In 1943, Dr Alice Hamilton, the first woman appointed to the Harvard Medical School faculty, published the memoirs of her pioneering work in occupational medicine under the title Exploring the Dangerous Trades. While conditions for US workers have improved greatly since the early 20th century, dangerous trades still exist. How much of that danger relates to contingent employment arrangements has yet to be determined. Even if the influence of contingent arrangements on health at the individual level is modest, the sheer size of the contingent workforce indicates that the magnitude at the population level may be substantial. Furthermore, in the context of increasing national rates of obesity and diabetes, the potential of contingent work arrangements to exacerbate poor eating and exercise habits, as suggested by an exploratory Australian study has enormous public health implications. Studying an unaffiliated, transient, and dynamic population of workers undoubtedly poses methodological challenges, and these challenges surely have limited investigative efforts thus far. Yet it is clear that demonstrating the effectiveness of interventions aimed at injury and illness prevention and health promotion for the contingent workforce is of paramount importance to the health of the nation.
Kristin J. Cummings, MD, MPH, Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1095 Willowdale Rd MS 2800, Morgantown, WV 26505
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