Serving While Sick High Risks & Low Benefits for the Nation's Restaurant Workforce, and Their Impact on the Consumer

8/4/2019 Serving While Sick High Risks & Low Benefits for the Nation's Restaurant Workforce, and Their Impact on the Cons

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SERVING WHILESICK

By The Restaurant Opportunities Centers United

High Risks & Low Benets for the Nations Restaurant

Workforce, and Their Impact on the Consumer

September 30, 2010

rimary Research Support Provided by:

he National Employment Law Projecthe UCLA Center for the Study of Urban Poverty

unding Provided By:

he Public Welfare Foundationhe Ford Foundationhe Rockefeller Foundation


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SERVING WHILE SICK

By The Restaurant Opportunities Centers United

High Risks & Low Benets for the Nations RestaurantWorkforce, and Their Impact on the Consumer

September 30, 2010

Primary Research Support Provided by:

he National Employment Law Projecthe UCLA Center for the Study of Urban Poverty

Funding Provided By:

he Public Welfare Foundation

he Ford Foundationhe Rockefeller Foundation


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EXECUTIVE SUMMARY

With over 10 million workers, the restaurant industry is one o the largest and astest-growing sectors

o the United States economy, even during the current economic crisis. However, most workers in this

industry work in restaurants that put them at high risk o injury and illness, and provide them with littleor no benets to cope with these challenges. Tese conditions increase the likelihood o workers commit-

ting dangerous practices that place the health o the dining public at risk.

Tis report is drawn rom analysis o 4323 surveys

o restaurant workers nationwide - the largest

national survey sample o restaurant workers ever

conducted as well as 240 employer interviews and

240 worker interviews, on their wages, working

conditions, and access to benets. It is also based

on 500 additional surveys and 20 additional

employer interviews on health insurance needs in

the industry. In all o these surveys and interviews,

restaurant workers across the country reported

very high rates o injury and illness and very low

rates o benets to cope with these symptoms. Tis

report will highlight the increased risk actors

aced by restaurant workers and their low access tobenets. It will also outline restaurant workers

and employers particular needs with regard to health insurance. Our ndings have important

implications not only or workers, but also or employers, taxpayers, policy-makers, and dining

consumers.

Our Findings

High rates o restaurant workers nationwide report working in low road restaurant jobs, with

strenuous work environments and little access to benets. Direct intervention to reduce stressul,

ast-paced working conditions in restaurants would reduce injury and illness in these workplaces.

However, access to benets such as health insurance and paid sick days are both also a necessity.

Te ability to take time o rom jobs and see a physician or prompt care o injury and illness

could shorten illness duration and help prevent uture injury and illness. Since the median wage

o all restaurant workers nationwide is $8.591, most workers who do not have paid sick days

are unlikely to take a day o to recuperate and are unlikely to receive timely medical attention

Our study reveals that there are two roads toprotability in the nations restaurantindustry the high road and the low

road. Restaurant employers who take thehigh road are the source o the best jobs inthe industry those that enable restaurant

workers to support themselves and theiramilies, remain healthy, and advance in theindustry. aking the low road to

protability, on the other hand, creates low-wage jobs with long hours and ew benets. Itultimately harms workers, other restaurantemployers, consumers, taxpayers and the

public health.

Two Roads to Profitability

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unless desperately ill i they do not have paid health insurance.

Restaurantworkersinoursurveysamplereportedfacinghighratesofexposurestodangerous

working conditions; 38.1% reported that they had done something while working that put

their own saety at risk. Almost hal (49.5%) reported being cut on the job, and nearly as many(45.8%) reported being burned on the job.

87.7%reportednotreceivingpaidsickdays.Morethan63%ofallrestaurantworkersreported

cooking and serving ood while sick, thus impacting consumers health.

Almost90%ofallworkerssurveyedreportednotreceivinghealthinsurancethroughtheir

employer. Workers without health insurance were three times as likely to visit the emergency

room without being able to pay as their counterparts with health insurance. Immigrants in our

sample were ar less likely to have health insurance than U.S.-born restaurant workers, with dire

consequences.

Finally,workerswhoexperiencedhighlevelsofemploymentlawviolationsintheirworkplace

were more likely to have worked under conditions that have negative consumer health impacts.

Workers who reported that they had done something as a result o time pressure that might have

harmed the health and saety o the customer were much more likely to experience overtime

violations(59.6%,asopposedto48.6%oftheentiresurveypopulation)andworkingothe

clockwithoutpay(63%,comparedto39.4%ofthetotalsurveypopulation).

In most o the urban areas we studied, the majority o workers in the restaurant industry are immigrants

and people o color. Because they are overrepresented in high-risk, low-wage jobs, immigrants and

workers o color disproportionately experience the combination o poor job conditions, high workplace

risk actors and low access to employment benets.

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From2003until2010,theRestaurantOpportunitiesCenter(ROC)workedwithlocalrestaurantindustrycoalitionsineightregionsNewYork,Chicago,MetroDetroit,NewOrleans,LosAngeles,Washington,Miami,andMaine-toconductcomprehensiveindustryanalyses,includingmorethan500worker surveys, 30 employer interviews, and 30 worker interviews in each locality. Tis study draws uponthe combined health and saety data rom these studies, and is thus based on analysis o 4,323 workersurveys, 240 employer interviews, and 240 worker interviews nationwide. In addition, rom January toJunein2010,ROCconducted500additionalsurveysofitsrestaurantworkermembersinsevenoftheselocalities on their health insurance needs and access, as well as their consumer preerences or insuranceproducts.ROCalsoconducted20employerinterviewsonthesameissueswithregardtohealthinsurance.isreportrepresentsacombinationofthesetwodatasets,andalsodrawsuponROCspreviousstudyonoccupationalsafetyandhealthamongNewYorkCityrestaurantworkers,Burned:HighRisksandLowBenetsforWorkersintheNewYorkCityRestaurantIndustry.

Methodology

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Our Recommendations

Restaurants should oer workers saer workplaces and conventional job benets, including health

insurance, paid sick days, and workers compensation insurance. Without these improvements, the

industry will continue to put both workers and consumers at risk. Our specic policy recommendations

areto:

1. Support ederal legislation and other policy eorts that would and require employers to provide

paid sick days and provide greater access to health insurance or all low-wage workers, includingimmigrants.

2. Provide education or employers and restaurant workers to help them identiy workplace risksand ways to reduce these risks, including rights to workers compensation insurance, strategies tore-organize workplaces to be more ergonomic, and the importance o providing benets.

3. Improve workplace saety and health conditions or restaurant workers, by having theOccupational Saety and Health Administration (OSHA) develop a special emphasis programto reduce injuries and illnesses in the industry, and encourage employers to ollow ergonomicguidelines developed or the restaurant industry.

4. Provide all workers with greater access to better jobs with improved benets through promotions

policies and anti-discrimination monitoring.

5. Publicize model occupational saety and health employer practices to provide much-neededguidance to other employers.

6. Supportcollectiveorganizingamongrestaurantworkerstoimproveworkingconditionsforall

workers in the industry, including better wages, access to health insurance, and other benets.


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CHAPTER 1: INTRODUCTION

Te restaurant industry is one o the largest private-sector employers in the nation, with over 10 million

employeesnationwideworkinginmorethan568,000foodserviceanddrinkingplacesthatmake

signicant contributions to the countrys tourism, hospitality and entertainment sectors and to its

economyasawhole.2NationwideandineachoftheeightregionsstudiedNewYork,Chicago,Metro

Detroit,NewOrleans,LosAngeles,WashingtonDC,Miami,andMaine-therestaurantindustryis

vibrant, resilient, and growing. Despite the current economic recession, the restaurant industry continues

to grow in each o the eight regions and nationwide.

Tis study is based on an analysis o the health conditions and access to benets among restaurant

workers rom survey data emerging rom the largest survey sample o restaurant workers ever conducted.

In more than 4,000 surveys o restaurant workers, 240 employer interviews, and 240 worker interviews

that we conducted in eight locations nationwide, we ound that health and saety challenges were a

primary concern or the restaurant industry in the United States. An additional 500 surveys o restaurant

workers in these eight locations and 20 employer interviews ocused on the health care coverage needs

oftheindustrythatexploredmoredeeplythechallengeofnothavinghealthinsurance.Forexample,

restaurant workers without health insurance reported that they were much more likely to avoid needed

EmergencyRoomtreatmentbecausetheywerenotabletopay(seeTable6).

We suspect that the magnitude o health problems and unsae practices may be higher than ound in this

study. Workers without access to health care coverage may under-report symptoms or illnesses that have

not been conrmed by a health care provider. Also, many workers may be reluctant to admit, even in a

condential survey or ocus groups, that they are compelled to engage in behaviors that harm the public.

