the food safety frame through stakeholder engagement, (2) developing worker power and protection at multiple levels, and (3) strategic starting points for advancing food work/food safety initiatives.

Building the Food Safety Frame Through Stakeholder Engagement

Many participants agreed on the importance of engaging food safety issues in partnership with a range of stakeholders. In addition to food workers, they identified food industry employers and management across sectors, the academic community, public health professionals, and other related organizations, such as groups engaged in labor issues, food justice, and food policy. Interviewees suggested that partnerships not only provided access to resources to build a policy agenda, such as data and funding, but also created an opportunity to learn about others’ interests. One respondent also explained that partnerships help to “make all of the connections among all of [the issues]” and develop more effective communication and framing for these public health issues.

For example, Respondent 7 suggested that by including food employers, organizations may create frames of “mutual benefit between labor and management,” such as how food workers, through better working conditions, could be “new solutions for food safety,” which was seen as an issue of primary interest to the food industry.

Respondent 1 added that involving workers and “[having them] tell their stories,” may engage the public while bypassing jargon and issue complexity. In relation to traditional campaign slogans, this participant explained:

So I think by the end of it we got pretty good at especially those personal narratives where people explain all of the outside influences that brought them to work that day. And also how that really affected them either to have to go into work or if they had to miss an extended period of work and that caused financial hardship. So the slogans were a lot harder and the personal narratives were a lot easier. Because people are people, right? They have that whole range of personal experience and they can really speak on it and really develop it out into a real story.

In addition to humanizing the issue, Respondent 5 added that workers’ personal narratives may further bolster them against the potential for negative consequences by revealing that workers “are upset and concerned about the situation too” and “want to be able to serve safe food.”

Developing Worker Power and Protection at Multiple Levels

To adopt a food safety lens within worker-led models, most participants described a need for stronger worker protection at multiple levels, including improved policies to protect workers from retaliation, labor laws that defined poor working conditions as an issue of health and safety, changes in work reporting structures and committees, and greater worker access to training and skills building. As examples of these activities, Respondent 5 described “explicitly opening up space for people to talk publicly and to report things that they’re seeing” through stronger whistleblower language in worker contracts and reporting committees “formed with workers and management.” Other participants focused on connecting these issues within the definition of state labor laws. Respondent 8 explained,

So last year we passed a law that … broadly defines health and safety to include that I am not being paid overtime, which makes the argument that, you know, if I’m not being paid the wages that I’m due, then that is a health and safety issue. If a worker is not given the minimum wage, they cannot feed themselves, and that is a health and safety issue.

Some participants added that while worker protections from retaliation do exist, they are “very difficult for a worker to use as a practical matter,” including years-long delays between firing and initiation of the legal process to be reinstated. To support worker-led engagement in food safety, participants recommended new worker protections that allow “people to get their jobs back quickly,” and that extend beyond speaking publicly about working conditions to include workers’ concerns with employers and employers’ products.

Strategic Starts for Advancing Food Work/Food Safety Initiatives

In building this multilevel approach to engaging a food safety perspective, participants suggested a number of advantageous starting points or recommendations for how they may pilot and develop this work. A few participants focused on starting in food sectors where the issue may be most obvious and visible, such as retail and service. Respondent 10 explained,

Obviously when we are in restaurants, some of it is visible to consumers, that connection. If the worker is sick, you can see it. But, you know, most food workers are completely invisible to us. And so who is going to the bakery when they are sick, who is going to the fish processing plant, who is packaging oranges and lemons, we don’t know, and in fact we don’t see them.

Other participants recommended engaging with issue-progressive groups. These stakeholders were defined as sympathetic populations (e.g., “students, people of faith, and sustainable food supporters”), more agile structures for policies and programs (e.g., state and local government; independent third-party labor standard programs), and receptive leaders and locations (e.g., public health-oriented areas and leadership). For example, highlighting one such leader in Oakland, California, Respondent 8 explained,

We have someone here in [our] County, where I live, who was a public health director and … while he was the director of the County Public Health Department, he was one of these guys who was making arguments about raising wages and collective bargaining as good for the public health.

By employing these strategies, participants agreed that a dialogue around poor food working conditions as an issue of food safety may be accessible to worker centers, unions, and related organizations, as well as the broader consuming public.

