research work on health

• U.S. Department of Health & Human Services

• Virtual Tour
• Staff Directory
• En Español

You are here

Science, health, and public trust.

September 8, 2021

Explaining How Research Works

We’ve heard “follow the science” a lot during the pandemic. But it seems science has taken us on a long and winding road filled with twists and turns, even changing directions at times. That’s led some people to feel they can’t trust science. But when what we know changes, it often means science is working.

Explaining the scientific process may be one way that science communicators can help maintain public trust in science. Placing research in the bigger context of its field and where it fits into the scientific process can help people better understand and interpret new findings as they emerge. A single study usually uncovers only a piece of a larger puzzle.

Questions about how the world works are often investigated on many different levels. For example, scientists can look at the different atoms in a molecule, cells in a tissue, or how different tissues or systems affect each other. Researchers often must choose one or a finite number of ways to investigate a question. It can take many different studies using different approaches to start piecing the whole picture together.

Sometimes it might seem like research results contradict each other. But often, studies are just looking at different aspects of the same problem. Researchers can also investigate a question using different techniques or timeframes. That may lead them to arrive at different conclusions from the same data.

Using the data available at the time of their study, scientists develop different explanations, or models. New information may mean that a novel model needs to be developed to account for it. The models that prevail are those that can withstand the test of time and incorporate new information. Science is a constantly evolving and self-correcting process.

Scientists gain more confidence about a model through the scientific process. They replicate each other’s work. They present at conferences. And papers undergo peer review, in which experts in the field review the work before it can be published in scientific journals. This helps ensure that the study is up to current scientific standards and maintains a level of integrity. Peer reviewers may find problems with the experiments or think different experiments are needed to justify the conclusions. They might even offer new ways to interpret the data.

It’s important for science communicators to consider which stage a study is at in the scientific process when deciding whether to cover it. Some studies are posted on preprint servers for other scientists to start weighing in on and haven’t yet been fully vetted. Results that haven't yet been subjected to scientific scrutiny should be reported on with care and context to avoid confusion or frustration from readers.

We’ve developed a one-page guide, "How Research Works: Understanding the Process of Science" to help communicators put the process of science into perspective. We hope it can serve as a useful resource to help explain why science changes—and why it’s important to expect that change. Please take a look and share your thoughts with us by sending an email to  [email protected].

Below are some additional resources:

• Discoveries in Basic Science: A Perfectly Imperfect Process
• When Clinical Research Is in the News
• What is Basic Science and Why is it Important?
• ​ What is a Research Organism?
• What Are Clinical Trials and Studies?
• Basic Research – Digital Media Kit
• Decoding Science: How Does Science Know What It Knows? (NAS)
• Can Science Help People Make Decisions ? (NAS)

Connect with Us

• More Social Media from NIH

Participating in Health Research Studies

What is health research.

• Is Health Research Safe?
• Is Health Research Right for Me?
• Types of Health Research

The term "health research," sometimes also called "medical research" or "clinical research," refers to research that is done to learn more about human health. Health research also aims to find better ways to prevent and treat disease. Health research is an important way to help improve the care and treatment of people worldwide.

Have you ever wondered how certain drugs can cure or help treat illness? For instance, you might have wondered how aspirin helps reduce pain. Well, health research begins with questions that have not been answered yet such as:

"Does a certain drug improve health?"

To gain more knowledge about illness and how the human body and mind work, volunteers can help researchers answer questions about health in studies of an illness. Studies might involve testing new drugs, vaccines, surgical procedures, or medical devices in clinical trials . For this reason, health research can involve known and unknown risks. To answer questions correctly, safely, and according to the best methods, researchers have detailed plans for the research and procedures that are part of any study. These procedures are called "protocols."

An example of a research protocol includes the process for determining participation in a study. A person might meet certain conditions, called "inclusion criteria," if they have the required characteristics for a study. A study on menopause may require participants to be female. On the other hand, a person might not be able to enroll in a study if they do not meet these criteria based on "exclusion criteria." A male may not be able to enroll in a study on menopause. These criteria are part of all research protocols. Study requirements are listed in the description of the study.

A Brief History

While a few studies of disease were done using a scientific approach as far back as the 14th Century, the era of modern health research started after World War II with early studies of antibiotics. Since then, health research and clinical trials have been essential for the development of more than 1,000 Food and Drug Administration (FDA) approved drugs. These drugs help treat infections, manage long term or chronic illness, and prolong the life of patients with cancer and HIV.

Sound research demands a clear consent process. Public knowledge of the potential abuses of medical research arose after the severe misconduct of research in Germany during World War II. This resulted in rules to ensure that volunteers freely agree, or give "consent," to any study they are involved in. To give consent, one should have clear knowledge about the study process explained by study staff. Additional safeguards for volunteers were also written in the Nuremberg Code and the Declaration of Helsinki .

New rules and regulations to protect research volunteers and to eliminate ethical violations have also been put in to place after the Tuskegee trial . In this unfortunate study, African American patients with syphilis were denied known treatment so that researchers could study the history of the illness. With these added protections, health research has brought new drugs and treatments to patients worldwide. Thus, health research has found cures to many diseases and helped manage many others.

Why is Health Research Important?

The development of new medical treatments and cures would not happen without health research and the active role of research volunteers. Behind every discovery of a new medicine and treatment are thousands of people who were involved in health research. Thanks to the advances in medical care and public health, we now live on average 10 years longer than in the 1960's and 20 years longer than in the 1930's. Without research, many diseases that can now be treated would cripple people or result in early death. New drugs, new ways to treat old and new illnesses, and new ways to prevent diseases in people at risk of developing them, can only result from health research.

Before health research was a part of health care, doctors would choose medical treatments based on their best guesses, and they were often wrong. Now, health research takes the guesswork out. In fact, the Food and Drug Administration (FDA) requires that all new medicines are fully tested before doctors can prescribe them. Many things that we now take for granted are the result of medical studies that have been done in the past. For instance, blood pressure pills, vaccines to prevent infectious diseases, transplant surgery, and chemotherapy are all the result of research.

Medical research often seems much like standard medical care, but it has a distinct goal. Medical care is the way that your doctors treat your illness or injury. Its only purpose is to make you feel better and you receive direct benefits. On the other hand, medical research studies are done to learn about and to improve current treatments. We all benefit from the new knowledge that is gained in the form of new drugs, vaccines, medical devices (such as pacemakers) and surgeries. However, it is crucial to know that volunteers do not always receive any direct benefits from being in a study. It is not known if the treatment or drug being studied is better, the same, or even worse than what is now used. If this was known, there would be no need for any medical studies.

• Next: Is Health Research Safe? >>
• Last Updated: May 27, 2020 3:05 PM
• URL: https://guides.library.harvard.edu/healthresearch

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Int J Environ Res Public Health

Women’s Health and Working Life: A Scoping Review

Marianne gjellestad.

1 Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, 4604 Kristiansand, Norway

Kristin Haraldstad

2 Department of Health and Nursing, Faculty of Health and Sport Sciences, University of Agder, 4604 Kristiansand, Norway

Heidi Enehaug

3 Work Research Institute, Center for Welfare and Labour Research, Oslo Metropolitan University, 0176 Oslo, Norway

Migle Helmersen

Associated data.

130 articles were included in this review. Included articles not cited in the text appear at the end of the reference list [ 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 , 146 , 147 , 148 , 149 , 150 , 151 , 152 , 153 , 154 , 155 , 156 , 157 , 158 , 159 , 160 , 161 , 162 , 163 , 164 , 165 , 166 , 167 ]. Other parts of the dataset are available from corresponding author on reasonable request.

Women’s health matters for participation in working life. The objective of this study was to explore female physiology in a work–life context and to investigate possible associations between women’s health, sickness absence and work ability. A scoping review was conducted to develop a systematic overview of the current research and to identify knowledge gaps. The search strategy was developed through a population, concept and context (PCC) model, and three areas of women’s health were identified for investigation in the context of work. A total of 5798 articles were screened by title and abstract and 274 articles were screened by full text; 130 articles were included in the review. The material included research from 19 countries; the majority of the studies used quantitative methods. The results showed an impact on the occupational setting and an association between sickness absence, work ability and all three areas of women’s health, but a holistic and overall perspective on female biology in the work context is missing. This review calls for more knowledge on health and work and possible gender differences in this regard. Women’s health and working life involve a complex connection that has the potential to develop new knowledge.

1. Introduction

Work participation is linked to several socio-economic factors affecting living conditions and public health [ 1 ]. Thus, work–life is an important field for the equalisation of social differences and gender inequalities. It is also a crucial arena for reaching the UN’s sustainable development goals regarding health, equality and work [ 2 ]. However, both history and the present situation show a gender-divided labour market, especially regarding sickness absence [ 3 , 4 , 5 , 6 ]. Using Norway as an example, the complexity of gender segregation in working life is substantial. Even though Norway is one of the world’s most equally oriented countries, the labour market is still divided by gender; women work part-time more than men, and they take more sick leave [ 7 ]. Women also have greater representation in occupations with low status and lower representation in leading positions [ 7 , 8 ]. Norwegian working life has developed based on industrial workplaces since the last century [ 9 ]. Although the concept of health, safety and environment (HSE) has changed over the years, the Work Environment Act, written nearly 50 years ago, still consists of guidelines originally prepared for issues and challenges in elder, male-dominated work places [ 9 , 10 ]. Sickness absence rates are increasing for women (6.8%) as opposed to men (3.8%) [ 11 ], and Norway is at the top of the sickness absence statistics compared to other European countries [ 3 ]. The gender gap in sickness absence has been investigated in relation to different structural and cultural contexts [ 12 ]. Possible causes, such as gender differences in the burden of care for children and relatives, workload, nature of the work, work environment, career choices and attitudes, have been studied and resulted in various conclusions, though have not achieved a common understanding of the reasons for women’s higher rate of sick leave [ 4 , 7 , 12 , 13 , 14 , 15 , 16 ].

Women and men face different health challenges due to differences in biology and physiology [ 17 , 18 ]. This may influence women’s work participation and, thus, public health in general. Although reports and research from the last decade have proposed biological differences as a possible explanation for the gender difference in sickness absence [ 12 , 18 , 19 , 20 , 21 ], women’s health has not been sufficiently explored in the context of work. Women’s health can be defined as ‘diseases and ailments that only women have, diseases that affect more women than men, that affect very many women or that have different consequences for women than for men’ [ 22 ] (p. 27). Throughout the course of a normal lifespan, women undergo vast physiological and psychosomatic changes, both within the menstrual cycle and through the different stages of age [ 23 , 24 , 25 ]. These changes are normal processes, but they can also cause various imbalances and diseases. The monthly hormone cycle involves conditions and issues, such as premenstrual syndrome (PMS) and dysmenorrhea, which affect approximately 40–70% of fertile women [ 24 , 26 , 27 ] and endometriosis, which is prevalent in 10% of women [ 28 ]. The conditions may last throughout the woman’s fertile age until menopause. Perimenopausal symptoms, often experienced as heat, sweat, sleeping problems and depression, can cause discomfort for years before and after final menstruation [ 23 , 29 ]. Pregnancy was addressed in the context of Norwegian working life in the late 90s, with a focus on risk assessment and facilitation of the working environment [ 30 , 31 ], but pregnancy-related sick leave is still considered the major cause of the gender difference in sickness absence [ 32 ]. As many as 15% of women or couples also need medical assistance to get pregnant [ 23 ], and hormonal and other medical treatments for infertility can have severe side effects. In addition, abortions, both induced abortions and miscarriages, can burden women’s health [ 23 ]. Furthermore, diseases and conditions that mainly affect women are more often chronic and have non-specific symptoms [ 7 , 17 ]. An example of this is the experience of headaches; a current report shows a 43% prevalence of permanent or recurrent headaches in Norwegian women aged 25–44 years [ 7 ]. Female biology can be seen as more complex by nature than male biology due to both normal variations or changes and disposition for various diseases [ 7 ], which might influence work–life participation. Our objective is to explore the burden of female physiology in the context of work, with a broad approach to women’s health, and to investigate possible associations between women’s health, sickness absence and work ability. By developing a systematic overview of current international research, we will explore and summarise established knowledge and identify existing knowledge gaps. Objectives, research question, inclusion criteria and methods were documented in a protocol according to the theory of Peters et al. [ 33 ], for use within the research team.

2. Materials and Methods

We followed the five steps for scoping reviews described in the methodological framework of Arksey and O’Malley [ 34 ], together with the PRISMA guidelines and methodological considerations from the Joanna Briggs Institute [ 35 ].

2.1. Stage 1: Identifying the Research Question

Based on this objective, the following research questions were formulated:

• How has women’s health been investigated in the context of working life?
• What is the association between women’s health, sickness absence and work ability?

2.2. Stage 2: Identifying Relevant Studies

We selected studies based on predetermined inclusion and exclusion criteria. To obtain a broad approach to the field, we searched for studies using quantitative and qualitative methods. Only primary studies were included to access first-hand research experience. A time span of 10 years (2012–2022) was set to identify trends or developments over the last decade. Only studies presented in the English language were considered due to the international scope and limited time and resources at hand. Because work life is culture- and context-dependent, only studies from countries with transferability to the Norwegian context were considered, namely European countries, the USA, Canada, Australia and New Zealand. The search strategy was developed using a population, concept and context (PCC) model [ 36 ].

2.2.1. Population

The population was women/females employed in paid work. No age limit was set for the population, as we wanted to include women at all stages of occupational life. Due to this objective, this study concerned women with female biology regarding hormones and sex organs. Thus, the extended gender-identity debate was not addressed.

2.2.2. Concept

The term women’s health was conceptualised into three areas relevant for investigation in the context of work: (1) Life stages of hormonal impact (menstruation, PMS, dysmenorrhea, endometriosis and menopause), (2) Pregnancy and reproduction (pregnancy, breastfeeding, infertility and abortion), (3) Chronic and complex disorders (chronic pain, headache, dizziness, fatigue and fibromyalgia). The selection and formulation of these areas were based on previous research and literature on medicine and public health [ 17 , 22 , 37 , 38 ]. Conditions and diagnoses were included to make a relevant and sufficiently comprehensive selection and did not constitute an exhaustive list. Some of the areas were expected to complement each other and overlap with regard to symptoms. Key words were set up for the search using the Emtree/MeSH browser.

2.2.3. Context

The context for the study was working life and the occupational setting. Outcome measures were sick leave/absenteeism, work ability, participation, presenteeism/reduced capacity and disability.

