Healthy Work Design and Well-Being Program
Burden, Need and Impact
NIOSH strives to maximize its impact in occupational safety and health. The Healthy Work Design and Well-Being program identifies priorities to guide investments, and base those priorities on the evidence of burden, need and impact. Below are the priority areas for the Healthy Work Design and Well-Being program.
The burden of shift work, irregular or long work hours, and insufficient sleep that is borne by American workers is immense. Data from the 2015 Occupational Health Supplement (OSH) of the National Health Interview Survey (NHIS) and from the 2017-2018 American Time Use Study suggest that 16% to 27% of part-time and full-time adult workers in the U.S. work on evening, night, rotating, split or employer-arranged irregular shifts.1, 2 The 2010 NHIS-OHS showed 18.7% of American workers worked 48 hours or more per week and 7.2% worked 60 hours or more per week.3 Shift work and long work hours may lead to many health and safety risks by disrupting sleep and circadian rhythms. Several studies have reported that shift work and long work hours were associated with shorter sleep duration and poor sleep quality.4-8 Substantial evidence supports the need for 7 or more hours of good quality sleep each day.9 The percentage of American civilian workers reporting 6 or fewer hours of sleep per day increased from 24% in the 1980s to 30% in the middle 2000s.10 Insufficient sleep is associated with a broad range of health and safety risks including premature death, obesity, vehicle crashes, adverse reproductive outcomes, and developing a wide range of chronic illnesses including cardiovascular, gastrointestinal, and musculoskeletal disorders, diabetes mellitus, cancer, Alzheimer’s disease, and disturbances to mood and cognition.11 A recent RAND report estimated that insufficient sleep cost the U.S. economy $280 to $411 billion annually in 2015-2016 , due to a range of negative effects. This study included early mortality due to insufficient sleep that in turn reduces the size of the working population; excess absences due to sickness of sleep deprived workers who also experience reduced performance while at work, and hindered skill development of future workers who were sleep deprived when they were young. 12
In many instances, there are opportunities to improve the work schedules but research is needed to develop effective dissemination strategies and ways to promote better scheduling practices. Due to the nature of the work, some worker’s schedules will remain challenging and this creates a need to focus on developing countermeasures to better manage fatigue and reduce the adverse impacts of these schedules. This need is particularly important for workers who provide critical services for society around the clock, including those in disaster response, healthcare, protective services, and utilities. Shift work and long work hours require research on interventions to reduce risks: testing various work scheduling patterns; manipulating light exposure, pharmacology agents, and diet regimes; work organization strategies and efforts to change workplace cultures; workplace interventions including policies, fatigue risk management systems, and education programs; mathematical models to predict risks; and studies of the impact of broader public policy. NIOSH is uniquely positioned for this work. NIOSH scientists across several disciplines and areas of research from surveillance to online training intervention research are recognized experts on this topic.
A wide range of positive outcomes can be expected from research to reduce the risks associated with shift work, long work hours, and related workplace sleep and fatigue issues. The short-term goal is that workers and their managers adopt workplace and personal strategies that promote sleep health and minimize circadian rhythm disruption. In the long term, these improvements will reduce risk for chronic disease and also reduce fatigue-related mistakes that can cause a range of problems to the employer and the community including patient care errors, vehicle crashes, and industrial disasters. An example of recent impact includes the demand for and evaluation of an online training program: NIOSH training for nurses on shift work and long work hours. In the first year and a half after launch, the training website had 37,000 visits and almost 3,000 people obtained continuing education certificates for taking the training. The evaluations showed about 95% agreed or strongly agreed with positive characteristics about the training. At least 45 external websites provide information about the training and a link.
1 CDC . CDC-NIOSH Worker Health Charts. Work Organization. Atlanta, GA: Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, https://wwwn.cdc.gov/Niosh-whc/chart/ohs-workorg/work
2 BLS (Bureau of Labor Statistics) . Job Flexibilities and work schedules — 2017 – 2018 data from the American Time Use Survey (USDL-19-1691). Washington D.C.: Department of Labor, https://www.bls.gov/news.release/pdf/flex2.pdfpdf iconexternal icon
3 Alterman T, Luckhaupt SE, Dahlhamer JM, Ward BW, Calvert GM . Prevalence of work organization characteristics among workers in the U.S.: Data from the 2010 National Health Interview Survey. Am J Ind Med 56(6):647-659.
