Improving Living Conditions in the House of Beauty: Nail Technician Participation in Policy Change - Tiffany Skogstrom
DISCLAIMER: This is my personal opinion. The opinions expressed here represent my own and not that of my employer or any of the mentioned organizations.
The current regulations enforced by the Massachusetts Board of Registration of Cosmetologist’s (BORC) fails to protect public health from the emerging issues of infections, sanitation and safety in nail salons. Regulations must be reformed to involve and meet the needs of the stakeholders who can make real change – nail salon workers. The current method of regulation is designed to prevent stakeholder participation, marginalizes the largely immigrant workforce and lacks necessary reassessment to proactively deal with newly materializing public health issues.
Awareness of safety and sanitation problems in nail salons stems from a series of nail salon complaints regarding sanitation and infection reported to the Boston Public Health Commission (BPHC) in 2009. The heightened number of calls may be a consequence of raised awareness generated by the Safe Nail Salon Project – a program working with nail salons on environmental health and chemical safety issues (1). Attention to this public health problem culminated when on December 31, 2009 BPHC closed down a nail salon after a consumer was hospitalized and treated for a Methicillin-resistant Staphylococcus aureus (MRSA) infection believed to have been contracted via a manicure with unclean tools. Research reveals that outbreaks of a variety of foot-spa related skin infections have occurred in Georgia (2, 3), California (4), Ohio (5) and Kentucky (5). Many nail salon infections are likely to go unreported. Although the Safe Nail Salon Project educates nail technicians on protecting themselves from chemical exposure while at work, staff was blindsided by the emerging concern about sanitation and infection.
The Massachusetts BORC is the sole regulating agency with which the nail technicians have interaction. The agency guides hygiene, sanitation and general salon standard operating procedures and its stated mission is to protect “the health and safety of the public by maintaining high standards for the industry.”(6) The BORC’s expectation that nail technicians will follow Massachusetts regulations is built upon the Health Belief Model (7). For example, once a nail technician has passed her examination for licensure, she is aware of the Massachusetts regulations. A licensed nail technician knows that not following those regulations would make her ‘susceptible’ to disciplinary action and that the ‘severity’ of penalty could result in a loss of license or closure of her salon. Once she has become a legally trained nail technician, there are no ‘barriers’ to her following the regulations. The ‘benefits’ of following the regulations are employment and a safe work environment. All of the above circumstances are ‘cues’ that should bestow in her the ‘intention’ to abide by the law and then ‘act’ on that intention. When a nail salon worker does break the law, she is faced with penalties and left on her own to remedy the situation.
A more holistic and inclusive approach would be the better method for bringing nail salons into compliance. The problem with applying the Health Behavior Model to this program is that “there is no attempt to facilitate empowerment of those involved in the (research) process, nor is there opportunity for reflection.”(8) To put this into context, it is important to note that nail technicians in Boston and beyond consist of a young, female and mostly immigrant workforce. Working long hours for low wages and being exposed to an array of toxic chemicals, nail salon workers are so marginalized that Time Magazine identified their job as being one of the worst in America (9). The BORC online licensing database shows that more than a third of working Vietnamese immigrants in the Boston area work in nail salons (10). Furthermore, according to an article titled Results from a Community-based Occupational Health Survey of Vietnamese-American Nail Salon Workers by Roelofs and Azaroff, “Nail salons are the core of the Vietnamese immigrant and refugee community’s economic support. Low entry requirements, limited need for English language skills, ethnic business networks, and flexible work schedules draw many Vietnamese women and some men to the work.”(11) The BORC, on the other hand, does not have any Vietnamese representation (12).
While it is not surprising that the BORC would fail to mirror the demographics of the people working within the salons, several of its outdated policies impede participation and some are even detrimental to worker and public health. It would be to the benefit of the BORC and public health to have nail technicians participate in the revision of regulations, and to identify how to remove barriers to compliance.
The theory of frame alignment states that pitfalls in organizational participation include: failure to correctly interpret the communal grievance; treating constituent participation as a static means to an end; and over-generalization of participation-related processes (13). This paper will demonstrate these shortcomings as a road blocks for stakeholder involvement in the BORC and reinforce the idea that nail technicians need to be linked and mobilized within an alternative organization that is external from, and can put pressure on, a government agency.