Literature searches were performed in the electronic databases MEDLINE/Embase (Ovid) and Scopus on 4 January 2022. See Table 1 for the search string. The search process was assisted by an experienced university librarian.

Search string, database Embase/MEDLINE (Ovid).

2.3. Stage 3: Study Selection

The criteria for inclusion/exclusion are presented in Table 2 . Due to the openness of the research questions and the breadth of the subject terms, the search identified many irrelevant articles, systematic reviews, and grey literature. These were excluded from our scope but nevertheless provided broader understanding and background knowledge.

Criteria for inclusion/exclusion.

A total of 5798 unique articles were screened by title and abstract for relevance to the inclusion and exclusion criteria, and 274 articles were screened by full text. Identified records were imported to EndNote and remaining duplicates were deleted. A minimum of two authors performed the same screening processes separately as the first author (M.G.) screened all articles and the co-authors (M.H., K.H., H.E.) each screened a third of the material. The electronic tool Rayyan was used for both steps. Disagreements around identified conflicts (max 15%, both stages) were discussed and resolved by all the authors. Finally, 130 articles were included in the review. The identification of studies is illustrated in Figure 1 .

Flowchart of study selection.

2.4. Stage 4: Charting the Data

Included articles’ author names, titles and publication years were transferred to Excel for charting and analysis. Articles were categorised by country, research design and the three defined areas of women’s health, including underlying conditions and measures on outcomes of working life. The aims and important results from each article were summarised in a separate column.

2.5. Stage 5: Collating, Summarising, and Reporting the Results

A template for categorisation was created using the predefined concepts, and a consistent approach was sought through the systematic collating of the data. Categorisation was done by the first author (M.G.) and was discussed among the co-authors. Samples were taken in all categories to check consistency.

The 130 included articles were geographically spread among 19 countries. Overall, 26 articles had a qualitative design, 2 used mixed methods and 102 were quantitative studies. The countries and designs are shown in Figure 2 . Together, the research in this review included data from 5,357,450 individuals.

Bar chart of countries and research design.

Table 3 shows the distribution of the three main areas of women’s health, sickness absence and work ability. The results showed that 70articles were about pregnancy and reproduction, whereas life stages of hormonal impact were addressed in 39 articles and chronic and complex diseases in 21. The division into three main areas of women’s health was the basis for charting the data, but the conditions and symptoms for each area overlapped in the articles.

Areas of women’s health with mapped conditions (*), sickness absence and work ability.

* The described conditions overlap both in the three main areas of women’s health and in the outcome measurements of sickness absence and/or work ability.

Sickness absence was discussed in 77 articles, and work ability was discussed in 55 articles. The risk of illness was addressed in 30; the majority of these were about pregnancy and the work environment. Other measures used in the categorisation were presenteeism/reduced capacity, disability and participation, with 22, 15 and 18 articles, respectively. White-collar professions were investigated in 36 articles, whereas the rest included both white collar and blue collar or did not specify. No studies in the search specifically addressed blue-collar workers. Of the articles that specified professions, 33 involved nursing or health care, 10 involved teaching, 4 involved service, 2 involved industry and 17 involved other professions. Of the included studies, 33 were from the public sector. The rest were either from both the private or public sectors or did not specify. In 87 articles, professions were not specified.

3.1. Life Stages of Hormonal Impact

Women’s hormonal changes were found to impact work participation in most of the included studies of life stages. Menstruation and menstrual problems, including endometriosis, were addressed in 20 articles. The various conditions overlapped to a large extent in the different studies (e.g., menstrual problems described as symptoms of endometriosis). Both PMS and menstruation in general, as problems in the work setting, have been investigated in our material, with diverging results. Only two of the included studies [ 39 , 40 ] used qualitative methods to explore women’s experiences in this regard. Hardy and Hardie [ 39 ] described how PMS symptoms, such as concentration problems, fatigue, tearfulness and heightened sensitivity to both people and the work environment, might contribute to presenteeism and absenteeism. Sang et al. [ 40 ] argued that the menstrual cycle is ‘a problematic source of gendered inequalities at work’ (p. 1) and suggested supportive workplaces and public health policies to approach the problem. They identified several themes in their study, including managing pain, menstrual leaking, stigma and the importance of access to facilities. The burden of menstruation comprises difficulties that affect female participation, especially regarding reduced capacity and work ability [ 40 ]. The prevalence and severity of the symptoms are also confirmed by quantitative studies [ 41 , 42 , 43 ]. However, two quantitative articles from the USA concluded that menstruation explains the gender gap in sickness absence to a very little extent [ 44 ] or not at all [ 45 ]. Endometriosis was studied in 13 articles, of which 10 were quantitative studies and 1 used a mixed method, showing prevalence and significant risk for absenteeism, presenteeism and reduced work ability [ 43 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ]. The included studies showed that endometriosis can affect the quality of daily working life but is also associated with impairment of professional life from a broader perspective, affecting career choices [ 55 ]. A study exploring the role of COVID-19 in women’s experiences [ 49 ] found that a home office could give women with endometriosis more flexibility, making it easier to take small breaks, avoid sickness absences and not have to hide associated pain. Menstruation was specially investigated in the context of shift work among nurses, showing diverging results: Lawson et al. [ 56 ] found that night work, working long hours and physically demanding work can lead to menstrual disturbances, while Moen et al. [ 57 ] found no association between menstrual characteristics and work parameters. Many of the studies addressed women’s health within several different contexts, with occupational life as only one area and did not specify the type of work.

Menopause and work were investigated in 19 articles, 15 of which were quantitative. Menopausal symptoms, such as hot flushes, poor concentration, poor memory, sleep disorders, tiredness and feeling depressed, can affect work ability negatively [ 58 , 59 ]. One of the included studies showed that three-quarters of menopausal women with symptoms reported serious problems in meeting the demands of their work [ 60 ], and another study showed that many women face difficulties being open to managers and others about their problems [ 61 ]. A supportive environment with understanding employers and colleagues is important for women handling symptoms while at work [ 58 , 61 , 62 , 63 ]. Having an organisational policy for menopause is recommended [ 64 ], but it is also suggested not to isolate menopausal symptoms but rather to approach health and ageing more holistically [ 62 , 65 , 66 ]. Research on menopause has measured, to a large extent, work ability rather than sickness absence, but findings from the included studies show that menopause clearly impacts both [ 60 , 67 , 68 , 69 , 70 , 71 , 72 ]. Menopause can also be an economic burden because of absence from work and thus has a social impact on the women affected [ 71 , 73 ].

3.2. Pregnancy and Reproduction

Pregnancy and work were investigated in 56 articles. Of these, 39 addressed sickness absence, 11 work ability and 23 different risks for sickness in the mother or damage to the foetus. Fourteen of the studies were from the healthcare sector. The included studies also showed that pregnant employees are a group that needs facilitation and individual adjustments to maintain work ability and avoid sickness absence [ 74 , 75 , 76 , 77 ], and a positive and supportive work environment is crucial for pregnant women staying at work [ 78 ]. Other identified factors are a common understanding between the employer and the employee and sufficient resources in the organisation to make necessary adjustments for specific work tasks. The leader’s role is decisive, and the individual needs of the pregnant employee must be the main focus of measures and practical adjustments [ 79 ]. The high sickness absence rates for pregnant women are substantial and have complex causes [ 80 ]. Physically demanding work and physical job stressors in pregnant workers increase the risk of different outcomes, such as pelvic pain [ 81 ], miscarriage or preterm birth [ 82 , 83 , 84 , 85 ]. Some of the included studies showed that working nights and long shifts might increase the burden on pregnant employees. A study of Danish hospital employees found an association between night shifts and post-partum depression [ 86 ], and increased risk of hypertensive disorders in pregnancy [ 87 ]. Multiple occupational risks and exposures increase the use of sick leave during pregnancy [ 88 , 89 ]. Despite the high rates of sick leave in pregnancy, women report struggling with credibility when requests for sick leave or medical care are rejected [ 90 ]. This problem is addressed in studies on two common complaints—pelvic pain [ 90 ] and nausea [ 91 ]—which reported that women feel trivialised or not taken seriously when seeking guidance from health care professionals. One Norwegian study explored sickness absences in pregnant immigrant women and found that more immigrant women reported absences from work than native women. Possible causes were poorer health status prior to pregnancy, more severe pregnancy-induced emesis among immigrants and poor proficiency in the Norwegian language [ 92 ]. The risk for sickness absence in pregnancy increases when the woman is multiparous or overweight/obese, and is lower if the woman is engaged in leisure-time physical activities [ 93 ]. The risk of sickness absence is also linked to the level of education, as higher education is associated with less sickness absence in pregnancy. Younger mothers have greater sickness absences, possibly partly because young women are more likely to have a lower education [ 94 ]. Postponement of the first pregnancy does not explain the increase in pregnant women’s sickness absence [ 80 ]. Pregnancy does not predict greater sickness absence later in life; studies show that women who have previously given birth have less sickness-related absences and less use of disability pensions than women who have not given birth [ 95 , 96 , 97 ].

Breastfeeding was investigated in 12 articles, 9 of which were from the USA. Most countries in the Western world have national policies that guarantee breaks for breastfeeding for more than six months [ 98 , 99 ] and breastfeeding at work is a matter of organisational culture [ 100 ]. Scott [ 101 ] argued that experiences depend on individual, interpersonal and organisational factors and that policies are helpful for handling different needs in different roles. Employers’ accommodations are decisive for what is done in practice [ 76 , 102 , 103 ], and it seems easier for employers to facilitate pumping than breastfeeding [ 104 ]. A qualitative study from an Australian university setting identified a positive and progressive environment and private and safe spaces for breastfeeding as important factors for the women [ 105 ]. The same authors found that breastfeeding women might feel self-conscious and unprofessional and develop a resilience to judgement. Another finding of this study was that employees with permanent positions had better terms than temporary employees, and the authors suggested that the gender perspective is not sufficiently addressed in this regard [ 105 ].

No studies on abortion and the context of work were identified in our search. Infertility and work were addressed in four articles, all quantitative. Infertility treatment was shown to have a clear impact on work ability and sickness absence [ 53 , 106 ], and the overall professional impact of infertility treatment was significantly higher for women than for men [ 106 ]. In one study, 49% of respondents reported a negative influence on work ability and 46% reported the necessity to lie about missing work because of treatment. Another study found that the majority disclosed the treatment to their employer because of the need to take time off work [ 107 ].

3.3. Chronic and Complex Disorders

Of the 21 studies on chronic and complex disorders, 14 were studies on chronic pain. Chronic pain as a symptom is a great burden and has a clear impact on work ability and sickness absence for women suffering from disorders such as fibromyalgia [ 108 , 109 , 110 ] and endometriosis [ 48 , 50 , 51 ]. Chronic low back pain is found to be a possible consequence of particularly strenuous work involving walking and heavy lifting for women [ 111 ]. A study that investigated immigrant women and their experiences of being on sick leave due to chronic pain found this group particularly vulnerable to social isolation and dropout from working life [ 112 ]. Another study showed that self-reported recurrent headaches were associated with impaired productivity at work; the association with reduced work ability and presenteeism was clearer than the association with sickness absence or absenteeism [ 113 ]. In a study of Bulgarian nurses, 40% of the respondents reported frequent headaches [ 114 ]. No studies of dizziness in the context of work were identified in our search. Fatigue was addressed as a condition or symptom in studies about fibromyalgia and endometriosis, and two studies investigated shift work and work stress among nurses, with fatigue among the measured outcomes. Fatigue as a symptom can negatively impact work ability and increase sickness absence, both in women with fibromyalgia [ 115 , 116 ] and endometriosis [ 53 , 54 , 55 ]. Working night shifts was associated with chronic fatigue [ 117 ], and fatigue was also prevalent in more than 70% of the nurses in the Bulgarian study investigating work stress and long working hours [ 114 ]. The search identified three relevant articles on chronic conditions and work regarding female urogenital health. Two were from the health care sector, concluding that urine incontinence is a condition of high prevalence and significant severity in female nurses and midwives [ 118 , 119 ]. The experience of symptoms is associated with delayed voiding because of the organisation of the work, focus on patients at the expense of self-care, relationships in the nursing team, demands of the nursing role and inadequacy of workplace amenities [ 119 ]. Arcas et al. [ 120 ] argued that women’s absences from work are of longer duration than men’s and must be seen in association with family–work role conflict, calling for a holistic approach to the field.

4. Discussion

This scoping review had two aims: to map the current knowledge on women’s health in the context of working life and to investigate associations between women’s health, sickness absence and work ability. We included and extracted data from 130 articles and found that some of the conditions within the field of women’s health are well-studied in the context of work, while others are weak or absent in the body of knowledge. Although individual studies have shown an association between sickness absence and work ability, a more holistic and overall perspective on the female burden in this context seems to be missing.

The included studies showed that the hormonal system can cause symptoms that influence work participation [ 39 , 41 , 43 , 58 , 59 ]. Menstruation affects most women, and almost half of them experience pain or physical or psychological tension before or during the period, which can amount to a significant burden at the work place [ 24 , 27 ]. However, this scoping review showed diverging results. Menstruation in general was investigated and found to have weak associations with work participation, but other findings show that specific conditions and ailments have an influence [ 27 , 41 ]. Endometriosis, affecting 10% of women, together with menopause, affecting most middle-aged women and causing symptoms in 80% [ 29 ] represents a burden for a substantial number of female employees. In addition, the unclear distinction of whether symptoms stem from normal conditions or diseases can delay openness to the employer. The overall proportion of women negatively affected by hormonal conditions is still unknown, as the total prevalence includes overlapping conditions that have not yet been investigated. Thus, knowledge of its overall impact on women’s working lives is fragmented and limited. However, several of the identified articles suggest a more holistic approach to age-specific female ailments and emphasise that experiences are individual [ 65 , 66 ]. Research on life-stage policies should be investigated and promoted in this context.

Many of the included studies focused on pregnancy. Being pregnant is not a disease, but it can cause and involve conditions that hinder women from functioning normally at work, depending on their work tasks. National work–life legislation protects women against negative health consequences, but implementation of the laws will depend on employers’ resources and possibilities. There are also substantial differences between legislation in the various countries, which can have consequences for sickness absence and dropout from the workforce. This, however, is outside the scope of this review and should be addressed elsewhere. Pregnant workers in the healthcare sector have been studied specifically. In this sector, resources are scarce and managers have a broad span of control, so measures can be difficult to implement in practice [ 80 ]. Hospitals were also the study sites for several of the studies on breastfeeding in the workplace. The findings show a system under time pressure [ 101 ]. Experiences of adjustments are influenced by individual, interpersonal and organisational factors, and leaders are responsible both for developing policies and for making practical arrangements [ 101 , 121 ].

