To grow up in Pittsburgh in the 1990s and 2000s—as I did—was to experience something paradoxical: slow-motion
whiplash. In my early childhood, everyone seemed to agree that the city was
dying around us—another victim of deindustrialization and globalization and a
general brain drain, the factories gone forever and talented young people fleeing
for greener pastures. A city that had once provided the steel to win world wars
and been home to more Fortune 500 companies than any other except New York and
Chicago had, by the early 1990s, lost almost half its people (down from a peak
in about 1950) and nearly all of the industry that had employed generations and
made the resplendently bearded robber barons—like Carnegie, Frick, Heinz,
Mellon, and Westinghouse, whose names adorn virtually all of the city’s
institutions—so damn rich. Pittsburgh exemplified “Rust Belt decline.” Yet by the time I was finishing high
school, Pittsburgh was back. Everyone said so. Former mills and
shuttered factories converted into upscale shopping centers; biotech
companies, startups, and cool new restaurants dotted the cityscape; affluent
hipsters were moving back from those greener pastures. Soon companies like
Google, Facebook, and Uber would arrive,
drawn by the city’s top-notch universities (and relatively cheap cost of
living). Pittsburgh had “transformed itself into a vibrant cultural and
artistic hub, all while remaining true to its Rust Belt roots,” pronounced The New York Times. And at the heart of this transformation was “the
relentless growth of healthcare jobs,” added the
Los Angeles Times, with the health care sector replacing “manufacturing
as the region’s powerhouse.”Yet, as many have pointed out, this
narrative of decline and resurgence—all on a foundation of health care jobs, all
in the brief span of my childhood—masked darker truths. The city itself hadn’t
really been dominated by manufacturing since the late nineteenth century, the
scholar Patrick Vitale noted
in an excellent article titled “The Pittsburgh Fairy Tale.” Instead, its
corporations had extracted wealth from the true midcentury mill towns, which
existed in Pittsburgh’s outskirts—communities like Aliquippa, Braddock, Clairton,
McKeesport, McKees Rocks. It is these communities that are still largely desolated
by deindustrialization, with many abandoned storefronts, crumbling homes, and
widespread poverty and addiction. The story of Pittsburgh’s renaissance has
been constructed on the erasure of its exploited environs. Further, as the
University of Pittsburgh law professor Jerry Dickinson recently wrote,
Pittsburgh “remains one of the most racially segregated cities by neighborhood
in America,” with profound disparities in income and medical outcomes
(especially for Black
women).It is this complicated, contested
transformation that forms the backdrop for Gabriel Winant’s trenchant new book,
The
Next Shift: The Fall of Industry and the Rise of Health Care in Rust Belt
America. Winant—a prolific essayist and historian at the University
of Chicago—has delved deep into the region’s archives and made excellent use of
oral history collections and original interviews to describe the transformation
of the working class in places like Pittsburgh and its outlying communities. At
the start of the 1950s, few people in the region worked in health care, while
nearly 20 percent of jobs were in the metals industry, especially steel; today,
few people in or around Pittsburgh work in steel or other industrial jobs, but
health care jobs account for nearly 20 percent of the area’s workforce.“It was not a coincidence that care
labor grew as industrial employment declined,” Winant writes. “The processes
were interwoven.” The industrial jobs wrought havoc on workers’ bodies,
prematurely stooping them or poisoning them over time; the decline of these
jobs wrought further havoc on the workers’ mental health. As steel jobs fell,
health care jobs rose, with more and more workers needed to care for the aging,
suffering former industrial laborers, especially as neoliberalism dismantled
community institutions and punctured the social safety net. Yet while the steel
jobs had been unionized and often provided enough to support an entire family,
the health care jobs are largely low-wage and excluded from numerous labor
protections. It is also no coincidence that while the industrial jobs of
yesteryear were the province of men (largely, though certainly not exclusively,
white men), the care jobs of today belong disproportionately to women,
especially to women of color. To many, these care workers are “invisible, or
disposable,” Winant writes, but they are the vanguard of the new working class.The city of Pittsburgh sits at the
confluence of three rivers, in the foothills of the Allegheny Mountains, at the
heart of northern Appalachia. It is a critical port on the Mississippi River
system, a vital meeting place for rail and for steam, once the artery
connecting the big cities of the Atlantic coast with the resource-rich Midwest.