The Three Frame Alignment Participation Pitfalls:
The BORC and Interpretation of Grievances (13)
The grievance most often heard from nail salon workers relates back to language barriers and takes the form of economical and job security concerns. The main complaint is that while in other states, such as California, “the nail salon industry draws so many Vietnamese workers that Vietnamese is one of the primary foreign-language option for the license examinations” (14), the Massachusetts BORC requires all examinations for licensure to be taken in English and refuses to allow translation. The BORC website declares that “EFFECTIVE OCTOBER 1, 1998, all examinations for licensure by the Board of Registration in Cosmetology will be administered in English only. Interpreters, dictionaries and other translation aids will not be permitted at any of the examination sites as of October 1, 1998. The decision of the Board to discontinue the use of interpreters and foreign language examinations is based on public health and safety concerns relating to the proper use of chemicals in the cosmetology profession and examination security issues in general.” (15)
The BORC ‘English-only’ policy for nail technician license exams forces people to work unlicensed and untrained in sanitation or any other trade skills. As a result, competing nail salons use cheap and unlicensed labor and undersell the businesses who are in compliance and abiding by the letter of the law. This also fosters potential for an underground economy for the buying and selling of nail technician licenses resulting in various forms of indentured servitude, and in extreme cases, human trafficking (16, 17, 18).
As outlined in Social Conditions as Fundamental Causes of Disease by Link and Phelan, “health policymakers should consider whether a proposed intervention will have an impact on just one disease or whether, because of its influence on a fundamental cause, it will affect many diseases.” (19) Failure to address the language grievance not only prevents the Vietnamese nail technicians from participating in mainstream government and society but also perpetuates the cycle of poverty, unsafe working conditions, unsanitary salons and general exploitation that has become ‘business as usual’ in nail salons.
The BORC and Dynamic Participation (13)
Nail technicians interactions with the BOC are a one-way relationship. Once nail technicians have passed their examination for licensure, the only expected interaction is through license renewals or a chance salon inspection. In 2003, there were 3 BORC inspectors and 1,206 salons in the state of Massachusetts (20). The BORC websites shows that a during a 2009 strike of 163 Boston beauty salon inspections, “56 were cited for violations ranging from unsanitary conditions to employment of unlicensed individuals and unlicensed shops.” (21) That one out of three of the businesses that were inspected had serious violations provides a telling snapshot of salon conditions. Salon employees tell tale of being issued citations without a clear understanding or direction on how to resolve the offenses. To draw an analogy from Siegel’s The Importance of Formative Research in Public Health Campaigns: An Example from The Area of HIV Prevention Among Gay Men, “public health efforts to change” a marginalized group’s “behavior must include efforts to change the way society treats” that group (22).
The BORC and Participation-Related Processes (13)
The BORC has put up many barriers for nail technician’s participation. For this reason, in June of 2009, a group known as the Massachusetts Healthy Cosmetology Committee met with the BORC with the goal of ‘nudging’ the agency to reconsider and revise some of cosmetology regulations for the sake of public health (23). This committee sought, among other things, to address:
·Allowing testing, training and hearings in languages other than English.
· The current requirement that nail technician licenses (as well as individual ‘health certificates') (24), which include home addresses, be prominently displayed in salons. The committee recommended that licensees’ home addresses not appear on licenses due to a story of a licensee being followed home and mugged for her tips.
· Clear and effective instructions for sanitation of nail salon tools (25).
· Eliminating the requirement for Steri-Dry (26) (dry sanitizer) and prohibit the use of any formaldehyde-based chemical in salons including Steri-Dry and formalin. Formaldehyde is a carcinogen, asthmagen, and strong irritant (27) and is unnecessary to assure salon hygiene and sanitation.
With the exception of the language request, the BORC was in agreement with the above mentioned items. However, rather than go through the process of rewriting and revising legislation, the BORC informed the committee that it was applying a ‘non-enforcement’ policy on those issues. The problem lies in the fact that if the laws are not formally changed, the nail technicians are unaware of which BORC rules are enforceable and which ones are not. In order to comply with regulations, nail technicians will continue to implement practices that put themselves and the public in harm’s way.