One of the studies on infertility found a severe impact on the working life of women undergoing treatment [ 106 ]. Considering how many women this applies to, it may represent a substantial burden for working women of fertile age. In many countries, infertility treatment is not a justified reason for sick leave. It is possible that the ailments are camouflaged in alternative diagnoses and one can question whether this affects stigma or lack of openness around the situation, but this is still unknown. Surprisingly, our results show that no studies on abortion and the context of work were identified by our search, so the consequences of abortion on women’s work participation seem to be unexplored. In particular, recurrent miscarriages can be assumed to have an impact, but this also represents a gap in knowledge.

The prevalence of headaches/migraines and their association with work was the main objective of only one article in our search [ 113 ], although almost half of all women reported permanent or recurrent headaches in a recent report [ 7 ]. Research on chronic pain and fatigue in relation to work life also represents gaps in the knowledge, as most studies on this topic were general, with fatigue being only one of several measures. Evidence lacks both in quantity, since the number of studies is small, but also regarding the variety of research designs, as different approaches contribute different types of knowledge.

4.1. Sickness Absence and Work Ability

Sickness absence and work ability are frequently used parameters in research on working life and occupational health. However, we found the terms used in various ways. Sickness absence is a measurable quantity that describes the time of absence from work. Still, the value depends on how it is measured. In some studies, data refer to sickness absence mandated by a doctor, partly because this is what generates numbers in national statistics [ 93 , 94 ]. Self-reported short-term absences are not part of this statistic and may be covered by the employer, depending on governmental policies. One can also ask how frequently short-term absence is associated with long-term absence. Some studies are based on self-reported absences, so the variations complicate comparisons and overviews. The term ‘work ability’ is also used in different ways. Work ability can refer to measurement by the Work Ability Index, a tool for assessing self-rated work ability, as used by Humeniuk et al. [ 59 ]. In other articles, it is used as a general term describing work ability or work capacity, such as by Hickey et al. [ 62 ]. The terms absenteeism and presenteeism for sickness absence and reduced work ability seem to be incorporated into the research on occupational health. The association between sickness absence and work ability was not explicitly addressed in our material, but the terms intertwine and overlap in different ways.

Conditions from all three of the identified areas of women’s health—life stages of hormonal impact, pregnancy and reproduction and chronic and complex disorders—were found to influence sickness absence and work ability. Pregnancy contributes to a large part of the gender difference statistically, and despite knowledge of important factors for keeping pregnant women at work [ 78 , 79 ], high levels of sickness absence persist. Therefore, the findings of this review suggest a need for new research questions. If it is an aim to reduce sickness absence for pregnant women, studies of the arrangement of welfare benefits, workplace accommodations or how women can be sufficiently empowered to maintain health and support while working during pregnancy should be increased.

Chronic conditions also show an association between work ability and sickness absence. Headache as a symptom was found to be more connected to presenteeism than absenteeism [ 113 ], which means that a huge proportion of women go to work despite having pain. Working while in pain may reduce work ability and thus challenge the experience of coping with and mastering an occupational setting. This, again, can lead to sickness absence over time.

4.2. Need for Diverse Research

Most of the included studies provided quantitative knowledge of the prevalence and measurement of risks. To explore mechanisms more elaborately, studies using qualitative methods would contribute to a more detailed picture. The included qualitative studies mainly explored women’s experiences. Extension of this perspective would identify areas in which more knowledge is needed, as well as strengthen the basis for developing adequate measures and solutions for working women in practice. Research from the employer’s perspective is also scarce and would contribute important information. The high number of studies not specifying sector or profession favours general insights and obscures details. General and cross-sector research provides a potential basis for making policies and developing guidelines for HSE work. However, adjustments and measures for practice must be rooted in contextual and specific needs and possibilities in different professions. Division by gender was a criterion for inclusion/exclusion in our review, so all the articles had gender-specific findings. Still, few studies have investigated the rationale behind gender differences or their experiences. More knowledge of the identified differences will provide directions for future research on gender and health in occupational settings.

5. Conclusions

Female biology makes women more disposed of different ailments that men naturally avoid. Some of these conditions are natural processes that cause bothersome symptoms, and some conditions are caused by illness. In this review, we wanted to investigate if and how female biology is associated with female work participation. Hormonal changes and menstruation-related ailments, pregnancy and reproductive matters and chronic and complex disorders were all found to impact the occupational setting. The existing knowledge is fragmented, as some of the conditions are investigated and others are not, and a holistic and overall perspective on female health in the context of work is missing.

The search was done in only three databases, which leaves us at risk of missing important studies. Several conditions and diagnoses within women’s health were excluded from the search due to space limitations; this also represents a weakness of this study. However, we found the three defined areas relevant and comprehensive. When considering the studies on the various ailments, it becomes apparent that women’s total burden can challenge work participation. At the same time, participation in work life is health promoting by itself [ 1 ]. Therefore, coping in the workplace despite health challenges should be an important strategy for employers and policymakers. The importance of individual adjustments and organisational strategies for facilitation was also a finding for several of the conditions of the included studies [ 63 , 79 ]. This review calls for more knowledge on the associations and connections between health and work and the possible differences between women and men in these interactions. Many of the conditions and diagnoses discussed have a diffuse character, and some do not qualify for sick leave and are therefore not registered in the sickness absence registers. Hence, it is difficult to obtain a scientific perspective on women’s health issues related to work participation. Over time, living and working with ailments can cause wear and tear. In combination with difficult working conditions, this might lead to reduced work ability and high levels of sickness absence. Women’s health and working life constitute a complex connection with the potential for the development of new knowledge, and the scope of this connection should be considered from a broader perspective of living conditions and public health.

Acknowledgments

Searches in databases were set up and performed with the assistance of university librarian Ellen Sejersted, University of Agder.

Funding Statement

Funded by the Research Council of Norway and Agder County Municipality.

Author Contributions

Conceptualisation, M.G., K.H., H.E. and M.H.; Methodology, M.G., K.H., H.E. and M.H.; Software, M.G., K.H., H.E. and M.H.; Validation, M.G. and M.H.; Formal Analysis, M.G. and M.H.; Investigation, M.G., K.H., H.E. and M.H.; Resources, M.G., K.H., H.E. and M.H.; Data Curation, M.G., K.H., H.E. and M.H.; Writing—Original Draft Preparation, M.G.; Writing—Review & Editing, M.G., K.H., H.E. and M.H.; Visualisation, M.G.; Supervision, K.H., H.E. and M.H.; Project Administration, M.G.; Funding Acquisition, M.G. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Data availability statement, conflicts of interest.

The authors declare no conflict of interest.

Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Why mental health needs to be a top priority in the workplace

U.S. surgeon general cites APA research in new guidance around strengthening workplace well-being.

• Mental Health
• Healthy Workplaces

Spotlighting the role of mental health in the workplace, the U.S. surgeon general issued new guidance outlining how long working hours, limited autonomy, and low wages aren’t just driving a U.S. labor shortage, but may actually be at the heart of the nation’s mental health crisis.

Putting mental health at the center of workplace policies is more important than ever as the nation grapples with financial stressors, shifts in workplace culture exacerbated by the pandemic, and growing concerns about stress among Americans. Extensive psychological research shows the importance of providing mental health coverage, appropriate training for employees, flexible work options, and equity in the workplace, among other evidence-based tactics to improve the workplace.

“A healthy workforce is the foundation for thriving organizations and healthier communities,” said U.S. Surgeon General Vivek Murthy, MD. “As we recover from the worst of the pandemic, we have an opportunity and the power to make workplaces engines for mental health and well-being.”

More than 160 million people are a part of the U.S. workforce today, and the average full-time employee spends approximately half of their waking life at work. Further, the covid -19 pandemic changed the nature of work for many and the relationship that some workers have with their jobs, often blurring the lines between their professional and personal lives and creating stress and burnout. In fact, nearly two in five (39%) workers report that their work environment has had a negative impact on their mental health, according to APA’s 2022 Work and Well-being Survey .

A happy, healthy workforce is good for employees and the bottom line

The Surgeon General’s Framework for Mental Health and Well-Being in the Workplace , which cites research from APA, is designed to encourage organizations to rethink how they protect workers from harm, foster a sense of connection among workers, show workers that they matter, make space for their lives outside work, and support their growth.

Specific recommendations in the surgeon general’s report, based on psychological science, include asking workplace leaders to listen to workers about their needs, increasing pay, and limiting communications outside of work hours.

Developing policies and practices supporting the mental health and well-being of all workers costs money, time, and energy. But evidence published by APA shows that the cost of failing to support employees’ psychological well-being is often far higher.

APA’s Striving for Mental Health in the Workplace initiative , launched in May 2022, found employees with high levels of stress are more likely to miss work or to show lower engagement and commitment while at work, which can negatively affect an organization’s bottom line. Even before the pandemic, employee stress levels were high. A 2018 analysis found the estimated cost of job stress nationwide may be as much as $187 billion, with 70% to 90% of those losses resulting from declines in productivity—and the pandemic has only worsened the situation.

Organizational leaders are well-positioned to influence a positive culture shift and normalize mental health in the workplace. These positive and supportive workplace practices can boost employee mental health, company morale, and your bottom line, said Arthur C. Evans Jr., PhD, APA’s chief executive officer.

“On average, we spend 90,000 hours of our lifetimes at work,” Evans said. “Businesses and employers have a responsibility to ensure that those hours are spent in environments that support the mental health of employees and their families. Doing so is not only better for people’s well-being, but better for the businesses themselves. We cannot underestimate the positive impact we can have when we align our workplace policies and practices with people’s psychological health.”

Evans and other workplace mental health advocates suggest leaders focus on several actions to improve employee mental health . Among them: training managers to support employees’ mental health; increasing employees’ options for where, when, and how they work; ensuring health insurance policies have robust mental health coverage; using employee feedback to improve and evolve the workplace culture; and looking at organizational policies through a lens of equity, diversity, and inclusion.

While training managers and making sure insurance plans cover mental health seem like obvious fixes, how flexible work arrangements improve mental health may be less apparent. However, research shows autonomy improves mental well-being.

“When we feel like we have more control over our lives, it reduces our psychological distress and improves our mental well-being,” Evans said. “I think it’s a mistake for leaders to discount the importance of having that flexibility.”

• Healthy workplaces
• 5 ways to improve employee mental health
• Supporting employees’ psychological well-being
• These organizations make mental health a priority
• How psychological science can improve well-being for public service workers

Contact APA Office of Public Affairs

You may also like.

Research Topics & Ideas: Healthcare

100+ Healthcare Research Topic Ideas To Fast-Track Your Project

Finding and choosing a strong research topic is the critical first step when it comes to crafting a high-quality dissertation, thesis or research project. If you’ve landed on this post, chances are you’re looking for a healthcare-related research topic , but aren’t sure where to start. Here, we’ll explore a variety of healthcare-related research ideas and topic thought-starters across a range of healthcare fields, including allopathic and alternative medicine, dentistry, physical therapy, optometry, pharmacology and public health.

NB – This is just the start…

The topic ideation and evaluation process has multiple steps . In this post, we’ll kickstart the process by sharing some research topic ideas within the healthcare domain. This is the starting point, but to develop a well-defined research topic, you’ll need to identify a clear and convincing research gap , along with a well-justified plan of action to fill that gap.

If you’re new to the oftentimes perplexing world of research, or if this is your first time undertaking a formal academic research project, be sure to check out our free dissertation mini-course. In it, we cover the process of writing a dissertation or thesis from start to end. Be sure to also sign up for our free webinar that explores how to find a high-quality research topic.

Overview: Healthcare Research Topics

• Allopathic medicine
• Alternative /complementary medicine
• Veterinary medicine
• Physical therapy/ rehab
• Optometry and ophthalmology
• Pharmacy and pharmacology
• Public health
• Examples of healthcare-related dissertations

Allopathic (Conventional) Medicine

• The effectiveness of telemedicine in remote elderly patient care
• The impact of stress on the immune system of cancer patients
• The effects of a plant-based diet on chronic diseases such as diabetes
• The use of AI in early cancer diagnosis and treatment
• The role of the gut microbiome in mental health conditions such as depression and anxiety
• The efficacy of mindfulness meditation in reducing chronic pain: A systematic review
• The benefits and drawbacks of electronic health records in a developing country
• The effects of environmental pollution on breast milk quality
• The use of personalized medicine in treating genetic disorders
• The impact of social determinants of health on chronic diseases in Asia
• The role of high-intensity interval training in improving cardiovascular health
• The efficacy of using probiotics for gut health in pregnant women
• The impact of poor sleep on the treatment of chronic illnesses
• The role of inflammation in the development of chronic diseases such as lupus
• The effectiveness of physiotherapy in pain control post-surgery

Topics & Ideas: Alternative Medicine

• The benefits of herbal medicine in treating young asthma patients
• The use of acupuncture in treating infertility in women over 40 years of age
• The effectiveness of homoeopathy in treating mental health disorders: A systematic review
• The role of aromatherapy in reducing stress and anxiety post-surgery
• The impact of mindfulness meditation on reducing high blood pressure
• The use of chiropractic therapy in treating back pain of pregnant women
• The efficacy of traditional Chinese medicine such as Shun-Qi-Tong-Xie (SQTX) in treating digestive disorders in China
• The impact of yoga on physical and mental health in adolescents
• The benefits of hydrotherapy in treating musculoskeletal disorders such as tendinitis
• The role of Reiki in promoting healing and relaxation post birth
• The effectiveness of naturopathy in treating skin conditions such as eczema
• The use of deep tissue massage therapy in reducing chronic pain in amputees
• The impact of tai chi on the treatment of anxiety and depression
• The benefits of reflexology in treating stress, anxiety and chronic fatigue
• The role of acupuncture in the prophylactic management of headaches and migraines

