The relationship between employment and health has long been recognized to involve workplace exposures, the organization of work, and attributes related to being employed such as income, geography, access to health care, and residential environment. As hazardous workplace exposures have become controlled and organization of work improvements have occurred from advances in occupational and environmental sciences, more attention has become focused on attributes of employment. Published research on attributes of employment, however, is early in its development. More research on smaller employers, the self-employed, and subgroups of workers such as young adults (18 to 34 years), immigrants and millennials is needed.
The study by Merchant et al1 presents the results of a random sample of 1271 working or willing to work but unemployed adult Iowans. It presents a valuable contribution to understanding the distribution of health behaviors, body mass index, quality of life indices, and productivity in different types or states of employment. The methods make creative use of publicly available surveys and questionnaires to construct the validated Rural Iowans Health Questionnaire, which provides rich profiles and comparisons of survey respondents and the three employment-based subgroups. The use and distribution to small employers of several surveys including the Center for Disease Control and Prevention 14-item Quality of Life Questionnaire was notable in the research group's attempt to provide small employers an easy way to assess their workforce and to give them statewide benchmark productivity measures. The study is constrained, however, by well-recognized limitations, many of which the authors acknowledge, and include cross-sectional observations, the use of fixed-line telephone survey methods, the use of voter registration lists for sampling, absence of the health insurance actuarial value, and seasonality (timing of survey).
Results from the survey confirm that employment compared with unemployment produces better quality of life, risk profiles, and behaviors such as smoking, exercise, diet, mental health, and body mass index. Of special interest in this survey is insight into self-employed adults in a state of smaller cities, towns, and farms. Weekly working hours in the self-employed were on average less than in those employed by organizations, any health insurance was less but surprisingly high at 87% compared with those employed by organizations, smoking rates were lower, and sleep of 8 hours or more was higher. Nevertheless, influenza vaccination and seat belt use were lower. Such heterogeneity compared with the unemployed and workers of institutions is potentially relevant for policies and approaches directed at self-employed populations. Further research into the self-employed and other worker subpopulations like this is desirable.
The data generated in this report come from one of four centers for total worker health supported by grants from the Center for Disease Control's National Institute for Occupational Safety and Health.2 These centers seek to advance the science and practice of occupational and environmental medicine by extending the health framework to include communities and nonoccupational exposures and dynamics. Their outreach is broad to many stakeholders including workers, employers, universities, community groups, municipal leaders, and other centers for total worker health. The intent is to provide a more comprehensive approach to the complex challenge of health in employed populations, to produce tools, and to generate and disseminate benchmark and best practice resources for action and change. This report is an excellent example of the methods and insights these centers are producing, including using multimodal data from different sources to supplement new data collection.3 Investments in this effort by the centers are essential and should be sustained.
1. Merchant JA, Kelly KM, Burmeister LF Employment status matters: a statewide survey of quality-of-life, prevention behaviors, and absenteeism and presenteeism. J Occup Environ Med. 2014;56:686–698.
2. Centers for Disease Control. NIOSH. Centers of Excellence to Promote a Healthier Workforce. Available at: http://www.cdc.gov/niosh/TWH/centers.html
. Accessed May 12, 2014.
3. Journal of Occupational and Environmental Medicine. 2012 Total Worker Health Symposium. Available at: http://journals.lww.com/joem/Fulltext/2013/12001/2012_Total_Worker_Health_Symposium.1.aspx
. Accessed May 12, 2014.