4 Pilcher JJ, Lambert BJ, Moore LT, Huffcutt AI . Effects of shiftwork on sleep: a meta-analytic review. Sleep Res 26:233.
5 Pilcher JJ, Lambert BJ, Huffcutt AI . Differential effects of permanent and rotating shifts on self- report sleep length: a meta-analytic review. Sleep 23:155-163.
6 Drake CL, Roehrs T, Richardson G, Walsh JK, Roth T . Shift work sleep disorder: prevalence and consequences beyond that of symptomatic day workers. Sleep 27:1453-1462.
7 Knauth P . Extended work periods. Ind Health 45(1):125-136.
8 Nakashima M, Morikawa Y, Sakurai M, Nakamura K, Miura K, Ishizaki M, Kido T, Naruse Y, Suwazono Y, Nakagawa H . Association between long working hours and sleep problems in white-collar workers. J Sleep Res 20(1 Pt 1).
9 Consensus Conference Panel, Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner MA, Kushida C, Malhotra RK, Martin JL, Patel SR, Quan SF, Twery M, Croft JB, Maher E, Barrett, JA, Thomas SM, Heald JL . Recommended amount of sleep for a healthy adult: A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 11:591-592.
10 Luckhaupt SE, Tak S, Calvert GM . The prevalence of short sleep duration by industry and occupation in the national health interview survey. Sleep 33(2):149-159.
11 Luyster FS, Strollo Jr. PJ, Zee PC, Walsh JK . Sleep: A health imperative. Sleep 35(6):727-734.
12 Hafner M, Stepanek M, Taylor M, Troxel WM, Van Stolk C . Why sleep matters — the economic costs of insufficient sleep: A cross-country comparative analysis. Santa Monica, CA: RAND Corporation, https://www.rand.org/pubs/research_reports/RR1791.htmlexternal icon
In 2017, more than one-tenth of the entire U.S. working population had a non-standard work arrangement.1 Non-standard work arrangements are characterized by temporariness, instability, irregularity, and lack of legal protections and social benefits for workers which, in turn, may affect worker safety, health, and well-being. Several non-standard arrangements involve temporary jobs and insecurity of employment and income, which have been linked to lower levels of health and well-being.2 Insufficient household income, non-standard or irregular hours, and lack of career opportunities are associated with poor mental health.3 Temporary staffing agency workers frequently lack safety and other general training, and suffer from the tendency for newer workers to be at greater risk of injury.4 Workers whose employers contract their services out to another employer may be at higher risk for injury and illness because the responsibility for safety is divided between two employers. Recent research has found higher injury rates among temporary staffing agency workers than among other workers in the same industries.5, 6 Workers who are self-employed are often relatively satisfied with their working arrangement, but many have demanding work schedules, and some may be supervised similarly to employees but lack employee protections. Work fatality rates suggest that they may be vulnerable to work demands of customers or lack resources to fully protect themselves from work hazards. The Bureau of Labor Statistics (BLS) reported that in 2017, self-employed workers had a rate of 13.1 fatalities per 100,000 full-time-equivalent workers, over four times the rate of workers who were employees.7 Using data from 2002-2014, a recent study concluded that for workers in standard arrangements and contractors, significant associations were observed between perceived job stress and reported unhealthy days. A similar association for reported days with activity limitations was observed for workers in standard and temporary staffing agency arrangements.8
Digital on-line platforms provide gig workers broader and quicker access to work in certain industries.9 This type of gig work is thought to represent something new, because of the way these platforms connect workers with customers, handle payments and determine rates of pay, and guide or incentivize their work. Using data from the 2017 Contingent Worker Supplement, BLS estimated that electronically mediated workers accounted for 1.0 percent of total employment.10 The same concerns arise for these workers as for other workers who may be misclassified as independent contractors and workers with inadequate and unsteady sources of income.