Discussion

The process of policy change has been examined through diverse theories and frameworks. Across these perspectives, a common starting point is agenda-setting, or putting a problem on the agenda (a set of problems to which policymakers pay attention) to be seriously considered for public action.^33,49,50 For policy actors to serve as catalysts in agenda-setting, however, theorists argue that these stakeholders must first engage the policy problem, which requires that a social problem and need for government intervention have been recognized, defined, and expressed.⁴⁹ Policy actors face a diverse range of problems to choose from and have finite time and resources to act. As a result, agenda setting involves issue selection, meaning that stakeholders identify a set of issues and the interpretation or construction of those issues for their own agenda and thus promotion in public policy.⁵¹

Based on these theoretical perspectives and examples from other industries, advancing poor food working conditions as an issue of food safety—through one set of key policy actors—requires, first, that we understand how these stakeholders engage with and think about issues of food safety, including opportunities and challenges in selecting a food safety frame. This study is the first to explore the problem of poor food working conditions for food safety from the perspective of key stakeholder groups. All stakeholders appreciated the connection between food work and safety, yet only a few currently employed this perspective in their work. Even though framing poor working conditions in terms of public safety has been a valuable strategy for advancing work standards by interest groups in other industries, including health care and transportation, study participants identified key barriers that were perceived to limit this opportunity among food workers and in the food industry.

Study results further show that theoretical requirements for agenda setting are not met as these key food policy actors do not yet select or call attention to the food safety issue in their own institutional work.^35,49,51 For example, even though participants recognized the impact of poor working conditions on food safety as a problem, the majority did not include the issue as a part of the social problems that they defined as critical for advancing their cause or for government intervention. Findings also reveal that rather than perceiving food safety as complementary to or strategic for their current work, some participants perceived this problem definition to compete with alternative and more persuasive frames, such as poor working conditions as issues of social justice or human rights. To advance the food safety issue among key stakeholders, research that draws clearer connections among issues of social inequality and workers’ health and hygiene—in the food industry and in relation to proper food safety practice—may be useful.

Study results show that participants are focused on other issues for institutional agendas that are considered to be more pressing and demanding of organizational and government attention, such as unemployment in the processing sector and risks to workers’ health and safety generally. Given that most stakeholders’ initiatives were worker-led, participants further identified a need for stronger protections for food workers to speak up about their conditions in the workplace. These findings suggest that to effectively advance the food safety issue through only these stakeholders, more work is needed to first address broader and more fundamental policy problems faced by the food worker population. The (likely) long-term time frame that is required to address such requirements underscores the importance of integrating a broader set of relevant interest groups to advance this agenda. For example, health economists may further inform the food work/food safety agenda by revealing the financial costs of workers’ poor jobs for workers’ health and food contamination. Public health researchers may communicate the connections between poor food system jobs (including low wages and a lack of access to benefits like paid sick days) and poor food worker health, complementing arguments of social injustice with consequences, too, for food and public safety.

Apart from competing policy problems and problem definitions, results show that stakeholders find the food safety frame to be complex and hard to define. For example, most participants were challenged to succinctly and clearly communicate the relationships among poor working conditions, workers’ health and hygiene practice, food contamination, and impacts for public health. This challenge directly conflicted with stakeholders’ primary work strategies, such as campaigns, which demand messages that are brief and clear. In some cases, barriers were perceived to vary by food system sector, such that the connection between work and food safety may be more salient in food service and retail, while less obvious for less visible food workers, such as those in food production and processing. Across sectors, however, the chain of events connecting food work to public safety was generally perceived to be convoluted and lengthy, which contrasts with the more direct relationship afforded to these issues in the health care and transportation sectors.

As a consequence of these factors, some participants suggested that stakeholders may steer clear of a food safety frame altogether, particularly for fear of misrepresenting the issue and potentially threatening workers’ employment while adding to a climate of worker blame. Altogether, these findings suggest that food stakeholder engagement with a food safety frame is shaped not only by organizations’ selection of alternative problems and problem frames for action but also by a number of unique factors associated with food work (e.g., hazardous jobs and insufficient workplace protections), stakeholder strategies (e.g., organizational mission and activities), and the food industry itself (e.g., shifting consumer demands, front-line work, and the complex chain of events from poor jobs to public health impacts).

