Glorian Sorensen, PhD, MPH, Harvard T.H. Chan School of Public Health; Jack T. Dennerlein, PhD, Bouvé College of Health Sciences, Northeastern University; Lisa Burke, M.S.Ed., Harvard T.H. Chan School of Public Health; Lisa Berkman, PhD, Harvard T.H. Chan School of Public Health; Erin L. Kelly, PhD, MIT Sloan School of Management; Erika L. Sabbath, ScD, Boston College School of Social Work; Cal Halvorsen, PhD, MSW, Boston College School of Social Work; Gregory R. Wagner, MD, Harvard T.H. Chan School of Public Health; Susan E. Peters, PhD, Harvard T.H. Chan School of Public Health
The Harvard T.H. Chan School of Public Health Center for Work, Health, & Well-being is a NIOSH Total Worker Health Center of Excellence funded since 2007. Its mission is to protect and promote the safety, health, and well-being of workers through integrated workplace policies, programs, and practices that foster safe and healthy conditions of work. Building on its systems-level conceptual model centered on the conditions of work, the Center has expanded this model to include employment & labor patterns and the social/political/economic environment (Figure 1).1
The conceptual model guides the Center’s three unifying themes, providing direction and a shared vision for our current and future research projects, as well as our outreach and dissemination strategies. Unifying Theme 1: Identify and improve conditions of work as critical determinants of worker safety, health, and well-being. The Center aims to enhance worker safety, health, and well-being through improvements in conditions of work, as illustrated by the centrality of conditions of work in our conceptual model. Our research has examined both physical hazards on the job as well as organizational and psychosocial risks, such as variable work hours and scheduling, harassment on the job, and job design.1-5 These conditions of work are included in the model as direct determinants of worker safety, health, and well-being, which include prevention of work-related injury and illness, as well as worker well-being, thriving, and mental health. These conditions of work also contribute to enterprise outcomes such as turnover, absence, productivity, and healthcare costs. The model illustrates the shared causal pathways through which workplace policies, programs, and practices are likely to influence worker outcomes, highlighting the importance of interventions that address conditions of work. We have used the model in our epidemiologic and intervention research as a framework to prioritize research questions, guide hypothesis development, and structure intervention planning.
Theme 2: Identify and seek to reduce disparities based on race, ethnicity, socioeconomic status, and age in the working conditions workers experience and in their health, safety, and well-being. The multi-level influences depicted by our conceptual model also play out as we study sources of disparities in work-related exposures and in workers’ safety, health, and well-being. Socio-political-economic environments shape who is employed and the types of available jobs, with their accompanying exposures and benefits, based on socioeconomic position, race/ethnicity, age, and other factors.6 Rising social inequalities have significant implications for workers’ safety, health, and well-being, with individuals? experiences shaped by their intersecting identities and related histories of exclusion and marginalization, both within workplaces and in the larger community.7 Conditions of work, such as workload, job demands, and physical exposures on the job, are not equally distributed across the workforce. For example, people of color are more likely to work in jobs that place their health at risk through heightened exposures to job hazards, job insecurity, implicit bias, overt discrimination, fewer benefits, and lower wages for the same work.8 The COVID-19 pandemic has increased attention to our reliance on frontline workers and has heightened awareness of inequalities, not only in who is more likely to do this work, but also in wages and exposures to hazards on the job.9-11
Theme 3: Improve mental health and worker well-being in the workplace through increased understanding of the influence of conditions of work. For most people who work, experiences at work have a profound influence on their ability to reach their potential to function optimally, not only within the workplace, but also at home and within their communities. Working conditions and policies linked with worker happiness, well-being, and good health include (a) co-worker and supervisor support, respect and fair treatment; (b) physical and psychological safety; (c) a sense of meaning and purpose; (d) balance between work demands and the time, training, and tools to accomplish them; (e) remuneration and job security; and (f) policies permitting balance between workplace and out-of-work demands.12-16 Psychosocial risks of the job include heavy workloads, lack of involvement in decision making, and harassment on the job.
The Center’s three unifying themes, informed by our conceptual model, provide a framework for setting priorities to ensure that our research and dissemination efforts make a difference in improving the conditions of work, thereby protecting and promoting worker safety, health, and well-being. In addition, the model provides cues for linking work-related health determinants with other life domains, while also guiding and informing policy and practice.