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	cancer, reproductive, cardiovascular

Input: Economic Factors

While economic factors are known to play an important role in many aspects of occupational health, there is incomplete understanding of specific economic factors affecting many occupationally-related health problems, such as the occupational illnesses and adverse reproductive health problems encompassed within the CRC cross sector. Additionally, the burden that occupationally-related chronic illnesses and adverse health outcomes may place on society has been studied but remains poorly understood. Both these issues, as they relate to the CRC cross sector, will be introduced in this section.

Economic factors that are related to chronic work-related health problems are complex; in any one situation, there may be multiple and interacting factors related to the cause of, and exacerbating, the health problem. Some of the adverse consequences of these factors can be alleviated by interventions that are appropriately designed and implemented, while others may be more difficult to address. The following text provides a brief discussion of economic factors that include demographic and technological factors and changes in managerial strategies and work organization.

The changing demographics of the working population may be having important effects on the potential for work-related health problems. For example, there are many immigrant and minority workers whose primary language is not English and who, therefore, may be less effectively trained and less aware of hazards and work practices intended to minimize hazards.

Regarding age, many workers continue to work past “normal” retirement age by choice or necessity. The overall aging of the working U.S. population may result in higher risks of occupational illness. The presence of chronic disease has been shown to increase with age, with the most dramatic rise --from 32.4 percent to 63.1 percent of people with at least one chronic condition-- occurring between early adulthood (ages 20-44) and midlife (ages 45-64) (Paez et al 2009). The shifting composition of the workforce may lead to a greater susceptibility to various exposures related to chronic conditions and/or exacerbation of certain chronic conditions related to workplace exposures. Additionally, this increased prevalence of chronic health conditions occurring in the middle of the usual working life points to the importance of the workplace as an opportunity to affect the chronic health of workers regardless of the origin of the health condition (occupational versus non-occupational).

More research is needed into the potential for adverse chronic health effects from new chemicals and technologies. For example, during 1979-2003, premanufacture notifications --required for all newly developed substances intended for the market-- for 36,000 new chemicals were submitted to the U.S. Environmental Protection Agency (US EPA). ( [PDF 155 KB] ). Information on acute and chronic health effects potentially related to this large number of new chemicals routinely introduced into industry is typically incomplete. Regarding new technologies, the rapid growth of the field of nanotechnology may lead to worker exposures to engineered nanoparticles whose effect on worker health has not yet been fully understood. ( /niosh/topics/nanotech/ )

Increased world trade, changes in production, the nature of employment contracts, and other human resources policies such as fringe benefits, have resulted in dramatic changes in management strategies and in the ways work is organized. These changes in organizational practices are believed to influence the risks of work-related stress and illness. ( /niosh/programs/workorg/economics.html ) Specific examples of factors related to changes in work organization include:

  • In recent decades, job and financial insecurity in the U.S. workforce has grown. (Moffitt and Gottschalk 2002) Part of this is associated with an increase in the number of individuals who work part-time, intermittently, or under contract as opposed to in full-time positions. These types of contingent workers are often not offered the same benefits or pay levels as workers in standard full-time positions and therefore may have to work multiple jobs on difficult schedules.
  • The share of workers working long hours has increased over the last three decades. Average work hours for families have risen because of a dramatic increase in the proportion of women working for pay and an increase in the number of weeks they work each year. This trend and the use of schedules with extended shifts have raised concerns about the risk to health and safety if working hours become excessive (Caruso et al 2006).
  • Changes in work organization often manifest as frequent changes in workers’ shifts and increased night work.