In 2017, more than one-tenth of the entire US working population had a non-standard work arrangement.6 Between 2002 and 2014, the prevalence of workers in non-standard work arrangements increased from 19% to 21%, based on reported information on their main job.8 These types of work arrangements are understudied, and their determinants and health and safety consequences are poorly understood. NIOSH has been assessing quality of work life for a long time and is well-positioned to holistically examine the effects of work arrangements on workers. In addition, since work arrangements are often shaped by industry and occupational context, NIOSH’s longstanding focus on specific industries and occupations can guide research and intervention efforts. Because this is a new and growing area of concern, all types of research are needed. Particularly needed are models to help explain the determinants and effects of work arrangements, efforts to improve their classification and description, and linkage of databases to allow more holistic research. Additionally, there are growing concerns regarding how non-standard work arrangements are measured, and efforts are underway to address these concerns in order to better understand their prevalence.10,11
Reducing the risks associated with non-standard work arrangements would improve safety, health and well-being outcomes for workers and their families, employers and society overall. In 2014, NIOSH jointly published recommended practices for protecting temporary workerspdf icon with the Occupational Safety and Health Administration, and continues to conduct research in this area and develop more detailed guidance. Two recent studies point to the importance of examining each type of work arrangement separately and in depth, in order to understand and effectively address gaps in research and practice. The first provided evidence that lack of access to paid sick leave is associated with an increased risk of suffering occupational injury.12 A second showed that psychosocial factors like job stress, feeling overworked, and freedom to make decisions varied by work arrangements.8 These findings mean that interventions to address specific gaps in psychosocial conditions by work arrangement would reduce job stress and improve health and productivity among workers in these arrangements.
1 BLS (Bureau of Labor Statistics) . Contingent and alternative employment arrangements – May 2017. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/news.release/pdf/conemp.pdfpdf iconexternal icon
2 Virtanen M, Kivimaki M, Joensuu M, Virtanen P, Elovainio M, Vahtera J . Temporary employment and health: a review. Int J Epidemiol 34(3):610-622. https://doi.org/10.1093/ije/dyi024
3 De Moortel D, Vandenheede H, Vanroelen C . Contemporary employment arrangements and mental well-being in men and women across Europe: A cross-sectional study. Int J Equity Health 13(1): 90. DOI: 10.1186/s12939-014-0090-6
4 OSHA (Occupational Safety and Health Administration) . Recommended practices: Protecting temporary workers. Washington, DC: U.S. Department of Labor, Occupational Safety and Health Administration, OSHA – 3735-2014. https://www.osha.gov/Publications/OSHA3735.pdf
5 Foley M . Factors underlying observed injury rate differences between temporary workers and permanent peers. Am J Ind Med 60(10):841-851. https://onlinelibrary.wiley.com/doi/full/10.1002%2Fajim.22763external icon
6 Al-Tarawneh I, Wurzelbacher S, Bertke S . Comparative analyses of workers’ compensation claims of injury among temporary and permanent employed workers in Ohio. Am J Ind Med [epub ahead of print] https://onlinelibrary.wiley.com/doi/abs/10.1002/ajim.23049external icon
7 BLS (Bureau of Labor Statistics) . Census of Fatal Occupational Injuries, Charts, 1992-2017. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/iif/oshwc/cfoi/cfch0016.pdfpdf iconexternal icon
8 Ray TK, Kenigsberg TA, Pana-Cryan R . Employment arrangement, job stress, and health-related quality of life. Safety Sci 100(2017):46-56, https://doi.org/10.1016/j.ssci.2017.05.003external icon
9 Howard J . Nonstandard work arrangements and worker health and safety. Am J Ind Med 60(1):1-10 DOI: 10.1002/ajim.22669
10 BLS (Bureau of Labor Statistics) . Electronically mediated work: new questions in the Contingent Worker Supplement. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/opub/mlr/2018/article/electronically-mediated-work-new-questions-in-the-contingent-worker-supplement.htmexternal icon
11 The National Academies of Sciences, Engineering and Medicine . Project Information: Contingent Work and Alternate Work Arrangements. Washington, DC: The National Academies of Sciences, Engineering and Medicine, https://www8.nationalacademies.org/pa/projectview.aspx?key=51472external icon
