Work is a major part of the human experience, and most individuals spend over one third of their waking hours doing a job. Considering this span of time, what we experience and encounter while working undoubtedly has significant bearing on our health. Moreover, the jobs we do typically define a large part of our identities, give meaning to our lives, and define our roles in society, thus having influence on our overall well-being.
The notion that working conditions can both directly and indirectly cause debilitating injury or chronic illness has been historically well established. Even the ancient Egyptians and Greeks documented diseases related to work or specific job tasks. From a social determinant of health perspective, the conditions in which people work are major contributors to health and well-being. For example, healthcare workers can be exposed to HIV and hepatitis B through a sharps injury, and miners commonly experience lung disease as a result of inhaling mineral dust. According to the Institute for Health Metrics and Evaluation (2017), occupational risk is one of the top 10 factors driving the most death and disability in the United States. In addition to the physical conditions of work, other aspects can insidiously cause harm. For example, overly demanding job duties and unfair treatment in the workplace can produce a stress response that can, over time, result in cardiovascular disease, as well as anxiety and depression. Furthermore, some populations, such as older workers, may be more vulnerable to the harmful effects of work, whereas those more marginalized, such as immigrants, may find themselves in exploitive employment situations. Some of the most dangerous, life-threatening jobs—such as in agriculture and construction—are often nonpermanent and filled by those with lower socioeconomic status. Thus, health disparities and inequalities can be directly connected to occupational circumstances.
Given the ubiquity of work in our lives and sizable contribution of working conditions to health and well-being, nurse researchers are well positioned to contribute to understanding how work influences health. Intentionally investigating work exposures and environments can uncover explanatory causes for illness and serve as foci for interventions that prevent disease and promote health. However, few nurse researchers include work-related factors as principal health determinants in their programs of research. Many scientific tools and instruments are available for nurses to characterize work exposures as causes or correlates of health. A disease outcome suspected to be linked to work can be assessed by identifying job title and industry type, delineating job tasks, and quantifying exposure to the hazardous agent (e.g., biological, chemical, physical, biomechanical). Psychosocial dimensions of work can be measured by survey instruments, such as the Job Content Questionnaire (Karasek et al., 1998), Effort–Reward Imbalance (Siegrist, 2010), and Quality of Work life Questionnaire (National Institute for Occupational Safety and Health, 2013). These instruments enable researchers to capture work organizational factors and work stress, which have been shown to be associated with poor physical health, such as hypertension, cardiovascular disease, and immune suppression, as well as psychological consequences, such as anxiety, burnout, and depression. Also, there is growing interest in the health effects of employment precarity (Howard, 2017; Lewchuk et al., 2016), which has been linked to alcohol use, reduced sleep, and poor mental health.
Three national initiatives currently offer outstanding opportunities for nurse scientists to emphasize occupational factors into their programs of research. The National Institute for Occupational Safety and Health (2016) has a research priority focused on Total Worker Health that recognizes work as a social determinant of health and how job-related factors impact workers, their families, and their communities. The Robert Wood Johnson Foundation’s (2015) new Culture of Health strategic plan values the critical role that the workplace plays in promoting health. A third example is the National Institute for Environmental Health Science’s priority area of exposome research. Rather than studying one chemical or exposure at a time, investigators are using metabolomic approaches to investigate all environmental exposures, including those that occur at work, but in combination with infections, diet, medications, and other factors across the life cycle to better understand the risk of developing disease.
These national research platforms serve as signals to nurse scientists to consider work-related factors as principal determinants of health. Work environments are under examined spaces for nurses to explore disease etiology, as well as design and test interventions focused on illness and injury prevention or health promotion. We encourage nurse scholars to pursue and seize opportunities that contemplate dimensions of work as foci for study. Also, given the changing profile and landscape of the world of work, there will be continued and emerging important questions that need to be asked and researched.