What is certain is that low road employment conditions that compel workers to do things that might

harm consumer health and saety, such as having to work while sick or not receiving proper health andsaety training, are pervasive in the restaurant industry nationwide.

Methodology

Tis report includes data rom comprehensive restaurant industry studies in eight locations, each titled

Behind the Kitchen Door, and rom an additional 500 worker surveys and 20 employer interviews

ocused on the health care needs o restaurant workers. Background inormation was also drawn rom the

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2009 reportBurned: High Risks and Low Benefts or Workers in the New York City Restaurant Industry , a

our-year study unded by the National Institute or Occupational Saety and Health on the occupational

safetyandhealthofNewYorkCityrestaurantworkers.Burned: High Risks and Low Benefts or Workers

in the New York City Restaurant Industry was based on 500 worker surveys, 40 worker interviews and 40

employer interviews specically regarding health and saety issues.

TeBehind the Kitchen DoorstudieswereconceivedofanddesignedbyRestaurantIndustryCoalitions

inNewYork,SoutheastMichigan,Chicago,NewOrleans,Washington,DC,LosAngeles,Miami,and

Maine,from2005untilthepresent.Ineachlocation,theseCoalitionsconsistofacademics,policy

analysts, worker advocates, worker organizers, unions, and others, and included participation rom

restaurant workers and restaurant industry employers. Tis document includes summary data rom the

Behind the Kitchen Doorreport rom those eight locations, with pooled survey data weighted or

position, industry segment, and local workorce size. In each locality,Behind the Kitchen Dooris one o

the most comprehensive research analyses o the restaurant industry conducted in that regions history.

Tis study is thus the most comprehensive national research analysis o the health needs and conditions

o restaurant workers conducted to date.

Each o the eightBehind the Kitchen Doorreports uses data rom more than 500 worker surveys,

approximately 30 one-hour interviews with restaurant workers, and 30 one-hour interviews with

restaurant employers in each region. Tus, this study includes data rom 4323 worker surveys the

largest in-depth survey sample o restaurant workers ever conducted nationwide and more than 240

employer interviews and 240 worker interviews. Te surveys contained questions regarding job hazards,wage and benets, working conditions, injuries, abuse, wage the and other employment law violations.

Great care was taken to match the survey sample with the ethnic and gender demographics o the

localrestaurantindustryasfoundintheUSCensusBureausAmericanCommunitySurvey(ACS).Each

report also included over 30 in-depth worker and employer interviews that were recorded, transcribed,

and coded. In each locality, the results o this primary research are supplemented by analysis o industry

andgovernmentdata,suchastheCensus,aswellasareviewofexistingacademicliterature,toproduce

the ullBehind the Kitchen Doorreport.

Te research orBurned: High Risks and Low Benefts or Workers in the New York City Restaurant

Industry was implemented rom August 2005 until July 2009 with primary unding rom the National

InstituteforOccupationalSafetyandHealth.TogetherwiththeHealthandSafetyTaskForce,the

RestaurantOpportunitiesCenterofNewYork(ROC-NY)conductedastudyoftheoccupational

safetyandhealthofNewYorkCityrestaurantworkers.eHealthandSafetyTaskForceincludedthe

QueensCollegeCenterfortheBiologyofNaturalSystems,theMt.SinaiSchoolofMedicine,theNew

YorkCommitteeforOccupationalSafetyandHealth,theNYUCenterfortheStudyofAsianAmerican



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Health,andMaketheRoadNewYork.estudyincluded502surveysofrestaurantworkers,10focus

groups with workers o dierent ethnicities, and 35 one-hour employer interviews. Te survey sample

wasstrictlymatchedtoraceproportionsofNewYorkCityrestaurantworkersinthe2000census.

Forthisreport,wesupplementedtheknowledgethatwehavecompiledabouthealthandsafetythrough

theBehind the Kitchen Doorand Burnedstudies with 500 health-care specic surveys and 20 employer

interviews that asked detailed questions about health care issues. and 20 employer interviews that asked

detailed questions about health care issues. Te surveys were completed by restaurant worker members o

theRestaurantOpportunitiesCenter(ROC),anationalrestaurantworkersorganization,ineightstates.

Te survey questions documented health care coverage needs, access and consumer preerences or

insurance. Te employer interviews explored employer perspectives rom seven states on the difculties

and benets o oering health insurance to their employees.



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CHAPTER 2: INCREASED RISK FACTORS

In2008,theU.S.DepartmentofLaborfoundtherestaurantindustrytobethethirdhighestintermsof

totalnonfataloccupationalinjuriesandillnesses.With227,600cases,FoodServicesandDrinkingPlaces

wasrankedbelowonlyElementaryandSecondarySchools(284,500cases)andGeneralMedicaland

Surgical Hospitals (258,200 cases).3

Our survey data revealed explanation or the industrys high ranking in terms o occupational injury and

illness. A majority o workers we surveyed reported working in ast, demanding and pressure-lledenvironments, and that their workplaces commonly do not employ or enorce regulations designed to

ensure the health and saety o workers, sometimes in violation o the ederal Occupational Saety and

Health Act (OSHA).4

Table1:HealthandSafetyViolationsReportedbyRestaurantWorkers


Violations Percent of Workers

Unsaely hot in the kitchen36.1%

Firehazardsintherestaurant 25.2%

Missingmatsontheoortopreventslipping 22.0%

Missingguardsoncuttingmachines 21.1%

Done something that put own saety at risk 38.1%

AsshowninTable1,36.1%percentofworkerssurveyedreportedthatitgetsunsafelyhotinthekitchenin their restaurant workplace. Signicant numbers o workers reported absences o guards on the

cuttingmachines(21.1%),aswellasmatsontheoortopreventslippage(22.0%),andrehazardssuch

as blocked doors or non-unctioning re extinguishers in the restaurant where they worked (25.2%).

Tirty-eight percent (38.1%) reported having done something at work that put their own saety at

risk.Despitetheprevalenceofhealthandsafetyhazardsinrestaurantworkplaces,66.6%ofallworkers

surveyed reported a lack o knowledge o workers compensation laws, and nearly a quarter o the workers

(33.0%) told us they did not receive health and saety training rom their employers


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Given the prevalence o work hazards reported above, it is not surprising that large numbers o workers

reportedsueringfrominjuryandillnessonthejob.Forty-nine(49%)percentofworkerssurveyedormore than 2000 workers out o 4188 surveyed - had suered work-related cuts on the job, and 45.8% o

all workers surveyed had been burned on the job. Almost one-quarter (24.5%) had come into contact

withtoxicchemicals.Almostseventeenpercent(16.7%)reportedthattheyhadslippedandinjured

themselves while at work. Additionally, 20.8% reported chronic pain that was caused or worsened by

their job.

In some restaurants people are doing a lot o physical labor, like I work at a three story restaurant where

Ihaultrashcansoficeupthreeightscauseduringbusinessyoucantusetheelevator.Sothereisthisgo, go, go! type o attitude and people wind up doing crazy stu like pulling things or slipping on thestairs. Broken glass, people getting their hands cut, [etc]. You know, youre in a ne dining restaurant

with the crispy bread and the knie slides along the bread into your nger. Ive seen that several times.Grease res and burns in the kitchen, Ive seen a lot o those kinds o health concerns. And I think its

just, people are generally in a high risk health situation. I have seen a lot o just not healthy stu or theworker. Male, NewOrleans, 13 years in the industry, Server.

IrecallonetimeIhadtothrowoutthoselongorescentbulbs,theonesyouseehereandIdontbelieve

that was part o my job description. It seems like something that should have been handled bymanagementcauseIthrewitoutandithitthesideofthedumpsteranditexplodedandglassewinmyace. So I had bits o glass in my ace. Male, Detroit, 1 year in the industry, Dishwasher


Injuries Percent of Workers

Burned while on the job 45.8%

Cutwhileonthejob 49.0%

Slipped and injured while on the job 16.7%

Cameintocontactwithtoxicchemicalswhileonthejob 24.5%

Have chronic pain caused or worsened by the job 20.8%

Table2:WorkplaceInjuriesReportedbyRestaurantWorkers


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able 3 reveals that understafng, which places inordinate pressure on workers, is a common industry

practice. An overwhelming majority o respondents reported working when their restaurant was

understaed(78.2%),andasimilarnumbersaidtheyhaveperformedseveraljobsatonce(77.5%).

Nearly orty-three percent (42.8%) responded that they have been required to perorm jobs or which

they had not been trained, and 38.1% o workers reported doing something that put their own saety at

risk. Such low road workplace practices not only aect workers, but can also have serious consequences

forconsumers.Forty-twopercent(42.5%)ofworkersreportedhavingdonesomethingasaresultoftimepressure that might have put the health and saety o the customer at risk. In act, as urther discussed in

Chapter4,surveydataindicatedacorrelationbetweenhealthandsafetyviolationsandnegativeimpact

on consumers.