Topics & Ideas: Dentistry

• The impact of sugar consumption on the oral health of infants
• The use of digital dentistry in improving patient care: A systematic review
• The efficacy of orthodontic treatments in correcting bite problems in adults
• The role of dental hygiene in preventing gum disease in patients with dental bridges
• The impact of smoking on oral health and tobacco cessation support from UK dentists
• The benefits of dental implants in restoring missing teeth in adolescents
• The use of lasers in dental procedures such as root canals
• The efficacy of root canal treatment using high-frequency electric pulses in saving infected teeth
• The role of fluoride in promoting remineralization and slowing down demineralization
• The impact of stress-induced reflux on oral health
• The benefits of dental crowns in restoring damaged teeth in elderly patients
• The use of sedation dentistry in managing dental anxiety in children
• The efficacy of teeth whitening treatments in improving dental aesthetics in patients with braces
• The role of orthodontic appliances in improving well-being
• The impact of periodontal disease on overall health and chronic illnesses

Tops & Ideas: Veterinary Medicine

• The impact of nutrition on broiler chicken production
• The role of vaccines in disease prevention in horses
• The importance of parasite control in animal health in piggeries
• The impact of animal behaviour on welfare in the dairy industry
• The effects of environmental pollution on the health of cattle
• The role of veterinary technology such as MRI in animal care
• The importance of pain management in post-surgery health outcomes
• The impact of genetics on animal health and disease in layer chickens
• The effectiveness of alternative therapies in veterinary medicine: A systematic review
• The role of veterinary medicine in public health: A case study of the COVID-19 pandemic
• The impact of climate change on animal health and infectious diseases in animals
• The importance of animal welfare in veterinary medicine and sustainable agriculture
• The effects of the human-animal bond on canine health
• The role of veterinary medicine in conservation efforts: A case study of Rhinoceros poaching in Africa
• The impact of veterinary research of new vaccines on animal health

Topics & Ideas: Physical Therapy/Rehab

• The efficacy of aquatic therapy in improving joint mobility and strength in polio patients
• The impact of telerehabilitation on patient outcomes in Germany
• The effect of kinesiotaping on reducing knee pain and improving function in individuals with chronic pain
• A comparison of manual therapy and yoga exercise therapy in the management of low back pain
• The use of wearable technology in physical rehabilitation and the impact on patient adherence to a rehabilitation plan
• The impact of mindfulness-based interventions in physical therapy in adolescents
• The effects of resistance training on individuals with Parkinson’s disease
• The role of hydrotherapy in the management of fibromyalgia
• The impact of cognitive-behavioural therapy in physical rehabilitation for individuals with chronic pain
• The use of virtual reality in physical rehabilitation of sports injuries
• The effects of electrical stimulation on muscle function and strength in athletes
• The role of physical therapy in the management of stroke recovery: A systematic review
• The impact of pilates on mental health in individuals with depression
• The use of thermal modalities in physical therapy and its effectiveness in reducing pain and inflammation
• The effect of strength training on balance and gait in elderly patients

Topics & Ideas: Optometry & Opthalmology

• The impact of screen time on the vision and ocular health of children under the age of 5
• The effects of blue light exposure from digital devices on ocular health
• The role of dietary interventions, such as the intake of whole grains, in the management of age-related macular degeneration
• The use of telemedicine in optometry and ophthalmology in the UK
• The impact of myopia control interventions on African American children’s vision
• The use of contact lenses in the management of dry eye syndrome: different treatment options
• The effects of visual rehabilitation in individuals with traumatic brain injury
• The role of low vision rehabilitation in individuals with age-related vision loss: challenges and solutions
• The impact of environmental air pollution on ocular health
• The effectiveness of orthokeratology in myopia control compared to contact lenses
• The role of dietary supplements, such as omega-3 fatty acids, in ocular health
• The effects of ultraviolet radiation exposure from tanning beds on ocular health
• The impact of computer vision syndrome on long-term visual function
• The use of novel diagnostic tools in optometry and ophthalmology in developing countries
• The effects of virtual reality on visual perception and ocular health: an examination of dry eye syndrome and neurologic symptoms

Topics & Ideas: Pharmacy & Pharmacology

• The impact of medication adherence on patient outcomes in cystic fibrosis
• The use of personalized medicine in the management of chronic diseases such as Alzheimer’s disease
• The effects of pharmacogenomics on drug response and toxicity in cancer patients
• The role of pharmacists in the management of chronic pain in primary care
• The impact of drug-drug interactions on patient mental health outcomes
• The use of telepharmacy in healthcare: Present status and future potential
• The effects of herbal and dietary supplements on drug efficacy and toxicity
• The role of pharmacists in the management of type 1 diabetes
• The impact of medication errors on patient outcomes and satisfaction
• The use of technology in medication management in the USA
• The effects of smoking on drug metabolism and pharmacokinetics: A case study of clozapine
• Leveraging the role of pharmacists in preventing and managing opioid use disorder
• The impact of the opioid epidemic on public health in a developing country
• The use of biosimilars in the management of the skin condition psoriasis
• The effects of the Affordable Care Act on medication utilization and patient outcomes in African Americans

Topics & Ideas: Public Health

• The impact of the built environment and urbanisation on physical activity and obesity
• The effects of food insecurity on health outcomes in Zimbabwe
• The role of community-based participatory research in addressing health disparities
• The impact of social determinants of health, such as racism, on population health
• The effects of heat waves on public health
• The role of telehealth in addressing healthcare access and equity in South America
• The impact of gun violence on public health in South Africa
• The effects of chlorofluorocarbons air pollution on respiratory health
• The role of public health interventions in reducing health disparities in the USA
• The impact of the United States Affordable Care Act on access to healthcare and health outcomes
• The effects of water insecurity on health outcomes in the Middle East
• The role of community health workers in addressing healthcare access and equity in low-income countries
• The impact of mass incarceration on public health and behavioural health of a community
• The effects of floods on public health and healthcare systems
• The role of social media in public health communication and behaviour change in adolescents

Examples: Healthcare Dissertation & Theses

While the ideas we’ve presented above are a decent starting point for finding a healthcare-related research topic, they are fairly generic and non-specific. So, it helps to look at actual dissertations and theses to see how this all comes together.

Below, we’ve included a selection of research projects from various healthcare-related degree programs to help refine your thinking. These are actual dissertations and theses, written as part of Master’s and PhD-level programs, so they can provide some useful insight as to what a research topic looks like in practice.

• Improving Follow-Up Care for Homeless Populations in North County San Diego (Sanchez, 2021)
• On the Incentives of Medicare’s Hospital Reimbursement and an Examination of Exchangeability (Elzinga, 2016)
• Managing the healthcare crisis: the career narratives of nurses (Krueger, 2021)
• Methods for preventing central line-associated bloodstream infection in pediatric haematology-oncology patients: A systematic literature review (Balkan, 2020)
• Farms in Healthcare: Enhancing Knowledge, Sharing, and Collaboration (Garramone, 2019)
• When machine learning meets healthcare: towards knowledge incorporation in multimodal healthcare analytics (Yuan, 2020)
• Integrated behavioural healthcare: The future of rural mental health (Fox, 2019)
• Healthcare service use patterns among autistic adults: A systematic review with narrative synthesis (Gilmore, 2021)
• Mindfulness-Based Interventions: Combatting Burnout and Compassionate Fatigue among Mental Health Caregivers (Lundquist, 2022)
• Transgender and gender-diverse people’s perceptions of gender-inclusive healthcare access and associated hope for the future (Wille, 2021)
• Efficient Neural Network Synthesis and Its Application in Smart Healthcare (Hassantabar, 2022)
• The Experience of Female Veterans and Health-Seeking Behaviors (Switzer, 2022)
• Machine learning applications towards risk prediction and cost forecasting in healthcare (Singh, 2022)
• Does Variation in the Nursing Home Inspection Process Explain Disparity in Regulatory Outcomes? (Fox, 2020)

Looking at these titles, you can probably pick up that the research topics here are quite specific and narrowly-focused , compared to the generic ones presented earlier. This is an important thing to keep in mind as you develop your own research topic. That is to say, to create a top-notch research topic, you must be precise and target a specific context with specific variables of interest . In other words, you need to identify a clear, well-justified research gap.

Need more help?

If you’re still feeling a bit unsure about how to find a research topic for your healthcare dissertation or thesis, check out Topic Kickstarter service below.

You Might Also Like:

16 Comments

I need topics that will match the Msc program am running in healthcare research please

Hello Mabel,

I can help you with a good topic, kindly provide your email let’s have a good discussion on this.

Can you provide some research topics and ideas on Immunology?

Thank you to create new knowledge on research problem verse research topic

Help on problem statement on teen pregnancy

This post might be useful: https://gradcoach.com/research-problem-statement/

can you provide me with a research topic on healthcare related topics to a qqi level 5 student

Please can someone help me with research topics in public health ?

Hello I have requirement of Health related latest research issue/topics for my social media speeches. If possible pls share health issues , diagnosis, treatment.

I would like a topic thought around first-line support for Gender-Based Violence for survivors or one related to prevention of Gender-Based Violence

Please can I be helped with a master’s research topic in either chemical pathology or hematology or immunology? thanks

Can u please provide me with a research topic on occupational health and safety at the health sector

Good day kindly help provide me with Ph.D. Public health topics on Reproductive and Maternal Health, interventional studies on Health Education

may you assist me with a good easy healthcare administration study topic

May you assist me in finding a research topic on nutrition,physical activity and obesity. On the impact on children

I have been racking my brain for a while on what topic will be suitable for my PhD in health informatics. I want a qualitative topic as this is my strong area.

Submit a Comment Cancel reply

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

• Print Friendly

• Newsletters

Search form

Research projects

The Center’s research aims to expand the scientific evidence base for promoting and protecting worker health through policies, programs, and practices that integrate and coordinate occupational health and safety, worksite health promotion, and related worker health initiatives.

Current research projects

Boston Hospital Workers Health Study

Fulfillment Center Intervention Study

Thriving Workers, Thriving Workplaces Study

Older Workers' Health and Well-being Study

Previous research projects

Enterprise Outcomes

Intervention Effectiveness

Download the document

To download this document, please provide the following information. We are required to track downloads as part of the reporting we submit to our funder, NIOSH. We may contact you in the future about your use of this resource and to share news from our Center, but will not share your information with others. Thank you.

The independent source for health policy research, polling, and news.

The Relationship Between Work and Health: Findings from a Literature Review

Larisa Antonisse and Rachel Garfield Published: Aug 07, 2018

• Issue Brief

A central question in the current debate over work requirements in Medicaid is whether such policies promote health and are therefore within the goals of the Medicaid program. Work requirements in welfare programs in the past have had different goals of strengthening self-esteem and providing a ladder to economic progress, versus improving health. This brief examines literature on the relationship between work and health and analyzes the implications of this research in the context of Medicaid work requirements. We review literature cited in policy documents, as well as additional studies identified through a search of academic papers and policy evaluation reports, focusing primarily on systematic reviews and meta-analyses. Key findings include the following:

KFF review: Research about the relationship between work and health finds only limited evidence that employment improves health, with some studies showing a positive impact and others showing no relationship or only limited effects.

• Job availability and quality are important modifiers in how work affects health; transition from unemployment to poor quality or unstable employment options can be detrimental to health.
• Selection bias in the research (e.g., healthy people being more likely to work) and other methodological limitations restrict the ability to determine a causal work-health relationship.
• The work-health relationship may differ for the Medicaid population compared to the broader populations studied in the literature, as Medicaid enrollees report worse health than the general population and face significant challenges related to social determinants of health.
• Limited job availability or poor job quality may moderate or reverse any positive effects of work.
• Work or volunteering to fulfill a requirement may produce different health effects than work or volunteer activities studied in existing literature.
• Loss of Medicaid coverage under work requirements could negatively impact health care access and outcomes, as well as exacerbate health disparities.

Introduction

On January 11, 2018, CMS issued a State Medicaid Director Letter  providing new guidance for Section 1115 waiver proposals that would impose work requirements (referred to as community engagement) in Medicaid as a condition of eligibility. On January 12, 2018, CMS approved the first work requirement waiver in  Kentucky , and three additional work requirement waiver approvals followed in  Indiana  (February 1, 2018), Arkansas (March 5, 2018), and New Hampshire (May 7, 2018). The new guidance and work requirement approvals reverse previous positions of both Democratic and Republican Administrations, which had not approved work requirement waiver requests on the basis that such provisions would not further the Medicaid program’s purposes of promoting health coverage and access. However, in both the new guidance and work requirement waiver approvals, CMS explains its policy reversal by maintaining that employment leads to improved health outcomes, and policies that condition Medicaid eligibility on meeting a work requirement will further this objective. Though the structure of work requirements is similar to those used in other programs, the administration’s stated goal of  improving health through Medicaid work requirements is different from the goals of welfare reform work requirements in the past, which were to strengthen self-esteem and provide a ladder to economic progress.

On June 29, 2018, the DC federal district court vacated HHS’s approval of the Kentucky Section 1115 waiver program. The court held that consideration of whether the waiver would promote beneficiary health in general is not a substitute for considering whether the waiver promotes Medicaid’s primary purpose of providing affordable health coverage and remanded to HHS to consider how the waiver would help furnish medical assistance consistent with Medicaid program objectives. However, the court also noted that plaintiffs and their amici assert that proclaimed health benefits of employment are unsupported by substantial evidence. Thus, there is likely to be ongoing debate and policy discussion over whether work requirements will further the aims of Medicaid.

To address whether work will further the aims of Medicaid, we examine the literature on the relationship between work and health and analyze the implications of this research in the context of Medicaid work requirements. Due to the large number of studies in this field spanning decades, this literature review focuses primarily (although not exclusively) on findings from other literature or systematic reviews rather than individual studies on these topics. We drew on studies cited in policy documents on work requirements in Medicaid, results of keyword searches of PubMed and other academic health/social policy search engines, and snowballing through searches of reference lists in previously pulled papers. In total, we reviewed more than 50 sources, the vast majority of which were published academic studies or program evaluations and most of which are reviews of multiple studies themselves. A more detailed description of the methods underlying this analysis is provided in the Methods box at the end of this brief.

What effect do health and health coverage have on work?

