Sue Ducat
Director of Communications
(301) 841-9962

Camille Ahearn
(202) 868-4827

Health Affairs’ February Issue: The Work/Health Relationship

Bethesda, MD - The February issue of Health Affairs contains a collection of papers about the complex work/health relationship. Work conditions can affect employees’ physical and mental health, and worker productivity can be affected by the demands employees face after returning home from the office.

The issue is supported by the Integrated Benefits Institute, Sedgwick, and UnitedHealth Group, as well as Pfizer and Pinnacol Assurance.

Will low-income minority employees with breast cancer retain their jobs after treatment? 
Breast cancer affects one in eight women in the United States, with approximately 70–80 percent of employed breast cancer survivors returning to work following diagnosis. Employer accommodations, such as schedule flexibility, have been associated with job retention in higher-income white women. In what may be one of the first studies to evaluate the role of employer accommodations of low-income minority women following breast cancer treatment, Victoria Blinder of Memorial Sloan Kettering Cancer Center and coauthors conducted a longitudinal study of a racially and ethnically diverse sample of employed women in New York City undergoing treatment for early-stage breast cancer. Of the 267 participants, 57 percent were either low- or middle-income. The authors found that women with low-incomes were half as likely as higher-income women to have accommodating employers and only one-fourth as likely to retain their jobs. They conclude that this study provides strong evidence of a disparity in job accommodations and retention that affects women in low-income households.

Medicaid waivers help parents of children with autism remain in the workforce. 
Having a child with autism spectrum disorder places tremendous demands on a family and can lead to a parent’s leaving the labor force to care, and coordinate care, for a child. To address this problem, several states have passed Medicaid home and community-based services (HCBS) waivers that expand eligibility criteria and available services for children with autism spectrum disorder. Douglas Leslie of the Penn State College of Medicine and coauthors evaluated data from two consecutive waves (2005–06 and 2009–10) of the National Survey of Children with Special Health Care Needs. According to the study, Medicaid HCBS waivers helped some of these parents to continue working, although the results varied by household income level and by waiver characteristics. The authors conclude that these waivers are effective policies to address these children’s care-related needs.

Another February study addressing autism and employment:

Chronic illness, safety, and job demands affect employee productivity.
As Americans remain in the workforce longer, employers increasingly face two interconnected challenges: high rates of work-related injuries and an increasing likelihood that employees are living with chronic health conditions. Kimberly Jinnett of the Integrated Benefits Institute and coauthors analyzed the combined impact of workplace safety, employee health, and job demands on worker absence and job performance, sampling nearly 17,000 employees who participated in a Colorado workplace wellness program in the period 2010–14. The study results show that absenteeism is highly related to physical job demands, but presenteeism (when employees come to work but perform at lower levels than usual because of health reasons) is highest when jobs are both physically and cognitively demanding. The authors conclude that employers will increasingly need to consider and address these factors when designing work processes, assigning job duties, and deciding on benefits and other investments that support workers’ well-being and productivity.

A related study in the issue:

Racial and ethnic differences in workplace injuries.
Despite improved safety standards, occupational injury remains a major source of employee disability. Seth Seabury of the University of Southern California and coauthors analyzed Census Bureau data sets to test for differences between minority and white workers in the risk for workplace injuries and the likelihood of incurring work-related disabilities. The authors found that non-Hispanic white workers consistently had among the lowest risk of workplace injury, particularly at older ages (see the exhibit below). They conclude that their findings suggest that disparities in economic opportunities expose members of minority groups to increased risk of workplace injury and disability.

Gaming hospital inspections in England.
In England, hospital cleanliness is a priority for the National Health Service (NHS). Since 2000, “unannounced” inspections have been used as a way to monitor and ensure quality of care. Because hospital staff members are notified in advance of an inspection within the next month, policy makers have voiced concerns about the potential for gaming of cleanliness inspections. In what is thought to be the first study of its kind, Veronica Toffolutti at the University of Oxford and coauthors looked for evidence of possible gaming effects, using data that link patients’ perceptions of cleanliness with hospital inspection dates in the period 2011–14. According to the study, during the inspection months and shortly before, there was a significant increase (2.5–11.0 percentage points) in the share of patients who reported “excellent” cleanliness. The authors conclude that their findings might cause the NHS to reconsider both announcing inspections in advance, and if inspections are the best way to measure and ensure quality.

NOTE: Check out Health Affairs’ newest web hub: From Obamacare to Trumpcare. Key health policy questions are explored for the Affordable Care Act (ACA), Medicare, Medicaid, and payment reform.

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print and online, with additional Web First papers and health policy briefs published regularly at You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download monthly Narrative Matters podcasts. Tap into Health Affairs content with the iPad app.