By the late nineteenth century, the city’s status as a commercial hub and its proximity
to the iron ore mined near Lake Superior and the coalfields of Appalachia gave
rise to the biggest steel operations in the world, which generated
extraordinary wealth and attracted waves of migrants. Few jobs have been as fetishized, as
mythologized, and as misunderstood as that of the steelworker. It’s certainly
true that the steel mills of western Pennsylvania provided steady, relatively
stable employment for generations throughout the twentieth century. By the 1940s,
these jobs were heavily unionized. Years of strikes and solidarity led to
average hourly wages of $3.36 by the early 1960s (equivalent to $28.53 in 2020
dollars). But these jobs were also brutal and dirty and dangerous. They slowly
wrecked men’s bodies, and often injured them much more quickly. In one mill in
McKeesport, Winant notes, 500 injuries were routinely reported per
month in a facility with just over 4,000 employees. Coke ovens, blast
furnaces, and open hearths exuded a punishing heat, with some workers inhaling
so much burning dust that they vomited blood. “Working-class men did not only
love and draw strength from this work,” Winant writes. “They also dreaded
spending their lives doing it, imagining all that it would require of them and
all that it would do to them.” The hell of steelwork was distributed
unevenly across racial and ethnic lines, with Black workers being subjected “to
the damage and humiliation of the job in greater concentration, more minutes
per hour, more hours per day,” Winant writes. They were disproportionately
shunted into “unskilled” positions and excluded almost entirely from the
skilled trades. They were often forced to live “at the bottom of the valleys,
where air pollution collected around smokestacks.”The physical and ecological wages of steelwork
had significant ramifications for their wives and families. Fumes and filth
meant considerable cleaning labor for women—rubbing overalls with lard to
remove industrial grease or scrubbing the basin of a washing machine to excise
dust and silt. One steelworker’s wife described herself as “an unpaid clean-up
woman for industry.” Fathers, sons, and brothers often worked different shifts,
necessitating women being “in and out of the kitchen all day long,” as one
steelworker’s daughter recalled. Surveys revealed housewives working more than 50
hours a week. And, in an industry where pain and slow violence were the
norm—and where to “drink, fight, drag heels, or sleep constituted a form of
resistance,” as Winant notes—many men had trouble turning this off at home; mental
and physical abuse were not uncommon. As a result of automation and capital
flight, the steel jobs gradually began to disappear in the 1960s. From 1960 to
1970, the number of metal manufacturing workers in the region fell from 162,514
to 128,142, part of a broader, massive decline in blue-collar industrial jobs
across the country. This decline hit Black workers hardest. Layoffs often affected
them at more than three times the rate of their white counterparts. Relatives, churches,
and ethnic community centers had long shared money, food, and assistance,
pooling their resources to care for families suffering as a result of a strike,
an injury, or a death. But these ties and institutions began to strain under
the weight of so much need. As community networks frayed and mutual
aid resources started crumbling, former steel families were increasingly forced
to turn to the health care system for care—and, eventually, for jobs. Steelworkers
had won robust health insurance decades before; Medicare had “seemed to open a
faucet of limitless funds” for hospitals and insurers, and facilitated greater
access for elderly people. This was of enormous importance in the Pittsburgh
area, as more and more people were becoming sick. The economic downturn and
decline of manufacturing jobs brought devastating health impacts; rates of
heart attacks, schizophrenia, alcoholism, depression, and suicide rose sharply,
far outpacing the national average.In the wake of the industrial layoffs
of the 1960s, many people in western Pennsylvania—but especially Black people,
and in particular Black women—turned to the booming health care industry for
jobs. These jobs were not terribly pleasant or well paid. Nor, for the most
part, were they unionized, in spite of federal legislation and considerable organizing
at the grassroots. The state legislature’s failure to intervene in 1970 “locked
in place a dynamic in which caregiving could be offered at large volume to the