Workplace Practices Percent of Workers

Worked when the restaurant was understaed 78.2%

Perormed several jobs at once 77.5%

Experienced verbal abuse rom supervisors 29.1%

Perormed a job not trained or 42.8%

Done something due to time pressure that has put own

health and saety at risk

38.1%

Done something due to time pressure that might have

harmed the health and saety o customers

42.5%

Table3:WorkplacePracticesReportedbyRestaurantWorkers


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At48yearsold,JuneLindseyisaproudmothero nine and a 30-year veteran o Detroit quick serve

restaurants.Sherstenteredintothislineofworkwhenshewas17years old and looking or a job. One o the ew businesses nearby was aMcDonaldsandtheyhiredme,andIhavebeenintheindustryeversince. Since that time she has not stopped struggling to support herchildren despite terrible working conditions. Her stories illustrate theadverse eects o these working conditions on the health and saetyon the worker as well as the eects on the greater public.

It was an extremely hot day and I was working in the ront counter at Popeyes.erewasnoACintherestaurant.SweatwasrunningdownmyfaceandIhadtoconstantlywipemyace and assist customers with their ood order and cashiering at the same time. I am so thirsty but I cantdrink in the ront because the manager tells me Im not allowed to drink in ront o customers, and thatI have to drink in the back. And when I try to go to the back and get a drink, the manager tells me againthatIcantleavethecounterandgobackforadrink.IsaidIamreallythirsty.Ifeeldizzy.Myvisionisblurry.Myearsarepoppingandsomethingiswrong.Ineedsomethingtodrink.emanagerthreatensme [that] i I go to the back I might as well just go home.

Aer about an hour the pain started to get worse and worse and I asked i I can leave and go to the ER .She reused again and threatened me o losing my job. I told her,[I] am really sick. I need this job; I have

children to eed at home. She reused, so I chose to go to the ER not knowing i I was going to have myjob or not. At the ER I ound out that my blood pressure was low because I was dehydrated. I have nohealth insurance so Ihad to pay a lot o money that I didnt have to spend. Te next I went back to workwiththeERdocumentsandwenttotheGMandexplainedmysituation.Iendedupkeepingmyjobbutwith a hostile attitude rom the manager that didnt want to let me go or have a drink o water.

[Anothertime]Iwasworkingatthesamejob.Ihadareallybadcold.Mynosewasrunning,Iwassneezing, [and] I had a bad cough and a ever. I could not call in sick because no work meant no moneyandIcouldntaorditatthattime.Mykidswereveryyoung,soIwenttoworktoseeifIcanmakeitthrough the day. Hal way through the day, the sneezing, coughing and runny nose got worse. I asked themanager,I am really sick and need to go because I could make others sick and I am dealing with ood.

She laughed and told me try not to cough then. So I had to work that day sick, and who knows howmany customers I got sick because I couldnt go to the back and leave the counter to wash my hands aereverysneezeornosewipe.Lateronallofusgotsickonebyone,andallthiscamefromanotherworkerthat came to work sick like me, but was not allowed to leave work!

I elt angry and just wanted to leave but I couldnt because I needed this job to support myamily. I elt like a slave!! o add insult to injury, it was especially hard to accept it because Iam almost 50 years old and being disrespected by amanager that was hal my age. Tis aectedmy sel esteem and sel worth. Its not my ault I got sick, and its just not air!

June Lindsey: DetroitTen Years in the Industry: Fast Food WorkerW

ORKER

PROFILE


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EMPLOYER LIABILITY

In interviews, many employers expressed that promoting health and saety practices in the restaurant

setting was a matter o liability orthe restaurant, both nancially and legally. One employer spoke the

need to meet the health and saetystandards set orth by local department o health and insurance car-riers. Oentimes when you have a restaurant this large and you have insurance carriers and insurance

brokers, they usually do a walkthrough [on] saety issues. Te Department o Health has a lot o issues

a lot o things they look at when they come and do an inspection that are also health related but also

saety related,but our insurance brokers the companies, beore they will issue a certicate o insurance,

willcomethroughandtalkaboutourstaircases,workingconditionsIthinkalotofthoseissuesarebasic

common sense.

In act, several employers noted that the costs associated with being noncompliant with government

saety standards were reason enough to promote high health and saety practices in the restaurants. One

employer stated, Beore i they nd [sic] an employee not wearing a hat, they used to let it go. Tey

would just put a correction, like you have to tell your employee. But right now its like a $200 ne per

employee. So things like that, you know so many things, which you dont have to pay or, they just let

you pay or and its getting higher and higher. And now Im paying almost $2000 a year. Which I used to

neverdo.Forlittlethings,thatneverhappenedbefore.Itsnotcriticalthing,itsjustsomethingyoucould

rectiy. Tats it.

Other employers drew a direct connection between promoting high health and saety standards throughtrainingandreducingcostsfortherestaurant.Forexample,oneemployerstated,Everynewhire,

depending on the department in which they are hired, they go through a training program. Tey

basically dont start in their positions on till they have successully completed this training program. Just

to insure that they know what theyre doing so we can prevent uture accidents or anything that might be

job-related just cutting any human costs, any nancial cost that might be associated with healthcare.

In act, employers expressed that while implementing strong health and saety training programs or

workers may require initial investment, it is more cost-eective in the long run than not providing

training..Forexample,oneemployerwhodidoerhealthandsafetytrainingreportedthatifsomeone

slipped and ell in the restaurant and broke something, Once they are out o work, you need to replace

that employee, two youre insurance has to cover it, you know insurance isnt ree, and the more oen you

use it, as ar as workmans comp, I would assume the more you have to pay, the more you crash your car,

themoreyourinsurancegoesup[but]Ithinkitallworksoutintheend;Ithinkitactuallyworksout

bettermoney-wise.Youproduceonevideoandthewholecompanygetsonevideo,andyousave100

people rom alling. I guarantee that didnt cost that much.


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Were concerned or our employees. We want to make sure that theyre healthy and happy. Maine, 5years at restaurant, Family style

As ar as what we can control is to provide a sae and riendly work environment. So they are not pissedo when they come to work because o something we are doing wrong. I they look at us like I hate thisplace I dont want to go to work but I get to make money, I lose those guys much more quickly. Plus nowwiththeeconomythewayitisbutstillwecankeepthemhappyandmakeitsomewhatfunbuteec -tive work environment then we can keep the turn over pretty low. Chicago, 17 years in business,

Family style

Te concerns expressed by the employers that we interviewed regarding liability issues are reafrmed by

government agencies and in numerous trade articles rom the restaurant industry. Particularly given the

high rate o cuts experienced by restaurant workers as reported by our survey sample, the cost associated

with cuts can be a tremendous liability to employers. OSHA reports that it is estimated that more than

$32,000 worth o direct (health insurance, workers compensation) and indirect costs, such as wages paid

to injured workers not covered by workers compensation, expenses related to time lost/work stoppage,

administrative time spent by supervisors ollowing accidents, employee training, replacement costs, lost

productivity related to new employee learning curves, accommodation o injured employees and

replacement costs o damaged material/property, can be attributed to just one cut or laceration.5

In

addition, all hand injuries, including cuts, which are all too common in restaurants, have been noted to

be one o the highest sources o employer cost among all occupational injuries. In addition to thephysicalpain,handinjuriestakeanancialtoll.eaveragehandinjuryclaimhasnowexceeded$6,000,

witheachlosttimeworkerscompensationclaimreachingnearly$7,500,accordingtotheBureauof

LaborStatisticsandtheNationalSafetyCouncil.eoveralldrainonemployeeproductivitybecomes

apparent, especially when you consider there are about 110,000 estimated lost time hand injuries every

year,accordingtoBLS.6

Restaurant trade journals have also noted the employer liability associated with occupational injuries and

illnesses. As cited in one major trade journal, in an age when litigation is prevalent, restaurant owners

and managers need to give some serious thought to the liability they are exposed to i they allow health

and saety issues to go unchecked.7

In 2005, more than 800 restaurants were ound to have critical health

code violations, resulting in major costs or the employers.8Forexample,food-bornedisease,whichcan

sometimesbeattributedtoworkersillness,cancostanestablishmentasmuchas$75,000inlegalfees,

medical claims, lost employee wages, cleaning and sanitation, discarded ood, and lost income.9

Similarly,

it has been reported that on-the-job injuries experienced by restaurant workers cost the industry $300

million in medical ees and lost labor.10

In act, in 2003, 24,000 restaurant workers lost a day o


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workduetoacut,burn,orscald,andintotal62,000restaurantworkershurtthemselvesbadly

enough to miss a day o work.11

Te ederal Occupational Saety and Health Act (OSHA) imposes standards or health andsaety in the workplace, requiring employers to provide protection or workers in hazardousenvironments and to keep records o all workplace injuries and accidents. OSHA covers toxicchemical use the statute requires gloves, or example, or dishwashers and kitchen cleaners whouse very heavy toxic chemicals and temperature o work environments, including excessivelyhot kitchens. While there is no mandatory requirement that employees be provided withspecic health and saety training, such training is eectively necessary to ensure compliance

with OSHA and workers compensation law.

