Marie-Anne S. Rosemberg, PhD, MN, RN, FAAOHN, University of Michigan; Alyssa McGonagle, Ph.D., University of North Carolina; Charlotte Tara A. Hartley, PhD, MPA, MPH, Worker Safety and Health Team, Health Systems and Worker Safety Task Force; Tapas K. Ray, PhD, National Institute for Occupational Safety and Health; Lee Newman, MD, University of Colorado; Casey Chosewood, MD, MPH, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention
Sixty percent of U.S. adults have one or more chronic health conditions, making it imperative to address both the work-related etiology of such conditions and how organizations can support workers managing them. Our purpose is to describe our work on the Healthy Work Design and Well-being (HWD) Cross-Sector Council of the National Institute for Occupational Safety and Health to identify current gaps in the National Occupational Research Agenda (NORA) pertaining to chronic conditions in the workplace and describe action plans to address these gaps.
The HWD Cross-Sector Council focuses on protecting and advancing worker safety, health, and well-being by improving the design of work, management practices, and the physical and psychosocial work environment. The HWD NORA identifies prioritized areas in which knowledge and actions are needed to protect worker health and well-being in the U.S. The current NORA agenda (2016-2026) includes seven objectives, one of which (Objective 4) pertains to work organization-related chronic health conditions. Our job was to review the nine research gaps identified in this Objective related to chronic health conditions and suggest expansion of these gaps, along with outputs and partnership/collaboration opportunities.
We (six) team members) met weekly to review the nine gaps on chronic health conditions. During the weekly meetings and using a shared platform, we identified priority areas for expansion of current gaps, actionable outputs associated with each gap, potential partners to help execute action plans, and stakeholders with interests in these actions. We further classified outputs/products based on short, medium and long-term goals. We presented the expansion plan to the entire HWD Council and made revisions based on the council members’ feedback.
Through this presentation, we report a summarized and abridged version of the expansion plan on chronic conditions. We identified five areas of expansion. (1) The first area is implications of COVID-19. This area includes mental health issues, substance use, missed/delayed screening; COVID-19 pounds (diet/obesity), loss of employer-assisted insurance, job loss and economic impacts leading to new or worsening of chronic diseases. (2) The second area needing expansion pertains to environmental exposures and climate change implications for chronic conditions. This includes wildfires and respiratory issues, drought and mental health issues, and heat-related illnesses and chronic health conditions such as kidney disease. (3) The third area focuses on the intersection of work design, worker wellbeing and chronic conditions and the need to shift focus to all forms of prevention, primary, secondary and tertiary in the context of optimizing chronic health disease outcomes. This also encompasses workplace supports for workers currently managing existing chronic health conditions as well as worker quality of life. (4) The fourth area of expansion pertains to small businesses-which are often overlooked- and the need to identify tools/products that are specific for small business operators. (5) The fifth area calls for a focus on disparities in the etiology and management of chronic conditions across industries and worker sociodemographic characteristics (e.g., race and ethnicity; socioeconomic status). Based on these varying expansion needs, we identified specific short-term, mid-term, and long-term outputs/products. Examples of these products include special journal issue calls, systematic reviews, and leadership training. Short-term, we are currently working with journals to partner on special issues on work-related etiology of chronic health conditions and work and organization support for workers with chronic health conditions. Mid-term we aim to conduct systematic literature reviews on areas such as; Financial and other related burdens of chronic conditions on organizations (e.g., productivity; presenteeism); Interventions at the organizational level that promotes chronic diseases management among workers (e.g., job control and management/leadership training); and Impact of environmental and climate changes on chronic conditions. Long-term, we recommend pilot testing and evaluating leadership/management training to support workers with chronic health conditions.
The NORA original gaps provided an agenda and platform for key stakeholders aiming to address chronic conditions among workers. However, much work remains to be done to operationalize and address these gaps while expanding to emerging issues pertaining to chronic conditions. In our work, we identified several areas of expansion and ways to move the agenda into action. We also identified several stakeholders and potential partners.
Chronic health conditions affect a large and growing number of U.S. workers. As members of the NIOSH HWD Council, we identified areas of expansion for current objectives related to chronic health conditions both at the individual worker and at organizational levels. Our work is a timely mid-decade approach to the NORA 2016-2026 Agenda.