insured fractions of the working class because its costs were passed on in such
significant proportion to hospital employees via low wages,” Winant concludes.In the years that followed, hospitals
expanded and began drawing administrators from the corporate sector. These
administrators began pushing for privatization and imposing harsh austerity
regimes on the facilities, constricting budgets even as sick and laid-off industrial
workers were showing up at the hospitals more and more. As a result of such
conditions, overcrowding and ultimately abuse became common. Throughout the 1970s and 1980s, the
layoffs continued, with the region shedding another 150,000 manufacturing jobs in
a single decade. By 1983, unemployment in the Pittsburgh area reached 17.1
percent, 60 percent higher than the national average and double the rate
of just three years earlier. For Black workers in the area, it was 25.6
percent. This further increased insecurity for men and led still more women
(especially women of color) to enter the labor market, especially in the care
industry, “doing the laundry, cooking and serving the food, changing the
sheets, and cleaning the bodies.” Steel plants began closing outright.
Meanwhile, the Reagan revolution decimated welfare services and the social
safety net.Because of steel’s seniority-based job-security
structure, layoffs disproportionately impacted the young, many of whom fled
Pittsburgh. As this process continued over decades, the city lost hundreds of
thousands of residents. The result was a “graying” of the population; soon,
Allegheny County was the second-oldest county in the country. These older
people—many of their bodies ravaged by years working in or living near steel
mills—required increased care. But the women who, in years past, had served as
caretakers were now working outside the home in greater numbers, and many of
the community institutions and state support systems of yesteryear were gone.The health care sector  added new jobs at a clip of 3 to 5 percent per year, but these jobs were
generally more meagerly compensated, more poorly protected, and more
irregularly scheduled than preexisting care jobs. Nursing home populations exploded, and
home-care agencies were soon overburdened. The health care sector flourished. It
added new jobs at a clip of 3 to 5 percent per year, but these jobs were
generally more meagerly compensated, more poorly protected, and more
irregularly scheduled than preexisting care jobs. People of color in particular
were shunted into “unskilled” parts of the industry, including in nursing homes
and ambulatory care. Big insurance providers—including Blue Cross of Western
Pennsylvania (later Highmark) and the University of Pittsburgh Medical Center—grew ever wealthier, gobbled up community hospitals across the region,
and began battling for dominance in the 1990s, each resisting unionization and
attempting to squeeze more labor out of fewer people working shorter hours.“Where there had once been a service
ethic—exploitative but also with real resonance—there was now something more
like servitude,” Winant writes. One medical secretary, whom he interviewed in
2018, said she believed she’d incurred damage to her bladder by trying to hold
in urine for so long, because her unit was so overworked; sometimes she
actually had to urinate on herself. Yet today, care workers personify not only
the new conditions of work but also the resistance to these conditions. Winant
notes that horrendous contemporary labor conditions led to a resurgence of
collective action in the late 2010s, with health care accounting for more strike
activity than any other industry. The Next Shift
is a deeply upsetting book. It meticulously charts the transformation of the
working class to show how the destruction of workers’ unions and bodies
occurred in a feedback loop, with capitalist exploitation demanding care,
demanding more exploitation, demanding still more care. The demolition of state
support and state protections served to speed up this feedback loop. It has
long since spun out of control.Although sometimes dense, Winant’s
language often feels imbued with a sort of restrained, righteous fury. And
while a lesser historian might have overlooked or given short shrift to the
gendered and racialized aspects of the transition from steel to health care, Winant
ably blends social and political history with conventional labor history to construct
a remarkably comprehensive narrative with clear contemporary implications.Today,
Pennsylvania is home to more Superfund sites than almost any other state.