Not surprisingly, research has demonstrated that being in poor health is associated with an increased risk of job loss or unemployment. 1 , 2 , 3 , 4 , 5 A meta-analysis of longitudinal studies on the relationship between health measures and exit from paid employment found that poor health, particularly self-perceived health, is associated with increased risk of exit from paid employment. 6 Another study that simultaneously examined and contrasted the relative effects of unemployment on mental health and mental health on employment status in a single general population sample found mental health to be both a consequence of and a risk factor for unemployment. However, the evidence for men in particular suggested that mental health was a stronger predictor of subsequent unemployment than unemployment was a predictor of subsequent mental health. 7 Additional research suggests that, in some cases, individual characteristics such as income, race, sex, or education level may mediate the relationship between poor health and unemployment. 8 , 9 10 Research also demonstrates that an unmet need for mental health or substance use disorder treatment results in greater difficulty with obtaining and maintaining employment. 11 , 12 , 13 , 14 , 15

Additional research suggests that, in addition, access to affordable health insurance and care, which may help people maintain or manage their health, promotes individuals’ ability to obtain and maintain employment. For example, in an analysis of Medicaid expansion in Ohio, most expansion enrollees who were unemployed but looking for work reported that Medicaid enrollment made it easier to seek employment, and over half of employed expansion enrollees reported that Medicaid enrollment made it easier to continue working. 16 Similarly, a study on Medicaid expansion in Michigan found that 69% of enrollees who were working said they performed better at work once they got coverage, and 55% of enrollees who were out of work said the coverage made them better able to look for a job. 17 A study on Montana’s Medicaid expansion found a substantial increase of 6 percentage points in labor force participation among low-income, non-disabled Montanans ages 18-64 following expansion, compared to a decline in labor force participation among higher-income Montanans. 18 National research found increases in the share of individuals with disabilities reporting employment and decreases in the share reporting not working due to a disability in Medicaid expansion states following expansion implementation, with no corresponding trends observed in non-expansion states. 19 Additional literature suggests that access to health insurance and care promotes volunteerism, finding that the expansion of Medicaid under the ACA was significantly associated with increased volunteerism among low-income adults. 20 , 21

What effect does work have on health and health coverage?

Overall, the body of literature examining whether work affects health shows mixed results, with some studies showing a positive effect of work on health yet others showing no relationship or isolated effects . A 2006 literature review found that, while “there is limited amount of high quality scientific evidence that directly addresses the question [of whether work is good for your health]… there is a strong body of indirect evidence that work is generally good for health and well-being.” 22 That assessment was based on comprehensive review of the literature, including other systematic reviews as well as narrative and opinion pieces. A more focused 2014 systematic review about the health effects of employment, which included 33 longitudinal studies, 23 found strong evidence that employment reduces the risk of depression and improves general mental health, yet it found insufficient evidence for an effect on other health outcomes due to a lack of studies or inconsistent findings of the studies. 24 A 2015 review of 22 longitudinal studies found an association between employment and re-employment with better physical health. 25

In contrast, research shows a strong association between unemployment and poor health outcomes, though researchers caution that these findings do not necessarily mean the reverse is true (e.g. employment causes improved health). The effect of unemployment on health has long been an area of research focus, and a substantial body of research from the U.S. and abroad consistently demonstrates a strong association between unemployment and poorer health outcomes, 26 , 27 , 28 , 29 30 , 31 , 32  with some evidence suggesting a causal relationship in which unemployment leads to poor health. 33 , 34 , 35 The bulk of the research in the unemployment and health field focuses on mental health outcomes. 36   Examples of negative health outcomes associated with unemployment include increases in depression, anxiety, mixed symptoms of distress, and low self-esteem. 37 , 38 A more limited body of research suggests an association of unemployment with poorer physical health (including increases in cardiovascular risk factors such as hypertension and serum cholesterol as well as increased susceptibility to respiratory infections), and mortality. 39 , 40 A 2006 literature review noted that there is continuing debate about the relative importance of possible mechanisms involved in this relationship, and adverse effects of unemployment may vary in nature and degree for different individuals in different social contexts. 41 Some evidence also indicates that cumulative length of unemployment is correlated with deteriorated health and health behavior. 42 However, despite the evidence of a relationship between unemployment and health, researchers caution against using findings to infer that an opposite relationship (employment causing improved health) exists. 43 , 44   In addition, researchers note that the literature on unemployment tends to study more negative than positive health outcome variables, 45 which may skew our understanding of the health effects of unemployment. 46

Another related area of research is studies examining the relationship between re-employment (i.e., returning to work) and health, which find some association between re-employment and mental health . A 2012 systematic review on this topic found support for a beneficial health effect of returning to work, with most of the 18 studies included in this review focusing on mental health-related outcomes. 47 The review also tried to assess to what extent the relationship was causal (i.e., reemployment caused health improvements) versus due to selection (e.g., people with poor health were more likely to remain unemployed) and concluded that both were at play. The review did not reach a definitive conclusion about mechanisms linking re-employment to improved health (due to lack of evidence), and it noted that it is still unclear whether health effects of reemployment are moderated by factors such as socioeconomic status, reason for unemployment, and the nature of employment. 48 The 2006 literature review described above also analyzed research findings on re-employment and found strong evidence that re-employment leads to improved psychological health and measures of general well-being, with a dearth of information on physical health and some but not all studies showing that re-employment/health relationship is at least partly due to health selection. However, these authors also cite evidence from numerous studies suggesting that “the beneficial effects of re-employment depend mainly on the security of the new job, and also on the individual’s motivation, desires, and satisfaction” 49

Research review: Low-quality, unstable and poorly paid jobs lead to or are associated with adverse health effects, suggesting that all jobs should not be expected to have similar effects on workers’ health.</p> <p>

Studies on work and health have found that the quality and stability of work is a key factor in the work-health relationship: research finds that low-quality, unstable, or poorly-paid jobs lead to or are associated with adverse effects on health. 50 , 51 , 52 , 53 , 54 , 55 , 56   For example, a 2014 meta-analysis of studies published after 2004 found that job insecurity can pose a comparable (and even modestly increased) risk of subsequent depressive symptoms compared to unemployment. 57 A 2011 longitudinal analysis found that while unemployed respondents had poorer mental health than those who were employed, the mental health of those who were unemployed was comparable or more often superior to those in jobs of poor psychosocial quality (based on measures of job control, perceived job security, and job demands and complexity) and the mental health of those in poor quality jobs declined more over time than the mental health of those who were unemployed. Moreover, while moving from unemployment into a high quality job led to improvement in mental health, the transitioning from unemployment to a poor quality job was more detrimental to mental health than remaining unemployed. 58 Additionally, a 2003 study that examined the association of different employment categories with physical health and depression found a consistent association between less than optimal jobs (based on economic, non-income, and psychological aspects of the jobs) and poorer physical and mental health among adults. 59

It is possible that the work-health association reflects people in good health being more likely to work, versus work causing good health. Some researchers caution against the possibility that selection bias has occurred in many of the studies on work and health. The existence of a “healthy worker effect”—in which relatively healthy individuals are more likely to enter the workforce whereas those with health problems are at increased risk to withdraw from and remain outside of the workforce—has been documented in multiple studies. 60 , 61 , 62 , 63 64 , 65   Authors of both individual studies and literature reviews on this topic explain that the healthy worker effect is difficult to control for even in studies that attempt to do so, and thus this effect may cause an overestimation of the findings in the literature on health effects of work. 66 , 67 As authors of a 2014 systematic review of studies on health effects of employment point out, there are no randomized controlled trials on this topic available in the literature because performing such trials would be unethical, 68 yet randomized controlled trials are the gold standard for determining a causal relationship.

Most study authors specifically note additional caveats to drawing broad conclusions about work and health. The 2006 review concluding a general positive effect of work on health emphasized three major provisos to this conclusion: (1) findings are about average or group affects, and a minority of people may experience contrary health effects from work, (2) the beneficial health effects of work depend on the nature and quality of work (described above), and (3) the social context must be taken into account, particularly social gradients in health (i.e. inequalities in population health status related to inequalities in social status) and regional deprivation. 69 These caveats could explain the seemingly contradictory findings about employment and unemployment: While unemployment is almost universally a negative experience and thus linked to poor outcomes, especially poor mental health outcomes, employment may be positive or negative, depending on the nature of the job (e.g., stability, stress, hours, pay, etc.). As discussed below, these provisos have implications for the applicability of research to Medicaid work requirements.

While work can help people access employer-sponsored health coverage, many jobs—especially low-wage jobs—do not come with an affordable offer of employer coverage. In 2017, just over half (53%) of firms offered health coverage to their employees, 70 and workers in low-wage firms are less likely than those in higher wage firms to be eligible for coverage through their employer. 71 In 2017, less than a third of workers who worked at or below their state’s minimum wage had an offer of health coverage through their employer. 72 Though most employees take up employer-sponsored coverage when offered, workers in low-wage firms are less likely to be covered by their employer even if coverage is offered, likely reflecting the fact that workers in such firms pay a larger share of the premium than workers in higher-wage firms. 73 The fact that work does not always lead to health coverage is further demonstrated by the large majority of uninsured people who are in a family with either a full-time (74%) or part-time (11%) worker. 74

What is the effect of volunteerism on health?

In the January 2018 guidance, CMS includes volunteering as a “community engagement” activity that may improve health outcomes, 75 and the Medicaid work requirement waivers approved to date all permit volunteer activities to count towards the required weekly/monthly hours of work activity.

However, there is limited existing evidence that volunteer activities benefit health outcomes. One literature review on the health effects of volunteering “did not find any consistent, significant health benefits arising through volunteering” based on experimental studies available at the time of the literature review. 76 The authors’ analysis of cohort studies revealed limited benefits of volunteering on depression, life satisfaction, and well-being (with no significant benefits on physical health). In addition, the cohort studies focused primarily on volunteers ages 50 and over, with some of the studies suggesting that the association between volunteerism and improved health outcomes may be limited to older volunteers and that that the health benefits of volunteering may diminish as hours of volunteering increase. 77 Another study (published in 2018) examined the health benefits of “other-oriented volunteering” (other-regarding, altruistic, and humanitarian-concerned volunteering) compared to “self-oriented volunteering” (volunteering focused on seeking benefits and enhancing the volunteers themselves in return). While the authors found beneficial effects of both forms of volunteer activity on health and well-being, other-oriented volunteering had significantly stronger effects on the health outcomes of mental and physical health, life satisfaction, and social well-being than did self-oriented volunteering. 78 As discussed below, this finding may indicate that health benefits of volunteering are likely to be weaker when individuals are compelled to engage in volunteering.

What does this research mean for Medicaid work requirements?

The body of literature summarized above includes several notable caveats and conclusions to consider in applying findings to a work requirement in Medicaid. Limitations and implications that are particularly relevant include:

Effects found for the general population may not apply to Medicaid, as the link between work and health is not universal across populations or social contexts. In general, the studies examined above analyze the relationship between work and health among broad populations of all income levels. However, several authors suggest that population differences may modify the relationship between work and health.  A 2003 study found that nationally, older adults, women, blacks, and individuals with low education levels were more likely to be employed in jobs viewed as “barely adequate” or “inadequate” (the types of jobs that the study found to be independently associated with poorer physical health and higher rates of depression) compared to other populations. 79 Authors of a 2006 literature review qualify their broad findings on the work/health relationship with the proviso that the social context must be taken into account (particularly social inequities in health and regional deprivation), and also cite evidence that the strong association between socioeconomic status and physical and mental health and mortality likely outweighs (and is confounded with) all other work characteristics that influence health. 80 Authors of a 2005 review on unemployment and health found a strong association between deprived areas, poor health, poverty and unemployment (although the exact relationship is not clear), and highlight the need for more research on the geographical dimension on unemployment and health. 81 These findings imply that the work/health relationship may differ significantly for the low-income Medicaid population, who report worse health status compared to the total US population and often face more significant challenges related to housing, food security, and other social determinants of health. 82 , 83 , 84 In addition, some volunteerism research suggests that the association between volunteerism and improved health outcomes may be limited to older volunteers, yet approved and pending Section 1115 Medicaid work requirement waiver requests all include exemptions for individuals above a certain age (which varies by state but ranges from 50 to 65 years). 85

Work or volunteering undertaken to fulfill a requirement may produce different health effects than work and volunteer activities studied in existing literature. For example, research on health effects of work requirements in Temporary Assistance for Needy Families (TANF) suggests that they did not benefit and sometimes negatively affected health among enrollees and their dependents. 86 Another study found that welfare reform was associated with increases in self-reported poor health and self-reported disability among white single mothers without a high school diploma or GED. 87 These adverse effects could reflect different relationships between work and health for low-income populations, as described above, or different effects of work undertaken voluntarily versus as a requirement. Authors of a 2006 literature review on work and health found that forcing claimants off benefits and into work without adequate supports would more likely harm than improve their health and well-being. 88 Similarly, most studies on volunteerism and health define volunteerism as an act of free-will (essentially, a voluntary act), a definition that may not be applicable to volunteer activity undertaken for the purpose of meeting work/community engagement requirements in order to maintain eligibility for Medicaid. Volunteer activities undertaken to retain Medicaid appear more closely aligned with the self-oriented form of volunteerism (volunteering focused on seeking benefits and enhancing the volunteers themselves in return), which research shows has weaker health effects than the other-oriented form (other-regarding, altruistic, and humanitarian-concerned volunteering).

Limited job availability, low demand for labor, or poor job quality may moderate any positive health effects of employment. Authors of a 2014 systematic review of prospective studies on health effects of employment commented that most studies in this field do not adjust for quality of employment and include all kinds of jobs in their analysis (e.g. part- and full-time employment, self-employment, and both blue- and white-collared jobs) despite the possibility that different forms of employment have different health effects. 89 Under Medicaid work requirement programs, the population subject to Medicaid work requirements may have access to only low-wage, unstable, or low-quality jobs to meet the weekly/monthly hours requirement, as these are the types of positions adults with Medicaid who currently work hold. 90 In discussing the policy implications of their findings, multiple researchers have concluded that such policies could be detrimental to health, with authors of one study asserting that, “Policies that promote job growth without giving attention to the overall adequacy of the jobs may undermine health and well-being.” 91

Long-term effects of work on health are unclear. Much of the evidence on the work/health relationship is about short-term effects after about one year, which, as authors of one literature review point out, is a short period when assessing health impacts. 92 There is less evidence on longer-term effects over a lifetime perspective. 93 In addition, research on work requirements in other public programs shows little evidence of long-term impacts on employment or income. Studies on welfare recipients subject to work requirements generally have found that any initial increase in employment after an imposition of a work requirement faded over time. 94 , 95 , 96 After five years, one study showed those who were not required to work were just as likely or more likely to be working compared to those who were subject to a work requirement, suggesting that these work requirements had little impact on increasing employment over the long-term. 97 Other research has found that employment among people who left welfare was unsteady and did not lift them out of poverty. 98 Thus, even short-term effects are likely to disappear as short-term boosts in employment fade over time.

