Boom time in jobs mostly held by women -- with lower pay.

Photographer: Scott Eells/Bloomberg

The Job of the Future Is ... Home Health Care

Justin Fox is a Bloomberg View columnist. He was the editorial director of Harvard Business Review and wrote for Time, Fortune and American Banker. He is the author of “The Myth of the Rational Market.”
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In January 1985, the Bureau of Labor Statistics began keeping track of employment in a new industry category -- home health care services. There were 138,400 home health care workers in that first month, just 0.14 percent of total nonfarm employment.

But it was a job with a future. As BLS economist Laura Freeman wrote a decade later in a Monthly Labor Review article headlined “Home-sweet-home health care,”

Expansion of Medicare benefits, lower costs for care at home relative to hospital care, and modern technology are among the reasons home health care has become the fastest growing segment of health care services, and the second fastest growing industry in the economy as of October 1994.

In October 1994 there were 576,300 home health care workers, and the BLS projected that by 2005 there would be more than 900,000. That didn't quite happen, because of a late-1990s decline following the passage of the Balanced Budget Act of 1997, which mandated big changes in Medicare. But then the growth resumed. In September there were 1.33 million home health care workers, according to the jobs report released today.

Thanks to the ongoing senescence of the Baby boom, the growth is expected to continue. The BLS has projected that by 2022 there will be 1.9 million home health care workers, making it the fastest growing industry in the land over the coming years, just ahead of the not entirely dissimilar categories of individual and family services and outpatient, laboratory and other ambulatory care services.

You could say, then, that home health care services is the defining industry of our age. As opposed to, for example, mining:

I might have used the auto industry as a comparison instead, but that data series only goes back to 1990. Mining clearly has a cyclical element -- rising prices for oil, coal and metals brought employment gains starting in the early 2000s, and the U.S. fracking boom drove a lot of growth, too -- but its long-term trajectory is basically flat, and it is declining as a share of overall employment.

This helps explain some things about how the overall labor market has changed since 1985. Jobs in mining pay better than the private-sector average, and 86 percent of them are held by men. Jobs in home health care pay worse than average, and 87 percent are held by women.

You can see from this where some of the America-in-decline rhetoric on the Republican campaign trail comes from, and why it resonates so strongly with men in particular. In fact, if you really want to take this pessimistic view to an extreme, there's this:

Once we were a land of manly men who cut down trees. Now we're a land of overweight diabetics with failed kidneys. Or something like that.

I'm incapable of leaving things on that down a note, though. And sure enough, after home health care and the other service industries listed above, the next two sectors expected to add jobs at the fastest pace through 2022 actually pay quite well: management, scientific and technical consulting services, and computer systems design and related services. For whatever it's worth, these are also fields that employ lots of men. Here's what they've done over the past 25 years:

These are good jobs, and the U.S. economy keeps creating more of them. Don't give up on the country just yet.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

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Justin Fox at

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Paula Dwyer at