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.