In Rust Belt cities across the globe, the sharp economic transitions of the recent past, from fiery industrial forges to glittering technical and educational hubs, have come to be described in stories of resilience, recovery, and rebirth. While each of these stories has local variation, broadly speaking, technological innovation, the active participation of critical anchor institutions, the broad and dynamic vision of community and business leaders, and support from various public and private institutions combine to create a new and different picture of the urban future. Yet, as these stories get told and retold, the facts become hazy, and like a John Ford western, parts of the legend become the story.

In The Next Shift: The Fall of Industry and the Rise of Health Care in Rust Belt America, Gabriel Winant seeks to complicate this telling of the making of the postindustrial Rust Belt by putting the voices of workers—both industrial and those in the service industry, particularly the healthcare sector—at the forefront of this story of change. Foregrounding workers reflects an important “implication” of the book: that the often overlooked and underpaid people who make up the caregiving sector may be the future of the American working class (pp. 23–24).

Winant locates his story in Pittsburgh, Pennsylvania, a city famous for its transition from a center for steel production to one now identified with its universities and large not-for-profit health systems. According to the author, the Pittsburgh region broadly represents industrial America. This claim is well supported, and here the book fits within a growing historiography that uses the city and the region as a focal point for studying the relationship between economic transition, complex business enterprises, not-for-profit organizations, and state, federal, and local government.

The Next Shift is divided into six chapters that tell a nuanced story of how the experience of working changed in industrial cities like Pittsburgh after World War II and why this matters for understanding the current inequalities that persist in the postindustrial economy. Business historians will likely be interested in chapter 1, which recounts the complex story of the steel industry's decline and how labor and management relationships changed in the years following World War II. A strength of the book is Winant's focus on working-class social networks, workers’ understandings of community, and the too often persistent gap between expectations and reality for many Pittsburghers. Winant's analysis expands beyond white, male steelworkers and helps to detail the experience of Black and female industrial and service workers, complementing the work of historians like Joe W. Trotter and Jared N. Day (Race and Renaissance: African Americans in Pittsburgh Since World War II [2010]). Chapter 2, in particular, examines the necessary but often unpaid domestic labor that many of the wives of male industrial workers provided to support their families and help moderate the ups and downs of the work cycle.

In the book's later chapters, Winant shows the intersection between labor and healthcare in several ways. Of particular interest for business historians is the discussion in chapter 4 of how the relationship between Blue Cross and unionized workers reshaped the working-class experience of receiving care while simultaneously supporting the growth of a healthcare infrastructure. Along with Christy Ford Chapin's work (Ensuring America's Health: The Public Creation of the Corporate Health Care System [2015]), this nuanced look at the business of health insurance is an important avenue for future study for business historians of healthcare.

The demand placed on area hospitals by well-insured workers also helped create a demand for healthcare employment, almost doubling, as Winant notes, “the health care workforce in the Pittsburgh area” between 1950 and 1970 (p. 151). Moreover, the book shows how “the expansion of the health care industry intersected with the decline of African American unemployment elsewhere, turning hospital service work into one of the most important labor market openings for Black workers” (pp. 151–52). Moreover, as Scott W. Stern notes in a review of Winant's book, that the transition from an industrial to a service economy, especially when combined with the environmental legacy of the region's industries, has important implications not just for the past but also for the future of Western Pennsylvania. (Scott W. Stern, “A Rust Belt City's New Working Class” The New Republic, March 31, 2021).

The Next Shift's final two chapters primarily focus on the 1980s and beyond. Here the book details the upheavals and high unemployment rates as primary metals manufacturing collapsed. An undertold part of the story that The Next Shift examines is how manufacturing unemployment led to multiple health crises, including managing the long-term effects of industrial employment on aging bodies, issues with addiction, mental health struggles, and domestic violence. Winant also discusses the rise of the region's nursing home and home care sectors. This story about aging is particularly important for Pittsburgh but is also understudied within the healthcare and business history literature. Finally, these chapters provide a comprehensive overview of some of the major healthcare consolidations that occurred during these same years and examine the experience of laboring within these health systems.

Part of the challenge of telling the story about the transition from an industrial economy to a postindustrial one, especially one that focuses on healthcare, is the fragmentary nature of the sourcing. Institutional sources are often incomplete or scattered. However, Winant uses numerous personal and institutional record collections across multiple archives and a rich variety of national and local newspapers. He also conducted interviews that add an important personal note to the story and help to enrich the reader's understanding of the lived experience of industrial and healthcare workers. Notably, The Next Shift eschews a simple story of replacement—the idea that industrial work was rapidly (and too often simply) replaced by service labor. Instead, as Winant argues, “this book shows how the industrial economy and the institutions that surrounded it created the care economy” (p. 7).

The Next Shift represents an exciting contribution to the labor and business history of healthcare. With its focus on workers, this book offers a new approach to understanding the waning days of the industrial economy in places like Pittsburgh and the reasons for the rise of its postindustrial care economy. It also reminds us that the deep inequalities that seem persistent in the American healthcare system are not inevitable.