Employers in every U.S. state and territory must secure workers compensation insurance orevery employee.

12MoststatesWorkersCompensationlawalsostipulatesthat,providedthe

employer is inormed o any workplace accident within a certain time period, workers relatedmedical expenses will be ully covered. Workers may also be eligible or weekly compensationi they lose work due to a work-related injury, and or xed compensation or any permanentdisability.

13


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CHAPTER 3: LITTLE OR NO ACCESS TO BENEFITS

Te vast majority o restaurant workers we surveyed reported not having paid sick days, to take time o

to care or themselves or loved ones, or, even i they had the ability to take time o, health insurance to

cover the cost o medical care. In surveys and interviews, workers regularly repeated their need or both

kinds o benets. Teir lack o benets impacts not only workers and their amilies, but also consumers,

taxpayers, and employers.

A. Paid Sick Days

Almostallrestaurantworkerswesurveyedreportednothavingpaidsickdays.87.7%ofallworkers

surveyedreportednothavingaccesstopaidsickdays,and63.6%reportedworkinginrestaurants

preparing, cooking, and serving ood - while sick.

able 4. Access to Benets


Do not get paid sick days 87.7%

Do not get paid vacation days 79.3%

Have worked when sick 63.6%

Sick time? I take my own sick time, i Im very sick I dont go. But many times you cant aord to takethe day o because youre sick, and all the time, especially this season and in the spring, a lot o mycoworkers they were sick, sneezing in the ood. Tey were disgusting. But you know, what can they do?Tey cannot aord to take the day o. Female, Maine, 4 years in the industry, Server

Tere [are] times when I call in and tell them Im sick and they still say you cant come in or a ewhours? Tey dont care! You gonna be sneezing, over peoples ood and stu like that and i you wanna

put a mask on or try to cover yoursel up or whatever then its bad or the business. Tats why you shouldhave allowed me to stay home. I told yall I was sick! Tats how it is right now [though]; they just dontcare. Female, New Orleans, 23 years in the industry, Server


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econceptdoesnotexist:thereisnosicktime,youcometoworkeitherway.Ifyoudontcomeyoudont get paid and i you stay o too long you get red, thats it, even i youve been there or two years. Male, Michigan, 5 years in the industry, Line Cook

Insomelocalities,weaskedworkersfurtherquestionsaboutwhythiswastrue.Forexample,inMaine,

o the workers surveyed who reported having gone to work sick, nearly hal (49.2%) reported needing to

work while sick because they could not aord to take the day o. One kitchen worker who has been in

the industry or 8 years explained, I remember going to work one week straight with a cold, coughs, sore

throat, everything, ever, and working and my manager didnt say anything and I was expecting he would

have gone go home, eel better because we work out back in the kitchen separating donuts and by the

timethesedonutsgetspreadoutitsalloverthestateofMaine.Imean,itcomesoutofmyhand,andyou

know i Im sick, everybodys sick. And I didnt want to call o because I wasnt going to get paid, or my

managerwasntgonnaletmecausehedidntexcuseme,soIjustbasicallyworked.Maineworkersalso

reported additional consequences or working while sick, with

31.8% o workers surveyed reporting that they endured a prolonged

illness, 21.4% couldnt complete tasks necessary or work, 19.9%

caused other workers to become sick, and 12% reported that they

coughed or sneezed into the ood when they went to work sick.

DuringtheoutbreakoftheH1N1SwineFluepidemicin

early 2009, the president and surgeon general both urged peoplestaying home to be the best way to minimize the spread o the

u.14

However, the act that nearly all ood service workers lack paid

sick days means that such an option would not be easible or most

ood service workers, thus contributing to the risk o the widespread

illness among both restaurant workers and the public they serve.

With restaurant workers in particular, given their regular interace with preparing, cooking and serving

ood or the dining public, the lack o paid sick days and high incidence o workers working while sick is

a public health concern.

OnApril30,2009,NewYorkTimescolumnistJudithWarnerproledaROCmemberworkingin

MiamiasaserverinarestaurantwhilesickwithuduringtheH1N1epidemic.15

Without paid sick

days, the worker knew that she would lose her job i she did not go to work, despite the act that she had

both a ever and cough. Te column reported that nationally, only 14 percent o the people serving and

handling ood in restaurants can stay home rom work when theyre coughing and sneezing , without ear

o losing their jobs.


18/37


Employers who orce restaurant workers to work while sick are contributing to a public healthchallenge.eU.S.CentersforDiseaseControlandPrevention(CDC)inAtlantaestimatesthatnoroviruses, a amily o pathogens associated with outbreaks o oodborne illnesses, are actuallymore common in restaurants. In 2004, the most recent year or which data are available, 251reported outbreaks o oodborne illnesses across the country involving 10,000 victims werethoughttobeviral.AccordingtoCDCstatistics,almostallwereclassiedasnorovirus-related,and 93 were norovirus outbreaks tied to restaurants.

16

I an employee stays home sick, its not only the best thing or that employees health, but also his

co-workers and the productivity o the company.17

CommerceSecretaryGaryLocke


19/37


Te son o an Arican-American mother and a Puerto Ricanfather,LuisDeLeonwasbornandraisedinChicago.Hestartedworkingback-of-the-houserestaurantjobswhenhewas17.Now,at27,hesaten-yearveteranoftheChicagorestaurantindustry. He started working in restaurants simply because it

was available to him and the application process was short.However, in the last our years he has developed a passionor the work and has no intention o leaving. Despite all

this,hesaysrestaurantworkcanbeverytough.Luissharedhis experience with illness in the workplace, a story that issimilar to many restaurant workers. He explained, In my10 years o working in the industry there have beennumerous times that I havegone to work while sick. I

would try and call o and tell a manager I dont eelgood but they still made me come in to work. I wassneezing in the ood, sweating,coughing, and eeling aint,and Im sure I was spreading germs to all my customers. I was less productive, ittook more time to get the ood out, it was an awul situation to be in.

I would stay sick or several days, and even up to a week, and all I really needed wasa ull day or two torest and recover. I never got, nor do I currently get, that day ortwo, because I am always orced to comein and i I dont, I know I will be red or myhours will be drastically reduced. I cant aord to lose my

job or get my hours cut so I just put up with it. I have to payrent, buy ood, and pay the other bills Imresponsible or- no job means no livelihood.

I want to just emphasize that i it were up to me Id stay at home to recuperate but my employerswont allow it- so in turn I jeopardize my own health and saety, that omy co-workers and that o youthe consumer, and it is not air to any o us.

Luis DeLeon, Chicago10 years in industry, grill cookW

ORKER

PROFILE


20/37

B. Health Insurance

Inoursampleof4,323surveys,89.7%ofallworkerssurveyednationwidereportednotreceivinghealth

insurancethroughtheiremployer,and61.5%reportednothavinghealthinsuranceatall.Almostone

quarter(22.7%)reportedthattheyorafamilymemberhadgonetotheemergencyroomwithoutbeingable to pay in the last year.

Given the high rates o injuries and illnesses suered by workers in this sector and the low rates o access

tohealthinsurancereportedbyrestaurantworkers,theRestaurantOpportunitiesCenter(ROC)sought

to understand the specic health care needs, access and consumer preerences o its membership in order

todesignanappropriatesolution.ROCthusconductedamorein-depthsurveyontheseparticularissues


Policies that would help the restaurant industry or the workers? Denitely health insurance is the mostimportantonebecauseyouwanttoretainyourstasothatwayyourenotturningoverpeoplebenets

would be key. So implementing some kind o health insurance would be vital or workers and owners andbeyond that, I know they work on sick days and sick days would be important but I think because the

way the restaurant industry is set up there has to be some way to compensate. Male, Maine, 13 years inthe industry, Bartender

Well, or me, its your lie, its how you pay your bills and the way I saw it was, you work with thesepeople. But I know I shouldnt get riendly or personal with these people but, you know, you spend somuch time together, and you make jokes together and you try to work and have un at the same time.

What I noticed was the owners o this restaurant that I used to work at they were more concerned aboutmy production than my well-being, or how I got along with everybody. And one o the owners came overto me and said, Well, now that youve done all your duties and all the work that youre supposed to do,

why dont you go to the back o the house and bring in, you know, this urniture, and I thought, youregiving me something something to do and Im going to break my back and you dont even provide me

with insurance. So we had this big-big argument and he said, Get back and do your job or else yourered.Anditwaslike,youdontgetit.Like,Ibreakmybackinhereandwhosgoingtotakecareofme,

whos going to eed me, whos going to pay my bills, Im only supposed to work in the restaurant. Im notyour maid! Male, Chicago, 9 years in the industry, Busser, Barback, & Server

Job Benefits and Health Reported by Restaurant Workers Percent of Workers

Does not receive health insurance through employer 89.7%

Do not have any health insurance coverage 61.5%

Gone to ER without being able to pay 22.7%

Table5:JobBenetsandHealthReportedbyRestaurantWorkers


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with 500 restaurant worker members nationwide, and interviews with 20 employers around the country.