Increased workplace-related stress is a potentially important issue in all these factors, and among other potential adverse effects, stress at work has been associated with a 50% excess risk of coronary heart disease (CSDH 2008). Evidence of health and safety effects associated with long work hours includes cardiovascular outcomes (such as hypertension, myocardial infarction, and angina), cancer, and reproductive health and infertility (Caruso et al 2006). There is evidence that long work hours can also lead to sleep deprivation, and that associated risks of illness and injury are exacerbated by high workloads and shift work (Caruso et al 2006). Epidemiologic studies also suggest that self-reported short sleep duration is associated with obesity, heart disease, and mortality (Banks and Dinges 2007). Changes in work organization manifested as changes in workers’ shifts and relationship to cancer is an area of active research. An IARC working group (Straif et al 2007) concluded that shiftwork involving circadian disruption is probably carcinogenic (Group 2A) (see also

The burden that occupationally-related illnesses and adverse health outcomes may place on society has been studied but remains poorly understood, due in large part to the difficulty of identifying individual cases of occupational disease. This in turn is due to a number of factors, including insufficient medical training related to occupationally-related chronic illnesses, lack of access of health professionals to the workplace, time/expense needed to identify and characterize workplace factors, perceived lack of relevance of origin of disease to treatment, long latency of many chronic conditions, and the fact that occupational factors are typically not the sole or dominant factors in diseases that are outcomes of a multiplicity of factors. The structure of the medical insurance and workers’ compensation systems may also be important. For example, these systems are often set up such that workers get compensated through the usual medical insurance system rather than through the workers’ compensation system for their work-related conditions. A study by Leigh and Robbins (2004) concluded that in 1999, workers’ compensation missed 46,000 to 93,000 deaths attributed to occupational illness, resulting in $8 billion to $23 billion in medical costs. The authors claimed that these deaths and costs represented substantial cost shifting from workers’ compensation to the medical insurance system, as well as to individual workers, their families, and taxpayers. Additionally, given the ongoing changes in the nature of work, the limitations of a focus on traditional occupational risks and exposures alone have become increasingly apparent. Factors (discussed above) such as the overall employment and working conditions, stress at work and home, and unhealthful diet and limited exercise are likely also to be important in understanding the etiology and burden of occupational illnesses (see /niosh/programs/totalworkerhealth/economics.html ). A review of estimates of the burden of occupational illness in terms of the prevalence of various types of conditions has been published by Driscoll et al (2005); in that review the strengths and limitations of data available to make such estimates are discussed.

References Cited

Banks S, Dinges DF. 2007. Behavioral and physiological consequences of sleep restriction. J Clin Sleep Med; 3(5):519–528.

Basner M, Fomberstein K, Razavi FM, William J, Simpson N, Rosa R, Dinges DF. 2007. American Time Use Survey: Sleep time and its relationship to waking activities.Sleep; 30(9):1081-1091

Caruso CC, Bushnell T, Eggerth D, Heitmann A, Kojola B, Newman K, Rosa R, Sauter SL, Vila B. 2006. Long working hours, safety, and health: Toward a National Research Agenda. American Journal of Industrial Medicine; 49:930–942.

CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health.

Geneva, World Health Organization . Available at

Driscoll T, Takala J, Steenland K, Corvalan C, Fingerhut M (2005). Review of estimates of the global burden of injury and illness due to occupational exposures. American Journal of Industrial Medicine; 48:491-502.

Kivimäki M, Virtanen M, Elovainio M, Kouvonen A, Väänänen A, Vahtera J. 2006. Work stress in the aetiology of coronary heart disease – a meta-analysis. Scandinavian Journal of Work and Environmental Health; 32(6):431-442.

Leigh JP, Robbins JA. 2004. Occupational disease and workers' compensation: Coverage, costs, and consequences. The Milbank Quarterly; 82(4):689–721.

Marmot M. 2004. The status syndrome: how your social standing affects your health and life expectancy. London, Bloomsbury.

Moffitt RA, Gottschalk P. 2002. Trends in the transitory variance of earnings in the US. Economic J 112:C68–C73.

Paez KA, Zhao L, Hwang W. 2009. Rising out of pocket spending for chronic conditions: A ten year trend. Health Affairs; 28(1):15-25.

Straif K, et al. 2007. Carcinogenicity of shift-work, painting, and fire-fighting. The Lancet Oncology 8(12):1065-1066.


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