The health of the U.S. workforce is an issue of importance to both workers and their employers. There is a wealth of evidence on occupational safety and health hazards that may potentially affect workers’ health. In addition to these hazards, personal characteristics and conditions, such as age, gender, genetics, or weight, can impact a person’s work and interact with workplace hazards. Individual characteristics and conditions may change the way workers respond to hazards which they may be exposed to on the job. In addition, employers face burgeoning costs of workforce healthcare which affect their companies’ productivity and profitability, and can constrain growth (ACOEM 2009; Hymel 2011). Maintaining a well-functioning workforce is increasingly critical as the workforce ages and is burdened on a personal level and financially by chronic disease. These issues affect U.S. well-being and competitiveness in the global environment. However, such work and personal factors are generally not considered together. Rather, they have been addressed separately. One impact of this traditional approach to occupational and personal risk factors is that the workforce suffers and subsequently the well-being of the nation is diminished.
In our recent paper published in the American Journal of Public Health, we provide a framework for considering the health of working people in a comprehensive manner (Schulte et al., 2011). As we mentioned, historically, work and personal factors have been considered separately. This separation of work and personal factors is due to the historic development of the labor and employment contract to limit liability. Subsequently, legislation to protect workers focused primarily on workplace hazards. However, most of the diseases and health conditions experienced by workers are influenced by multiple factors. The need exists for more research into the causes of diseases, and relevant interventions, which investigates the interaction of occupational risk factors and personal risk factors.
While the need for this research pertains to workers of all ages, it is particularly needed for older workers as our workforce ages. As the ACOEM (2009) noted, “The United States needs an able and available workforce to compete in the global economy, and to do this, must maintain a critical balance of net contributors versus net dependents. The current workforce of net contributors is aging and is increasingly burdened with chronic illnesses, functional impairment, and work disability, some of which could have been prevented, delayed, or mitigated.” One example of unique risk factors for older workers examined in our paper is how hearing loss experienced with increasing age might be further affected by exposure to organic solvents that could potentially cause additional hearing damage.
In our paper, the interactions between personal risk factors and occupational risk factors are described by four models that combine both work and personal risk factors. Using these models, we examined eight personal risk factors, genetics, age, gender, chronic disease, obesity, smoking, alcohol use, and prescription drug use, resulting in 32 examples presented in this paper. One illustration of a model in which a personal risk factor might change the effect of an occupational exposure on health is in the role of obesity in the development of osteoarthritis among workers whose jobs may necessitate kneeling or squatting. Another example relates to the variable risks for bladder cancer that can occur among workers who possess different NAT2 (a gene involved in the metabolism of dyes) gene alleles (alternate form of a gene), and who are exposed to various types of aromatic amine compounds (compounds used to make dyes). In this situation, workers with certain types of NAT2 polymorphisms (form of gene with different observable properties) have an increased risk of bladder cancer when exposed to certain aromatic amines, while workers with other NAT2 polymorphisms may be protected from developing bladder cancer when exposed to benzidine in the absence of other aromatic amine exposures. Framing of these issues is important to help raise awareness among occupational medicine and primary care clinicians of the interactions of personal risk factors and occupational risk factors, since such interactions can influence diagnosis, treatment, intervention, and prognosis. It has long been recommended that primary care practitioners take an occupational history, and more recently, the case is being made to include occupational information in electronic medical records (IOM 2011).
We also note that “explaining the distribution of health and disease exclusively in terms of risk factors only partly addresses the health of the workforce.” There is still a need to understand other factors that may play a role in the health of the workforce, including social, economic, cultural, political, and environmental variables.
There is a growing body of evidence on the effectiveness of workplace interventions for occupational outcomes (e.g., musculoskeletal disorders, mental health) and personal factors (e.g., smoking and overweight). Future models for interventions that consider both work and personal risk factors would provide a foundation for an integrated worklife approach that combines health protection from workplace hazards and health promotion. This approach is advocated by NIOSH through its Total Worker Health program. Ultimately, consideration of the totality of the health of the workforce is a prescription for better health and well-being of the nation.
We welcome your thoughts on these issues.
Dr. Schulte is the Director of the NIOSH Education and Information Division.
Dr. Pandalai is a medical officer in the Risk Evaluation Branch of NIOSH’s Education and Information Division.
- American College of Occupational and Environmental Medicine (ACOEM) . Healthy workforce/healthy economy: the role of health, productivity, and disability management in addressing the nation’s health care crisis: why an emphasis on the health of the workforce is vital to the health of the economy. J Occup Environ Med 51(1):114-119.
- Hymel PA, Loeppke RR, Baase CM, Burton WN, Hartenbaum NP, Hudson TW, et al . Workplace Health Protection and Promotion A New Pathway for a Healthier-and Safer-Workforce. J Occup Environ Med 53(6):695-702.
- Institute of Medicine . Incorporating occupational information in electronic health records. The National Academies Press, Washington, DC.
- NIOSH. NIOSH Current Intelligence Bulletin 63: Occupational Exposure to Titanium Dioxide. DHHS (NIOSH) Publication No. 2011160.
- Schulte PA, Pandalai S, Wulsin V, Chun HK . Interaction of occupational and personal risk factors in workforce health and safety. Published ahead of print on October 20, 2011 as 10.2105/AJPH.2011.300249 the latest version is at http://ajph.aphapublications.org/cgi/content/abstract/AJPH.2011.300249v1.
- Schulte PA, Vainio H . Well-being at work – overview and perspective. Scan J Work Environ Health 36(5):422-429.