HD420 Unit 10 Determinants Report Example

Paid by the Drop, Insured by No One: A Unit 10 Determinants Report on App-Based Delivery Drivers in a Composite Metro Area

[Student Name]

Purdue University Global

HD420: Social Determinants of Health and Health Behavior

Unit 10 Determinants Report

[Instructor Name]

[Date]

The metro area, the drivers and every figure are composite; the review of precarious employment, the social determinants framework, the access framework and the ecological model cited are real.

Who the Drivers Are

Composite figures drawn from a local survey of [410] drivers: median age 34; about [60] percent drive more than thirty hours a week; [45] percent were born outside the United States; [70] percent use their own car and [12] percent use bicycles or scooters. Most are classified by the apps as independent contractors, not employees.

Work and Income

Drivers are paid per delivery plus tips, minus their own fuel, maintenance and insurance. Median earnings after vehicle costs come to about [$12] an hour of time logged in, with large swings week to week. Income depends on accepting orders quickly, which pushes drivers to stay online for long stretches and to accept late-night orders that pay more. Precarious employment, meaning work that is insecure, irregular and without protections, is now counted among the social determinants of health (Benach et al., 2014).

Health Coverage and Care

Because drivers are contractors, the apps do not offer employer health insurance. About [38] percent of surveyed drivers had no coverage. Those with marketplace plans reported high deductibles. Taking a day off for a medical appointment means a day without income, and there is no paid sick leave.

Injury and Violence

Drivers spend hours in traffic and reported crashes, falls on stairs and in parking lots, and, among bicycle couriers, collisions with cars. About [1] in [8] reported being threatened or assaulted on a delivery in the past year, most often at night. Without workers' compensation, an injury can end income entirely.

Daily Conditions

Drivers reported having no reliable access to bathrooms, since restaurants often refuse non-customers, and many limit drinking water during shifts as a result. Meals are eaten in cars. Long periods of sitting, irregular sleep and heat in summer add up over months.

Control and Stress

Drivers can be deactivated by the apps, sometimes after customer complaints they cannot see or answer. Many reported this as their largest worry. Algorithms set pay and assign orders in ways drivers cannot predict. Low control over work is a recognized source of chronic stress.

Each condition on the list makes the others worse: low pay requires long hours, long hours increase crash and assault risk, and the lack of coverage and income protection turns any injury or illness into a financial crisis, all under the threat of losing the job with no explanation.

A Typical Week

To show how the conditions combine, the report follows one composite driver through a week. Marisela is thirty-eight, arrived in the country more than a decade back and delivers from late morning until about eleven at night, six days a week, to support two children. On Monday she earns well during the lunch rush and poorly in the afternoon lull, when she waits in parking lots with the engine running in the heat. On Wednesday a restaurant refuses her the bathroom, and she drinks nothing for the rest of the shift. On Friday night a customer argues about a missing item and follows her to her car; she does not report it because she worries a complaint against her could get her deactivated. On Saturday her car needs a new tire, which costs most of a day's earnings. She has a toothache she has had for a month and no plan to see a dentist, because a day off means a day without pay and she has no dental coverage. By Sunday she has worked about sixty-five hours and cleared roughly [$700] after fuel and the tire. None of these events would appear in a single health statistic, but together they describe the conditions that shape her health.

Placing the Findings in a Framework

The social determinants framework separates structural determinants, such as labor law and the classification of workers, from intermediary determinants, such as working conditions, material circumstances and access to care (Solar & Irwin, 2010). For delivery drivers, the structural determinant at the root is contractor status, which removes coverage, sick leave, workers' compensation and minimum wage protections in one stroke. The intermediary determinants, from bathrooms to late-night assaults, flow from how the work is organized. Access to care is limited not only by insurance but by the cost of time away from the app, a barrier the access framework describes as a person's ability to reach and pay for care (Levesque et al., 2013).

Levels for Action

The ecological model suggests action at several levels at once (McLeroy et al., 1988). At the policy level: worker classification rules, portable benefits funds and minimum pay standards that count waiting time, debated in several states and cities. At the community level: city-supported rest stops with bathrooms and water in delivery hot spots, and better lighting and safety patrols in late-night pickup areas. At the organizational level: app policies requiring restaurants to allow drivers bathroom access and transparent deactivation appeals. At the interpersonal and individual levels: driver associations that share safety information and help members enroll in coverage.

What the Report Recommends

1. The county health department should add delivery drivers to its occupational health surveillance, using emergency department data and driver surveys.

2. The city should pilot two driver rest stops in its busiest delivery districts.

3. Health navigators should hold evening enrollment sessions where drivers wait for orders.

4. The county should support state measures that extend injury protection and sick leave to app-based workers. A first step that costs little is to collect better data, since current injury surveillance rarely records whether a crash victim was working at the time, which hides the scale of the problem from the agencies that could act on it.

Limits

The survey is a convenience sample of drivers who answered an online link shared in driver forums and at two restaurant pickup areas, and may overrepresent those most dissatisfied. Earnings and injury figures are self-reported. And the drivers are diverse; some work a few hours a week for extra income and face far fewer of these risks.

Conclusion

The health risks of app-based delivery work are not separate problems to be addressed by separate programs. They share a root in how the work is classified and paid, and that root is where the most effective action lies.

References

Benach, J., Vives, A., Amable, M., Vanroelen, C., Tarafa, G., & Muntaner, C. (2014). Precarious employment: Understanding an emerging social determinant of health. Annual Review of Public Health, 35, 229-253. https://doi.org/10.1146/annurev-publhealth-032013-182500

Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. International Journal for Equity in Health, 12, 18. https://doi.org/10.1186/1475-9276-12-18

McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351-377. https://doi.org/10.1177/109019818801500401

Solar, O., & Irwin, A. (2010). A conceptual framework for action on the social determinants of health (Social Determinants of Health Discussion Paper 2). World Health Organization.