12 Asfaw A, Pana-Cryan R, Rosa R . Paid sick leave and nonfatal occupational injuries. Am J Public Health 102(9):e59-e64, http://dx.doi.org/10.2105/AJPH.2011.300482external icon
U.S. workers report significant levels of job stress. More than a third of the respondents to the NIOSH Quality of Work Life (QWL) survey report their jobs to be “often” or “always” stressful.1 Job stress has significant adverse effects across the spectrum of well-being (e.g., physical and mental health, behavior, productivity, social, non-work outcomes), and has been linked with a range of adverse physical, mental, cognitive, behavioral, safety, and performance outcomes and even mortality. Stress is present in all industries and occupations and has implications for businesses in a number of ways, including, but not limited to, lost workdays and increased healthcare costs. In 2016, in industries where workers reported the most stressful jobs, estimated costs for lost workdays due to workplace stress were substantial: $2.6 billion for transportation, $3.2 billion for wholesale/retail trade, $2.9 billion for manufacturing, and $1 billion for construction.2 Using data from 1990-1995, a study found that workers who reported high levels of job stress had nearly 50% greater health care expenditures than those who reported low levels of job stress.3 A recent study used 2002-2011 data from different sources and estimated that more than 120,000 deaths per year could be attributed to ten stressors including unemployment, lack of health insurance, exposure to shift work, long working hours, job insecurity, work–family conflict, low job control, high job demands, low social support at work, and low organizational justice (i.e., employee perception of fairness in the workplace).4 Long working hours, work-family conflict, and low job control increase the odds of mortality per year by 20-40%.5
Reducing job stress is an important step toward improving worker well-being. There is a critical need to develop effective tools that organizations can use to assess and address sources of job stress. Additionally, there is great interest by organizations in the concept of worker well-being, and in integrative approaches to improve worker well-being. NIOSH has expertise in this area, as well as unique nationally representative databases on occupational stressors and health and safety outcomes that can guide more focused research and interventions to specific sectors, occupations, and demographic groups. NIOSH has developed strong partnerships with industry and such collaborations can help advance efforts to improve work design and promote worker well-being.
NIOSH has partnered with the American Psychological Association (APA) since 1990 on the Work, Stress, and Health conference seriesexternal icon, and on the development of the field of Occupational Health Psychology (OHP) within the United States. The conference series and the field of OHP have been influential in both shaping work organization and stress research in the United States, and in the development of OHP specialists that are working with companies to implement stress interventions in the workplace. NIOSH is also developing tools to identify and deal with risk factors for job stress, and associated best practices, training, and informational products. The adoption of healthy work organization structures and practices should reduce worker stress and improve associated health and safety outcomes. This improvement, in turn, is expected to significantly reduce the economic burden associated with injuries, poor health, and reduced productivity, which will benefit workers, employers, families, and communities/society.
1 Unpublished data from the 2014 NIOSH Quality of Work-Life survey. More information about this survey is available at https://www.cdc.gov/niosh/topics/stress/qwlquest.html
2 Unpublished NIOSH data from 2016.
3 Goetzel RZ, Anderson DR, Whitmer RW, Ozminkowski RJ, Dunn RL, Wasserman J . The Health Enhancement Research Organization (HERO) Research Committee. The relationship between modifiable health risks and health care expenditures: An Analysis of the Multi-Employer HERO Health Risk and Cost Database. J Occup Environ Med 40(10):843-854. DOI: 10.1097/00043764-199810000-00003
4Goh J, Pfeffer J, Zenios SA . The relationship between workplace stressors and mortality and health costs in the United States. Manag Sci 62(2), https://doi.org/10.1287/mnsc.2014.2115external icon
5Pfeffer, J. (2018). Dying for a paycheck. New York: Harper Collins Publishers.