New Study Highlights Differences in Access to Health Care Services Among Essential Workers

March 10, 2021
NIOSH Update:

MEDIA CONTACT: Nura Sadeghpour,, 202.245.0673

New Study Highlights Differences in Access to Health Care Services Among Essential Workers

Improving access to health care is critical to worker health and workforce stability

illustration of people of different professions

A new study published online this month in the journal Public Health Reports evaluates access to health care services among selected essential workers. Health care access is crucial in the midst of a pandemic, when the health and safety of essential workers is paramount. Researchers at the National Institute for Occupational Safety and Health (NIOSH) identified several occupations where workers have less access to health care services when compared to other workers. Limited access may hinder workers’ ability to address underlying conditions and may increase their risk of severe outcomes from infectious diseases, such as COVID-19.

Study Results

Using the most recently available data from the Behavioral Risk Factor Surveillance System (BRFSS), researchers examined health care access by occupation among workers between the ages of 18‒64 in 31 states during the years 2017 and 2018. The study looked at four health care access measures: 1) having health insurance, 2) being able to afford to see a doctor when needed, 3) having a personal health care provider, and 4) having a routine checkup in the previous year.

“This study used data from before the start of the COVID-19 pandemic, so it provides a baseline to understand what kind of health care access was in place for essential workers,” said Winifred L. Boal, MPH, research epidemiologist and lead author of the study. “Improving access to health care for all workers, including essential workers, is critical to ensure workers’ health and workforce stability.”

Of all occupations studied:

  • Workers in farming, fishing, and forestry occupations were most likely to have no health insurance (46.4%).
  • Personal care aides were most likely to have been unable to see a doctor when needed because of cost (29.3%).
  • Construction laborers were most likely to lack a personal health care provider (51.1%) and to have not had a routine physical checkup in the past year (50.6%).
  • Workers in three broad occupation groups—food preparation and serving; building and grounds cleaning and maintenance; and construction trades—had significantly lower levels of health care access for all four measures, compared with workers in general.

Importance of Access to Health Care Among Essential Workers

The risk for becoming infected with the virus that causes COVID-19 may be higher for essential workers who are required to report to the workplace, rather than telework, and who cannot physically distance from patients, the general public, and/or coworkers. Furthermore, essential workers without routine access to health care services, and especially those lacking paid sick leave, may delay seeking medical attention and work while ill. Consequences may include severe outcomes for the workers themselves and increased potential for exposing coworkers and members of the public to infection.

Multiple reports in 2020 identified large numbers of COVID-19 cases among people working in the essential workforce, including several occupations identified in this study. Addressing barriers to health insurance coverage and health care services is critical to ensure the health of essential workers during the COVID-19 pandemic.

Please access the full text of the recent NIOSH study here: Health Care Access Among Essential Critical Infrastructure Workers, 31 States, 2017‒2018

Please see the following CDC resources for essential workers: Interim List of Categories of Essential Workers; Identify Essential Workers for Public Health Data Collection and AnalysisCOVID-19 Vaccine Communication Toolkit for Essential Workers; Essential Workers & Employees: When & How to Get Vaccinated | CDC; The Importance of COVID-19 Vaccination for Healthcare Personnel | CDC.

NIOSH is the federal institute that conducts research and makes recommendations for preventing work-related injuries, illnesses and deaths. Find more information about NIOSH at