Opportunities to Advance Occupational Health Research by Considering Work as a Social Determinant of Health

The role of work in creating health disparities has not been fully explored in studies in the United States. This might be because of a narrow perception of the relationships between work and health. A recent article by a researcher from the Indiana University-Purdue University Indianapolis and NIOSH researchers explores additional avenues for improving health by taking a broader, more nuanced view of work.

Beyond the traditional view of occupational health

Traditionally occupational health research has focused on exposure to workplace hazards and health outcomes directly related to those exposures. Reflecting this perspective, our monitoring and surveillance systems are designed to capture specific occupational hazards and resulting occupational health outcomes. While this approach has made tremendous progress in protecting and improving worker health, seeing work as simply a source of hazardous exposure limits our understanding of the full impact of work on health.

Looking at the workplace in a broader sense, we realize that the work we do gives us identity, pride, and social recognition, in addition to income and access to healthcare. The workplace offers a setting where social norms are formed (e.g., acceptability of cigarette smoking) and social support is exchanged. At work, people may experience power dynamics (e.g., harassment, discrimination). In some cases, the workplace is part of the community and neighborhood. Work and other domains of life influence each other (e.g., work-family balance) partly depending on organizational policies and practices (e.g., flextime, paid leave).

All of these factors have health implications, and the same worker can be experiencing them all at the same time. If we recognize these complexities and view work as a complex construct for research, then any number of health outcomes are plausibly related to work.

Opportunities through expansion and collaboration

With a broadened lens on work and health, we find opportunity to collaborate with the larger public health research community and share expertise. Such collaboration will expand the range of questions we ask and answer about work and health.

For example, we can examine racial and gender segregation in occupation and its health implications (e.g., female-dominant jobs, leave policies, maternal and child health); the labor market and worker health (e.g., local unemployment rates, disability accommodation in the workplace, and the rate of return-to-work after injury).

These perspectives help us see occupational health more clearly in the social context, which in turn suggests points of intervention previously not explored. In addition, because the characteristics of employment and work are not distributed equally by gender, race/ethnicity, immigrant status, or education levels, investigating work in social contexts helps us better understand health inequalities.

Expanding the notion of work-related health research offers opportunities to expand the positive influences of work. Everyone stands to benefit from healthful work. Collaboration between occupational and non-occupational researchers means we could better address health inequities and improve health for everyone. If you have suggestions for such research please comment below.

Kaori Fujishiro, PhD, is a Senior Epidemiologist in the NIOSH Division of Surveillance, Hazard Evaluations and Field Studies. 

For more information, please see:

Ahonen, E.Q. Fujishiro, K., Cunningham, T., Flynn, M. Work as an inclusive part of population health inequities research and prevention. American Journal of Public Health 108(3):306-311.