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

Posted on by Kaori Fujishiro, PhD

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.

Posted on by Kaori Fujishiro, PhD

7 comments on “Opportunities to Advance Occupational Health Research by Considering Work as a Social Determinant of Health”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    Dear Dr. Fujishiro,
    Congratulations on an important article that expands on the typical concept of “human work,” as differentiated from “mechanical work.” As so well described in this article, “human work” is more complex than the measure of physical (i.e., metabolic) activity. In the US and other developed countries, a substantial amount of this “human work” is performed within non-industrial facilities by occupants who provide services for other occupants, such as in offices, retail stores, schools, hospitals, and residences. The physical and social interactions of the “workers” and those who receive the services (e.g., customers, students, patients, homeowners) can also have deleterious and beneficial effects on both types of occupants as well as on stakeholders of the facilities.
    I have been studying this phenomenon for several years through the theory and practice of building diagnostics, which has as its foundation a medical paradigm. Recently, I have expanded this building diagnostic approach to incorporate the concept of “dynamic balance.” In this approach, balances are measured and evaluated within and between two types of outcomes: primary, which pertain to human responses, such as measures of health, safety and security; and secondary, which pertain to human performance and other measures of interest to the stakeholders, such as energy, economics and sustainability; and four types of systems, which control the physical and social environmental stressors on the occupants.
    It seems that a merger of the expanded concept of “human work,” as described in this article, and “dynamic balance” in occupied facilities might provide a framework for scientific study and investigations that could produce measured outcomes within defined limits-of-error or uncertainties.

    Sincerely,
    James E. Woods, Ph.D., P.E.

    Thank you for your thoughtful comment, Dr. Woods. The shift from manufacturing to service industries in the U.S. workforce poses various challenges in our conceptualization of occupational health and its impact beyond the workers. Dynamic balance of occupied facilities in which services are provided and received seems to be an interesting way to capture the complexity of work within its social and environmental context. The built environment has been a public health interest for years, but mainly from the perspectives of safety and physical activity, not of occupation. There may be a room for collaboration right there.

    Dr. Fujishiro, as I understand your concept human health benefits from work may mitagate or offset some of the employment risks experienced on the job. It occurs to me that there may be a geographical or cultural component to the results of your research in addition to socioeconomic controls.
    I have often heard that when a person retires their status changes and they may have negative health consequences unless they are engaged in substantial alternative activities.

    Thank you for your comment, Dr. Alexander. I agree that geographic and cultural components are important aspects when we try to capture the meaning of work in a broader sense. Instead of controlling for them, researchers will gain more insight by investigating these and other contextual characteristics. Retirement and health are intertwined in complex ways. Without work, retirees may lose opportunities to perform engaging activities; but also they may be relieved from job stress and other negative factors.

    I am delighted to read your perspective of work and employment as social determinants of workers’ health. I Believe it is a great step of progress from the traditional risk assessment research and methods, to assess and research the impact of social determinants social of workers’ health. This is the avenue to explore, identify and understand the disparities caused by two groups of variables (working conditions and employment conditions) in the complex and varied world of work that we live in the 21st century. However, to assess such conditions requires the support of social epidemiology and the use of standardized methods, such as those proposed by PAHO/WHO, that bring about opportunities to learn about the methods that identify gaps from different sets of variables for the groups aforementioned. We are exploring such differences to provide better information that allow decision and policy makers, understand the impact of work and employment in a broader way than the basic relation of work and health under which risk assessment has historically been framed.

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