NIOSH: a healthy work design and well-being perspective helps during the COVID-19 pandemic

The COVID-19 pandemic is adversely affecting worker well-being in many ways, including through decreased economic security. Economic aspects of overall health and well-being, along with physical, psychological, and social aspects, are a fundamental focus of the NIOSH Healthy Work Design and Well-being Program (HWD).

The mission of HWD is to protect and advance worker safety, health, and well-being by improving the design of work, management practices, and the physical and psychosocial work environment.

While there is no standard definition of economic security, it has been defined to include having adequate income and assets, access to benefits such as paid leave and health insurance, and some control over job content and the opportunity to build a career. Another definition includes individual and collective rights (such as worker rights protected by law and the right to be represented by trade unions), the opportunity for income-earning activities, protection of income-earning work, working conditions that are safe and promote well-being, and the opportunity to gain and retain skills. Regardless of how it is defined, economic security is a critical determinant of worker well-being.

Some examples of NIOSH-sponsored research findings that highlight the importance of economic security among workers include:

  • Unemployment adversely affects worker health and is a major source of psychological stress (Ray and Sauter, 2012).
  • Job security improves worker engagement, which in turn improves their productivity and the health of organizations and communities (Asfaw and Chang, 2019).
  • Low wages limit the funds available for food, shelter, and healthcare and adversely affect self-esteem and job satisfaction (Leigh and De Vogli, 2016).
  • Access to paid sick leave affects the ability of workers and their families to seek medical care (Asfaw and Colopy, 2017), workers’ ability to take time off to recuperate from illness and avoid occupational injuries (Asfaw et al., 2012), and their ability to reduce the spread of infections at work (Asfaw et al., 2017).
  • Fewer than half of workers in agriculture, forestry, fishing, and construction industries had access to paid sick leave in 2018 (Asfaw et al., 2019).
  • The percentage of all workers without health insurance decreased from 17.5% in 2010 to 10.9% in 2015. However, in 2015, workers in non-standard work arrangements, such as independent contractors, those working for temporary staffing agencies, and those working “on-call,” were less likely to have health insurance (21% or above) than workers with regular, permanent work arrangements (9.1%) (Luckhaupt et al., 2017).

In addition, research has demonstrated the associations of economic security with suicide, parent’s ability to satisfy children’s needs, and access to adequate housing:

  • Unemployment is associated with greater incidence of suicide; the risk is greatest in the first five years and persists for up to 16 years after unemployment (Milner et al. 2013).
  • There is strong evidence linking low income to children’s development, academic achievement, and health and evidence that financial security can improve parents’ ability to satisfy children’s basic needs (e.g., food, shelter, medical care) and provide developmentally appropriate child care.
  • Economic security is associated with homelessness that can both worsen health and the ability to seek treatment.

Problems with economic security during the COVID-19 pandemic are already evident through data collected through the COVID Impact Survey. The survey is conducted by the National Opinion Research Center at the University of Chicago for the Data Foundation and asks how households experience the pandemic using physical health, economic security, food security, and employment metrics. Data collected in April and May 2020 demonstrate that:

  • Despite the economic stimulus effort, respondents in 17% of households in April and 16% in May reported they would not be able to pay for an unexpected $400 expense.
  • Respondents in approximately 27% of households worried about having enough food over the past month, and 22% of households reported not being able to afford to buy more food when it runs out. Six percent of respondents also received support from food pantries across the country.
  • Both “worry about” and “experience with” food insecurity were higher for respondents without a high school diploma (53% worry, 47% experience), with household incomes less than $30,000 (47%, 41%), and in households with children (36%, 32%) compared to respondents with more education, higher incomes, and no children.

Of those who continue to work during the pandemic, many are unable to work remotely. This distinction has health, social, and economic implications. Those working remotely are less exposed to infection, better able to preserve their economic security, and already earning more than those who are unable to work remotely. During April and May 2020, 57% of those in households earning more than $125,000 per year reported working remotely, only 19% of those in households earning less than $60,000 per year reported having this ability.

Multiple pandemic-related changes affecting worker economic security are taking place simultaneously, rapidly, and on a global scale. This makes it hard to fully assess the long-term effects of these changes for workers, their families and communities, and their employers. While economic security is a determinant of worker well-being regardless of overall economic conditions, the current pandemic provides an opportunity to design strategies both at the policy and the organizational levels that improve both the level and distribution of economic security for all workers, including through adequate income and benefits.


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