Loss of health insurance coverage due to not meeting reporting or work requirements under waivers could affect access to health care and health. Low-wage workers typically work in small firms and industries that often have limited employer-based coverage options, and very few have an offer of coverage through their employer. Work requirements in Medicaid could lead to large Medicaid coverage losses, especially among people who would remain eligible for the program but lose coverage due to new administrative burdens or red tape versus those who would lose eligibility due to not working. 99 Several studies on individuals leaving TANF following welfare reform show reductions in insurance coverage across this “welfare leaver” population, with significant decreases in Medicaid coverage that were not fully offset by the smaller increases in private coverage. 100 , 101 , 102 , 103 , 104 A study evaluating welfare-to-work interventions found that some programs led to a reduction in health insurance coverage for both children and parents. 105   Given the evidence of Medicaid’s positive impact on access to care and health outcomes, 106 as well as data demonstrating that uninsured individuals go without needed care due to cost at much higher rates than those with Medicaid coverage, 107 widespread coverage losses as a result of Medicaid work requirements are likely to result in adverse effects on health outcomes. In TANF evaluations, for example, studies found that children of TANF enrollees who lose benefits for failure to comply with a work requirement experience adverse health effects such as behavioral health problems 108 or hospitalization. 109

Policies that have disproportionate effects on certain Medicaid enrollees could widen health disparities. Data demonstrate the persistence of clear disparities in health insurance coverage, access to care, and health outcomes for certain vulnerable populations in the US, including people with disabilities (compared to their non-disabled counterparts) 110 and people of color (compared to whites). 111 Research shows that people with disabilities and people of color are face disproportionate challenges in meeting and are disproportionately sanctioned under existing work requirement programs. 112 , 113 If racial minority groups, people with disabilities, or other vulnerable populations face similarly disproportionate challenges in meeting work requirements when they are attached to the Medicaid program, these policies could result in wider disparities in health insurance coverage and health outcomes.

Looking Ahead

Taken as a whole, the large body of research on the link between work and health indicates that proposed policies requiring work as a condition of Medicaid eligibility may not necessarily benefit health among Medicaid enrollees and their dependents, and some literature also suggests that such policies could negatively affect health. While it is difficult to determine a causal relationship between employment and health status (largely due to challenges controlling for health selection bias and the inability to conduct randomized controlled trials on this topic), there is strong evidence of an association between employment and good health. However, research suggests that factors like job availability and quality, as well as the social context of workers, mediate the effect of work or work requirements on health. Given the characteristics of the Medicaid population, research indicates that policies could lead to emotional strain, loss of health coverage, or widening of health disparities for vulnerable populations. As debate considers the question of whether policies to promote health—versus health coverage—are the aim of the Medicaid program, the question of whether work requirements will promote health also will remain key to the ongoing debate over the legality of work requirements in Medicaid.

• Work Requirements
• ISSUE BRIEF

news release

• Does Employment Lead to Improved Health? New Research Review Finds Mixed Evidence with Caveats that Could Impact Applicability to Medicaid Work Requirements

Also of Interest

• Implications of a Medicaid Work Requirement: National Estimates of Potential Coverage Losses
• Implications of Work Requirements in Medicaid: What Does the Data Say?
• Explaining Stewart v. Azar: Implications of the Court’s Decision on Kentucky’s Medicaid Waiver

• Share full article

Advertisement

Supported by

Children With Autism Carry Unique Gut Flora, Study Finds

The research, which builds on previous work, eventually may lead to a more objective diagnostic tool, scientists said.

By Teddy Rosenbluth

The process for diagnosing a child with autism heavily relies on a parent's description of their child’s behavior and a professional’s observations. It leaves plenty of room for human error.

Parents’ concerns may skew how they answer questionnaires. Providers may hold biases, leading them to underdiagnose certain groups . Children may show widely varying symptoms, depending on factors like culture and gender.

A study published Monday in Nature Microbiology bolsters a growing body of research that suggests an unlikely path to more objective autism diagnoses: the gut microbiome.

After analyzing more than 1,600 stool samples from children ages 1 to 13, researchers found several distinct biological “markers” in the samples of autistic children. Unique traces of gut bacteria, fungi, viruses and more could one day be the basis of a diagnostic tool, said Qi Su, a researcher at the Chinese University of Hong Kong and a lead author of the study.

A tool based on biomarkers could help professionals diagnose autism sooner, giving children access to treatments that are more effective at a younger age, he said.

“Too much is left to questionnaires,” said Sarkis Mazmanian, a microbiome researcher at the California Institute of Technology. “If we can get to something we can measure — whatever it is — that’s a huge improvement.”

We are having trouble retrieving the article content.

Please enable JavaScript in your browser settings.

Thank you for your patience while we verify access. If you are in Reader mode please exit and  log into  your Times account, or  subscribe  for all of The Times.

Thank you for your patience while we verify access.

Already a subscriber?  Log in .

Want all of The Times?  Subscribe .

Ellice Weaver / Wellcome

Understanding what works for workplace mental health: putting science to work

This report summarises what we’ve learned from our first commission on promising approaches for addressing workplace mental health. It also sets out why businesses and researchers need to work together to take a more scientific approach to supporting mental health at work. 

• Share with Facebook
• Share with X
• Share with LinkedIn
• Share with Email

What’s inside

• findings from ten research projects that looked at the evidence behind promising approaches for supporting workplace mental health 
• suggested actions businesses can take, based on this evidence 
• reflections on gaps in the evidence and why it’s important for businesses and scientists to work together to understand what works. 

Who this is for

• policy makers
• researchers.

Key findings  

Businesses all over the world are thinking about how they can most effectively support the mental health of their staff. But despite growing interest and investment in workplace mental health initiatives in recent years, there is still so much we don't know about what works and what doesn’t. 

In 2020, Wellcome commissioned ten global research teams to look at the existing evidence behind promising approaches for addressing anxiety and depression in the workplace, with a focus on younger workers. 

Key findings include:

• Excessive sitting has risks for both physical and mental health. Reducing the time office workers spend sitting by an hour a day may reduce depression symptoms by approximately 10% and anxiety symptoms by around 15%.
• Flexible working can benefit mental health by decreasing the amount of conflict people experience between their work and home lives. This conflict can be a source of stress and may contribute to anxiety and depression.
• More job autonomy is associated with lower rates of anxiety and depression. Employers can increase employees' autonomy by allowing them more freedom to craft how they do their roles. 
• There is significant evidence from high-income countries to show that workplace mindfulness interventions have a positive impact on mental health. But far less is known about their effectiveness in low- and middle-income countries. 

The research identifies important gaps in our knowledge about what works. Businesses and scientists need to work together to fill these gaps in the evidence to understand how employers can most effectively support the mental health of their staff. 

Downloads  

Summary report.

• Putting science to work: understanding what works for workplace mental health PDF 7.3 MB

Individual research reports submitted to Wellcome

• Breaking up excessive sitting with light activity PDF 1.1 MB
• Buddying at onboarding PDF 1.2 MB
• Employee autonomy PDF 1.9 MB
• Financial wellbeing interventions PDF 1.1 MB
• Flexible working policies PDF 1.4 MB
• Group psychological first aid for humanitarian workers and volunteers PDF 1.3 MB
• Mental health peer support PDF 1.8 MB
• Mindfulness in hospitality and tourism in low- and middle-income countries PDF 1.8 MB
• Social support interventions for healthcare workers PDF 3.3 MB
• Workforce involvement and peer support networks in low- and middle-income countries PDF 1.4 MB

Contact us  

For more information, contact Rhea Newman, Policy and Advocacy Adviser, at [email protected] .

• Mental health

Related content  

Mental health at Wellcome: looking forward

Why science needs lived experiences of mental health challenges

Mental Health

Rethinking organizational health for the new world of work

‘The OHI is like an MRI,’ says McKinsey partner Bryan Hancock  on this episode of McKinsey Talks Talent . He joins partner Brooke Weddle  and global editorial director Lucia Rahilly to discuss McKinsey’s recently updated Organizational Health Index : how it works, what has changed, and why it’s still among the best predictors of whether your company will thrive over the long term.

This transcript has been edited for clarity and length.

The difference organizational health makes

Lucia Rahilly: Organizational health is not a new conceit—but the business environment has changed considerably. In this new context, does organizational health still matter?

Brooke Weddle: Organizational health maintains its ability to predict long-term performance, even though the Organizational Health Index [OHI] and the organizational health body of research is over 20 years old.

We continue to live in a very dynamic environment. There is a lot of focus these days on building resilience , on productivity , and on new preferences  about how employees want to work and interact with their employers.

But the research is very clear: not only is organizational health correlated with long-term performance; it is causal to it. Organizational health drives long-term performance.

Lucia Rahilly: Give us some examples of how better organizational health makes a measurable difference in performance outcomes.

Bryan Hancock: There’s a set of what we call power practices . From an organizational-health standpoint, in order to drive performance, organizations need to implement these practices correctly.

Strategic clarity is one power practice. Are our goals clear and measurable? Are they articulated at all levels? Role clarity is another. Do people understand what they’re supposed to be doing day-to-day? Personal ownership is a third. Do people feel ownership over their work? And competitive insights is another. Do we understand how we fit in versus our competitors? If people are excelling on those power practices, performance follows.

Subscribe to the McKinsey Talks Talent podcast

Brooke Weddle: I work with a lot of business leaders who say, “Look, I’m doing what I think are the right things. I’m measuring engagement. I’m looking at employee satisfaction. And yet I don’t see the behaviors in terms of how we are running the place that I want to see, that would help drive performance.”

Those could be leaders having courageous conversations, taking risks, innovating more at pace. But organizational health is all about aligning on strategy, translating it into the work environment, and renewing the organization over time. It’s an organization-level metric, rather than an individual-level metric. When you assess organizational health, you don’t just ask about things like, “Do you have a great relationship with your manager?” It’s not to say that’s not important; of course it’s important. But that’s not what organizational health is about.

You start to look at a measure that allows you to say, “I have engaged and satisfied employees, and I’m pointing those employees in the right direction to support execution, to renew the organization over time.”

Where to start—including in the mirror

Lucia Rahilly: We hear again and again that leaders are navigating what might be the toughest-ever operating environment, given serial disruptions like gen AI , rising geopolitical risk , persistent economic uncertainty , and so forth. In this context, what matters most to organizational health? Where should leaders focus their energies?

Brooke Weddle: I’d start with the four power practices Bryan named: strategic clarity, role clarity, personal ownership, and competitive insights. These are must-haves. There’s real statistical evidence behind this. If those four practices are in the bottom quartile of our databases, as measured against the benchmark, your chances of high organizational health are essentially zero.

Now the second-order question is, “OK, I have those four things. How do I start to think about designing a bespoke recipe that will allow me to create the conditions I need to run this business?” And there is no one answer to that question because we live in a world with lots of different business models and leadership preferences about how to run organizations. So that’s where you get into more tailoring of the specific practices, behaviors, and mindsets that you would want to see—those that would enable your own performance outcomes.

Bryan Hancock: At the same time, we’ve added a new survey section on employee experience, looking at things like well-being, including burnout  and psychological safety ; connection to meaning, which postpandemic is more important than ever; and career growth and talent attraction and retention . We’ve also added more specific questions on inclusion , making sure we’re creating an environment where everyone feels like they are included and belong.

Lucia Rahilly: What about leaders themselves? You talk in the research about the importance of decisive leadership. Is that just about velocity of decision making—or is it more?

Brooke Weddle: The exact definition we’re using for decisive leadership is making and following through on decisions in a timely manner. Decisive leadership replaces another leadership practice in the OHI, because it turns out to be a better predictor of overall leadership as an outcome. The other one was called authoritative leadership or applying pressure to drive results. We’re seeing that it’s actually not a good way to lead these days, so it didn’t make the cut this time around.

Lucia Rahilly: How does data help here?

Bryan Hancock: The way our colleagues often describe this is fast but good decision making . And data helps fast and good decision making in two ways. First, the better data you have at your fingertips, the more informed you’re going to be and the easier it is to make clear decisions.

Second, data is useful for making sure we’re following through. There’s research from Stanford that looks at uses of generative AI in organizations. One of the things they’ve done is look at how teams converge after a decision has been made. They look at the different Slack streams for a given team and see if the team is, after the decision, really moving on that decision or whether there is still divergence happening. So, the data can also be helpful to make sure leaders understand where there are still rumblings of dissent in the organization. Then they can revisit to make sure they are addressing those root-cause challenges within their team.

Listening to the front line

Lucia Rahilly: Can data also empower employees to innovate, in addition to what you just described—making better, faster, more frictionless decisions?

Brooke Weddle: Yes. When you’re talking about data at the fingertips of employees at all levels, including frontline employees, understanding data can be very powerful in terms of driving innovation.

Employee innovation has always been a well-performing practice in the OHI survey. It used to be called bottom-up innovation because it’s about harnessing the best ideas from all levels, including the front line, to drive innovation and continuous improvement.

A lot of times, a frontline employee on the ground can say, “Here’s five ideas for how this could go better.” Organizations that listen, in a structured way, can be very effective at driving that continuous improvement. There should be a process for gathering this feedback, and it should be directed in the right ways, in keeping with top-down innovation.

Bryan Hancock: But data-driven decision making needs to go along with other parts of the organizational-health framework to be successful. Someone famous once said, “If you torture data long enough, it’ll tell you whatever you want it to say.” What you need to pair with that data-driven decision making is an open and trusting work environment, where people feel it’s safe to raise questions.

McKinsey Talks Talent Podcast

Bryan Hancock, Brooke Weddle, and other talent experts help you navigate a fast-changing landscape and prepare for the future of work by making talent a competitive advantage.

Lucia Rahilly: There’s a great example of data-driven innovation in the research related to Major League Baseball. I confess it resonated in part because I’ve benefited from it personally as my kids have gotten more interested in going to baseball games. Talk us through that example.

Brooke Weddle: Major League Baseball used data analytics to drive some pretty significant changes in how it runs teams and how managers think about recruiting the best talent. Lucia, you might be referring to one of the data-driven innovations that changed the way pitching works so the games aren’t as long. I’ve benefited from that as well. It’s a little bit of the Moneyball approach here: using those analytics to inform innovations that make the end user experience more enjoyable and of course drive more productive outcomes as well.

