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Men in hardhats were once the heart of America’s working class; now it is women in scrubs. What does this shift portend for our future? Pittsburgh was once synonymous with steel. But today most of its mills are gone. Like so many places across the United States, a city that was a center of blue-collar manufacturing is now dominated by the service economy—particularly health care, which employs more Americans than any other industry. Gabriel Winant takes us inside the Rust Belt to show how America’s cities have weathered new economic realities. In Pittsburgh’s neighborhoods, he finds that a new working class has emerged in the wake of deindustrialization. As steelworkers and their families grew older, they required more health care. Even as the industrial economy contracted sharply, the care economy thrived. Hospitals and nursing homes went on hiring sprees. But many care jobs bear little resemblance to the manufacturing work the city lost. Unlike their blue-collar predecessors, home health aides and hospital staff work unpredictable hours for low pay. And the new working class disproportionately comprises women and people of color. Today health care workers are on the front lines of our most pressing crises, yet we have been slow to appreciate that they are the face of our twenty-first-century workforce. The Next Shift offers unique insights into how we got here and what could happen next. If health care employees, along with other essential workers, can translate the increasing recognition of their economic value into political power, they may become a major force in the twenty-first century.

Medical economics --- Community health aides --- Industries --- Health workers, Primary --- Health workers, Village --- Primary health workers --- Village health workers --- Allied health personnel --- Community health services --- Public health personnel --- Volunteer workers in community health services --- Economics, Medical --- Health --- Health economics --- Hygiene --- Medical care --- Medicine --- Industrial production --- Industries, Primitive --- Industry --- Economics --- Economic aspects --- Northeastern States --- Middle West --- American Midwest --- Central States --- Central States Region --- Midwest --- Midwest States --- Midwestern States --- North Central Region --- North Central States --- Mississippi River Valley --- Northwest, Old --- Northeast (U.S.) --- Northeastern United States --- United States, Northeastern --- Economic conditions. --- Affective labor. --- Care work. --- Deindustrialization. --- Emotional labor. --- Health care work. --- Hospital worker. --- Industrial decline. --- Labor history. --- New working class. --- Nursing home job. --- Pittsburgh history. --- Steelworkers. --- Working class.