Similar to the rates reported rom the more general, non-member survey conducted with more than

4,000workersnationwide,64.5%ofROCssurveyedmembersreportednothavinghealthinsuranceat

all. And, as victims o the low-road jobs previously described, members without health insurancereported lower wages than those with access to health insurance. Whereas those workers with access to

health insurance rom their employer reported earning a median weekly income o $400, workers

without access to health insurance reported a median weekly income o only $330 an annual income

ofonly$17,160.79%ofworkerswithouthealthinsurancestatedthatthemainreasontheydidnothave

it was because they could not aord it. And, as can be seen in able 5 below, although workers with and

without healthcare were both hospitalized at similar rates, workers with health insurance were ar more

likelytohavebeentreatedforamajorcondition(22.3%asopposedto16.8%),takeprescription

medication (45.5% vs. 29.2%) and receive treatment or a chronic illness (18.4% compared to 12.8%).

Not surprisingly, while restaurant workers with and without healthcare both clearly had medical needs,

workers with health insurance were more likely to receive regular treatment.

Table6:Relationshipbetweenhealthcareneedsandhealthinsurance

Have you or a family member been... Percent of workerswith healthcare

Percent of workerswithout healthcare

Hospitalized in the past year 19.3% 17.9%

Been treated or a major condition 22.3% 16.8%

ake prescription meds 45.5% 29.2%

Chronicillnessorpersistingmedicalconditionreceivedtreatmentforwithinthepast6months

18.4% 12.8%

Unortunately, even restaurant workers with health insurance reported paying large amounts out o

pocket or medical costs. Among those with health insurance, only 8.8% reported that their employer

paid or the insurance in ull. In act, workers with health insurance reported paying more than $1000out o pocket in medical care costs in the past year at higher rates than those without health insurance

(28% vs. 19.5%).Not surprisingly, all workers both those with and without health insurance reported

avoidingmedicalcarebecauseoftheirinabilitytopay.However,ascanbeseeninTable6below,workers

without health insurance were three times as likely to avoid emergency care as workers with health

insurance, but also three times as likely to report using the emergency room because they could not

receive health insurance elsewhere, and three times as likely to go to the emergency room without being

able to pay. Tus, restaurant workers lack o access to benets clearly has a public cost.


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Table7:AordabilityofHealthInsurance

Percent of workerswith health insurance

Percent of work-ers without health

insurance

Avoided doctors visits because couldnt pay 91.9% 94.7%

Avoided prescription drugs because couldnt

pay

58.5% 48.6%

Avoided ER when needed because couldnt pay 13.2% 37.6%

Went to ER because couldnt receive healthinsurance elsewhere

11.1% 33.4%

Went to ER without being able to pay 13.6% 37.2%

Inattemptingtodesignasolution,ROCthensoughttounderstandwhatexactlyitsmemberswould

wantoutofahealthplan.Avastmajority71.5%-reportedthattheysoughtahealthplanasawayto

protect against high medical bills, and in particular, to see the doctor or general checkups a ew times a

year, get cheaper medication, and be able to visit the emergency room i needed, and only 28.4% sought

a health plan to treat recurring medical conditions. Tis statistic indicates that, despite the high rates o

injuriesandillnessestheysuerintherestaurantdescribedinChapter2,ROCssurveyedmembersarea

largely healthy population seeking preventative treatment rather than treatment or chronic conditions.In addition, a majority 55.5% - reported that the major actor in selecting a plan was cost, not

surprising given these workers low income.

Employer Perspectives on Health Insurance

Employers generally agreed that health insurance was a necessity or the restaurant workorce, both or

the welare o their own employees, and or their restaurant to be able to recruit and retain qualied

employees. When asked what might incentivize them to oer insurance besides having access to a low-costplan,onegeneralmanagerfromMaineinacasualfamilystyleestablishmentstated,Idontthink

I would need other incentives. I eel like its something everyone deserves access to. Several employers

cited the importance o providing health insurance in being able to recruit and retain qualied

employees. One amily-style restaurant owner in New York stated that oering health benets would

make working here more competitive better sta because [we give] better benets o working Its a

higherprioritythanithasbeeninthepasttopeopleAnothergeneralmanagerfromaMiamifamily-

style establishment stated that they wanted to provide benets in order to raise [our] restaurants image


23/37


among possible applicants; i restaurant workers hear that we oer benets then we would be able to

attract more qualied workers, improve worker moral and reduce turnoverA rustrated general manager

fromMainerecounted,Ivehademployeesleavesotheycangogetrealjobssotheycangetinsurance

that covers prescriptions!

Several employers also stated that they would be willing to join a collective o employers and workers to

obtainacheaperrate.Moreover,iftheyfoundsuchanaordableplan,thattheywouldbewillingtopay

a portion o weekly premiums or their employees. When asked what would be the important actors o

such a plan, at least one employer stated that it was important to them to have a plan that would cover

their undocumented immigrant employees.

One o the ew employers we interviewed who were able to provide ull insurance or all her employees

explained the tremendous return that oering these benets has brought to the restaurants bottom line.

Astheownerofafamily-styleestablishmentinMichigan,sheexplainedthat:Employeesfeelmore

invested in and they are thereore more committed to their work and do a higher quality job. I your

employees eel ownership over their business and their work, they require less day-to-day supervision,

which rees business owners to be able to do more work on expanding the business and improving

conditions and opportunities which ultimately benets everyone.

Immigrant Restaurant Workers & Health Care Coverage

enationsfoodserviceindustryreliesheavilyonimmigrants.48.7%ofthe4,323restaurantworkerswesurveyednationwidewereforeign-born,and14.7%reportednothavinglegaldocumentstoworkinthis country, while only 12.8% o the total U.S. population is oreign-born, and recent estimates place theundocumented portion o the total population at only 4%.

18

Unortunately, not only in the restaurant industry but also nationwide, immigrant restaurant workersand, in act, all immigrants, are signicantly underrepresented in the nations healthcare system. In 2008,15%ofnativecitizens,22%ofnaturalizedcitizens,and46%ofnon-citizenslackanyformofinsurance, regardless o whether it was obtained privately, through anemployer, through a amilymember, or through some orm o public program. Examined on their own, 59% o all undocumentedimmigrants nationwide lack coverage.

19Using a cross-national comparative approach, public health

researchers Siddiqi, Zuberi and Nguyen ound that this disparity in health insurance is a critical cause othe dierences in unmet medical needs between immigrants and non-immigrants.

20Inaddition,7%ofall

people under age 18 in the United States are children o undocumented immigrants. While almost ourin ve o them are U.S.-born citizens eligible or public insurance, and many o the immigrant childrenare even eligible or public insurance benets, immigrants are still severely underinsured. 45% oimmigrant children and 25% o U.S. born children o undocumented immigrants are uninsured ascompared to only 8% o children o U.S. born parents.

21


24/37


Amongrestaurantworkerswesurveyed,26.3%ofnon-citizensand14.3%ofundocumentedworkerslackaccesstohealthinsurance,comparedto61.5%ofallworkerssurveyed.Andwhileonly10%ofallrestaurantworkersreceivehealthinsurancethroughtheiremployers,afarsmallerpercentage-only6.2%- o undocumented workers have access to health insurance through their employer. Teir lack o accessto care is compounded by their lack o access to paid sick days. While only 13.3% o all workers surveyed

reported having access to paid sick days, only 8.2% o undocumented workers had paid sick leave.Additionally,immigrantshavefarlessincometopayformedicalcostsoutofpocket.Medianwagesdecreasewithdocumentationstatus:inourtotalsurveypopulation,themedianwagereportedwas$11.25forcitizens,$10.00forauthorizednon-citizens,and$8.61forundocumentedimmigrants.Notonly do immigrants and particularly undocumented immigrants lack sufcient health insurance, theyalso lack sufcient purchasing power to purchase health insurance out o pocket.

