A worker entering the U.S. Steel Clairton Works in Clairton, Pennsylvania DREW ANGERER/GETTY IMAGES

Heavy industry once drove Pittsburgh’s economy. Now health care does—but without the same hard-won benefits.

The Next Shift: The Fall of Industry and the Rise of Health Care in Rust Belt America
by Gabriel Winant
Harvard University Press, 368 pp., $35.00

Reviewed by Scott W Stern

The New Republic

March 31, 2021 – 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.” …Read More