The BORC reluctance to make adjustments to outdated regulations demonstrates “collective conservatism” or ‘the tendency of groups to stick to established patterns even as new needs arise.” (23) The groups’ resistance to consider any outside suggestions, especially those with which they are in agreement, shows that the only way to participate in the BORC is if you are an appointed member of the Board or on the receiving end of a disciplinary action. Working conditions, sanitation, and environment cannot improve or get resolved with the current lack of opportunities to reevaluate situations. Even though the BORC agreed with most of the recommendations for improvements, the entity refused to be nudged. As stated in Klandermans’ Potentials, Networks, Motivations, and Barriers, “willingness is a necessary but insufficient condition of participation.” (28) The method of participation is ‘one-size-fits-all’, meaning that impermeability ensures that no one outside of the BORC gets to participate.
Analysis of the Three Participation Pitfalls and the BORC
The issues presented in the three pitfalls to participation reveal the BORC as an entity that works counter to its mission statement to “protect the health and safety of the public by maintaining high standards for the industry.” (6) The rigidity of the organization in terms of adapting to the training needs of the Vietnamese workforce results in consumers contracting infections. In any language, the BORC regulations continue to be outdated and unclear, and fail to address emerging infections or salon conditions.
Furthermore, during these turbulent economic times, low wage service workers are even more desperate for income and happy to do the work as unlicensed and exploited nail technicians. Unlicensed workers not only hurt the local economy by underselling their law abiding competitors, but create the perfect circumstances for indentured servitude where licenses can be bought and are worked off for exorbitant prices. The English-only examination policy further alienates an already marginalized community of people and makes young immigrant women even more vulnerable to exploitation through cheap labor and human trafficking.
Clearly there is no method to work within the BORC to make the necessary public health and worker safety changes. For this reason, Vietnamese nail technicians must link with an organization that shares their values, ideologies and beliefs in order to externally pressure the regulating agency to make important policy changes. Furthermore, the process of reviewing the pitfalls is valuable to make improvements because “efforts to reduce risk by changing behavior may be hopelessly ineffective if there is no clear understanding of the process that leads to exposure”.(19) Proactive public policy and interventions can be created by reflecting on the shortcomings of existing regulations.
Frame alignment is a theory of collective action where un-mobilized individuals and an organization are linked together based upon shared ideology and a need to act (13). Social movements are comprised of people working together as ‘framing agents’ to define the world within which they live (29). According to Snow and Benford, the ongoing and necessary processes of a successful social movement are frame bridging, frame amplification, frame extension and frame transformation.
The four processes of frame alignment act as an organizational prophylactic against participation shortcomings and are necessary, flexible and fluid parts that aim to ensure momentum. Frame bridging (13) is the process of linking two or more ideologically congruent ‘frames’ (individuals and an organization) and building momentum through recruitment, leadership development and activities that are consistent with the shared ideology. Frame amplification (13) consists of value and belief amplification. Value amplification is the process where the group decides upon goals and mobilizes on them. Belief amplification is faith that the value amplification actions will have the desired impact. Frame extension (13) is the organization’s flexibility in what it can offer and incorporate to meet the needs of its constituents. Frame transformation (13) is the process of redefining or nurturing new values to find commonalities between the individual and organization that may not be immediately obvious. Frame transformation can be ‘domain specific’ where actions result in a change in status for a group of people, or ‘global interpretive’ which is a philosophical process of being “the change you want to see in this world.” (30) When linked together, the four frame alignment processes inoculate against the three pitfalls of participation and can create meaningful change.
1. Frame Alignment and the Interpretation of Grievances:
The first step of the process, known as frame bridging, involves identifying the organization best capable of properly interpreting the Vietnamese nail technician’s grievances and with which they would be best aligned. The Vietnamese – American Initiative for Development (Viet-AID) is a prominent organization within the Vietnamese community. Viet-AID’s mission to “provide comprehensive economic development programs and services to alleviate poverty and advance civic participation” (31) is complementary to the values and reflects the grievances of the nail technicians’ struggle for decent employment. Viet-AID has good relationships with the Vietnamese business leaders and plays a major role in the Safe Nail Salon Project and the Massachusetts Healthy Cosmetology Committee. This sets the stage for aligning the un-mobilized nail technicians with Viet-AID in a pact to force policy change.