O the 505 surveys we conducted specically on restaurant workers health insurance needs, 30 wereundocumented immigrants, and 90% o these immigrants did not have access to any health insurance,comparedto64.5%ofthetotalsurveypopulation.eseworkersreportednotonlyaninabilitytoaccesshealth insurance due to cost, but also a general lack o knowledge and inormation about the health care

system in the United States. Among undocumented immigrants surveyed that did not have insurance,themostcitedmainreasonfornothavinghealthinsurance,besidesthatitwastooexpensive(69.6%),wasthattheydidnotknowhowtoobtaininsurance(21.7%).Only5.2%ofU.S.citizensinthesurveysample cited not knowing how to obtain insurance as an important actor, less than a quarter o the

percentage o undocumented immigrants who reported the same.

eAordableCareActthatwassignedintolawonMarch23,2010willreducethetotaluninsuredpopulation in the United States through better regulations o health insurance companies and publicsubsidies or individual health insurance. However, immigrants who have been in the country or lessthan ve years and undocumented immigrants have been excluded rom key pieces o the health reorms.AuthorizedimmigrantscontinuetobebarredfromMedicaidfortheirrstveyearsofresidency.

However, they will have access to the state exchanges in which health insurance will be competitively soldand to all o the subsidies available to low-income amilies in that orum. On the other hand,undocumentedimmigrantscontinuetobebarredfromMedicaidandarenotevenallowedaccesstothestate exchanges to buy unsubsidized insurance. Barring undocumented immigrants rom the stateexchanges denies this part o the U.S. population rom their right to health.

Moreover,itincreasestheburdenoncitizensandauthorizedimmigrants.emedianageforundocumented immigrants in all industries (35.5 years) is more than a decade younger than authorizedimmigrants(45.9years)andcitizens(46.3years).

22Including this younger and healthier segment in the

insurancepoolwouldreducecostsfortherestofthepopulation.AccordingtotheKaiserFamilyFoundation,manylawfullyresidingandundocumentedimmigrantswouldstilllikelybedependenton

saety-net providers, such as community health centers, clinics, and public hospitals, and state and localsaety-net programs or care and assistance.

23While undocumented immigrants pay taxes and thus

contribute to the public coers that must pay or these institutes, it would be preerable to everyone orthem to be able to pay into an insurance pool or proper health carecoverage and thus help reduce theburden on publicly-unded saety-net providers.

Providing immigrants access to proper medical care is not only a question o their well-being. As so manyimmigrants work in restaurants preparing, cooking, and serving ood, and so ew get paid sick days,depriving them o proper access to medical care is a threat to consumer saety and public health.


25/37


Carlosisa33year-oldundocumentedimmigrantthathasbeenlivinginMiamiforveyearsworkingintherestaurantindustry.Athiscurrent

job he brings 10 years o restaurant industry experience, including 5 yearsin his birth country o Guatemala. In his current restaurant he works as abarback but occasionally bartends and has the ability to ll other

positions due to his long experience in the industry. Recently though,Carloswasbadlycutonthejob.Hefacedanintimidatingsituationthatheclaimsisnotuncommonintheindustry.BecauseCarlosdidnot

know his rights, his bosses were able to pressure him to work at risk o aggravatingthe injury and they discouraged rom using workers compensation when he brought it up.

All o this really happens because o how nervous you are not to break anything. I was cleaning coeecups while one o the owners was at the bar. I dropped one o the cups and I tried so hard to catchit but it broke right as I tried to grab it and it cut me really deep. Te manager helped me clean it upbut then I ound a piece o porcelain in it. When I pulled it out [my wrist] really started to gush darkblood and I got really lightheaded and scared. I was worried I cut an artery.

Tey bandaged it up though and gave me a latex glove and told me to nish the last hal hour o myshiuntil4:00.InisheditandwhenIleItoldthemthatmywristreallyhurtandIdidntfeelgood.

Tey told me to go home and take some ylenol, or something or the pain and to come back andnishmydouble[shi]at7:00andmaybehewouldletmegoalittleearly,maybeatmidnight.

IthurtalotsoIcalled[theROCorganizer].BeforethatIdidntevenknowwhatworkerscompwas.Aer I talked to him I called the restaurant and told them I wasnt going in and I was going to thehospital. He was mad but when I mentioned workers comp he said I could take the day o and tocall tomorrow but dont worry about workers comp. At the emergency room they x-rayed my handto make sure there wasnt any more porcelain in there and the doctor gave me a bill or my boss and anote that said I wasnt supposed to work or a ew days. When I brought the note to the owner he wassomadhewouldnteventalktome.IhadtogivethepaperworktothemanagereownercalledmelatertoseeifIhadanyinsurance.ItoldhimthatIdidnthaveinsuranceHewasangry.Itwasnally

the manager that called me back to tell me that I could go back to the hospital when I need to get thestitches out and that I would get paid or the time I spent at home recuperating but that i I go workanywhere else during those days I could get in trouble with the law. I told him I only have one job and I

was going to use those days to get better. Its good in a way what happened because I learned how to goabout making sure my rights are respected no matter i you dont have insurance, no matter i you donthave documentation, it doesnt matter you have rights. And so this experience taught me how to goabout getting those rights respected and it also allowed me to serve as a sort o guide to my co-workersin the uture should anything like this happen to them. Now I know what to do and I can help themout to make sure their rights are respected.

Carlos, Miami

10 years in industry, BarbackWOR

KER

PROFILE


26/37


Carlosnowfeelsempoweredthathecanbenetfromtheprotectionsthatworkerscompoersbuta more difcult adversity or him to overcome is his lack o health insurance. Despite his generallygoodhealth,heisconcernedabouthislackofinsuranceinthecaseofanemergency.Moreover,hehas

wanted to go to the doctor at certain points in the past but has avoided doing so because o the cost.Frustratedaboutthissituationheassertsthattherighttohealthisarightthateverybodyshouldhaveindierent o your immigration status or where youre coming rom. Tis is a right you are born with.Carlosnowfeelsempoweredthathecanbenetfromtheprotectionsthatworkerscompoersbuta

more difcult adversity or him to overcome is his lack o health insurance. Despite his generallygoodhealth,heisconcernedabouthislackofinsuranceinthecaseofanemergency.Moreover,hehaswanted to go to the doctor at certain points in the past but has avoided doing so because o the cost.Frustratedaboutthissituationheassertsthattherighttohealthisarightthateverybodyshouldhaveindierent o your immigration status or where youre coming rom. Tis is a right you are born with.

Carlos, Miami,

10 years in industry, BarbackWOR

KER

PROFILE


27/37

CHAPTER 4: CONSUMER EFFECTS

atswhytheyhavethatshowRamseysKitchen.IcantellyouIvebeenintoalotofkitchenssomeo the kitchens that are out here in Portland are just as bad. But, yeah it does aect like especially peoplelike, you catch colds, and this and that, and then youre wondering why, just take into mind/considerationwhereyouveeateninthelastcoupleofdays.Causeyoucouldhavecaughtthatcoldfromthat restaurant. When Im coughing on a plate and then just putting your ood there, youre saying Othat gravy tastes good, rubbing your nger and licking it. Male, Maine, 25 years in the industry, LineCook

A. Serving While Sick

I have been in the restaurant industry on and o or 4 years. I have spent many days sick, in the back oa kitchen or in ront o customers - too many to remember. I had the choice o either taking the day oonly i I could nd someone to cover my shi, or go to work sick. Nine times out o ten I went into worksick. I did my best to keep a sanitary kitchen, but when youre sick with a viral or bacterial inection it isalmost impossible not to inect others, as well as the ood youre preparing or serving. I recall oneevening;Ihadtogointoworksickwithareallybadcaseoftheu.IcalledintoseeifIcouldstayhome,but the owner told me I had two choices; come in or not come back. I had to choose between living in ahouse or on the streets. I I didnt come in, I wouldnt have been able to aord my rent or even to eat orthat manner. I I did come in, I ran the risk o becoming more sick and inecting those around me.Unortunately, I had to go into work. It was an incredibly busy weekend, at one point, one o my ellow

workers sat me down because I was about to aint. Te smell o grease and long shi had taken their toll. Ispent the next 5 days vomiting, expectorating phlegm, and drinking a lot o orange juice. I had to orcemy co-workers to cover or me and work double shis, they didnt want to see me red, and I didnt wanttolosemyjob.Laterthatweek,twoofmyco-workerscaughtmyvirusaswellasquiteafewcustomers.-Male, Chicago, 4 years in industry CookTable 4. Access to Benefts

I may have been, had a cold and been at work and then served ood that could have spread a [contagiousillness] Im sure because Ive caught colds rom other people at work. Female, Maine, 6 years in the



28/37


Our research ndings strongly suggest that low road workplace practices prevalent in the restaurant

industrycanincreasepublichealthrisks.Forinstance,63.6%ofworkerswespokewithinthecourseof

our study reported working while sick. And workers without paid sick days were ar more likely to work

whilesickthanthosewithpaidsickdays.Amongthosewithpaidsickdays,lessthanhalf(46.7%)report-

edgoingtoworkwhilesick,whileamongthosewithoutpaidsickdays,nearlyseventypercent(68.5%)reported preparing, cooking, and/or serving ood while sick.