Bryan Hancock: But you need a view of both the end user experience and the data, because some of the data could have made baseball more boring.

For example, there are different ways to position infielders for different power hitters. Some of the best-hitting players could choose to hit into what is more likely the “not an out” direction, or take a relatively boring bunt, or hit the other way to get a single. Baseball took a step back and said, “Well, from a user experience standpoint, this doesn’t create a more exciting game that attracts more followers. So now we’re going to reengineer the rules to make sure we have the proper number of folks on one side of the infield and the proper number on the other side.”

Data needs to be looked at holistically, not just in the narrow context of, “How do I get this batter out?” but instead, “Why is this an exciting game?” How do you use data holistically to get to the broad end goal—not just the narrow one?

Mobility matters

Lucia Rahilly: There’s a great data point in the research showing that employees who experience more mobility at work are considerably less likely to burn out. I think the figure was 27 percent. What stands in the way of enabling more mobility  in organizations?

Bryan Hancock: A few things. One is how we think beyond the typical career progressions that someone might experience. If you’re in a siloed organization where the only next job you’re going to get is your boss’s job, moving up will be harder for you. But if your organization recognizes that your underlying skills, your capabilities, your potential could be well suited in other parts of the organization, you get the benefit of being able to move to a different environment where you’re learning, able to grow, and able to move. Brooke, what’s your take?

Brooke Weddle: I agree. Getting access to development and mobility over time are key drivers to help employees stay at an organization. Burnout was one of these new features but is now a core set of practices, within employee experience, that we ask about when assessing organizational health. And it has turned out to be very important: if you are burned out, you have a very low probability of perceiving anything about your organization as remotely healthy.

Lucia Rahilly: Brooke, do you have an example—either from your client work or from the research—of an organization that is mitigating burnout productively?

Brooke Weddle: I’ve worked with a couple of organizations that have taken that on as a key priority in the broader frame of, “How do we address wellness? How do we get employees to thrive in a way that helps our business achieve its outcomes?”

People have a lot of different thoughts about burnout. But what does addressing burnout actually mean? It has to do with figuring out how roles are defined. There are certain parts of roles that might be rethought, and tools like gen AI can now be used to push off some of the transactional work  that demotivates employees. Another key factor for a manager at one organization was spending time connecting one’s work to the larger purpose of the organization.

And the last thing is that it’s a journey. One organization in particular understood that capability building  would be a large part of that journey over time. As it helped managers figure out their role in addressing burnout, there was an awareness they had to generate on that front.

New world, new measures of organizational health

Lucia Rahilly: Any other changes in this OHI revamp that you want to highlight and that reflect the current complexity of the world of work?

Bryan Hancock: We introduced two new sections. One was on employee experience, as we talked about before. And the other was on workplace flexibility : where are people working today, what are their preferences, what’s the primary means of communication, what’s the schedule or location flexibility, what’s the workspace design?

There’s a recent article that highlighted the practices of Land O’Lakes. It had an acute shortage of people working in its manufacturing facilities. It used to have two set 12-hour shifts—a day shift and a night shift—because that was the way to maximally drive production. Unfortunately, there weren’t enough workers to actually fit those shifts. So it switched to having employees pick which hours they wanted to work. That put a little more burden on the system, a little more burden on the managers, but providing that flexibility enabled employees to get more total working hours done.

Brooke Weddle: The other thing I’ll highlight about the revised OHI is the addition of a couple of other management practices. One is social responsibility as it relates to a larger category of external orientation. This is a core part of how organizations add value. Employees are putting a lot of importance on it in terms of the attractiveness of an organization.

Another is feedback. The practice of feedback  was added to the broader category of accountability, recognizing that as you think about performance management and the manager and “managee” relationship, that feedback loop cannot be taken for granted and must be a core practice to get accountability right.

The last one I’ll mention is direction. Having a common purpose  was added with strategic clarity and shared vision, recognizing, again, the importance that many companies are placing on having a clear articulation of their purpose in the world and how that connects back to employee value proposition and employees seeing their employers as a place where they can derive individual purpose as well.

Lucia Rahilly: These features, these “intrinsics” of organizational health, have changed. Does the bar for what health means also move over time? In other words, are companies generally healthier now than they were a decade ago?

Bryan Hancock: There are still a broad range of organizational-health outcomes across organizations. And while some of the least healthy organizations may have ceased to be organizations, there are others coming in to replace them at the bottom. So the bar may be moving. The average may be moving. But we still have a pretty broad distribution of performance. And we still see, across that distribution of performance, those that are healthier are better performing.

The path to outperformance

Lucia Rahilly: Do you see leaders really investing in organizational health as a priority?

Brooke Weddle: Absolutely. I’m working with a number of organizations that are making this a priority. One started with a very low OHI score. And it has been a good story because its leaders used it as a rallying cry to say, “We can do something different here, right? And we can do something different that really matters.” They’ve embarked on a transformation that is just as much about driving better execution and performance as it is about building their culture and investing in their ranks up and down the organization.

Bryan Hancock: I’m also seeing an uptick in organizations saying, “What is my baseline of the managerial practices that drive organizational health? How can I help my managers get better at those practices that actually drive our performance day-to-day?”

When organizations align on their organizational-health recipes they say, “OK, we know we need to do this through our managers. How do we help our managers provide more role clarity for people on their teams? How do we help managers link what we’re asking the teams to do to the broader purpose?”

Answering these questions helps managers become better leaders  and will improve overall organizational health.

Lucia Rahilly: A quick follow-on on the efficacy of OHI as a tool. It’s so much easier to survey employees now than it was when we first introduced the OHI. Is survey fatigue inevitable? And if not, how should leaders avoid it?

Brooke Weddle: I think survey fatigue is always going to be hard. We’ve seen more bite-size versions of pulsing, to make it not only feel more digestible but also more real-time. There are, of course, passive ways to collect data as well—for instance, creating social network maps based on email traffic flows, calendar invites—that can give you a pretty good sense, too, of some of the features of organizational health. You really have to take more of a strategic view of listening these days and not rely as much on these traditional heavy efforts to survey employees.

Bryan Hancock: The analogy I use is that OHI is like an MRI. What we’re doing is looking at all the systems. And yes, that does take time. But it creates the ability to identify where, having taken the holistic view, there may be specific opportunities.

Once we have the MRI and we say, “Let’s look at the heart or the circulatory system in this area,” or whatever sub-element comes up, then you don’t need to do an MRI again next month to track how you’re doing. You can just track the heart.

Lucia Rahilly: Suppose I’m a leader, and I’m looking to energize my organizational-health efforts. Talk me through what next steps look like.

Brooke Weddle: There’s a beauty to bringing math and science to a discussion on organizational health. You begin by measuring your starting point and creating a common language around what you’re trying to create—not just from a current-state perspective but where you want to head.

Then it’s all about taking action. That will include things like leader role modeling. It will certainly involve some change stories and an integrated communications plan. Sometimes the reason a leader doesn’t embrace a new behavior is that they have no idea how to. Capability building is a big component.

And finally, there’s the alignment of incentives. Think through the talent system and how people are rewarded, not just financially but with nonfinancial recognition. If that’s not in keeping with the behaviors you want to emphasize, guess what? People won’t embrace them. There’s a real holistic and rigorous methodology behind not just the diagnostic part of this but also taking action.

Bryan Hancock: You also need a CEO and a senior leadership team who want to take a hard and honest look at how they run the place . If senior leaders aren’t ready to take that hard look, it doesn’t make sense for them to ask employees for answers to questions like, “How are we going to make progress in these areas? And what are we going to do?” It takes real leadership commitment and belief in the data that shows, “If we run the place better, we get better outcomes.” If you have that alignment at the top, combined with all the things Brooke just said, that’s a real recipe for success.

Explore a career with us

Related articles.

Organizational health is (still) the key to long-term performance

Raising the resilience of your organization

2024 and beyond: Will it be economic stagnation or the advent of productivity-driven abundance?

Firearm-violence public health crisis ‘a wake-up call’

• Expert Viewpoint
• Feinberg School of Medicine
• Institute for Policy Research

In a recent advisory, U.S. Surgeon General Vivek H. Murthy declared America’s firearm violence a public health crisis that requires the nation’s immediate awareness and action.

Since 2020, firearm‑related injury has been the leading cause of death for U.S. children and adolescents, surpassing motor vehicle crashes, cancer and drug overdose and poisoning, according to the advisory. In 2022, 48,204 total people died from firearm‑related injuries, including suicides, homicides and unintentional deaths.

The Firearm Violence Advisory cited the work of several Northwestern faculty, and Northwestern Now spoke to three of them about the impact of gun violence and potential solutions.

Community violence intervention 

“This report is another wake-up call for solutions to address the staggering toll gun violence continues to inflict on Americans each year,” said Andrew Papachristos , whose research on secondary traumatic stress among community violence interventionists in Chicago was cited in the advisory. “Our research points to a way forward. It starts with an investment in street outreach workers, who use their lived experiences with gun violence to help break the cycle of violence.”

“These unarmed workers work in community violence intervention, or CVI, programs in communities that see the most violence. In one Chicago CVI program, we saw a double-digit decline in violence-related arrests. The participants stopped carrying guns, getting into fights and robbing or shooting people — calming communities and saving lives.”

However, the high levels of trauma and violence on the job takes a “massive toll” on the outreach workers, Papachristos said.

“One of our studies revealed more of them were shot at while working on the job (12%) than police officers (1%). Another uncovered that 94% of outreach workers reported signs of secondary traumatic stress. So, to stop this public health crisis, we also have to take care of — and invest in — these critical frontline workers and build a community-focused violence prevention infrastructure to support them.”

Papachristos is also the director of the Institute for Policy Research, the John G. Searle Professor of Sociology and director of the Center for Neighborhood Engaged Research and Science.

Safe firearm storage

“We have things that work; we need to implement them and study them,” said Rinad Beidas , whose research on long-term consequences of youth exposure to firearm injury was cited in the advisory. The report calls out the need to conduct implementation research to improve effectiveness of prevention strategies.

Beidas has published work on implementing a safe firearm storage program via pediatrician visits and is funded to do a larger trial with that program. “This is a non-political, relatively inexpensive and scalable approach to save lives.”  

Beidas is chair of medical social sciences and the Ralph Seal Paffenbarger Professor of implementation in medical social sciences at the Feinberg School of Medicine.

We have things that work; we need to implement them and study them.”

Addressing compound issues

“While the nation’s youth and young adults are disproportionately affected by the daily occurrence of firearm deaths and non-fatal firearm injuries, our research shows youth who have been previously involved with the juvenile justice system had up to 23 times the rate of firearm mortality than the general population,” said Linda Teplin , whose research on crime victimization in adults with severe mental illness was cited in the advisory.

Teplin is vice chair for research and Owen L. Coon Professor of Psychiatry and Behavioral Sciences at Feinberg. She is also the primary investigator for the Northwestern Juvenile Project, the first large-scale longitudinal study of mental health needs and outcomes of delinquent youth after detention.

“To reduce firearm violence, a creative and multidisciplinary approach is needed, one that involves legal and health care professionals, street outreach workers and public health researchers. People who have been shot are more likely to be injured again or killed. Therefore, hospital emergency departments are ideal settings to implement violence prevention interventions. Poverty also begets violence. We need to address the compound issues that lead to urban blight, such as inadequate housing, unemployment and poor infrastructure. “The public cares a great deal about mass shootings, but they comprise less than 4% of all firearm deaths. We need to focus on the other 96% of everyday violence that disproportionately affects poor, urban youth, especially people of color.”

Editor’s Picks

Deering Library undergoing major renovations

Northwestern celebrates the groundbreaking of new ryan field, forget imitation crab — researchers test snackable snails, related stories.

A new way to teach synthetic biology

Strategic changes in the office for research to improve efficiencies, staff support, the heart health benefits of urban green and blue spaces.

Fact sheets

• Facts in pictures

Publications

• Questions and answers

Tools and toolkits

• Endometriosis
• Excessive heat
• Mental disorders
• Polycystic ovary syndrome
• All countries
• Eastern Mediterranean
• South-East Asia
• Western Pacific
• Data by country
• Country presence 
• Country strengthening 
• Country cooperation strategies 
• News releases
• Feature stories
• Press conferences
• Commentaries
• Photo library
• Afghanistan
• Cholera 
• Coronavirus disease (COVID-19)
• Greater Horn of Africa
• Israel and occupied Palestinian territory
• Disease Outbreak News
• Situation reports
• Weekly Epidemiological Record
• Surveillance
• Health emergency appeal
• International Health Regulations
• Independent Oversight and Advisory Committee
• Classifications
• Data collections
• Global Health Estimates
• Mortality Database
• Sustainable Development Goals
• Health Inequality Monitor
• Global Progress
• Data collection tools
• Global Health Observatory
• Insights and visualizations
• COVID excess deaths
• World Health Statistics
• Partnerships
• Committees and advisory groups
• Collaborating centres
• Technical teams
• Organizational structure
• Initiatives
• General Programme of Work
• WHO Academy
• Investment in WHO
• WHO Foundation
• External audit
• Financial statements
• Internal audit and investigations 
• Programme Budget
• Results reports
• Governing bodies
• World Health Assembly
• Executive Board
• Member States Portal
• Fact sheets /

Occupational health: health workers

• About 54% of health workers in low- and middle-income countries have latent tuberculosis, which is 25 times higher than the general population.
• Between 44% and 83% of nurses in clinical settings in Africa have chronic lower back pain, compared to 18% among office workers.
• Globally, 63% of health workers report experiencing any form of violence at the workplace.
• During the coronavirus disease (COVID-19) pandemic, 23% of front-line healthcare workers worldwide suffered depression and anxiety and 39% suffered insomnia. Furthermore, medical professions are at higher risk of suicide in all parts of the world.
• Unsafe working conditions resulting in occupational illness, injuries and absenteeism constitute a significant financial cost for the health sector (estimated at up to 2% of health spending).
• However, so far only 26 out of the 195 Member States of WHO have in place policy instruments and national programmes for managing occupational health and safety of health workers.

Health workers are all people engaged in work actions whose primary intent is to improve health, including doctors, nurses, midwives, public health professionals, laboratory technicians, health technicians, medical and non-medical technicians, personal care workers, community health workers, healers and traditional medicine practitioners. The term also includes health management and support workers such as cleaners, drivers, hospital administrators, district health managers and social workers, and other occupational groups in health-related activities as defined by the International Standard Classification of Occupations (ISCO-08).