Nail technicians working with Viet-AID for changes in the salons would vicariously be partnering with the BPHC Safe Nail Salons Project. BPHC is a governmental agency, and a population such as the Vietnamese community, who fled their country of origin to escape an oppressive government, may be gun-shy at the prospect of such a partnership (22). Through frame transformation, ‘regulatory’ values and activities would have to be made appealing to participants. Activity examples include creating model regulations that would be adopted by various municipalities across Massachusetts that would: require annual nail salon registration with the health department; make Safe Nail Salon training a condition of the annual registration; and create specific local requirements for sanitation.
To appeal to nail technicians, these regulatory methods must be framed to address nail technician’s grievances of an unsafe work environment, inequity amongst business’ underselling practices and low wages. The unlikely partnership between a government agency and the Vietnamese workers is made more attractive by revealing how BPHC’s public services might be beneficial. The BPHC Safe Nail Salon Project has a rich history of frame extension through helping people access health care and providing valuable public health services. Therefore, the closer relationship with a local government agency would be a partnership to bring nail technicians into the mainstream, rather than an additional regulatory burden.
While BPHC focuses on local regulations, Viet-AID may be the more appropriate vehicle to turn nail salon worker’s grievances into an active campaign to put external pressure on the BORC. These simultaneous efforts could lead to effective public health change.
2. Frame Alignment and Dynamic Participation
Frame bridging is needed to mobilize leaders and interpret grievances into movement activities. Viet-AID’s frequent visits to the salons helps recruit leaders who participate in activities, get the community talking about the problem and encourage others to take part. As stated by Klandermans, “informal recruitment networks are necessary conditions for the arousal of motivation to participation.” (28) This paves the way for frame value and belief amplification, where nail technicians “employ an ‘injustice framework’ that links personal and vicarious experiences of stigma and discrimination” (32) to Viet-AID’s mission of social and economic development.
Frame value and belief amplification involve articulating grievances in terms of ‘injustice’ and forming them into solution oriented actions. The conditions of belief amplification (13) are that people will mobilize when (a) they believe there is a serious problem; (b) there is an antagonist (the BORC) that is defined as the source of the problem and (c) with whom the constituents have stereotypical beliefs about power; (d) people believe that the identified actions will lead to change; and (e) there is importance in standing up together to overcome the injustice.
The frame transformation is domain specific, where actions result in the change in status of how a group of people are treated by the BORC. Potential actions, depending upon the will of the constituents, could include letters to the editor or public demonstrations demanding that the governor command the BORC to provide examination translation, or Vietnamese representation on the BORC. The dynamic participation feeds the recruitment aspect of frame bridging where “people show more of a tendency to participate in collective action if they expect that others will do so as well.” (28)
3. Frame Alignment and Participation-Related Processes
The theory of frame alignment requires that participants are active in all processes. Participation-related processes consist of recruitment and leadership development of frame bridging, identifying goals and strategic activities during frame amplification, recognizing innovative ways to meet the ongoing needs of the community through frame extension, and nurturing new values that serve the benefit of the community through frame transformation.
Where Vietnamese nail technicians have been alienated by the BORC, the frame alignment process of this proposed campaign welcomes participation in the ‘linked’ organization at all levels. If the frame alignment recipe is followed correctly, the result will be a functioning organization that serves the needs of its constituents. The processes could be the blueprint for a Nail Salon Business Leadership Council that might be housed within Viet-AID. The new leadership group would autonomously decide the best course of actions in the interest of nail technicians. It would drive its agenda through participation in other economic and social justice initiatives, and ideally, the BORC itself.
Ongoing success is only guaranteed if all of the frame alignment processes are participant driven. Furthermore, it is necessary to reevaluate and adapt all processes to meet emerging needs and realities in order to retain and accumulate constituents. An ideology that becomes set in stone will lose members and momentum (29), and becomes susceptible to mirroring the rigidity of the entity that it seeks to influence.
In absence of the nail technician’s ability to participate in the BORC, the most sensible intervention involves collective action to improve public health policy. The most fundamental change would be to allow nail technicians to test for licensure in their own language. This single policy change will have astounding results such as giving people access to safe and well paying jobs and safer nail salons. While municipalities can put out fires by implementing city regulations, real change must happen within the BORC to tackle the root of these problems.
The frame alignment process has potential to bring a historically marginalized group of people into the mainstream. The multi-level methods address health inequities through strengthening individuals and communities, improving people’s access to services, and fostering economic and cultural change (33). This proposal builds meaningful, innovative and sustainable partnerships and a model that could be emulated in other parts of the country, further building momentum for social change.
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