Employers acknowledged the connection between worker exposures, the lack o benets, and consumer

healthrisk.OneNewYorkCityemployerjoked,Sickdays.erearentasetamountperyear.Youknow

itsoneofthejokesintherestaurantindustry:therestaurantindustrykeepsNewYorkCitysickbecause

we dont take days o. We single-handedly keep New York sick during the winter months because we

donttakedaysoWerepassingonalltheillnessestothecustomers.atsjustajoke.Youknow,itall

depends. Sta calls in sick all the time. Its kind o known as ar as management goes is that you show up

andthengetsenthome.Nomatterhowsickyouare:showupandthengetsenthome.

A2008studybyBarry-EatonDistrictHealthDepartment(BEDHD)inMichiganpublishedintheJournalofAmericanMedicalAssociationinvestigatedthesourceandagentofinfectiontodeterminethescope o illness among patrons and employees at a national chain restaurant. Te BEDHD environmentalassessment o the restaurant identied deciencies with employee hand-washing practices, cleaning andsanitizing o ood and nonood contact suraces, temperature monitoring and maintenance o potentiallyhazardous ood, and maintenance o hand-sink stations or easy accessibility and proper use. As a resulto a lack o health and saety training in cleaning up the incident (the restaurant had used an ammonium-based sanitizer that was ineective against norovirus), a total o 95 people had gotten sick (an attack rateof33.7%)and64peopleexperiencedanorovirustransmission(anattackrateof13.5%).Unfortunately,transmission continued through the next day. BEDHD intervened and mandated that (1) all ood

prepared during the dates o attack be discarded; (2) all ill employees were excluded rom working or atleast72hoursaertheirsymptomshadsubsided;and(3)thefacilitywascleanedextensivelywithdisinfectaccordingtoMDCHandMichiganDepartmentofAgricultureguidelinesforenvironmentalcleaning and disinection o norovirus.

24

B. Pressure to Cut Corners, with Potential to Harm the Customer

Over orty percent (42.5%) o the 4,323 workers surveyed had done something as a result o time

pressure that might have put the health and saety o a customer at risk. Employers pursuing a low road

business strategy place enormous pressure on workers, and oen cut corners on health and saety

training, leading to workplace practices that endanger employee and ood saety, and consequently public

health.AsdemonstratedbyFigure1,workerswhoreportedemploymentlawviolationsattheirplace

o work were also much more likely to report workplace practices such as ailure to provide health and


29/37


training, being required to work when the restaurant is understaed or perorm several jobs at once, and

being asked to perorm a job or which they are not trained. Tis combination o workplace conditions

could have harmul eects on the health and saety o customers. Workers who reported that they had

done something as a result o time pressure that might have harmed the health and saety o the customer

weremuchmorelikelytoexperienceovertimeviolations(59.6%,asopposedto48.6%oftheentiresurveypopulation),andworkingotheclockwithoutpay(63%,comparedto39.4%ofthetotal

survey population).

Figure1:LinkagebetweenRiskstoConsumerHealthandWorkplaceViolations

Employers engaging in high road practices provide saer and healthier dining experiences or

consumers. Tese employers understand the public health risks involved with orcing workers to work

while sick and putting so much pressure on workers that they are orced to cut corners that harm the

health and saety o the consumer. Tese challenges in the restaurant industry have public health

implications, which should be concern to employers, legislators, and consumers alike.

Worker did something to puther/his own saety at risk

Among Workers WhoExperiencedNoLaborViolations

Among Workers WhoExperiencedAnyLabor

Violations

13.443.9

21.8 46.7

64.780.5

25.946.7

65.281.1

16.936.7

020406080100

Worker had to cut corners

because o time pressure thatmight have harmed the health

Worker had pressure to perormseveral jobs at once

Worker had to do a job or whichworker was not trained

Worker had to work whenrestaurant was understaed

Worker did not receive healthand saety training rom

employer


30/37


OwnerGeorgeWeldandGeneralManagerHollyHoward run Egg, a Brooklyn restaurant that utilizesa concept o sustainability that not only integratesnutritional and environmental actors but alsoassures that the labor that prepares and serves theood is able to do so with dignity. Eggs mission isrst, to make it a great place to work, second tomake it a great place to eat, and third to change the way the ood system worksessentially to give ac-

cess to good ood to more people.

Aside rom generous wages, Egg employees receive health insurance on a 50-50 split and ten days paidtime o per year that they can use or sick time, personal days or vacation. When asked why Egg oerssuch benets that are uncommon in the restaurant industry, Weld emphasized the irony o how societytreats restaurant workers as compared to white-collar jobs and wanting to change this relationship. Heexplained, I worked in ofces or a while. Part o it is the rustration o seeing people who barely li anger all day long in an ofce getting rich benets or what they do and having their parents proud othemItsfrustratingtobein[therestaurant]industrythateveryonelooksdownonasdeadendjobsor people who dont have any other skills. I want people to take [restaurant jobs] seriously. I want peopleto look at the restaurant business and say this is work; this is a good alternative or people who are well

educatedandreallywanttomakeadierenceintheworld.Forme,abigpartofitisjusttreatingthejobthe way that it should be treated. It should have a dierent prole. Howard added rom an operationalpoint o view, its a high risk environment that people are in and as an employer you owe it to yourworkers to provide health care i theyre around knives. And you know everyone is on their eet all daylong. I also think that it helps us keep a low turnover rate. When people come to work here, they getreally excited about it. Its a reason that they stay. So our turnover rate is really low, which o course savesmoney on training.

Although they insist that oering health insurance and paid time o benets the restaurants bottomline, when asked about any challenges in oering the benets, the two named cost as the biggestchallenge. However, Weld claimed that cost should not even be as big o an issue i large business lobbies

would not take such a belligerent stance on employment law reorm and instead invest their resourcesintoproductivematters:atsoneofthethingsthatsfrustratingabouttheNationalRestaurantAssociation and groups like that. I dont know why they couldnt use their bargaining power to get betterhealth care rates and to do good instead o always being on the deensive against change and innovation.It just seems that they have a very narrow ocus. And thats the other thing. I dont know anybody that is

part o the NRA. Teyve never approached me. I dont know who they represent. I dont know i theyrepresent big chains or multi-million dollar restaurants or what. I dont think 90% o the restaurants inthis neighborhood have any contact with them at all.

EMPLOYER PROFILE: Egg, Brooklyn, New York

Owner George Weld, 5 years in the industry

General Manager Holly Howard, 10 years inthe industry


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When asked how this type o business model could spread in the industry Weld and Howard wereoptimistic.Oneingredientwasre-educatingconsumers.Weldasserted,ItsthesamewaytheGoodFoodMovementspreadthroughrestaurants.Oncepeoplestarttorealizethattheywanttosupportrestaurants

that support their workers, then theyll go to those restaurants. Another ingredient to a solution involveshow restaurants are run. Howard added I think its also about a reeducation o business owners. Tere issuch a way o doing things and its been done or so long that people really need to be reeducated. Weldalso expanded on this idea claiming that seeing restaurants that are protable and ethical is inspiring toowners. You dont want to be the last guy paying your workers under the table below minimum wage.Tey want to be as good as the best people in their business. And i you can show that you can do that atour scale, its exciting. You dont have to have 15 million dollars o revenue to do a good job. You can doit at a smaller scale.

Both Weld and Howard had advice or others that are considering the high road restaurant model.Howardcounseledthatownersshouldfocusonthelong-termbenetsovertheshort-termcosts:Ithink

thatpeoplegetoverwhelmedattheideaofit.Forinstance,ourhealthinsurance,onoursideofit,forayear will cost about $15,000. But when you tell a small restaurant like ours that thats $15,000 dollars oyour prot that youre going to lose, people tend to reak out. But you know when you break it down andthinkaboutwhatitmeanstomake$15,000over365days,itsnotthatmuchmoremoneythatyouneedto make. But its a commitment. So many people in the restaurant industry get into it orimmediate rewards or ast cash. But when you are trying to build a sustainable business, which includes

providing employee benets, its important to be able to think long term and realize that you might notsee the rewards immediately. She also added that owners should understand that certain practices willchange:Becauseitbringsaboutsomanychangesinyournancesandyourschedulingandyourpersonnel,Ithinkitssoimportanttobeexibleandopentoproblem-solving.

Weld advised other owners that these practices have positive results on the restaurants bottom line buthe also emphasized the non-monetary actors o the personal relationships between owners and work-ers:epayofordoingthingscorrectlyhasnancialawards,[butitalso]hashugeemotionalawards.Iknow restaurant owners who hide rom their employees when theyre o somewhere taking a break andtheir employees are killing themselves to make the money. Its a horrible way to eel. He argued thatlow-road employer practices necessarily have a toll on owners too. Te emotional rewards or these high-road practices are more than ample enough to justiy making these changes.