Stretches of Pittsburgh’s rivers still stink.In light of such careful, comprehensive
accounting, it almost feels nitpicking to focus on an apparent omission, but it
is a shame Winant devotes so little space to environmental history. He does occasionally
note the rampant air pollution produced by industrial processes, but he mainly
does this to illustrate the “ecological domestic labor”—the cleaning, washing,
and sweeping—it produced for women, especially Black women. He does not dwell
on one of twentieth-century Pittsburgh’s defining characteristics—its built
environment stained by the omnipresent soot, an industrial poison so pervasive
that it often blocked out the sun and resulted in the nickname, “Hell With the
Lid Off.” And Winant’s last mention of such ecological conditions is a brief
reference to the fact that air pollution stood at twice the federally
recommended level in 1970, resulting in an upsurge of patients presenting at
hospitals with chronic lung disease. Yet in the years since 1970, pollution
in the region’s water and air has lingered, and today
Pittsburgh’s air is still some of the dirtiest in the nation. The only mentions
of mesothelioma or black lung are in the book’s epilogue, but their profusion
and their symptoms—to say nothing of the immense number of former extractive
industry workers who are denied medical coverage for these conditions as a
result of industry
lobbying—go unmentioned. Meanwhile, for decades, industrial
discharge darkened the area’s sewers and groundwater, a situation that is
arguably even more dire today, in light of the spread of fracking in western
and central Pennsylvania, which also goes entirely unmentioned. Although it is
banned within Pittsburgh’s city limits, fracking continues unabated in the
region’s exploited outlying areas, a devastating ecological and medical
disaster described in Eliza Griswold’s excellent recent book, Amity
and Prosperity. Indeed, the rise of fracking
complicates the narrative of the “fall” of industry in the first place. Today,
Pennsylvania is home to more Superfund sites than almost any other state.
Stretches of Pittsburgh’s rivers still stink.The way this ecological crisis
manifests today—in lingering pollutants and the abandonment of dying industrial
laborers—is inextricable from an understanding of the evolution of the Rust
Belt and its dominant forms of work and suffering.Despite this omission, Winant’s book is
a stunning achievement, sure to become a classic in the field of labor history,
a study of the denial of care constructed with, well, admirable care.In The Next Shift’s epilogue,
Winant notes that he completed the manuscript amid the rise of the coronavirus.
“Like a flash of lightning,” he writes, “the pandemic illuminated our society,
revealing who is valued and who is dispensable”—those left to die in prisons
and in nursing homes, as well as those unable to work from home. Seventy-three percent of
the health care workers who became infected in the first two months of the
pandemic were women. In December 2020, men in the U.S. gained 16,000
jobs, while women (nearly all of them women of color) lost
156,000. And, as The New York Times reported, the
coronavirus has disproportionately affected Black and Latinx people across the
country—in part because of medical racism, in part because of inequities in
health care coverage, and in part because of inequities in the labor market.It’s hard not to see a solution to some
of the suffering, staring back at us from the pages of The Next Shift:
organized labor. It was unions that secured health care for their members; it
was unions that made steel jobs so remunerative, in spite of their myriad other
flaws; it is unions that health care bosses continue to try to deny to care
workers. The first anti-poverty program, Martin Luther King Jr. once noted, was
the union, and labor organizing is a program in which women have always been
at the forefront. Pittsburgh itself has a proud history as a vanguard of the
American labor movement.                                                       Our society—descending ever deeper into
privatized suffering and a desperate fight for scraps—is in the midst of an
acute “crisis of care,” the scholar Emma Dowling recently argued. This
crisis is plainly apparent in postindustrial western Pennsylvania. “There is
no sense of community here,” one heroin overdose survivor from the region said
in an addiction study cited by Winant. “Left to your own devices, somebody
that’s drinking and drugging is gonna continue drinking and drugging. Nothing
else, cause there ain’t shit else to do.” The steel jobs aren’t coming back,
nor should we want them to. But the security and stability—the care—that the
steel jobs promised are very much worth fighting for.
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