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RELATIONSHIP BETWEEN WORK AND HEALTH

People who are fully employed spend over one third of their lives at work, commuting to or from work, or engaged in other work-related activities. To a greater or lesser extent, work furnishes the material resources that enable people to address basic human needs, including housing, food, and access to health insurance. Work helps individuals flourish by providing a sense of purpose, meaning, and social support. And, when work provides adequate resources, it also enables people to address out-of-work responsibilities and pursue nonwork interests. On the other hand, employment and the work environment can pose serious threats to health and well-being by exposing workers to hazardous conditions that may result in physical injury, illness, disability or death, or to stressful, bullying or discriminatory environments that threaten psychological well-being. In private industry, work hazards account for at least 5200 injury-related deaths, almost 3 million serious injuries, and unnumbered deaths from occupational exposures annually.1 By all measures, work is a significant determinant of health.

This chapter briefly explores selected U.S. laws and policies that are designed to protect people at work, assist them when they are injured, and ensure they are treated fairly. This encompasses not only direct regulation of hazards within workplaces, but also other legislation that is designed to promote worker—and therefore population—well-being.

Most of the relevant worker-protection legislation and policies were developed to address “standard” employment relationships in which individuals have an identified employer with defined responsibilities. While there has always been a range of work arrangements, the diversity of current forms of employment, often enabled by new technologies or creative profit seeking, have resulted in new threats to worker health and well-being and challenge the adequacy of current protections. Similarly, new technologies such as robotics, and workplace exposures to new substances such as manufactured nanoparticles, may themselves pose physical and psychological risks not adequately addressed by current standards and regulations. In the final section of this chapter, we touch briefly on these looming challenges.

PROTECTING WORKERS FROM WORKPLACE HAZARDS: LEGISLATION AND ITS ENFORCEMENT

Federal, state, and local government agencies have multiple opportunities to improve public health by regulating hazards and thereby reducing injury and disease from work. During the first half of the twentieth century, all states enacted some form of compensation program for workers injured on the job; these became known, collectively, as workers’ compensation. Until the late 1960s, worker health and safety protection and workplace inspections were generally seen as functions of state government or were left to private market forces. The intensity of governmental oversight and the consequences of safety failures varied widely from state to state, and there were few laws providing any national harmonization.

While workplace hazards threaten public health, the motivation and possibility of government action to reduce these threats is based on a complex calculus involving an assessment of the ...

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