A Comprehensive Approach to Workforce Health

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.

More info - Source: National Institute for Occupational Safety and Health (NIOSH)