Health workers are the backbone of any functioning health system. While contributing to the enjoyment of the right to health for all, health workers should also enjoy the right to healthy and safe working conditions to maintain their own health.

Health workers face a range of occupational risks associated with infections, unsafe patient handling, hazardous chemicals, radiation, heat and noise, psychosocial hazards, violence and harassment, injuries, inadequate provision of safe water, sanitation and hygiene.

The protection of health and safety of health workers should be part of the core business of the health sector: to protect and restore health without causing harm to patients and workers.

Safeguarding the health, safety and well-being of health workers can prevent diseases and injuries caused by work, while improving the quality and safety of care, human resources for health and environmental sustainability in the health sector. 

Safeguarding the health, safety and well-being of health workers  

The protection of health and safety of health workers contributes to improving the productivity, job satisfaction and retention of health workers. It also facilitates the regulatory compliance of health facilities with national laws and regulations on occupational health and safety, bearing in mind the specific working conditions and occupational hazards in the sector. Unsafe working conditions resulting in occupational illness, injuries and absenteeism represent a significant financial cost for the health sector. For instance, in 2017 the annual costs of occupational illnesses and injuries in the health care and social services sector in Great Britain were the highest among all sectors, estimated at the equivalent of US$ 3.38 billion (1) .

Globally, improving health, safety and well-being of health workers lowers the costs of occupational harm (estimated at up to 2% of health spending) and contributes to minimizing patient harm (estimated at up to 12% of health spending) (2) . Furthermore, implementing key interventions to protect the health and safety of health workers contributes to increasing the resilience of health services in the face of outbreaks and public health emergencies and contribute to strengthening the performance of health systems through: 1) preventing occupational diseases and injuries; and 2) protecting and promoting the health, safety and well-being of health workers, thereby improving the quality and safety of patient care, health workforce management and environmental sustainability.

Policy actions

Only one third of countries have some national policy instrument to protect health, safety and well-being of health workers. Based on the experience of such countries, the following policy interventions have been demonstrated to be beneficial in the protection of health workers:  

• introducing new and updating existing regulations, standards and codes of good practices for protecting health and safety of health workers;
• making the protection of health and safety of health workers an integral part of the management of health care at all levels; 
• creating mechanisms and building capacities for management of occupational health and safety in the healthcare sector at the national, sub-national and facility levels;
• expanding the coverage of health workers with competent occupational health services, including for risk assessment and management, health surveillance, vaccination and psycho-social support; and
• establishing collaboration with organizations of employers and health workers for improving working conditions.

Responsibilities and rights

While employers have the overall responsibility for ensuring that all necessary preventive and protective measures are taken to minimize occupational risks, health workers have the responsibility to cooperate with the management and participate in the measures for protecting their health, safety and well-being.

Health workers have the right to remove themselves from a work situation that they have reasonable justification to believe presents an imminent and serious danger to their lives or health. When a staff member exercises this right, he or she shall be protected from any undue consequences. 

WHO response

In 2022, with resolution WHA74.14 on protecting, safeguarding and investing in the health and care workforce , the World Health Assembly called upon Member States “to take the necessary steps to safeguard and protect health and care workers at all levels”. The global patient safety action plan 2021–2030, adopted by the 74 th World Health Assembly, includes action on health worker safety as priority for patient safety. 

WHO’s work on protecting the health, safety and well-being of health workers includes:

• development of norms and standards for prevention of occupational risks in the health sector;
• advocacy and networking for strengthening the protection of health, safety and well-being of health workers; and
• supporting countries to develop and implement occupational health programmes for health workers at the national, subnational and health facility levels. 

WHO and ILO have jointly issued a guide on the development and implementation of occupational health and safety programmes for health workers  and work with international partners to build capacities for its implementation in countries.

WHO also provides guidelines and recommendations about prevention and management of occupational hazards in the health care sector .

• Costs to Britain of workplace fatalities and self-reported injuries and ill health, 2017/18. [Internet]. Health and Safety Executive; 2019. Available from: https://www.hse.gov.uk/statistics/pdf/cost-to-britain.pdf
• Bienassis De K, Slawomirski L, Klazinga N. The economics of patient safety Part IV: Safety in the workplace: Occupational safety as the bedrock of resilient health systems, OECD Health Working Papers, No. 130. [Internet]. Paris: OECD Publishing; 2021. Available from: https://econpapers.repec.org/RePEc:oec:elsaad:130-en

WHO's work on occupational health

Occupational hazards in the health sector

Caring for those who care: Guide for the development and implementation of occupational health and safety programmes for health workers

Caring for those who care: national programmes for occupational health for health workers. World Health Organization/International Labour Organization policy brief

Protection of health and safety of health workers: checklist for health care facilities

Interim guidance on occupational health for health workers in COVID-19

ILO/WHO toolkit on work improvement in healthcare facilities – a trainers guide and action manual

Protecting health and safety of health workers

Online training courses

Occupational health and safety for health workers in the context of COVID-19

Rapid Response Teams Essentials Online Learning Programme. Module 8: Responder well-being and ethics in emergency preparedness and response

• Health Tech
• Health Insurance
• Medical Devices
• Gene Therapy
• Neuroscience
• H5N1 Bird Flu
• Health Disparities
• Infectious Disease
• Mental Health
• Cardiovascular Disease
• Chronic Disease
• Alzheimer's
• Coercive Care
• The Obesity Revolution
• The War on Recovery
• Adam Feuerstein
• Matthew Herper
• Jennifer Adaeze Okwerekwu
• Ed Silverman
• CRISPR Tracker
• Breakthrough Device Tracker
• Generative AI Tracker
• Obesity Drug Tracker
• 2024 STAT Summit
• Wunderkinds Nomination
• STAT Madness
• STAT Brand Studio

Don't miss out

Subscribe to STAT+ today, for the best life sciences journalism in the industry

EcoHealth Alliance: Covid’s anti-science mob extracting its pound of flesh

By Peter Staley July 8, 2024

I magine this post-9/11 scenario: A New York City fire company is forced to shut down and lay off its firefighters because some Americans believe a bizarre conspiracy theory that this fire company brought down the World Trade Center towers.

A Covid-19 version of this freakish tale is happening today. Instead of a fire company, the conspiracy gang is targeting an important, successful, decades-old nonprofit organization that researches viral epidemics and tries to predict and forestall future “fires” — new viral outbreaks — that might kill millions of people. It broke my heart to hear testimony in a hearing convened by the House of Representatives that staunch supporters of science like Francis Collins and Anthony Fauci have tacitly agreed to this witch hunt.

advertisement

Why do I care? I was diagnosed in 1985 with HIV, then an assuredly deadly virus, and joined ACT UP protests against government scientists and pharmaceutical companies, often condemning them in harsh terms. But we never wanted them to stop doing research. We wanted them to do more research, on a faster timeline. Basic science saved my life, and AIDS activists are among its greatest defenders.

The basic science organization threatened now, EcoHealth Alliance , was founded in 1971. Early on, the alliance worked on the connections between wildlife and human health and the environmental changes that were causing a rise in emerging diseases. By the early 2000s its reputation at tracking and predicting viral outbreaks was second to none. It identified the key bird reservoirs of West Nile virus in the U.S. and predicted how it might spread to important conservation sites like the Galapagos and Hawaii. That work was used by the State of Hawaii and the Department of the Navy to change the way they managed the risk of importing mosquitoes that could carry the virus.

Related: HHS suspends federal funding for EcoHealth Alliance

EcoHealth Alliance worked in Australia to assess the risk of Hendra virus , a lethal virus harbored by fruit bats. In Malaysia, the organization showed that a related virus, Nipah virus, emerged from bats into pigs , leading to a severe outbreak in people, because of the intensification of pig farming.

In 2008, EcoHealth Alliance published the world’s first ever hotspot map of emerging diseases that showed where pandemics originate: mostly in countries with high wildlife biodiversity, growing human populations, and lots of environmental changes that push people and animals closer together. Published in the journal Nature, it was a seminal report that has been used by governments around the world, as well as by the World Health Organization, to identify where to conduct surveillance and build pandemic preparedness to stop diseases from emerging and spreading.

The United States Agency for International Development (USAID) and the National Institute of Allergy and Infectious Diseases (NIAID) have used the hotspot map to design and fund large programs assessing what viruses might emerge next, and to help design vaccines and drugs against them.

EcoHealth’s work on H5N1 bird flu in the 2000s showed that the U.S. had vulnerabilities for infection via the poultry trade and was used by the U.S. Government Accountability Office to assess the Department of Agriculture’s flu surveillance program .

After severe acute respiratory syndrome (SARS) emerged from Chinese wildlife markets in 2003, the National Institutes of Health funded work by EcoHealth to identify the origins of this virus. And it did , showing in 2005 that SARS had originated from bats, and that other viruses circulating in bats in China had the potential to infect people. The organization became a leading expert on the risk of bat coronaviruses, and repeatedly raised a red flag that these viruses were likely to emerge and had pandemic potential.

Related: Lawmakers, as part of ‘lab leak’ Covid inquiry, press to bar EcoHealth from federal research funds

As early as 2004, EcoHealth’s president, Peter Daszak, basically predicted Covid-19 on 60 Minutes , saying, “what worries me most is that we’re going to suddenly find a SARS virus that moves from one part of the planet to another, wiping people out as it moves along. … That’s something to be keeping you awake at night.”

EcoHealth Alliance worked with the WHO to have SARS-related viruses listed on WHO’s “Disease X” list of high priority pathogens to help raise funds to develop drugs and vaccines against them. Early Covid treatments like remdesivir and molnupiravir were studied against viruses that EcoHealth Alliance identified, allowing researchers to place a short-list of drugs in a kind of break-glass-in-an-emergency box should Daszak’s prediction come true.

As badly prepared as our country was against Covid-19, the basic science prep had been strong, leading to much quicker vaccines and treatments. EcoHealth deserves thanks for this. Instead, it is struggling to keep its doors (and labs) open.

Why? Because one of its partners in studying bat viruses had been the Wuhan Institute of Virology.

Once rightwing media outlets discovered that NIAID, led by Dr. Anthony Fauci, a man these outlets revile, had funded some of the research EcoHealth Alliance did with the Wuhan Institute of Virology in the years before Covid-19, all hell broke loose. The lab leak theory on Covid’s origin — which claims that the virus causing Covid-19 emerged from a viral research laboratory in Wuhan, either accidentally or as part of a bioweapons program — was given specific villains. President Trump ordered the NIH to cancel the grant, the only time in history when the White House has overruled the peer-review process at the NIH.

Related: NIH awards $7.5 million grant to EcoHealth Alliance, months after uproar over political interference

The White House got lucky in finding a willing partner at NIH, Michael Lauer, the deputy director for extramural research, to pull off the abrupt cancellation. Since 2018, Lauer had been leading a secretive purge of Chinese-born scientists from ongoing NIH grantees, with more than 100 of these scientists losing their jobs at American universities. Lauer wrote the grant cancellation letter to EcoHealth Alliance, citing “for convenience” as the reason for cancellation.

Within months, though, Lauer was forced to backtrack and reinstate the grant after EcoHealth’s lawyers appealed the blatantly illegal cancellation. But he immediately suspended the grant , pointing to new concerns about biosafety at the Wuhan Institute of Virology. From that point forward, Lauer launched multiple fishing expeditions, including an investigation by the Department of Health and Human Services’ Office of Inspector General to find reasons to re-cancel the grant.

Lauer’s vendetta is made clear in an internal email he wrote to other NIH officials in May 2021. The subject line said, “Gift.” After searching for more than a year for reasons to support terminating EcoHealth’s grant, Lauer and the NIH uncovered the late submission of a report and used it to justify their actions.

The Inspector General’s report ultimately found some compliance issues on all sides, including the NIH’s, but did not recommend any sanctions. The Inspector General asked the NIH and EcoHealth Alliance to work through the issues they found and, by October 2023, an NIH audit committee determined that all of them had been resolved.

None of this mattered to the lab leak mob blaming Daszak and Fauci for creating Covid in a Wuhan lab. All the compliance issues raised with the Inspector General’s report became fodder, morphing into major crimes.

Sign up for First Opinion

The smartest thinkers in life sciences on what's happening — and what's to come

By the time Daszak was brought before the House Select Subcommittee on the Coronavirus Pandemic for a Republican-led thrashing, even the Democrats, in a calculated decision to find something they could use for an improbable unified report by the entire subcommittee, joined in voicing their dismay at perceived — but not real — ethical lapses by EcoHealth Alliance. Democrats offered the mob their pound of flesh.

The NIH caved to Republican demands by launching a debarment investigation against Daszak and EcoHealth Alliance. Debarment is a rarely used blunt tool for punishing extreme malfeasance by an individual or organization receiving an HHS grant, resulting in a permanent ban from all current and future funding by the government. Such a ban would effectively shut down EcoHealth Alliance, ending all of its ongoing basic research.

For me, the saddest moment of the House subcommittee’s hearings came when it grilled former NIH director Francis Collins, former NIH acting director Larry Tabak, and former NIAID director Anthony Fauci, and asked each of them whether or not they supported debarment of EcoHealth. In what now stands as a tragic example of how McCarthyite these hearings have become, all three, in order to save their own necks, said “Yes.”

As an activist, I’ve worked with Collins and Fauci for many years, and consider Fauci a close friend. It was painful to watch the hunted help the hunters, turning scientist against scientist.

It scares me — and should scare you — that conspiracy theorists are winning. And because of them, we will be less prepared for the next pandemic.

Peter Staley is a long-time AIDS activist, currently as a co-founder of PrEP4All, an advocacy organization promoting a national HIV prevention plan.

About the Author Reprints

Peter staley.

infectious disease

STAT encourages you to share your voice. We welcome your commentary, criticism, and expertise on our subscriber-only platform, STAT+ Connect

To submit a correction request, please visit our Contact Us page .

Recommended

Recommended Stories

The ethical implications of Elon Musk’s unorthodox approach to medical science

First Opinion readers respond to psychiatry and social contracts, Medicare and weight loss meds, and more

STAT Plus: Troubled for-profit chains are stealthily operating dozens of psychiatric hospitals under nonprofits’ names

STAT Plus: Ascension is racing to unload hospitals as execs work to stem losses

STAT Plus: What’s next for Cassava Sciences, and Cartesian Therapeutics has a novel excuse for dodgy data