To overcome identified barriers to action, findings reveal a number of strategies to reconstruct the food safety issue to be more accessible to key stakeholders, policymakers, and the public. Primarily, findings reveal that collaboration among diverse stakeholders (including employers, food safety groups, and the public health community) may lead to clearer, more comprehensive issue communication, while also allowing for framing that better aligns with, and accounts for, varied stakeholder strategies and interests (e.g., food workers, through stronger labor standards, as a food safety solution for businesses). At the same time, these collaborations may also bring new resources that allow participants to expand their own carrying capacity for alternative policy issues and definitions, such as including a food safety issue where useful.⁵¹

Participants also defined particular decision settings for pushing forward this alternative policy problem, including with workers in the food service sector, with more progressive members of the public and government (including first advancing policy change at the local level), as well as geographic regions. These strategies are supported by policy process research that describes these venue-shopping tactics as important for opening doors among otherwise excluded groups and achieving the best prospects for achieving policy goals.^51,52

Finally, the few participants that reported using a food safety frame suggested that these strategies—including campaigns of workers’ stories of illness on the job and marketing a reduction in food safety concerns and costs from improved working conditions—were central to the growth and success of their own initiatives. Studies to evaluate these interventions, and the food safety impacts of improved food working conditions, represent vital opportunities to raise awareness of these relationships, both in the food industry and among the public. The food safety frames adopted by these programs should also be tested for resonance with key stakeholders not currently working on, but reporting interest in, using a food safety approach. Altogether, study findings help to clarify where and how public health advocates may begin to collaborate with key stakeholders to more effectively prioritize, define, and advance poor working conditions in the food industry by using a food and public safety frame.

This study should be considered in light of a few limitations. Findings are based on a small sample of stakeholders, though the selection was intentionally diverse and included a narrow set of organizations that were identified to play a central role in the future of food working conditions, worker rights, and food safety in the United States. Further, interpretation of the research agenda and study findings are necessarily subjective and therefore vulnerable to participant and researchers’ personal biases. The resultant subjective and in-depth exploration, however, represents a primary goal of the study and adds to the conceptual generalizability of advancing the topic of working conditions as an issue of public safety.

Conclusion

As the issue of poor food working conditions and the problems of foodborne disease continue to gain traction on the national agenda, the perceptions and experiences of the key stakeholders described here may be useful for connecting these issues to better support food workers, food safety, and public health. Future research should consider the perspectives of other stakeholders, including economists, food employers, food safety groups, and advocacy organizations in other industries with significant consequence for public safety, who may help to define, adopt, and act upon issues of food work and food safety for consideration on the public policy agenda. The involvement of public health researchers and advocates—who may conduct and translate research that draws clearer connections among working conditions, food workers, and public safety—and their relevance for the mission and strategies of key interest groups, will also be important to this work.

Footnotes

Appendix. Stakeholder Organization Interview Guide

Acknowledgments

Megan L. Clayton received support for her doctoral training from the Johns Hopkins Center for a Livable Future-Lerner Fellowship, which made this research possible.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Note

Author Biographies

Megan L. Clayton is a research scientist with RTI International in Washington, DC. Her research focuses on the impact of work on public health, wellness, and safety. She holds an MPH and PhD in social and behavioral science from The Johns Hopkins Bloomberg School of Public Health, where this research was performed.

Katherine C. Smith is an associate professor in the Department of Health, Behavior and Society in the Johns Hopkins Bloomberg School of Public Health. She also directs the Johns Hopkins Center for Qualitative Studies in Health and Medicine. Smith’s research focuses on the communication of health information, and how different communication mechanisms influence health outcomes. She has a PhD in Sociology from the University of Nottingham in the UK.

Keshia M. Pollack is an associate professor in the Department of Health Policy and Management in the Johns Hopkins Bloomberg School of Public Health. She is also the Director of the Johns Hopkins Institute for Health and Social Policy, Associate Director of Training and Education in the Johns Hopkins Center for Injury Research and Policy, and Program Director of the Johns Hopkins Occupational Injury Epidemiology and Prevention Training Program. Pollack’s research focuses on identifying risk factors for, and strategies to prevent, injuries related to work, obesity, sports and recreation, physical activity, transportation, and the built environment.

Roni A. Neff is an assistant professor in the Department of Environmental Sciences in the Johns Hopkins Bloomberg School of Public Health. She is also Director of the Food System Environmental Sustainability and Public Health program at the Johns Hopkins Center for a Livable Future (CLF). Neff’s research focuses on understanding and changing food systems, particularly promoting food system environmental sustainability and addressing food system inequities, in light of complex environmental and social realities.

Lainie Rutkow is an associate professor in the Department of Health Policy and Management in the Johns Hopkins Bloomberg School of Public Health. She is trained as a public health lawyer and researcher and her work focuses on use of the law (i.e., legislation, regulation, litigation) to protect and promote the public's health. Rutkow uses legal, qualitative, and quantitative methods to conduct research about public health law and policy, with an emphasis on emergency preparedness and chronic disease prevention.

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