EMPLOYER PROFILE: Egg, Brooklyn, New York


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CHAPTER 5: POLICY RECOMMENDATIONS

Some o the health challenges addressed in this report can be improved by educating workers and

employers about best practices to avoid injury and illness on the job. However, to eectively address the

high rates o injury and illness among workers, it is clear that education is not sufcient; while it will

reduce the risks workers ace in the workplace, workers need to be able to care or their health in any

situation. Tese workers need benets, including health insurance, paid sick days, and paid vacations.

Without both education and intervention, the industry will continue to put both workers and

consumers at risk.

1. Benefts.

Workers who have access to ringe benets are better able to cope with injury or illness on the

job. Since injury and illness is related to demanding work environments, having the ability to take

timeoortoseeadoctorcouldpreventtheappearanceofnewsymptoms.Legislationshould

ensure restaurant consumer saety and level the playing eld by mandating paid sick days or all

workers and creating a public system that provides health care coverage or all, including

immigrants. Until such legislation is achieved, eorts to provide uninsured workers with low-cost

orfreehealthinsurance,suchasthroughROCsNationalRestaurantWorkersHealthInsurance

Plan (see box), should be supported.

2. Education or workers.

Workers should receive health and saety training on paid time, and in their own language. All

workers should be educated on workers compensation insurance, with language-specic written

materials and verbal education.

3. Saety and health conditions in restaurants need to be improved.Trough incentives or penalties, employers should be encouraged to ollow restaurant-specic

ergonomicguidelinesdevelopedbyROC,andgenerallyprovidesafe,well-ventilated,

well-organized environments or their workers to work; all employers should provide health and

saety training to their workers. Occupational Saety and Health Administration (OSHA)

standards or the restaurant industry should be improved and enorced.


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4. Education or employers and consumers.

Employers and consumers could benet rom learning the inormation gleaned rom this study,

to help employers avoid liability by re-organizing their workplaces and providing benets, and to

help consumers better understand what occurs behind kitchen doors.

5. Greater access to better jobs.

Since it is clear that higher-level positions provide greater access to benets, and that immigrants

and people o color are underrepresented in these jobs, we should work toward more equal

opportunity or these workers to obtain higher positions, including a ormal and transparent

protocol or workers to apply or promotion to higher-paying positions and the monitoring o

discrimination.

6. Model employer practices should be publicized to provide much-needed

guidance to other employers.

With policy makers support, research can be conducted and materials created to help employers

understand the benets o promoting rom within and creating a sae and diverse work

environment, as well as the negative consequences o ailing to provide such opportunities. All

ocus groups reported that i employers were willing to spend even minimal time and money on

saety, accidents and injuries could be avoided.

7. Collective organizing among restaurant workers should be supported.

Rather than simply providing workers with access to living-wage jobs, we must simultaneously worktoimproveworkingconditionsforallworkersintheindustry.Collectiveorganizingeorts

which oster better wages and working conditions enable restaurant workers to access health

insurance and other benets, and acilitate advancement, investment and ownership in the

industry.


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THE ROC-UNITED NATIONAL RESTAURANTWORKERS HEALTH INSURANCE PLAN

In 2010, based on the 505 worker surveys and 20 employer interviews ocused specically on workers

health insurance access and needs and consumer preerences with regard to health insurance, the

RestaurantOpportunitiesCenters(ROC)Unitedlaunchedanationalrestaurantworkershealth

insurance plan, in an attempt to oer its low-wage restaurant worker members with access to aordable

healthcarecoverage.Bypoolingits6,000membersnationwide,ROCwasabletonegotiateanaordable

rate or a limited benet plan through Aetna.

ROC-Unitedbelievesthathealthcarecoverageshouldbearightforall

peopleincludingundocumentedimmigrants.us,ROC-Unitedhasormed a National Health Insurance Plan to (1) oer aordable health

care coverage to all low-wage restaurant workers, especially those

excluded rom national Health Reorm legislation; (2) demonstrate that

undocumented immigrants are an insurable population, and (3)

encourage legislation to ll the gaps in coverage created by Health

Reform.ROCwillbeoeringtheplantoits6000membersineight

states, and partnering with high road employers looking to provide

aordable health insurance benets to their employees.

ROCsplanisnotcomprehensivecoverage.roughouttheprocessofenrollingitsmembers,itwill

continue to educate restaurant workers on the benets and limitations o a low-cost limited medical plan,

and limit membership enrollment to those restaurant workers whose needs would be best suited by a

low-costplan.Forlow-incomerestaurantworkerswhohavechronicillnessesorgreaterhealthcareneeds,

ROCcontinuestoinformthemaboutotherhealthinsuranceoptions,includingMedicaidifqualied

and discount clinics.

Mostimportantly,ROCisdocumentingitsexperienceinprovidingthisaordablecaretolow-wage restaurant workers to educate legislators about the need or, importance and potential o covering

populations that have been excluded rom national Health Reorm legislation, including undocumented

immigrants. Ultimately, we hope to provide easier access to health care or all.


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APPENDIX | Survey Demograpics

As mentioned above, this report was based on two dierent data sets. Te larger data set was a sample o

4,323surveysadministeredbysta,members,andvolunteersfromRestaurantOpportunitiesCenter

aliatesinChicago,Detroit,NewOrleans,Maine,NewYork,Miami,LosAngeles,andWashington,DC,aswellasinpartnershipwithvolunteersfromallyacademicorcommunitybasedorganizationswith

signicant contacts among restaurant workers and access to workplaces in the industry. A total o 4,323

surveys were conducted rom 2003 until 2010. Tey were conducted ace-to-ace with workers in the

vicinity o restaurants during breaks or at the end o shis, and inside restaurants.


Percent of Sample Percent of Sample

Race Restaurant Segment

White 36.9 FancyExpensive 33.6

Black 20.0 FamilyStyle 38.4

Hispanic/Latino 18.5 Fast/QuickServe 27.1

MiddleEastern 1.6 Location

Asian 14.4 Maine 12.1

Mixed 2.7 Chicago 13.3

Sex Michigan 11.7

Male 45.1 New Orleans 12.4

Female 54.8 New York 12.3

Age Miami 13.4

Below 25 46.6 Washington,DC 11.8

26-35 34.9 LosAngeles 13.0

36-45 11.7 TOTALSAMPLESIZE 4323

46-55 5.3

Above 55 1.5

Table8:CharacteristicsofLargeNationalRestaurantSurveySample(Unweighted)

Source:RestaurantOpportunitiesCentersUnitedsurveydata


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Notes on Large National Restaurant Survey Sample

Because there is no government data source listing individual restaurant workers in each city, it would

have been extremely difcult to conduct a strictly random sample o this industry. Tus, in each location

we conducted a convenience sample survey, but used stratication to ensure that our sample was asrepresentativeaspossibleofthecitysrestaurantindustry.WeusedBureauofLaborStatisticsindustry

datatoidentifythesizeofkeyrestaurantindustrysegments,andCensusdatatoidentifythesizeofkey

demographic groups (race, gender, age, and county o residence), in order to develop sampling goals in

eachcity.Overaperiodof6to12monthsineachindividuallocality,andsevenyearstotalinalllocalities,

interviewers then contacted restaurants workers on the streets and in communities in which restaurant

workers reside, identiying workers as they le restaurants, or in restaurant uniorms, or simply by asking

individualsiftheyworkedinarestaurant.Likeallmethods,oursamplingmethodologyhasstrengthsand

limitations. While ours were not strictly random surveys, the strength o our outreach methodology is

thatitallowedustoincludepopulationsofworkerstypicallyunderrepresentedintheCensus.In

addition, in-person surveys lead to high question-specic response rates. Aerelding the surveys, we

weighted the data as a nal step to ensure representativeness. Specically, using data rom the United

StatesBureauofLaborStatistics,weweightedoursampletomatchthedistributionofbackofthe

house and ront o the house sta in ull-service establishments and limited-services eating places

inthenationsrestaurantindustry.Finally,inpoolingallofthelocaldataintoonenationaldataset,we

weighted each citys sample by the relative size o its restaurant industry, to ensure that restaurant workers

in dierently-sized markets were represented appropriately.



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eRestaurantOpportunitiesCentersUnited(ROC-United)wouldliketothankthemanystudents,

volunteers, restaurant owners, and restaurant workers who devoted countless hours to conducting, input-

ting, and analyzing surveys and interviews and generally assisting with this project. Photos were taken by

membersandstaoftheRestaurantOpportunitiesCentersUnited(ROC-United),especiallyROC-

NY,ROC-NOLA,andROC-Chicago.

RestaurantOpportunitiesCentersUnited

350 Seventh Ave., Suite 1504

New York, NY 10001

(212)243-6900

fax:(212)243-6800

d

Documents

Serving While Sick High Risks & Low Benefits for the Nation's Restaurant Workforce, and Their Impact on the Consumer